Hamilton's urban aboriginal people face multiple barriers to health care, significant rates of chronic disease and elevated emergency room visit levels compared to the rest of the city, according to a landmark study from St. Michael's Hospital.
The study, published Thursday in medical journal BMJ Open, marks the first time researchers have accessed detailed information about how an urban aboriginal population in Canada uses health care.
'Older people have been taught to be fearful of institutions.'- Danielle Boissoneau, Hamilton resident
The findings illustrate stark disparities between urban First Nations individuals and the general population, researchers say. "Given the striking levels of poverty combined with poor access to housing and good food … this is affecting people's health and well-being," said Michelle Firestone, an associate scientist with St. Michael's Hospital's Centre for Research on Inner City Health.
More than 10 per cent of First Nations adults visited Hamilton's emergency room six times or more in the previous two years — but only 1.6 per cent of Hamilton's general adult population could say the same.
"Hamilton has extensive health and social services but 40 per cent of respondents felt their access to health care was either fair or poor," Firestone said. "This shows geography is not the only health care barrier for First Nations people."
'Are you drinking?,' mother asked after suffering stroke
Danielle Boissoneau, who is aboriginal and lives in Hamilton, says there are two things contributing to the chasm between native people and the health care system: fear and stigma.
The fear comes from older aboriginal people, who are weary of institutions after enduring years of abuse in residential schools, she says. The stigma comes from the way institutions look at Aboriginal people — something she found out firsthand when visiting a local emergency room with her mother last weekend.
Danielle Boissoneau says there are two things contributing to the chasm between native people in Hamilton and the healthcare system: fear and stigma. (Adam Carter/CBC)
"Right away they were asking 'are you drinking?' Were you using prescription medication?" she said. Neither was the case. Her mother had suffered a mini-stroke, called a TIA. But that was the first line of questioning based solely on her mother's race, Boissoneau says.
"Older people have been taught to be fearful of institutions for reasons like this," she said. "A lot of health care providers need to be educated. I was so afraid for my mom at the time — and this is the response we got?"
According to the study, among First Nations adults living in Hamilton:
- 73 per cent of people reported an upper respiratory tract infection in the past year
- 25 per cent reported having been injured over the past year
- 78 per cent earn less than $20,000 per year
- 70 per cent live in the city's lowest-income neighbourhoods
The need for 'culturally safe' health care
On top of those statistics, almost half of respondents reported that long waiting lists to see a specialist were a barrier to accessible health care. Other common issues were not being able to arrange transportation to see a doctor and not being able to afford direct costs or services that weren't covered by non-insured health benefits.
It's a "perceived lack of access" to community-based health care that is "culturally safe" that needs to change, Firestone said. That way, aboriginal people can go to a doctor or hospital and not feel dismissed or disgruntled. To do that, aboriginal people need to be consulted on the construction and delivery of health care systems at the very top, she says.
"Aboriginal people must have full involvement and choice when it comes to all aspect of health care delivery," she said. "It's quite difficult — that's why a lot of what needs to happen needs to happen upstream."
While adjustments to the health care system are necessary, the underlying poverty issue here needs to be addressed as well, Firestone says. The fact that 78 per cent of Hamilton's urban aboriginal population makes under $20,000 a year and that 70 per cent live in the city's lowest income neighbourhoods illustrates that. There's a cycle of poverty there that needs to be broken — and that will in turn alleviate some of the strain on the health care system, Firestone says.
"A lot of work needs to be done at the start, before these health issues even emerge," she said.
"These are things people really need to lead a healthy life."
Firestone Unmasking Health Determinants Outcomes BMJ Open July102014 (PDF)
Firestone Unmasking Health Determinants Outcomes BMJ Open July102014 (Text)
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