Reconciliation – Moving Forward One Step at a Time

Achieving reconciliation is like climbing a mountain – we must proceed a step at a time. - Commissioner Justice Murray Sinclair

Truth and reconciliation have been in the news again recently with Pope Francis making a pastoral visit to Canada making a stop in Maskwacis on July 25, 2022. The Pope’s visit was to provide him with the opportunity to listen and speak with Indigenous Peoples (Canadian Council of Catholic Bishops, 2022) and again ask for forgiveness for the “deplorable conduct” of the Catholic Church at residential schools in Canada. This visit comes after First Nations, Metis and Inuit delegations met with the Pope in Rome back in March 2022 to discuss the legacy of residential schools. Pressure had been building on the Pope to come to Canada after the discovery of 215 unmarked graves at a former residential school in Kamloops B.C. in 2021 and subsequent discoveries at other former residential schools across Canada (Yun, 2022).

The Truth and Reconciliation commission, which was established to “facilitate reconciliation among former students, their families, their communities and all Canadians” (Government of Canada, 2021), found that an estimated 150,000 Indigenous children attended the residential school system from the 1800s to 1996. The commission estimated that about 4,100 to 6,000 children died amid abuse and neglect while in the residential schools system (Yun, 2022). In order to advance the process of Canadian reconciliation, the Truth and Reconciliation Commission of Canada (TRC, 2015) made calls to action. One such call to action under the heading Church Apologies and Reconciliation is #58:

We call upon the Pope to issue an apology to Survivors, their families, and communities for the Roman Catholic Church’s role in the spiritual, cultural, emotional, physical, and sexual abuse of First Nations, Inuit, and Métis children in Catholic-run residential schools. We call for that apology to be similar to the 2010 apology issued to Irish victims of abuse and to occur within one year of the issuing of this Report and to be delivered by the Pope in Canada. - Truth and Reconciliation Commission

This may have been a good first step in addressing this particular call to action, although many believe it does not go far enough but there are 93 other such calls to action. Among them, the commission also identified the need to address health inequalities as this is also essential to the reconciliation process. The residential school system has affected whole generations’ social determinates of health. Social determinates of health are the conditions in which people live, work, and play (National Centre for Determinates of Health, 2015). The residential schools caused a shift in the intersection of the social determinates of health - impacting the health of individuals, groups, communities, and Canada as a whole.

The TRC have not been the only one to call to close the health gap between Indigenous and non-Indigenous peoples in Canada. To do so, the intersecting determinants of health that hinder Indigenous health outcomes must be addressed, including access to housing, clean water, food security, education and employment, among others (National Collaborating Centre for Indigenous Health, 2019). Specifically, with my position as an environmental health officer within a First Nation community, I would like to focus on two calls to action that I feel that I am well situated to help advance. The first, is #23:

We call upon all levels of government to: i. Increase the number of Aboriginal professionals working in the health-care field. ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities. iii. Provide cultural competency training for all healthcare professionals - Truth and Reconciliation Commission

I am a First Nation person who is the environmental public health officer (EPHO) and the environmental public health program manager for Maskwacis Health Services (MHS). The environmental health program at MHS is funded by the federal government through Indigenous Services Canada to provide environmental public health services to the 4 First Nations that make up the Maskwacis People in Treaty 6 Territory in Central Alberta. The program works with the First Nation Communities it serves to identify and prevent environmental public health risks that could impact the health of the community members. The program also includes recommending corrective action to reduce these risks.

Having an increase in the number of First Nation professionals in First Nation communities can decrease the system level barriers. By having a member of the community a relationship can start from one of an equal footing as opposed to one of a power imbalance. A relationship built on trust and respect can be formed, thereby effectively building health protection capacity within the community. Communities that trust EPHOs begin to view them as educators rather than government employees (Rideout et.al. 2015). This creates a scenario that allows the MHS environmental health program and the 4 First Nations to work together to respond to public health challenges that may not be obvious to individuals without a close connection to the community. “Trust, respect, and compassion” are vital elements of effective working relationships that help “EPHOs recognize barriers and relate to local perspectives to find solutions that can work” (Rideout et.al. 2015).

The next call to action that I would like to highlight is the need to address health inequalities that are critical to reconciliation is #19:

We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services - Truth and Reconciliation Commission

Like many vulnerable populations, First Nations communities experience a gap in health outcomes. There is a disproportionately high burden of chronic disease and associated risk factors compared with the general population. Health inequities in this vulnerable population occur across the life course and are shaped by the relationship between health and the effects of racist colonial policies (First Nations Information Governance Centre (FNIGC), 2018).

