THE ISSUES AND CONCERNS FACING ABORIGINAL PEOPLE IN HEALTHCARE
IN CANADA
by
Leah Karpan
MBA, University of Northern British Columbia, 2016

PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF BUSINESS ADMINISTRATION

UNIVERSITY OF NORTHERN BRITISH COLUMBIA
October 2016
© Leah Karpan, 2016

Executive Summary
Within Canada, the Aboriginal population fares more poorly in almost every health
determinant when compared to the rest of Canada (National Collaborating Centre for Aboriginal
Health 2013). The Canadian Aboriginal population is also not as educated in comparison to the
rest of Canada (Biswal 2008). It has the highest rates of addictions, chronic disease, and mental
health issues in comparison to other cultures residing in Canada. This issue is worsened by the
fact that many Aboriginal patients are treated poorly within healthcare due to racism,
stereotypical assumptions, misunderstanding the Aboriginal culture, and having a lack of
resources to adequately care for Aboriginal patients. Many healthcare providers do not have
knowledge of Aboriginal experiences, culture, traditions, and the historical reasons behind their
poor health outcomes and, consequently, do not treat Aboriginal patients appropriately. These
challenges are troublesome because the health status of Aboriginal people is in dire need of
improvement. The racism experienced by Aboriginal patients attending the Emergency Room in
hospitals due to being seriously ill is a good example. Upon seeing a Physician, Aboriginal
patients frequently receive improper care and a misdiagnosis because it is assumed that they are
under the influence of alcohol, drugs, or suffer from addictions whereas in reality, many
Aboriginal people in Canada live addiction free lifestyles (Health Council of Canada 2012).
The goal of this project was to identify the variety of issues that Aboriginal people face in
Canada’s healthcare system. Solutions to these issues are discussed but the main insight is the
categorization of these existent issues. The challenges that Aboriginal people face in the
healthcare system are complex and require further examination to determine effective
resolutions.

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To gather perspectives among providers and community members regarding their beliefs
about areas requiring improvement in healthcare, qualitative interviews were performed.
Qualitative interviews were chosen because they provide subjective information regarding
participants’ beliefs, experiences, and opinions. The findings revealed that both Aboriginal and
non-Aboriginal participants shared the same understandings of the leadership characteristics that
an Aboriginal healthcare provider should have. These include being honest, trustworthy, having
humility, an ability to communicate, the capability to build relationships, and having an
understanding of the issues and culture of Aboriginal people. It was found that as a result of
colonialism healthcare professionals struggle to work with the intergenerational trauma of
Aboriginal patients and Aboriginal people do not think highly of the healthcare system much of
the time. Findings also revealed that important resources were lacking that could increase the
quality of care to Aboriginal patients. These included medical travel, increased communication
between health provider and patient, more funding for health programs, and improved living
conditions. Participants had their own ideas of restorative practices to implement for the benefit
of Aboriginal healthcare which included providing more opportunities for Aboriginal healthcare
graduates to obtain jobs, offering advancement prospects for Aboriginal employees working in
healthcare organizations, and providing healthcare staff with increased cultural competency
training.
Recommendations for improving Aboriginal healthcare are (i) to gain further information
regarding participant experiences with Aboriginal healthcare providers, (ii) assist Aboriginal
people in becoming more fully educated in healthcare programs, and (iii) to provide more
opportunities for advancement among Aboriginal staff within healthcare organizations.

3

Acknowledgement and Dedication
I would like to acknowledge all of the assistance I received to complete this thesis
project. Thank you to Professor Rick Colbourne for his mentorship and support throughout the
whole process. I would also like to thank all of my participants who provided me with much
knowledge by sharing their experiences, stories, and challenges while accessing Canada’s
healthcare system.
I am dedicating this research paper to my mother who has struggled with chronic disease
for over 30 years. Due to diabetes complications and renal failure, my mother is now awaiting a
kidney transplant. I am also dedicating this project to my Kokum who passed away from cancer
difficulties in 1997. I have watched my mother, Kokum and other Aboriginal people struggle
with their health and healthcare services. Somehow, I wanted to assist in making a difference to
improve the health and wellbeing of Canada’s Aboriginal population.

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Table of Contents
Chapter 1: Introduction ................................................................................................................... 6
Background of Problem .............................................................................................................. 6
Canadian Aboriginal History ...................................................................................................... 7
Statement of Problem ................................................................................................................ 13
Chapter 2: Literature Review ........................................................................................................ 15
Current Challenges in Aboriginal Healthcare ........................................................................... 16
Canadian Aboriginal Leadership .............................................................................................. 18
Aboriginal Healthcare Leadership ............................................................................................ 21
Restorative Practices ................................................................................................................. 24
Chapter 3: Methodology ............................................................................................................... 27
Qualitative Methods .................................................................................................................. 28
Choice of Methodology ............................................................................................................ 28
Ethical Considerations .............................................................................................................. 33
Research Limitations ................................................................................................................ 35
Chapter 4: Data Analysis .............................................................................................................. 35
Findings..................................................................................................................................... 36
Discussion ................................................................................................................................. 52
Recommendations ..................................................................................................................... 60
Chapter 5: Conclusion................................................................................................................... 63
Appendices .................................................................................................................................... 67
References ..................................................................................................................................... 68

Table of Tables
Table 1 Pseudonyms for Interviewees .......................................................................................... 31
Table 2 Leadership Characteristics ............................................................................................... 53
Table 3 Terminology..................................................................................................................... 67

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Chapter 1: Introduction
Background of Problem
Background of Researcher
To begin with, I, Leah Karpan, am the primary researcher, I come from Aboriginal
ancestry and have been working for the Vancouver Coastal Health Authority since August 2009.
My family comes from the Muscowpetung First Nation within the Fort Qu'Appelle area of

Saskatchewan and I am a mixture of Ojibway, Cree and European (Croatian). My interests
have always involved improving the wellbeing of Aboriginal peoples within Canada as this
population has suffered many hardships that are often ignored or have become unrecognized.
Poor Health Determinants among Canada’s Aboriginal Population
In Canada, the term “Aboriginal” is defined as the first people to occupy Canadian
territory and refers to those with Inuit, Metis, or Indian (status and non-status) ancestry
(Indigenous and Northern Affairs Canada 2012). Therefore, within Canada, the term
“Aboriginal” refers to those who are of Inuit, Metis, or Indian (status and non-status) ancestry.
Aboriginal people were also the first inhabitants of Canadian territory.
Aboriginal people have the highest rates of physical and mental illness when compared to
other cultural groups in Canada. For example, there are rampant cases of infancy deaths, suicide,
diabetes, and malnourishment among Canadian Aboriginal groups in comparison to the rest of
Canada. The social determinants of health, income and employment, for example, exhibit poorer
outcomes in the Aboriginal population when compared to other cultural backgrounds in Canada
(National Collaborating Centre for Aboriginal Health 2013). Other examples of poorer social
determinants of health include the average income for Aboriginal people being $10,000 less than
for those who have Non-Aboriginal ancestry in Canada; the number of Aboriginal people who
6

are unemployed is two times higher than the rest of Canada’s population; and, Aboriginal people
tend to live in poorer home environments when compared to their non-Aboriginal counterparts
(NCCAH 2013). In terms of education, only 68% of Aboriginal individuals between the ages of
25-34 received their high school diploma when compared to the rest of Canada where 90%
completed high school (NCCAH 2013). Canada’s government has largely ignored the many
Canadian Aboriginal females that have disappeared without explanation or died in very
suspicious circumstances leading many to believe they were murdered (Reading & Farber 2015).
Canada’s Aboriginal population has high rates of mental and physical illness when
compared to the rest of the country (Reading & Farber 2015). There is a notable 14 infancy
deaths per 1000 births on Canadian reserves and this rate is higher when compared to other
countries and, the number of deaths by suicide among young Aboriginal people in relation to
suicide is 11 times higher when compared to other countries globally (Reading & Farber 2015).
Among the Inuit population, in particular, there are epidemic levels of suicide and their life
expectancy is approximately fifteen years shorter when compared to other cultural groups where
rates are lower (Reading & Farber 2015). The number of Aboriginal people with diabetes is
twice that of non-Aboriginal peoples (and Aboriginal people are three times more likely than
other groups to develop Type 2 Diabetes) (Glauser, Tepper & Konkin 2016; Reading & Farber
2015). Canada’s Aboriginal population suffers from being undernourished, and there are high
rates of people dying accidently (NCCAH 2013). The next section discusses Canadian
Aboriginal history to provide insights into why health devastation has occurred among
Aboriginal people.

