Towards Reconciliation Efforts: The Need for Indigenous Voices in Indigenous Health Strategies

In 2015, the Truth and Reconciliation Commission of Canada (TRC) released its Calls to Action to “redress the legacy of residential schools and advance the process of Canadian reconciliation” (TRC, 2015, p.1). Many of the calls are applicable to universities and researchers because institutions of higher learning have the resources and influence to enable change in education, health and reconciliation. This article is a precursor to the emerging literature on institutional best practices of answering the calls. The purpose is to encourage individuals who are involved and capable of being involved to step back and reconsider their approach.

Although Indigenous Peoples face some of the most devastating health outcomes worldwide, related health intervention research in academic contexts has been both sparse and limited in scope. One review of effective Indigenous community cardiovascular health programs found researchers were “…unable to find any cardiovascular treatment programs focused exclusively on the First Nations populations” (Huffman & Galloway, 2010, p. 354). A review of Arctic Indigenous mental health initiatives found a lack of culturally-relevant studies (Lehti et al., 2009). 

Beyond being few in number and diversity, extant research in Indigenous health rarely measures effectiveness of interventions (Angell, Muhunthan, Irving, Eades, & Jan, 2014), including methods and evaluation. Researchers rewarded with grants for implementing and evaluating interventions among Indigenous People are usually not held accountable for benefiting the Indigenous communities. For example, Lehti and colleagues (2009) found that although many studies described the Indigenous populations and living environments related to their interventions, they failed to integrate that information into culturally appropriate research. Studies regarding health benefits of interventions are generally measured using Westernized individualistic evaluation methods, rather than Indigenous holistic community measures, missing the opportunity to appropriately assess intervention effectiveness (Angell et al., 2014). It is also common for interventions aimed at changing health behaviours, specifically in diabetes and obesity, to not address the underlying Indigenous historical realities of neocolonialism and marginalization (Rice et al., 2016). Health and social indicators have informed interventions and evaluations by highlighting various socio-cultural and historical aspects to consider and integrate (Marks, Cargo, & Daniel, 2007). However, these indicators are only applicable or representative when regarded from an Indigenous lens that considers a holistic approach to community issues, priorities and systems (RCAP, 1996). 

Many interventions targeting Indigenous populations have had minimal success because they lack an Indigenous holistic wellness perspective (Smylie et al., 2009). There is a recognized contradiction between most researchers’ perspectives in identifying and addressing community health issues and an Indigenous community’s priorities and common goals (Maar et al., 2011). Most Indigenous health researchers and practitioners are not Indigenous; consequently, they face complexities as outsiders that can introduce potential socioeconomic and power imbalances symptomatic of a colonial history (Kirmayer, Simpson, & Cargo, 2003) and persisting neocolonial structures, such as universities (Duran & Duran, 1995). This can only be diminished through genuine collaboration with Indigenous communities (Kirmayer et al., 2003), and creating spaces for Indigenous voices on systems, values and traditional knowledge. Otherwise, health researchers and practitioners can unintentionally perpetuate neocolonialism of social disorganization, collective suffering and culture loss (Kirmayer, Brass, & Tait, 2000). For example, the failure of suicide prevention activities in Indigenous communities has been attributed to the cultural incongruences experienced by Indigenous Peoples (Wexler & Gone, 2012). In fact, the interventions have caused cultural and community disturbances, which have been correlated with higher rates of suicide of Indigenous People (Tatz, 2005). Alternatively, lower suicide rates have been correlated with community empowerment, community and family connectedness, and Indigenous cultural affinity (Fleming & Ledogar, 2008). Researchers must recognize that research is most successful when ownership is shared with Indigenous communities (Cochran et al., 2008), and culturally-focused approaches are employed.  Reducing negative health outcomes for Indigenous populations must move beyond borrowing terms to include authentic Indigenous voices. 

It is important to recognize some health researchers working well with Indigenous communities and supporting the perspective of Indigenous Peoples and leadership (Drawson, Toombs, & Mushquash, 2017; Lavallee, 2009; Lincoln & Gonzalez, 2008). Reflecting on these studies and personal experiences, there are commonalities amongst effective research collaborations that apply to answering the TRC calls: 

1. Mentoring Indigenous students to take the lead as researchers and academics 
2. Self-reflection before answering a call and examining one’s own intent
3. Supporting the decolonizing process for non-Indigenous faculty and students through thought-provoking activities and critical assessment
4. Finding new ways of collaborating to promote Indigenous perspective, dialogue and feedback 

These suggestions point back to one overarching theme: Indigenous Peoples and their ways of knowing are valid. It is time to move away from the superficial invitations of Indigenous participation that have researchers simply checking a box. It is time to acknowledge that Western knowledge and perspective is not the only way. Non-Indigenous people need to recognize that they hold a non-Indigenous worldview — no matter how many Indigenous People they know or have researched. 

Integrating Indigenous perspectives in health research, programming and protocols interrupts the perpetuating colonial intention that ‘Indigenous problems need solving’ and challenges the position that the ‘solution’ is the colonizer and colonial structures, such as post-secondary education and research institutions. Many of the TRC calls specifically say “in collaboration with Aboriginal groups.” Although not emphasized in every single call, participation and leadership of Indigenous People and communities are imperative. The calls are not solely directives for problems Indigenous People and communities face, but are also designed to break the colonialism that is perpetuated by past and present actions of Canadians. The recommended actions put forth by the TRC were not new and had been previously shared by Indigenous leaders. They were purposely repackaged as Calls to Action to evoke and inspire change. They tell both Indigenous and non-Indigenous people to stop participating as passive vessels in Canada’s systems and take action. Therein lies the problem: colonial approaches are often unnoticeable, unchallenged and routine fallback. It is time for a change — time to support a new voice.

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