To close the gap in health outcomes we must understand the health inequalities of First Nations Peoples. Health inequities are differences in health that are associated with the social determinants of health, which are modifiable, and that are considered unfair. To have health equity all people (individuals, groups, and communities) need to have a fair chance to reach their full health potential and are not disadvantaged by social, economic, and environmental conditions (National Collaborating Centre for Determinants of Health, 2015). EPHOs can bring forward the intersecting social determinates of health that impede health outcomes like health and housing, safe drinking water, and food safety. One example of a health is housing and more specifically household mould and mildew.

A healthy home means that residents have the physical and social conditions necessary for health, safety, hygiene and comfort (Health Canada, 2008). The FNIGC (2018) reports that a higher percentage of First Nations adults with chronic health conditions lived in houses that had mould or mildew compared to those without chronic conditions. Signs of mould and mildew in the home have been shown to be significant determinant of respiratory outcomes in First Nation adults (Pahwa et al., 2017) and children and youth (Karunanayake et al., 2017). This calls for action to the relationship between housing quality and chronic health conditions in First Nations. EPHOs like myself can be at the forefront.

The residential school system has a profound effect on the social determinates of health for First Nations, Metis and Inuit peoples of Canada. This system of forced assimilation of social and community networks, socio-economic, cultural and environmental conditions the First Nation, Metis and Inuit were forced to live in was indeed called a genocide by the Pope (Deer, 2002) that will effect generations of Canadians to come. To move our society forward I encourage everyone to read all 94 calls to action and see if you can take a step.

References

Canadian Council of Catholic Bishops. (2022). Walking together. Pope Francis in Canada. Retrieved July 30, 2022, from https://www.papalvisit.ca/

Deer, K. (2022, July 30). Pope says genocide took place at Canada's residential schools | CBC News. CBCnews. Retrieved July 31, 2022, from https://www.cbc.ca/news/indigenous/pope-francis-residential-schools-genocide-1.6537203

First Nations Information Governance Centre. (2018). National Report of the First Nations Regional Health Survey Phase 3: Volume One, (Ottawa: 2018). 181 pages. Published in March 2018.

Government of Canada; Crown-Indigenous Relations and Northern Affairs Canada. (2021, June 11). Truth and reconciliation commission of Canada. Government of Canada; Crown-Indigenous Relations and Northern Affairs Canada. Retrieved July 30, 2022, from https://www.rcaanc-cirnac.gc.ca/eng/1450124405592/1529106060525

Health Canada. (2008). First Nations: Environmental Public Health Program. Retrieved May 27, 2022, from https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/fniah-spnia/alt_formats/fnihb-dgspni/pdf/pubs/promotion/2009_env_prog-eng.pdf

Karunanayake CP, Rennie DC, Ramsden VR, Fenton M, Kirychuk S, Lawson JA, Henderson R, Jimmy L, Seeseequasis J, Abonyi S, Dosman JA, Pahwa P; The First Nations Lung Health Project Research Team. Bronchitis and Its Associated Risk Factors in First Nations Children. Children (Basel). 2017 Nov 24;4(12):103. https://doi.org/10.3390/children4120103

National Collaborating Centre for Indigenous Health. (2019). Access to health services as a social determinant of First Nations, Inuit and Métis health. Prince George, BC: Author. Retrieved July 30, 2022, from https://www.nccih.ca/docs/determinants/FS-AccessHealthServicesSDOH-2019-EN.pdf

Pahwa, P., Karunanayake, C.P., Rennie, D.C. et al. (2017). Prevalence and associated risk factors of chronic bronchitis in First Nations people. BMC Pulm Med 17, 9. https://doi.org/10.1186/s12890-017-0432-4

Rideout, R., Oickle, D., Scarpino, J., Chang, H., Ness, T., Vecchiarelli, V., & Ma, L. (2015, December 18). Opportunities for environmental public health action on the Social Determinants of Health and Health Inequity. Environmental Health Review. Retrieved July 15, 2022, from https://pubs.ciphi.ca/doi/full/10.5864/d2015-027

Truth and Reconciliation Commission of Canada. (2015). Truth and reconciliation commission of Canada: Calls to action. Truth and Reconciliation Commission of Canada. Retrieved July 20, 2022, from https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf

Yun, T. (2022, July 23). Key things to know about pope Francis' visit to Canada. CTVNews. Retrieved July 30, 2022, from https://www.ctvnews.ca/canada/what-to-know-about-pope-francis-visit-to-canada-1.5997067