Canadian Aboriginal History
7

There have been numerous historical factors that contributed to the ill health described
above that Canada’s Aboriginal population experiences today. For the purposes of this project,
and for increased understanding, it is significant to mention the historical events that have
created the conditions Aboriginal people are currently dealing with. The detrimental effects
from these events have been passed down generationally and still require extensive healing in
order for Canada’s Aboriginal people to live fulfilling and healthy lives. The section that follows
discusses the Indian Act followed by an examination of the impact of Residential Schools and
ending with a review of the Sixties Scoop.
Indian Act
The Indian Act controls almost every aspect of First Nations peoples’ lives including
their land, money, assets and First Nations status. Its implementation has had detrimental effects
on the wellbeing of Canada’s First Nations population ((Hurley 2009; Allan & Smylie 2015).
The Indian Act was written in 1876 with the intent of combining all regulations that applied to
First Nations people into one body of law (Makarenko 2008). The Act was developed with the
purpose of assimilating First Nations peoples through managing First Nations lands, and ridding
traditional sources of food from the First Nations people (Allan & Smylie 2015). Furthermore,
First Nations people, through the Indian Act, were urged to develop European practices and
discontinue following their First Nations culture (Makarenko 2008). The idea of this Act was to
encourage the process of colonization by stripping First Nations people of their traditional ways
of life, making them increasingly reliant on Canadian authorities (Allan & Smylie 2015).
The Implementation of the Indian Act created many difficulties that Canada’s First
Nations population still struggle with today. The most prominent ill effect is that this ruling was
developed for the Canadian First Nations population only, and despite amendments, it tacitly
8

promotes racism towards Canada’s First Nations population in projecting to other Canadians that
First Nations people are secondary to the general population (Monchalin 2016). Historically
under this Act, if First Nations women married a non-Aboriginal male, they lost their First
Nations status (Monchalin 2016). If these women had children, then this loss of status would be
extended to their offspring (Monchalin 2016). Even though First Nations women and children
no longer lose their status upon marrying a non-First Nations man, they are still considered
second-class citizens under this Act because it is rooted in a patriarchal perspective (Monchalin
2016). The Indian Act forced First Nations people to be dependent on others and was a powerful
tool for controlling the behaviours and activities of First Nations people and communities
(Borrows 2008). It separated families, reduced the quality of healthcare for First Nations people
and reduced working and educational opportunities for Canada’s First Nations population
(Burrows 2008).
Overall the Indian Act controls almost every aspect of Canadian First Nations peoples’
lives and has created detrimental results from implementation. It promoted ill effects that
include racism, sexism, patriarchy, First Nations people being controlled, having a reduced
quality of healthcare and less career opportunities. At the same time as the Indian Act was
having a negative effect on First Nations people in Canada, the implementation of residential
schools resulted in First Nations peoples being subjected to additional and increased trauma and
devastation.
Residential Schools
After the Indian Act, residential schools were implemented in Canada. The instituting of
residential schools caused some of the most detrimental effects on the health and wellbeing of
Canada’s Aboriginal population. The Residential School era was in effect for over 100 years and
9

operated through churches via the Government. It was implemented with the sole purpose of
removing Aboriginal culture and tradition from the lives of Aboriginal children (Truth and
Reconciliation Commission of Canada 2016). Residential schools were developed all across
Canada with the last one closing in the 1990s after approximately 150,000 Aboriginal children
attended these schools and were separated from their parents for unconscionable amounts of time
(Truth and Reconciliation Commission of Canada 2016).
The Truth and Reconciliation Commission heard many stories of mistreatment within
residential schools. One survivor, who attended the Kamloops Indian Residential School in the
1930s recounted that Aboriginal children were forced to stop speaking their Aboriginal language,
and that they were told that teachings from relatives were incorrect (Haig-Brown 2002). This
same survivor also states that the food provided to students in residential schools was of low
quality, while workers were afforded healthy nutrition (Haig-Brown 2002). Other examples of
mistreatment within residential school include students developing an unstable persona, and staff
using religious views to deter the practice of Aboriginal cultural and spiritual practices. Students
in residential schools experienced abuse of every type including physical, mental, emotional,
sexual and spiritual (Haig-Brown 2002).
Children in residential schools witnessed many deaths of other students including those
of their brothers and sisters and throughout these traumatic experiences; children did not have
much consolation provided to them (Partridge 2010). When Aboriginal children were taken
from their families to attend residential school, their home community was also left feeling
empty without offspring around for many years. As Aboriginal communities think of themselves
as one living being, in removing something as important as children there was a real fear
concerning the death of communities (Chidiac 2016; Julien, Wright & Zinni 2010).
10

As a child, my grandmother expressed many horror stories of her abuse endured while
attending residential school. One horror story my grandmother mentioned was being unable to
run because of a disability with plastic hip joints. But, nuns who supervised within this
residential school system forced my grandmother to participate in various running sports despite
her mobility difficulties. When my grandmother was unable to run, like the rest of her
classmates, the supervising nuns would beat or whip her. Overall, for many Aboriginal people,
these residential school experiences along, with other traumatic events such as those described
above, have led to lifelong trauma for the Aboriginal population today.
The damaging results of residential schools can be traced throughout generations of the
Canadian Aboriginal population today (Truth and Reconciliation Commission of Canada 2016).
Aboriginal people, as a result of intergenerational trauma from residential school, now suffer
from a loss of who they are, have substance abuse issues, engage in self-harm, and mistreat
others (Partridge 2010). Due to assimilation within residential school, Aboriginal people
frequently misunderstand their own cultural languages and many survivors are traumatized from
witnessing their brothers and sisters pass away in residential school (Partridge 2010). It has been
determined that healing from such detrimental effects of residential school will take a strong
commitment to change from generations of Aboriginal people (Truth and Reconciliation
Commission of Canada 2016).
The Sixties Scoop
The residential school era, ending in the 1950s, gave rise to Aboriginal children being
taken into social service homes in the 1960s, which was called, “The Sixties Scoop.” During the
Sixties Scoop, approximately one third of Aboriginal offspring were taken from their family of
origin and placed mainly into Caucasian families (Milner 2001; Allan & Smylie 2015). The
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actions of these child welfare agencies represented another form of assimilative practices that
impacted the Aboriginal population and continues to date, as there is an overrepresentation of
Aboriginal children in foster care compared to other populations in Canada (Allan & Smylie
2015).
The experiences related to the Sixties Scoop were devastating to Aboriginal peoples as
children were separated from their families, communities and cultures and experienced various
forms of abusive behaviour and prejudice in their foster homes (Milner 2001). As a result, later
in life, those Aboriginal children who experienced the sixties scoop had difficulties attaching to
others due to the trauma they suffered. Having been forcefully separated from family and many
times being the only Aboriginal person in the adoptive family meant that Aboriginal children
became disconnected from their language and cultural traditions (Milner 2001).
Overall, the historical events of implementing the Indian Act, creating residential schools
and further banishing children from their families in the sixties scoop have had detrimental
effects for the Canadian First Nations population. The Indian Act sought to control almost every
aspect of First Nations peoples’ lives and residential schools were implemented with the intent of
banishing Aboriginal children from their culture, family and language. Aboriginal children were
further assimilated in the sixties scoop when they lived in social service homes run by nonAboriginal people. These events are significant, because as mentioned above, they enacted
policies of assimilation and colonization that have led to adverse intergenerational trauma for
Canadian Aboriginal people today. Canada’s Aboriginal population now experiences a loss of
culture, language and identity and because of these assimilation experiences, now engages in
addictive behaviours, self harm and remain traumatized from, for example, witnessing their
siblings die in residential school. As demonstrated above, Canada’s history of enacting policies
12

for managing Aboriginal people have contributed directly to poor health outcomes in almost
every health determinant when compared to the rest of Canada’s population.

Statement of Problem
From my experience of working in the health sector of Vancouver, many Aboriginal
people are challenged with a variety of issues within Canada’s healthcare system. My interest is
to increasingly learn about these issues because my career aspirations are to eventually work
with Canada’s Aboriginal community within a healthcare setting. It is therefore imperative to
comprehend the challenges that Aboriginal people are faced with in healthcare so I can provide
increased quality care for this population. Once there is an increased amount of knowledge
about these issues, then a variety of solutions can be determined to effectively enhance the
quality of care for Canada’s Aboriginal population. Solutions are discussed in this project, but
the main insight is to categorize the varying issues that Canada’s Aboriginal people are
challenged with in healthcare.
There is also a more significant reason for exploring the issues that Aboriginal people
face in healthcare. As demonstrated above, there is a dire need to improve the health of
Canada’s Aboriginal population because this group has the poorest health determinants in
Canada. The healthcare issues are complex and it is therefore imperative to focus more closely
on the factors that facilitate or constrain Aboriginal access to and participation in Canadian
healthcare initiatives. Consequently, I am interested in learning where improvements can be
made to assist the healthcare needs of BC’s Aboriginal population. Overall, my belief is that
there must be increased focus on the wellbeing of Aboriginal populations in Canada and
internationally because they are suffering to a large degree.
The purpose of this paper is to generate insights into how health deficiencies within the
13

Aboriginal population might be minimized by determining the most prominent issues that
Aboriginal people are facing in healthcare today. There are four objectives, with the first one
being to understand the variety of issues that Aboriginal people are currently challenged with in
healthcare. Secondly, I would like to examine if racism towards Aboriginal people is existent in
Canada’s healthcare system, and if it is, understand the resulting impacts on Aboriginal people.
Thirdly, I would like to provide the Aboriginal community with a voice to speak of their current
healthcare issues. And, my last objective is to learn about community members’ perceptions of
the healthcare providers that they have come into contact with.
According to the Aboriginal Health Strategic Initiatives Department of Vancouver
Coastal Health (Aboriginal Health Strategic Initiatives 2016), within Aboriginal communities,
health focuses on harmonizing the physical, mental, emotional and spiritual aspects of an
individual. My goal therefore, is to determine how to improve the physical, mental, emotional
and spiritual aspects of Aboriginal patients through exploring the issues they currently face in
healthcare and determining the most effective solutions to solve these challenges. I have worked
in the Aboriginal Health Strategic Initiatives Department and believe the Aboriginal cultural
practices and advocacy offered by this department has greatly assisted Aboriginal patients. The
following research questions were chosen based on my experience of working in the Aboriginal
and non-Aboriginal healthcare field and from my experiences in the Aboriginal community:
1. What are community members’ perceptions of Aboriginal and non-Aboriginal healthcare
providers?
2. What are non-Aboriginal perceptions of healthcare in the Aboriginal community?
3. What are the effects of different leadership styles on the experience and outcomes of
healthcare for Aboriginal people?
4. Is there a difference in leadership styles between Aboriginal & non-Aboriginal healthcare
providers?
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5. If there are distinctions in leadership styles between Aboriginal & non-Aboriginal
healthcare providers, what types of differences exist?
6. How can leadership/managerial practices be improved to increase the overall health of
the Aboriginal population?

