Indigenous people now make up 4.9% of the Canadian population (Statistics Canada 2018) but we really haven’t crafted breast cancer screening initiatives that focus on this group. We have created an environment that doesn’t provide an equal opportunity to cancer screening to this vulnerable group because of the general exclusion of any programs created to cater to the needs of this unique group.
We have a breast cancer screening program in Ontario as do other provinces that allow for a woman to get a mammogram in the defined age bracket without a doctor signed requisition, but we are lacking in culturally specific initiatives that will help encourage vulnerable groups to participate in them. An example of a vulnerable group is Indigenous women. While in the past, Indigenous women have had lower rates of breast cancer, that number is climbing. Indigenous women are more likely to die from breast cancer when compared to non-Indigenous women, mostly due to the fact the cancer is found when it is already more advanced as a result of a lack of screening (Ahmed, Shahlid & Episkenew 2015). In New Brunswick 65% of women had been screening in the previous 2 years compared to 77% of non-Indigenous women. Manitoba data also shows similar findings of underscreening (Ahmad et al. 2015).
Indigenous women have a lack of understanding of cancer screening due to a number of factors. There is a lack of public health programs within these communities, a lack of health literacy and a general mistrust at conventional medicine related to past transgressions within residential schools. There is also a lack of culturally specific material available (Ahmad et al. 2015). While distance can also be a factor effecting screening for the northern Indigenous populations, they too have even lower rates of screening when compared to other northern groups (McDonald and Trenholm, 2010). Also identified as a barrier was “a lack of cultural competence among the healthcare providers” (“Cancer Care Ontario” 2019)
Without changes, it is expected that the cancer rates in the Indigenous population will surpass the non-indigenous populations (Ahmad et al. 2015). We need to address the inadequacies that exist for breast cancer screening for indigenous women by changing how they feel cancer impacts them, their trust in healthcare, improving the social determinants of health such as poverty and housing inadequacies in order to help improve cancer outcomes.
Thankfully it appears that there is work being done to improve health in this vulnerable population. An example of this is Cancer Care Ontario working with Sunnybrook Research Institute to increase the rates of Indigenous women participating in the existing Ontario cancer screening programs by considering multiple factors including policy analysis, the community experience and a look at past initiatives (“Cancer Care Ontario” 2019). While this is a good step, there is lots of room for improvement for this group.
We know it is time for change. In order to reduce barriers to the vulnerable Indigenous group, changes to policy at the federal level as they relate to the Indian Act of 1876, that would be more inclusive of Indigenous peoples right to health care as equals to those of the rest of Canadians is a start (Richmond & Cook 2016). Tailored community efforts to create programs that are appropriate to the Indigenous people’s needs, improved accessibility to screening centres and doctors and finally increasing cultural sensitives for health care provides delivering care to this group of people are also important steps. Hopefully we will be able to equalize the rates of screening for Indigenous people with the current work organizations like Cancer Care Ontario and Sunnybrook are creating.
Resources week 11 unit 6
Ahmed, S., Shahid, R., & Episkenew, J. (2015). Disparity in cancer prevention and screening in aboriginal populations: recommendations f
Cancer Care Ontario- Addressing Disparities in Access to Cancer Screening Experienced by Indigenous Peoples in Ontario (2019, April 17). Health and Medicine, Social Sciences. Scientia. Retrieved November 16, 2019 from https://www.scientia.global/cancer-care-ontario-addressing-disparities-in-access-to-cancer-screening-experienced-by-indigenous-peoples-in-ontario/
Chiefs of Ontario, Cancer Care Ontario and Institute for Clinical Evaluative Sciences. Cancer in First Nations People in Ontario: Incidence, Mortality, Survival and Prevalence. Toronto, 2017.
Retrieved November 9 2019 from https://www.cancercareontario.ca/sites/ccocancercare/files/assets/CancerFirstNationsReport_Accessible.pdf
McDonald, J.T. & Trenholm, R. (2010). Cancer related health behaviours and health service use among Inuit and other residents of Canada’s north. Social Science & Medicine 70 (2010) pg.1396-1403. Retrieved November 16 2019 https://0-www-sciencedirect-com.aupac.lib.athabascau.ca/science/article/pii/S0277953610000766?via%3Dihub
Richmond, C.A.M., & Cook, C. (2016). Creating conditions for Canadian aboriginal health equity: The promise of public health policy. Public Health Reviews, 37. doi: 10.1186/s40985-016-0016-5
Statistics Canada (2018). National Indigenous Peoples day….by the numbers. Retrieved November 9 2019 from https://www.statcan.gc.ca/eng/dai/smr08/2018/smr08_225_2018
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