Chapter 2: Literature Review
There is a variety of literature available discussing the Canadian Aboriginal population’s
current health statistics, and their challenges in accessing healthcare (see for example: National
Collaborating Centre for Aboriginal Health 2011 and National Collaborating Centre for
Aboriginal Health 2013). There are also numerous data sets that discuss the characteristics
Aboriginal leaders view as significant to being successful at guiding others (see Julien, M.,
Wright, B. & Zinni, D.M. 2010 and Kirmayer, L.J., Valaskakis, G.G. & Erasmus, G.H 2014).
Extensive data is available that focuses on areas in Aboriginal healthcare where improvements
are required and that compare Aboriginal appreciations of health with westernized views.
Lastly, much research has been completed that examines restorative practices to increase the
quality of medical care among the Canadian Aboriginal population (see for example: Beavis,
A.S. et al. 2015 and Todd, R., Thornton, M. & Collins, D.N. 2001)
The section that follows begins with a discussion of the challenges Canadian Aboriginal
people are experiencing with the current healthcare system, followed by an examination of
Canadian Aboriginal leadership. It goes on to explore Aboriginal healthcare leadership and the
characteristics Aboriginal people believe an individual ought to have to become a successful
healthcare leader and then examines restorative practices to determine if there are reasonably
demonstrable means for the improvement of the quality of healthcare delivered to Aboriginal
patients.
15

Current Challenges in Aboriginal Healthcare
To assist Canada’s Aboriginal population in receiving improved care it is important to
identify the unique challenges they face in today’s healthcare system. Research has shown that
Aboriginal people, because of history, stereotypes, and living conditions have unique challenges
within healthcare when compared to the rest of Canada. It is important for healthcare providers
to take these factors into account when working with Aboriginal patients (Beavis et al. 2015). In
particular, the challenges faced by Canada’s Aboriginal population include racism, healthcare
funding, gender, and reserve/rural access to healthcare.
Racism
One of the first challenges Canada’s Aboriginal people face when accessing healthcare is
racism. A primary example of racism that occurs in healthcare happens when physicians refuse
to provide medicine for Aboriginal patients because of the belief that they suffer from addictions
or that they may become dependent on the medication. Another example concerns Aboriginal
patients who attend the Emergency room of hospitals because they are seriously ill, but are
mistaken for being under the influence of alcohol and drugs because of their Aboriginal ancestry
(Health Council of Canada 2012). Due to stereotypical views that exist towards Aboriginal
people, quality evaluations of their health symptoms are frequently not performed and
consequently, many Aboriginal people feel insecure about using healthcare services because of
the mistreatment that frequently follows in healthcare settings (Health Council of Canada 2012).
In reality, many Aboriginal people who do use healthcare facilities work full time, live addiction
free lifestyles and really do require medical attention (Health Council of Canada 2012).
Healthcare Funding

16

Canadian Aboriginal people also face difficulties in healthcare today because the Federal
Government has reduced funding that supports many Aboriginal health related initiatives
(Webster 2012). For example, the 2012 Federal budget indicated that Governmental
departments, such as Aboriginal Affairs, had decreases in funding of up to $165 million dollars
(NCCAH 2012). The Native Women’s Association, which focuses on the wellbeing of
Aboriginal women, has had funding decreases of up to 40% in their health initiatives, which has
resulted in a loss of $1.5 million dollars annually (National Collaborating Centre for Aboriginal
Health 2016). Examples of programs where budget cuts have taken place are those related to
HIV/AIDS, diabetes, mental health, addictions, suicide, fetal alcohol issues, and sexually
transmitted infections (Webster 2012). With decreased funding in these departments there is less
money available to provide for Aboriginal healthcare (National Collaborating Centre for
Aboriginal Health 2016). These budget cuts have resulted in a decreased number of Aboriginal
leaders within healthcare because many Aboriginal people are responsible for Aboriginal health
related initiatives and has resulted in predominantly non-Aboriginal healthcare providers being
responsible Aboriginal patient healthcare (Webster 2012).
Gender
Aboriginal women in Canada experience adverse healthcare issues in comparison to other
females in Canada. For Canadian Aboriginal women, the ability to receive quality healthcare has
been adversely affected by discrimination and the use of labelling (Denison, Varcoe & Browne
2014). Aboriginal women do not access healthcare as often non-Aboriginal women in Canada
because of existing prejudices and because of the fear that their children will be detained so they
stay away from healthcare facilities (Denison, Varcoe & Browne 2014). Additional research has
found that the conditions contributing to Aboriginal women avoiding accessing healthcare relate
17

to their social rank, their experience of various types of abuse, prejudice, negative interactions
with child welfare agencies, and in having not received quality assistance from healthcare
facilities in the past (Denison, Varcoe & Browne 2014).
Reserve and Rural Access to Healthcare
Canada’s Aboriginal population faces challenges accessing quality healthcare services on
reserves and in rural areas. Limited access to healthcare services from these rural areas stems
from the lack of mobility to and from healthcare facilities, and an inability of many Canadian
rural Aboriginal people to speak the English language (NCCAH 2011). Not as many people live
in rural areas in comparison to the number of individuals living in urban vicinities, which means
that it is costlier for healthcare to be carried on in rural areas. On reserves and in rural areas,
healthcare staff also tend to be those in predominantly nursing professions, so specialized care
from physicians is frequently not available (NCCAH 2011). Furthermore, reserves and rural
areas face a scarcity of healthcare staff and there is high turnover (NCCAH 2011).
There are unique, challenging and complex problems that Aboriginal people face in
healthcare today when compared to the rest of Canada. As demonstrated above, budget cuts
have decreased assistance to many programs related to Aboriginal health. Aboriginal women
experience negativity while accessing healthcare and tend to access care less frequently when
compared to other cultures in Canada. To compound these challenges even further, Aboriginal
people experience issues accessing care when living in rural areas, and have communication
difficulties due to language barriers. Finally, as mentioned previously, Aboriginal people fare
more poorly in almost every standard of living when compared to other Canadian, cultural
groups.

Canadian Aboriginal Leadership
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Statistically, the Canadian Aboriginal population tends to complete educational programs
at lower rates when compared to the rest of Canada and this has had a negative impact on the
potential for Aboriginal leadership. Approximately 30% of Aboriginal people complete postsecondary education in comparison to 46.6% of non-Aboriginal individuals (Biswal 2008). The
lack of educational completion rates among the Aboriginal population is due to the historical
effects of colonization and assimilation and as a result, there are less Aboriginal graduates
because they are disadvantaged monetarily, educationally and traditionally (King 2008).
Aboriginal people have challenges balancing home, individual, and academic responsibilities and
this prevents them from completing their educational programs (King 2008). Many Aboriginal
women are largely responsible for caring for their household, while at the same time some are
single mothers and these additional responsibilities create further challenges for completing
education (King 2008).
A study conducted by Human Resources and Social Development Canada (2003) found
that Métis people scored higher in tests of literacy when compared to those of other Aboriginal
backgrounds and increased literacy scores were positively correlated with education and
employment (Biswal 2008). The Canadian Inuit population fared the poorest but this outcome
may have been influenced by the fact that tests were conducted in English and many Inuit people
do not speak the English language (Biswal 2008). Aboriginal people as a group tend to fare
more poorly than those of non-Aboriginal ancestry. But, those Aboriginal people whose
outcomes were highest in the study earned an equal amount of income when compared to those
of non-Aboriginal ancestry (Biswal 2008). Approximately 62% of working age Aboriginal
people were employed in comparison to 73% of non-Aboriginal people in the workforce (Biswal
2008).
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There are differences in views and practices when comparing Aboriginal and nonAboriginal leadership. In particular, Aboriginal leadership is increasingly centered on
community, spirituality and equality in comparison to non-Aboriginal practices. This section
begins by examining the main elements of Aboriginal leadership and then concludes by
discussing Aboriginal Board members’ views of what constitutes successful leadership.
Aboriginal Leadership
Aboriginal beliefs about what constitutes leadership are very different in comparison to
mainstream practices. Julien, Wright & Zinni (2010) have observed that Aboriginal leadership is
more centered in spirituality and equality; has a communal centered focus that believes in
unifying instead of separating; and focuses on the whole individual (Julien, Wright & Zinni
2010). Aboriginal leaders guide in subtle ways that include teaching through stories,
visualizations, and descriptions and bonding within the community and maintaining congruence
is also significant within Aboriginal leadership (Julien, Wright & Zinni 2010). Aboriginal
leadership believes that spiritual practices assist community members in maintaining their ethnic
distinctiveness and when making major choices, Aboriginal leaders ensure there is agreement
prior to making a selection (Julien, Wright & Zinni 2010). Lastly, Aboriginal leadership focuses
more on femininity, what has been taught previously, and responsibilities to children who will
soon become adults and leaders within the community (Julien, Wright & Zinni 2010).
Aboriginal Leadership Characteristics

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When examining the leadership characteristics of Board members in Aboriginal
friendship centers throughout Canada,1 it was found that these leaders required specific
personality traits to become an effective member (Durst 2006). Characteristics required for
board membership were for members to have a vision, be flexible, have a competent
comprehension of the challenges Aboriginal people face, be esteemed members in their home
territory, display independence, autonomy, empathy, and, most importantly, care for the
wellbeing of others (Durst 2006). Aboriginal leaders must also have personality traits of
truthfulness, uprightness, generousness, and practice humility to be considered into leadership
roles (Julien, Wright & Zinni 2010).

Aboriginal Healthcare Leadership
Competencies
Leadership competency is defined as the personality traits and skills of an individual that
increase his or her likelihood of success within their position. There is a common understanding
among professionals that improvements within healthcare leadership are needed to improve the
quality of care to patients in general (Baker 2003). Specifically, improvements are required at
the individual, organizational and systemic levels, and Baker (2003) believes that focusing on the
competency of healthcare providers will improve healthcare outcomes.
It has been discovered that university training of various healthcare programs offers little
education on Aboriginal matters (Shah & Reeves 2012). A study conducted within Ontario with
approximately 25 post-secondary institutions and 17,700 new health providers, concluded that
only nursing and various health support programs offered training about Canada’s Aboriginal

1

Friendship centers were located in the Whitehorse of the Yukon Territory, Victoria, BC, Thunder Bay, Ontario,
and Halifax, Nova Scotia and Aboriginal females and males were the participants in the age range of 25-64 years
(Durst & Zimmerly 2006).

21

people. When Aboriginal training was offered within these health programs, non-Aboriginal
professors conducted most of the teachings (Shah & Reeves 2012).
To be effective leaders in Aboriginal healthcare it has been determined that healthcare
providers must have an understanding of the issues prominent within the Canadian Aboriginal
community (Shah & Reeves 2012). Other healthcare leadership competencies include knowing
Aboriginal backgrounds, Aboriginal traditions, and having an understanding of the Aboriginal
patient themselves besides their illness. This includes knowing when to provide an Aboriginal
patient with time to discuss their concerns and if needed, providing increased time in visitation
sessions (Zhou et al. 2011). In developing the characteristics discussed above, healthcare leaders
would be provided with the skills required to increase rapport and interaction between the
healthcare provider and Aboriginal patient thereby improving Aboriginal healthcare outcomes
(Zhou et al. 2011).
Traditional Healing
“Traditional healing” refers to practices used since before the occurrence of mainstream
treatments, to encourage intellectual, physiological and transcendent health among Aboriginal
individuals (Herring, Waldram & Young 2000). Aboriginal healthcare leaders view rituals,
tradition and culture as significant to healing (Herring, Waldram & Young 2000). Traditional
healing can include spiritual practices, medicines, Elder teachings, ceremonies and discussions of
past or current issues (Kirmayer, Valaskakis & Erasmus 2014; Herring, Waldram & Young
2000).
Ceremonies
Within Canadian Aboriginal culture, the use of ceremony is meant to address illness,
bring people together, and heal participants. Aboriginal health leaders use ceremonies that focus
22

on healing all aspects of the human being in patients including the mind, emotions, physiology
and transcendent aspects (Health Council of Canada 2012). In most Aboriginal healing
ceremonies, there is always an association between the divine and the sickness that is occurring
(Kirmayer, Valaskakis & Erasmus 2014). The “Vision Quest”, for example, is a healing
ceremony used by Canada’s Aboriginal population to enable individuals to realize their
transcendent selves (Kirmayer, Valaskakis & Erasmus 2014). These ceremonies frequently
entail the use of sacred medicines such as sweetgrass, sage, cedar, and tobacco. Many
ceremonies such as a smudge ceremony, are meant to heal, purify and stabilize participants’
sense of wellbeing (Monchalin 2016). Even though healthcare facilities allow use of
ceremonies, Aboriginal people who use them feel that they are frequently misinterpreted and
judged as undesirable by non-Aboriginal people (Health Council of Canada 2012).
Mainstream literature has indicated that hospital facilities require increased adaptability
to incorporate ceremonies into the healing and wellbeing process for Aboriginal patients.
Aboriginal shamans, for example, frequently perform healing ceremonies for patients in
healthcare facilities and many times, these ceremonial rituals require the use of fire and smoke
which means hospital amenities need to be able to accommodate these needs (Herring, Waldram
& Young 2000).
Elders
Different Aboriginal backgrounds have varying names for Elders but they are most
noteworthy for being intelligent, having a rich life understanding, and assisting members in their
home territory. In Aboriginal culture, most Elders are senior people in the community who are
highly esteemed, are considered very knowledgeable and are traditional Aboriginal leaders who

23

offer residents leadership, focus and realization of the self (Monchalin 2016; Kirmayer,
Valaskakis & Erasmus 2014).
Aboriginal people usually seek restoration assistance from Elders when they are
struggling and require healing (Monchalin 2016). Elders are significant health leaders in that
they offer ancestral guidance, storytelling, and leadership to their people when needed
(Monchalin 2016). There have been examples where suicidal ideation was reduced among youth
because Elders taught them their cultural traditions and this provided youth more constructive
ways to deal with problems in their lives (Kirmayer, Valaskakis & Erasmus 2014).
In closing, leadership competency refers to the personality traits and skill sets an
individual possesses that increases the likelihood they will be successful in their position. It was
found that within healthcare, improvements are required at the individual, organizational, and
systemic levels to increase the quality of care provided to patients. Competencies suggested to
improve Aboriginal healthcare include having an understanding of the culture, traditions and
issues that Aboriginal people deal with. Other abilities mentioned include providing lengthy
visitation time with Aboriginal patients to discuss impending issues, and developing increased
rapport. Hospital facilities also require increased acceptance of Aboriginal healing practices,
including the use of ceremonies, and visits from Elders.

Restorative Practices
Restorative practices are designed to increase health among individuals by ridding them
of illness to restore individuals back to the way they were before illness occurred (Waldram
2013). Literature has provided many suggestions as to where restorative practices can be
implemented to increase the health and wellbeing of Canada’s Aboriginal population. According
to Warry & Robson (2000), a restorative practice should allocate responsibility for healthcare
24

services to the Aboriginal population themselves. The allocation of healthcare delivery to
Aboriginal people is a primary stage of redesigning the healthcare system today. Warry &
Robson (2000) explain that a large trial for Canada’s Aboriginal population would demonstrate
their ability to adequately care for their own healthcare and that the allocation of healthcare
services to Aboriginal people would display Governmental approval of empowering Aboriginal
people.
Measures to address the racism prevalent among healthcare providers are an important
goal of restorative practices (Glauser, Tepper & Konkin 2016). Educating healthcare workers on
Aboriginal history, common stereotypes that exist toward Aboriginal people and how their own
biases may affect the quality of care delivered to Aboriginal patients would be a starting point to
increasing the quality of care. As pointed out, racism has greatly affected the care Aboriginal
people receive, in the section that follows, restorative practices that address living conditions will
be discussed, followed by an examination of the issues related to geographical location and
ending with a discussion of cultural competency training.
Living Conditions
Todd, Thornton & Collins (2001) suggest concentrating on restorative practices that
focus on Canada’s Aboriginal population’s living conditions is crucial for improving healthcare
outcomes. They explain that increased expenditures on prescription medication, etc., have not
been effective because they are not adequately focused on the healthcare needs of the Aboriginal
population. Instead, restorative practices need to consider the mindset of Canada’s Aboriginal
population and focus on decreasing scarcity, and improving living conditions such as the
quantity of water available, cleanliness, and home accommodations (Todd, Thornton & Collins

25

2001). Finally, improving ecological pollutants around Canadian Aboriginal living areas would
be beneficial for decreasing illness (Todd, Thornton & Collins 2001).
Geographical Location
Other restorative practices suggested to improve the health of Canada’s Aboriginal
population are to take into account what is required per geographical location (Newbold 1998).
For example, some reserves are closer to cities than others, so it is easier to access healthcare due
to proximity factors and Aboriginal people, who live in cities, tend to visit the doctor more
frequently than those residing on reserves (Newbold 1998). Aboriginal people have indicated a
need for more health-related training, increased access to counsellors, and easier availability of
healthcare services in their place of residence (Newbold 1998).
Cultural Competency & Cultural Safety Training
A last restorative practice suggested is to introduce cultural competency and ethnic safety
training among healthcare staff (Beavis et al. 2015). Cultural competency is a process that
focuses on training physicians, nurses and other healthcare leaders with the education,
knowledge, abilities and mindsets to properly care for patients of different ethnicities while
cultural safety training focuses on the power relationship that exists between the healthcare
provider and patient (Beavis et al. 2015). Cultural competency and safety training are significant
to healthcare practice because this education will teach healthcare providers that focusing solely
on mainstream thinking and medicine will not provide optimal care for Aboriginal patients and it
will inform them about how colonization has impacted the health of Canada’s Aboriginal
population today. Aboriginal healthcare outcomes can be improved through introducing the
historical influences of colonialism, how this colonization impacts healthcare provided to
Aboriginal patients, and the ways a physicians’ own life experience and understandings
26

influence the care they provide to Aboriginal clients (Beavis et al. 2015). This involves
understanding Aboriginal worldviews and considering who trains healthcare staff, the methods
of teaching, and who explains the reasoning behind why competency training is being offered.
Finally, cultural competency training should be taught with and by Aboriginal people for
increased legitimacy.
Canadian Aboriginal people are suffering and will continue to have the highest difficulty
with healthcare unless there are revisions to Canada’s healthcare system and improvements to
living environments that are in the Aboriginal population’s best interests. The Government,
healthcare managers, Chiefs and all leaders need to work together for the improvement of
healthcare delivered to Canada’s Aboriginal population. It is imperative that restorative
practices are implemented, and cultural competency training offered to healthcare providers.

Chapter 3: Methodology
To begin, there is a difference between the terms “Research Methodology and “Research
Methods.” Research Methodology consists of the theory and scientific explanation for every data
collection method and it enables individuals to critically examine the development and errors
that exist among research methods (Adams et al. 2007). Adams et al (2007) state that when we
are able to understand the reasoning behind data gathering methods, then we are more able to
critically analyze information. Research methods refers to the data collection technique used to
manage and examine the research area and are the data collection techniques used to manage and
present data on a research area of interest (Adams et al. 2007). The researcher must determine
which technique to use to obtain the most meaningful results related to their research objectives.
Qualitative methods were chosen for this project because the research was focused on
gathering subjective opinions, and perspectives on healthcare leaders. In this research,
27

qualitative interviews were the means used to gather this subjective information. Quantitative
data gathering methods would not suffice as they are focused more on objectivity, and to get
enough quantitative information would require enlisting subjects in so large a number that it
would be outside the scope of this research (Health Research Funding 2015).

Qualitative Methods
Qualitative research focuses on the subjective nature of human perspectives and actions
and thus was the most suitable method for this project (Adams et al. 2007). All information from
interviewees in this project was subjective, therefore allowing participants to express their
opinions, feelings, and leadership styles around the topic of Aboriginal healthcare. The goal of
this research was to see if there were common themes that might arise amongst participant
responses. This research also focused on providing participants with a voice to speak about their
experiences while accessing healthcare.
Deductive Reasoning
This project chose to employ the deductive approach of methodology. There was an
understanding around the topic of Aboriginal healthcare leadership prior to conducting this
research therefore an outline was developed prior to analyzing the data. With deductive
methodology, an individual has their own philosophies, and develops an outline prior to analysis
(Burnard et al. 2008). The deductive approach is faster than using the inductive method and is
most beneficial to use when researchers have knowledge of and can anticipate the types of
participant replies they will receive (Burnard et al. 2008).

Choice of Methodology
Interviews
28

Qualitative interviews were chosen as the method of data collection because they are
beneficial when gathering information based on a participant’s worldview and their perspective
on a specific issue (Cassell & Symon 2004). Qualitative interviews assist the researcher in
determining how the participant came to view the topic of interest in this manner and, this type
of research tends to have a minimal structure, asks open-ended questions and focuses on a certain
topic of interest (Cassell & Symon 2004). In qualitative interviews, the interviewee is the key
information provider for the project and can dynamically determine the course of the question
process (Cassell & Symon 2004)
The use of qualitative interviews for data collection has many advantages. Within
companies, for example, qualitative interviews assist with determining perspectives on larger
matters such as those of being a male or female in an organization, cultural implications for
companies, and the repercussions of joblessness (Cassell & Symon 2004). These types of
interviews also assist with assigning significance to areas where quantitative methods or other
forms of qualitative data collection techniques would not produce useful results. Cassell &
Symon (2004) indicate that participants are more likely to participate in interview data gathering
methods because most individuals are acquainted with this process from other areas of life.
Qualitative interviews were chosen because the goal of this project was to examine
individual perceptions of the current healthcare system and how it could be improved to increase
quality of care to Aboriginal patients. As mentioned above, the focus of this paper was to gather
respondents’ points of view on healthcare leadership and the experience of patients in the
delivery of care to the Aboriginal population. There are also disadvantages to the qualitative
interview process. For example, qualitative interviews take many hours to prepare, conduct, and
examine (Cassell & Symon 2004). At times, there is also a considerable amount of time taken
29

from participants, and it therefore may be challenging to obtain interviewees (Cassell & Symon
2004). Cassell & Symon (2004) indicate that many times, data collectors feel overwhelmed by
the number of hours it takes to conduct each step of the interview process. In this project, it
would have been more beneficial to conduct an increased number of interviews, but due to time
constraints, only 14 interviews were conducted.
The Researcher’s Role
I was the primary researcher for this project. As mentioned previously, I am of
Aboriginal ancestry and my interest has always been in improving the wellbeing of Canada’s
Aboriginal population. I work within the health sector of the Vancouver Coastal Health
Authority. More specifically, I work within Vancouver General Hospital’s Department of
Vancouver Acute and Medical Affairs. I have gained much experience working directly with the
Aboriginal population. For example, I have held a front-line position within an Aboriginal
Women’s shelter in Yellowknife, Northwest Territories. These Aboriginal women were fleeing
from domestic abuse and required emergency shelter along with their children. Other
occupations in which I was working directly with individuals of Aboriginal ancestry include
homecare centers, the Health and Social Services Department of the Government of the
Northwest Territories, an activity aide on a Psychiatry ward and lastly, a Program Assistant for
an Aboriginal funding service. While growing up, the majority of my friendships came from
Aboriginal ancestry and I can recall that many friends and family suffered from various
dysfunctional situations within their homes. My belief is that these dysfunctions were the result
of intergenerational trauma experienced from colonization.
My life and work experiences have equipped me with the tools to establish a trusting
relationship with participants who may be more sensitive to the topic of Aboriginal healthcare. I
30

plan to share my experiences and background with all interviewees in hopes of gaining increased
rapport. In light of this, I estimated that participants would share an increased amount of
information with a higher level of comfort. My role as the researcher was to listen to
participants’ responses and request further clarification if required. I listened to my interviewees
with a non-judgmental attitude and made data comparisons among participants upon completion
of the interview process.
Sample
A total of 14 interviews were conducted in this project, with each lasting 40 minutes to 1
hour in length. Interviewees included 7 Aboriginal, and 7 non-Aboriginal individuals who were
chosen because they came from various occupations and backgrounds (see Table 1).

Table 1 Pseudonyms for Interviewees

Pseudonym
Participant 1
Participant 2
Participant 3
Participant 4
Participant 5
Participant 6
Participant 7
Participant 8
Participant 9
Participant 10
Participant 11

Characteristics
Female, Aboriginal healthcare worker
Male, Aboriginal healthcare worker
Male, non-Aboriginal healthcare worker
Female, non-Aboriginal healthcare worker
Female, non-Aboriginal healthcare worker
Female, Aboriginal community member
Male, Aboriginal healthcare worker
Female, Aboriginal community member
Female, non-Aboriginal community member
Male, non-Aboriginal community member
Male, non-Aboriginal healthcare provider

Physicians, Aboriginal Patient Navigators and policy healthcare workers were interviewed for
this research that work mainly within the Vancouver Coastal Health Authority and the First
Nations Health Authority. Community members of Caucasian, Asian, and varying types of
31

Aboriginal ethnicities were also interviewed for this project that live around the vicinity of
Vancouver. All interviews took place in a quiet, confidential area of the participant’s choice and
the interview process provided participants with an opportunity to voice opinions, needs, and
wants from a subjective point of view. Importantly, all interview questions were open-ended to
ensure answers were not biased.
It was difficult to obtain interviewees from the Reserves to participate in this project. My
experience was that prospective on-Reserve participants did not return my calls or were not
interested in participating. Due to time constraints, I had to proceed with this project without
interviewing someone from a Reserve.
Data Collection
Participants were primarily recruited via email, phone, social media and face-to-face
interactions. I asked my current supervisors if they would like to participate in my interview
process, and they were useful in assisting me. As mentioned above, it was difficult to obtain
participants from the Reserves despite calling, using social media, and emailing.
Informed Consent
It is important to obtain informed consent prior to the interview process for ethical
reasons (Cahana, Samia & Hurst 2008). Informed consent provides participants with an
opportunity to agree or disagree with participating in a research project and allows a researcher
to step into a participant’s boundaries of privacy (Cahana, Samia & Hurst 2008). All informed
consent is voluntary and participants should never be coerced into participating in a research
project if they do not wish to (Cahana, Samia & Hurst 2008).
Prior to interviews taking place, I gathered informed consent from participants to ensure
they understood that I am an MBA student conducting research for my thesis project.
32

Participants signed an informed consent form. Participants also understood that all interviews
were video-recorded and they were provided with the primary researcher’s contact information if
concerns arose. In the event that a participant did not wish to be recorded on camera, their
preference was respected and the video camera was turned off. Lastly, participants were
provided a copy of the interview questionnaire in advance of the session’s commencement.
Confidentiality
I have ensured that all information collected in the interviews has remained confidential.
All video-recorded interviews are stored in a secure, confidential storage space. My Supervisor,
Professor Rick Colbourne, was the only other individual who viewed these results. As
mentioned above, the interview location required a quiet atmosphere so voice recordings, if used,
could be heard. Accordingly, all interviews took place in a quiet and confidential space of the
interviewee’s preference.

Ethical Considerations
Research with Aboriginal Participants
It is imperative to examine the ethics and rapport around working with Aboriginal
participants because past research with Aboriginal people was conducted mainly by nonAboriginal individuals who did not understand the culture and traditions of Aboriginal
communities and, as a consequence, research has historically not benefitted the Aboriginal
population (Panel on Research Ethics 2015). It is significant, therefore, to build rapport with the
Aboriginal community being researched prior to conducting fieldwork (Panel on Research Ethics
2015). Researchers must ensure that their work will benefit the Aboriginal community and
building rapport with Aboriginal participants includes community engagement practices, and
providing information about who will view the data upon completion (Panel on Research Ethics
33

2015). Other forms of rapport building include obtaining consent from leaders in the community
prior to selecting a participant (Panel on Research Ethics 2015).
In this project, Aboriginal people encompassed a significant portion of the study and I
ensured that all areas such as their cultural background, traditions, intergenerational trauma,
living conditions, and history of colonization were respected. Responses from Aboriginal
participants assisted in determining how the community, as a whole, viewed healthcare
leadership practices. Even though this research involved a significant portion of Aboriginal
interviewees, participants were not singled out, or specific traits identified. This research with
Aboriginal interviewees was collaborative in that I ensured there was a mutually respectful
relationship with participants. As mentioned above, I am part of the Aboriginal population and
have therefore developed an understanding of various Aboriginal customs. Throughout this
project, I ensured consent from leaders prior to conducting any interviews.
My belief is that this research will benefit Canada’s Aboriginal community. To begin,
during the research process, Aboriginal people, whether or not they identified as members of an
Aboriginal community, enjoyed freedom of expression in this project, and were free to consent
in research projects that they considered of personal or social benefit. This project’s research has
also contributed to facilitating individual health and wellbeing because participants provided
increased knowledge of how healthcare leaders can revise their practices to better care for
Aboriginal patients. Aboriginal peoples are particularly concerned that research should enhance
their capacity to maintain their cultures, languages and identities as First Nations, Inuit or Métis
peoples. Overall, I do not believe there was a significant impact on Aboriginal communities
resulting from this project’s research and the belief is that this study was ultimately low risk.

34

I was careful to ask if there were questions or concerns before conducting interviews to
confirm that all interviewees were at their maximum comfort level. I also performed check-ins
throughout the interview process to ensure participant wellbeing. Respondents were not
pressured to answer questions if they did not wish to. I understood that some topics may be a
sensitive issue for interviewees to discuss and therefore did not probe anyone to answer
questions they may have felt uncomfortable with. Assistance while conducting interviews was
not required because all participants were English speakers and had full functioning capacity.
Lastly, participants were offered a copy of the project when completed.

Research Limitations
While acknowledging that answers may not be found to all objectives, as much relevant
data as possible was gathered. As mentioned above, interviewees may not be comfortable
answering various questions and this may hinder data gathering as well. Participants cannot be
forced to answer what they do not wish as this would be against ethical considerations.
Although it would have been beneficial to attain an interviewee from a reserve, due to time
constraints and lack of responses, I was unable to obtain a participant from there. Results,
therefore, are limited to Aboriginal leaders, non-Aboriginal leaders and community members
throughout the vicinity of Vancouver. If this study were to be implemented again in the future, it
would be beneficial to obtain participants from Reserves close to Vancouver.

Chapter 4: Data Analysis
The following steps guided this analysis process:
1.

Interview responses were read through numerous times to search for common
themes that arose among interviewee answers

2.

Themes were linked to what was presented in the literature review section
35

3.

The data was clarified using quotes from respondents, narratives and citations
from the literature review section

Themes which emerged from the data were first, both Aboriginal and non-Aboriginal
participants had similar characteristic expectations of a successful leader in Aboriginal
healthcare. Second, the effects of colonization are a challenge when dealing with Aboriginal
patients. Third, the lack of resources in healthcare and in the environment, play a significant
factor in the quality of healthcare received by Aboriginal patients. Lastly, both Aboriginal and
non-Aboriginal participants had their own perspective of the restorative practices required to
increase the quality of healthcare to Aboriginal patients. In the section that follows, the results
from the interviews will be examined with regards to themes that arose followed by an analysis
of the significance of the findings and ending with recommendations.

Findings
Leadership Characteristics in Aboriginal Healthcare
The first theme arising out of interviews was that both Aboriginal and non-Aboriginal
participants had similar understandings of leadership characteristics required to be successful in
Aboriginal healthcare. Interviewees mentioned having quality communication skills, being
respectful, having compassion, understanding the population that serving, being honest,
trustworthy, and having experience working with Aboriginal people. For example, female
Aboriginal, healthcare provider Participant 1 stated:
“I think that some of the best qualities or characteristics would be humility,
compassion, dedication, trustworthiness, honesty, self awareness, and commitment
to the work, team and themselves. Leaders must always have that transparency,
that vision to always be moving forward, always having the best interests of our
people in our heart.”
36

According to Participant 1, a quality healthcare provider for Aboriginal people would be honest,
committed, is humble and would always have the best interests of Aboriginal people while
working. Participant 1 works directly with Aboriginal patients on a daily basis so had extensive
knowledge about Aboriginal matters.
Other examples of Aboriginal healthcare leadership characteristics included having
knowledge of Aboriginal culture, excellent ethics, and being assisted by providers who were of
Aboriginal ancestry. When interviewees were asked about the qualities of a successful leader in
general, both Aboriginal and non-Aboriginal participants cited that all leaders should have
compassion, ability to listen, capacity to understand the perspectives of others, have high ethics,
a vision, humility, and a great sense of humour. For example, male Aboriginal healthcare
provider Participant 2 noted:
“Healthcare leaders should have relational skills, I think its good to have
management skills, you need to be able to relate to people, have communication
skills, change management skills, a clear and comprehensive understanding of
government processes, and also of health authority structures, roles and
responsibilities.”

Participant 2 states that ensuring to stay professional and working within organizational rules is
important for building relationships with Aboriginal people that lead to quality healthcare
outcomes and asserts that quality communication is essential to building and sustaining
relationships with Aboriginal patients. Participant 2 is an Aboriginal healthcare leader who
oversees staff, so he has first hand experience of leadership within Aboriginal health.
Personality traits mentioned included the ability to identify strengths of team members,
offer praise, be supportive, fair, assertive, respectful, flexible, and have an ability to assert
boundaries. Important characteristics mentioned included having excellent communication,
37

honesty, transparency, fairness, ensuring not to micromanage, having patience, a high emotional
intelligence, an ability to delegate, a willingness to make mistakes, overcoming bias, and the
desire to know the individual that one is working with. One male, non-Aboriginal healthcare
provider Participant 3 explained:
“…listening, being able to understand the perspectives of others, high
ethical standards, I guess a relentless sort of pursuit of improvement, always
pushing things forward to improve, interpersonal style and abilities. We have a lot
to learn about Aboriginal communities, and their needs, how they present their
needs, and how to match the services of care to their unique environments. I don’t
think we can simply apply western, modern, medical treatments in a blanket way to
Aboriginal individuals without thinking about their preferences, and their needs,
and the environment in which they live.”
Participant 3 understands the significance of having high ethical standards while caring for
Aboriginal patients. He also states that it is acceptable for Aboriginal health leaders make
mistakes, as long there is follow to work on those areas requiring improvement. Participant 3
realizes that in order to provide quality care to Aboriginal people, a provider must get to know
them and their needs, so they can match their care and services accordingly. He works in
mainstream healthcare within Vancouver General Hospital, but still has knowledge of the
characteristics required to adequately care for Aboriginal patients.
Therefore, the interviews indicate that Aboriginal healthcare leadership requires honesty,
an ability to listen, high ethics, excellent communication, and building relationships. It was also
mentioned that developing strong Aboriginal leadership requires getting to know the Aboriginal
patient, their culture and style of communication as well as working within the policies of their
healthcare organization.
Colonization
38

The effects of colonization emerged during the interviews as an important challenge
facing Aboriginal patients and healthcare providers. For example, male Aboriginal health
provider Participant 2 noted:
“It is challenging dealing with the public misunderstanding of our people in
terms of not being able to connect the dots between the current health status and
colonialism.”
He observes that events such as the implementation of the Indian Act, Residential schools, and
the sixties scoop have had detrimental effects on the wellbeing of Canada’s Aboriginal
population. Participant 2 believes that many non-Aboriginal people do not understand the effects
that these situations caused Aboriginal peoples and he believes that the general population just
sees a dysfunctional Aboriginal person while not considering the reasons why they are that way.
Participant 2 notes:
“It is challenging addressing the myths, for example, that we get
everything for free, that we don’t pay taxes, that we get all healthcare for free. So
not true.”

According to Participant 2, there are a lot of stereotypes that affect how non-Aboriginal
individuals view Aboriginal people and these biases have a negative effect on the way
Aboriginal people are treated.
Aboriginal healthcare providers further indicated that dealing with the lingering effects
of residential school, and colonization were challenging when working with Aboriginal patients.
Intergenerational effects include addiction issues, poor physical health, mental health challenges,
having difficulties attaching to others, harming self, and being violent towards others. Other

39

lingering effects include having an inability to trust others, dealing with racism, and being treated
poorly by others, including healthcare providers. Aboriginal male provider Participant 2 noted:
“Dealing with the lingering effects of residential schools in hospitals, and
colonialism is the most challenging. People are often left with complex health
challenges, so the work we have to do with Aboriginal people is very complex and
multijurisdictional. We’re dealing with a system that’s side looped, and
fragmented, and it’s our job to bring those pieces together to create some sort of
coordinated plan. And, that’s really challenging.”

He is stating that there has been extensive intergenerational trauma due to colonization and that
the trauma is so devastating that it has triggered numerous health challenges on many levels
including mental, emotional, physical, etc. Participant 2 believes that the mainstream healthcare
system fails to consider the complexity of care required for Aboriginal patients and the
constraints faced by Aboriginal healthcare providers having to work within this westernized
system to provide quality services.
Another female, non-Aboriginal healthcare provider who works with Aboriginal patients
indicated that because of colonialism, many Aboriginal patients do not feel comfortable or safe
and there is a need to rebuild relationships so they will access care more frequently. Female,
non-Aboriginal provider Participant 4 explained that:
“Due to colonization, many Aboriginal patients do not feel comfortable or
protected when accessing healthcare and there is a need to rebuild relationships so
they will access care more frequently.”

Her view is that many Aboriginal community members avoid accessing healthcare because they
are treated poorly or frequently misunderstood. Participant 4 is non-Aboriginal but works within
the First Nations Health Authority and so deals with Aboriginal patients regularly. Based on her
40

experience, Non-Aboriginal provider Participant 5 cited the impacts of colonization in working
with all cultural groups, noting that some Aboriginal patients do not want to be associated with
their culture.
“Many Aboriginal people do not want to be associated with their culture and
we should not assume that they want to follow the ways of First Nation people. But
we often do.”

She observes that while many healthcare providers assume that an Aboriginal person wants to
include cultural healing practices in their care, many Aboriginal people are unfamiliar with their
culture or do not wish to be a part of it because negative associations generated by past practices
of colonization and assimilation.
An Aboriginal interviewee described a situation when she was diagnosed with Post
Traumatic Stress Disorder from her brother passing away at the age of twenty-five years due to
alcoholism and she was trying to receive healthcare but it was challenging. She was placed on a
long waiting list of seven months and required more care than what was ultimately received.
The health effects from her trauma were so complicated that she needed increased health
assistance. This participant was fearful of her family being judged by the non-Aboriginal
healthcare staff because her brother passed away so young from alcoholism. This female
Aboriginal community member Participant 6 2016 stated:
“It really just depends on the human being, there’s very beautiful people full
of compassion and understanding of the human experience but sometimes there is
that disconnect, that fear of judgement from people that simply just don’t
understand what its like to be a First Nations person growing up here in Canada and
the different challenges we face as First Nations people. Its not the same
upbringing as it is to be a middle class white person. You know my brother died at
the age of twenty-five due to alcoholism. I felt the judgement. What are they
thinking? What do people see when they see this?”
41

She was fearful that non-Aboriginal healthcare staff were judging her because her brother passed
away at such a young age from alcoholism. This is an example of community members feeling
unsafe and uncomfortable with mainstream healthcare services.
Therefore, within Aboriginal healthcare, due to practices of colonization and
assimilation, it is challenging working with Aboriginal patients because of the residual trauma.
It is also difficult for Aboriginal healthcare workers to provide care in a predominantly
westernized culture that does not fully consider the needs of Aboriginal patients. In receiving
care, due to the effects of colonization, Aboriginal patient sometimes do not wish to be
associated with their culture, and many Aboriginal people are fearful of the mainstream
westernized medical staff.
Lack of Resources
The interviews revealed that the lack of resources in healthcare plays a significant factor
in the quality of care received by Aboriginal patients. For example, female, Aboriginal health
provider Participant 1 noted:
“Resources in general are lacking so supporting clients can be really
difficult, especially in times of crisis.”

Participant 1 works with Aboriginal patients in both rural and urban environments and she
discussed not having enough resources in terms of housing, transportation, food, localized access
of resources, and proper communication with other healthcare providers as being challenging
especially in times of crisis. Her organization, however, strives to provide high quality care to
their Aboriginal patients despite lacking these resources.
42

Another male provider working directly with Aboriginal patients cited lack of housing,
insufficient climate resources, the absence of health transportation and insufficient health access
as being challenging when providing care to this part of society. Male, Aboriginal provider
Participant 7 notes:
“I was thinking it would be beneficial to have resources linked to healthcare
housed in one centre, so whether that’s Aboriginal Patient Navigators, and/or
housing specialists, or community resources, having them linked together and
providing additional resources for the Aboriginal community so they can access
healthcare, housing, community supports. If we had a team linked all together it is
possible that as Aboriginal healthcare leadership, we would feel stronger.”

According to Participant 7, because it is difficult to find accurate resources to support Aboriginal
patients it would be easier to access support and crucial resources if they were all accessible
through on location. He works directly with Aboriginal patients in Aboriginal healthcare so had
extensive knowledge of what resources are required to improve the assistance provided to
Aboriginal patients.
Other resources that are missing or challenging on Aboriginal reserves include
substandard living conditions, poor quality drinking water, lack of nutrition, communication
barriers such as an inability to speak English, etc. Aboriginal patient navigators listed lack of
resources in terms of housing (for both urban and rural Aboriginal patients), drinking water, food
access, escorts, financial resources, and parking passes as being the most difficult aspects of
providing care for Aboriginal patients. Male Aboriginal provider Participant 7 notes:
“I feel, in working with clients, at the time of discharge, it is challenging
searching for adequate resources, and housing in order for them to continue healing.
You can say this problem exists for both urban and on Reserve patients.”

43

According to Participant 7, of all the resources, it is especially difficult to find adequate housing
for Aboriginal patients within all areas. He notes:

taps.”

“In some communities, they can’t drink the water that comes out of the

Participant 7 indicates that living conditions are so substandard in areas that Aboriginal live, that
in some places they are unable to drink out of their taps at home.
Aboriginal healthcare providers indicated that economic and geographic barriers are
challenging factors when caring for Aboriginal patients. Female, Aboriginal healthcare provider
Participant 1 notes:
“Resources in general are lacking. Not having the financial resources,
ourselves to help families with is a challenge so access to maybe food vouchers at
the hospital, parking passes and that sort of thing is one of the biggest things.”

According to her, it is difficult to obtain adequate resources without the finances available to do
so. Therefore, Aboriginal healthcare providers are constantly searching for vouchers for food,
parking, etc. which Aboriginal patients can use.
A female, non-Aboriginal healthcare provider working with Aboriginal patients indicated
that the challenges around medical travel, funding and lack of communication when a patient
lives in remote areas as being “testing.” Often in remote areas, a phone or computer is
unavailable for communication purposes and this creates difficulties when caring for Aboriginal
patients. Female, non-Aboriginal healthcare worker Participant 4 notes:
“From community engagement work that I am a part of, many of our
challenges come from transportation to appointments. Or, if Aboriginal patients are
44

needing to leave their region entirely to come down here to Vancouver General
Hospital (VGH), medical transportation, or arrangements for funding can be
challenging to navigate. And, communication can sometimes be a challenge if
they’re living in a rural or remote area with limited Internet services, or if you don’t
have a computer, or telephone, keeping up with the health provider and follow up
appointments can be difficult.”

According to Participant 4, it is challenging providing care for Aboriginal patients living in
remote areas because there are extreme communication barriers in some areas. As mentioned
above, Internet services are lacking or a phone is unavailable. These barriers make it difficult to
care for Aboriginal patients living outside of the city.
Lastly, a male, non-Aboriginal, provider cited the need for increased advocacy to open
communication lines with Aboriginal patients. Male, non-Aboriginal provider Participant 3
notes:
“I think first of all we should be engaging that community in a separate
way. You know they are stakeholders. They have a disproportionate number of
injuries, medical issues, and medical problems. And, we are not really engaging
them in the planning and provision of the kind of care that they want. They have
unique needs related to their Aboriginal communities and heritage, and I don’t
think we’re very sensitive to that. So, if we had, for example, an Aboriginal liaison
officer, or teaching assistant in the hospital, I think that would be very helpful.”

According to Participant 3, it is essential to have Aboriginal feedback in providing quality care.
An advocate would therefore be beneficial to speak on behalf of Aboriginal people regarding
their unique healthcare needs.
Healthcare leaders indicated that the lack of resources was equally challenging when
caring for non-Aboriginal patients. A healthcare provider cited that he had the same issues as
when dealing with Aboriginal patients. Aboriginal Patient Navigators said that non-Aboriginal
spouses and children were unable to receive support, transportation, and food. And, a non-

45

Aboriginal physician cited said access to care was similarly a significant issue for nonAboriginal patients. Male, non-Aboriginal provider Participant 3 noted:
“Its more than just access to care. Access to care is the big issue. But, nonAboriginal people seem very eager to advocate for themselves. Where as
Aboriginal people are less aggressive at advocating for themselves.”

Participant 3 indicates that for non-Aboriginal patients access to care is equally challenging
when compared to working with Aboriginal patients, however, the difference is that nonAboriginal people are more likely to speak their mind regarding their needs in comparison to
Aboriginal patients whose culture and upbringing might not support such behaviour.
Community members indicated the lack of resources as being challenging for quality
healthcare. For example, referring to Aboriginal community members, a female, Aboriginal
participant complained about the lack of communication between healthcare providers and
patients as being challenging. She described the challenges of not receiving consistent messages
of where to access proper healthcare, in not being told who will assist her with healthcare
problems or who is going to follow through with her. This same participant also felt that within
healthcare, many items fall through the cracks. She complained of having to search for travel
assistance and was required to pay for her own healthcare at times. This same female,
Aboriginal community member Participant 8 2016 notes:
“I can’t go to First Nations Health for an issue. I have to go to Nisga’a
Valley Health. One will tell me I have to talk to the other, and the other will tell me
I have to speak with the other person. When trying to sign up for First Nations
Health, nobody wanted to help me. It is just the communication and who will help
me with this, and follow through with it. I took my application right to Health
Canada and there was months of nothing. This is something that you shouldn’t
have to deal with.”
46

Participant 8 was frustrated when applying for First Nations Health because she was receiving
inconsistent messages of how to access healthcare and was forced to approach many people in
order to try to receive assistance. She believes there should be improved communication of how
to access care.
Another female Aboriginal participant described that she required more healthcare
assistance for dealing with her Post-Traumatic Stress Disorder (PSTD) than she received.
Female, Aboriginal community member Participant 6 notes:
“I had a brother who passed away last October and I was really struggling
with my mental health, so right away I contacted Vancouver Coastal Health to see
what I could do to help myself. I saw a psychiatrist and she said everything I was
going through is normal and that I had post-traumatic stress disorder from losing
my brother. It took over 7 months to get accepted into a group she referred me to.
In the meantime, I really had to struggle learning to cope and deal with my PTSD
and that was really challenging because I would be on my way to work in tears, I’d
be at work in tears. I think I needed more help than what I received. It took a lot
out of me.”

Participant 6 complained of having to wait long periods of time to receive adequate healthcare
for her PSTD. She was left on her own to fend for herself while waiting for care and felt that she
should have received more thorough care instead waiting for months at a time for acceptance
into a PTSD program.
Non-Aboriginal community members also complained about the lack of resources in
healthcare. For example, a female, non-Aboriginal community member explained that there are
long wait times when trying to access healthcare, and there is little interaction with healthcare
staff much of the time. This same female, non-Aboriginal community member Participant 9
notes:

47

“When seeing my Family Doctor there were three hour wait times even
though an appointment was made. He was at the end of his career and had a huge
portfolio. I have since changed doctors.”

Participant 9 complained of long wait times to see her family doctor, even though she had made
an appointment. According to her, some physicians have too big of a portfolio to adequately
care for the number of patients they have.
A male, non-Aboriginal community member said that waiting long spans of time to
receive healthcare, was a challenge, and that there are often difficulties finding an adequate
family physician. This male, non-Aboriginal community member Participant 10 notes:
“I had to go to the children’s hospital for Penny (my daughter), and there
were long wait times, but physicians were good. It also took a long time to find a
family doctor because there are not many around and they’re not accepting
patients.”

Participant 10 similarly complained of having to wait long periods of time at the children’s
hospital for his daughter to access care.
Overall, it was found that a large increase in resources is required to improve the health
conditions among Canada’s Aboriginal population. Examples of resources that are needed
include increased funding, housing, transportation, communication, increased opportunities for
Aboriginal healthcare graduates, decreased wait times to see physicians and perhaps having a
variety of resources linked in one area. There is also access to care issues for non-Aboriginal
patients.
Restorative Practices

48

Aboriginal and non-Aboriginal participants differed in their perspectives on the types
restorative practices required to increase the quality of care for Aboriginal patients. For
example, female, non-Aboriginal provider Participant 4 states:
“I find each individual tends to have their own style and personality, that it
is hard to say there is one thing that will work for everyone. When I was thinking
about my workplace, I think it is important to have a strong, solidified set of core
values within the team. So, it would be beneficial to offer training of how you can
go about having conversations with your team, or your organization to develop
those core values. Also, leading by example and role modelling is important, doing
what you think should be done. Being less instructive and more demonstrative.”

According to Participant 4, a restorative practice ensures there is a set of core values among the
Aboriginal healthcare team. She felt that it is imperative for Aboriginal health leaders to lead
community members by setting an example through living a clean and healthy lifestyle.
Other examples of restorative practices mentioned by participants include increasing
counselling services, offering more assistance for family members providing care for children,
introducing Aboriginal people to mainstream healthcare processes, and providing increased job
opportunities for new healthcare graduates. One non-Aboriginal healthcare provider Participant
11 notes:
“Students are graduating, but they aren’t getting jobs because they don’t
have experience. There should be internships for new graduates.”

According to Participant 11, for new Aboriginal graduates to gain experience and obtain jobs,
there should be internship programs available for new graduates. This would increase the
number of Aboriginal employees within Aboriginal healthcare. He also states:

49

“There should be broad exposure for Aboriginal people to mainstream
healthcare processes.”

Participant 11 believed that Aboriginal patients would more easily adapt to westernized,
mainstream medical practices if they were exposed to them through job experiences and
internships.
Other examples of restorative practices discussed in interviews included having
comprehensive healthcare resources linked in one centre, increasing learning opportunities for
healthcare staff, providing mentorship programs which would expose staff to different styles of
leadership, and increasing opportunities for graduates to participate in practicums. Female,
Aboriginal healthcare provider Participant 1 observes:
“There needs to be more opportunities made available for learning, for
mentoring with senior staff, and leaders, and more opportunity for upward
movement within an organization, instead of feeling like staff have to go
somewhere else afterwards. Because often what will happen is employees will do
their degree, then go somewhere else after they have gotten their Masters. And,
that happens a lot.”

According to Participant 1, to retain Masters Level Aboriginal graduates, it is imperative to
provide mentorship programs and room for advancement for them within Aboriginal healthcare
organizations. Otherwise these newly skilled employees will be lost.
Interviewees mentioned that receiving assistance with increased quality living conditions
would be beneficial. The living conditions requiring improvement included having cleaner
drinking water, and more educational opportunities for Aboriginal people to create a life separate
from dysfunction. Other restorative practices mentioned by participants include leading by
example, participating in cultural competency training, and generating increased awareness about
50

intergenerational trauma that occurs among Aboriginal populations. Female, Aboriginal
healthcare provider Participant 1 notes:
“One of the larger challenges of working with Aboriginal clients is working
with the team that struggles to work with Aboriginal clients and family. And so,
the challenge is more building that relationship with the team to help foster the
relationship with the patient and family so that you can support a successful
healthcare plan that is culturally safe and appropriate.”

In addition, she observes that:
“Sometimes it takes a lot of work with the team to be successful because
people have those invisible backpacks. They don’t know that they have all of these
things in their life that they take for granted and that Aboriginal people don’t have.”

According to Participant 1, many non-Aboriginal healthcare providers do not understand the
issues, culture and traditions of Aboriginal people so there are difficulties working as a team with
them. She believes that non-Aboriginal providers do not realize the benefits they have in their
lives in comparison to non-Aboriginal people.
“Aboriginal people see, view and live in the world in a different way than
the dominant discourse in society. Therefore, everything has to be looked at from a
different perspective. It cannot be looked at from this westernized, medical kind of
concept.”

Participant 1 believes it is imperative to include Aboriginal concepts of healing, culture and
traditions with westernized medicine for maximum care of Aboriginal patients.
Finally, it was suggested that health information sessions should be advertised so they
can become more popular with the public, and that to increase the effectiveness of healthcare,
providers should engage with Aboriginal communities according to their preference.
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Restorative practices mentioned by participants to improve the quality of care for
Aboriginal participants include Aboriginal health leaders leading by example, having more job
opportunities for new graduates and including advancement opportunities for Aboriginal
healthcare employees. Other restorative practices include exposing Aboriginal patients to
mainstream medical practices for them to adapt. Lastly, participants felt that it was imperative
for healthcare providers to take cultural competency and safety training for improved
relationships with Aboriginal patients.

Discussion
The findings indicate that characteristics considered imperative for Aboriginal healthcare
leadership are respect, compassion, having an understanding Aboriginal people, being
trustworthy and ethical. They also revealed that intergenerational trauma within patients is
challenging for healthcare providers to work with, that Aboriginal patients do not feel
comfortable accessing healthcare much of the time and that many non-Aboriginal providers
misunderstand Aboriginal healing traditions and the culture. Examples of resources that are
lacking to provide adequate care for Aboriginal patients include housing, funding, transportation,
and communication. Restorative practices mentioned in the findings to improve Aboriginal
healthcare include providing increased opportunities for new Aboriginal healthcare graduates to
obtain jobs, offering advancement prospects within healthcare organizations for Aboriginal staff,
and providing increased cultural competency training for healthcare providers.
Aboriginal Health Leaders
Both Aboriginal and non-Aboriginal participants had similar understandings of
leadership characteristics for promoting success in Aboriginal healthcare and these included
Aboriginal leaders having respect, compassion, an understanding of the population that they are
52

serving, being truthful, trustworthy, and having experience working with Aboriginal people.
Other examples of Aboriginal healthcare leadership characteristics mentioned in interviews
included staff being humble, knowing Aboriginal traditions, having good ethics, and ensuring
Aboriginal patients were assisted by providers of Aboriginal ancestry. Overall, participants
identified specific characteristics they thought healthcare leaders should possess to be successful
(see Table 2).

Table 2 Leadership Characteristics

Leadership Characteristics

Respect
Compassion
Understand population that serving
Truthful
Trustworthy
Experience working with population that
serving
Humble
Ethical
Being Aboriginal

Definition

Think highly of the Aboriginal culture
Care for the Aboriginal patients that working with
Understand Aboriginal ways of thinking, healing, and dealing with
things
Being honest to Aboriginal patients, and healthcare team
Ensuring that will keep the best interests of Aboriginal patients
Has worked with Aboriginal patients in similar settings previously
Does not power differentiate when working with Aboriginal
patients
Know what is right from wrong when caring for Aboriginal patients
Provider comes from Aboriginal ancestry

These findings support the literature that mentions Aboriginal leaders must also have
personality traits of truthfulness, uprightness, generousness, and practice humility to be
considered into leadership roles (Julien, Wright & Zinni 2010). The findings presented here did
not support the literature in that the interviews did not discuss spiritual aspects of Aboriginal
healthcare. The literature mentioned that Aboriginal leaders are more focused on culture,
spirituality, the whole person, and community more than mainstream providers are (Julien,
Wright & Zinni 2010). The reason why spiritual aspects were not mentioned in interviews is
most likely because participants are unfamiliar with Aboriginal healing practices and due to

53

colonization, Aboriginal ways of dealing with illness are not popular in mainstream, western
society and medicine.
There is a second gap within the data in that both Aboriginal and non-Aboriginal
community members interviewed had not seen Aboriginal healthcare providers in the past so
could not comment on their experiences with them. These findings support King (2008) who
states that due to the lack of resources, there are less Aboriginal people who become educated
and because there are less educated Aboriginal people there is a limited number of Aboriginal
healthcare providers to care for Aboriginal patients. Non-Aboriginal participants in particular
felt that their level of knowledge was too inaccurate to comment on their perception of
leadership within Aboriginal communities and because of their lack of understanding,
community members could not comment on whether Aboriginal and non-Aboriginal leaders
provided differential treatment or practiced differently.
The findings support the literature in that they also support the significance that
understanding Aboriginal healthcare leadership, culture and communication styles of Aboriginal
patients is crucial for enabling healthcare providers to provide increased quality of care. The
literature mentions that to be effective leaders in Aboriginal healthcare it has been determined
that providers must have an understanding of the issues prominent within the Canadian
Aboriginal community (Shah & Reeves 2012). Other healthcare leadership competencies
mentioned in the literature include knowing Aboriginal backgrounds, Aboriginal traditions, and
having an understanding of the Aboriginal patient themselves besides their illness (Zhou et al.
2011).
The findings support the literature in revealing that if providers understood Aboriginal
forms of communicating and ways of dealing with illness then it would assist them in providing
54

high quality caring for Aboriginal patients. Rapport would also be increased between the
provider and Aboriginal patient because sensitivity would be heightened towards Aboriginal
culture and traditional ways of handling illness.
Colonization
The findings support the literature in that they identified that one of the most challenging
aspects of working with Aboriginal patients is dealing with the intergenerational trauma that has
occurred as a result of colonization. These findings support the literature, which recognizes that
the Indian Act, the Residential School system and the Sixties Scoop have had extremely
detrimental effects on the wellbeing of Canada’s Aboriginal population. As demonstrated above,
the Indian Act made Aboriginal people dependent on others, separated families, reduced the
quality of healthcare and limited working and educational opportunities for Canada’s Aboriginal
population (Burrows 2008). Aboriginal people today, as a result of intergenerational trauma
from residential schools, suffer from a loss of identity, have substance abuse issues, engage in
self-harm, and mistreat others (Partridge 2010). Aboriginal people, have interpersonal
challenges due to the Sixties Scoop that result in difficulties attaching to others, and in many
finding their own cultural traditions to be foreign to themselves (Milner 2001).
The findings support the literature in revealing that Aboriginal patients do have complex
issues as a result of trauma from colonization and that healthcare providers have difficulties
working with Aboriginal patients and the Aboriginal health care teams because patient issues are
so complex that they are frequently misunderstood by non-Aboriginal healthcare workers.
Lastly, the findings support the literature in that Aboriginal patients frequently do not
wish to be associated with their culture because they do not understand it or view their traditions
negatively. They support the literature suggesting that colonization has negatively affected the
55

way Aboriginal patients are treated by healthcare providers, and that the trauma has been so
devastating that Aboriginal people sometimes wish to avoid accessing care altogether. The
findings indicated that because there are poor relationships with healthcare staff, Aboriginal
people do not wish to access care supporting the literature that identifies how Aboriginal women,
out of fear of the healthcare system, avoid accessing care more frequently than non-Aboriginal
women do (Denison, Varcoe & Browne 2014).
Healthcare facilities need to be places where Aboriginal people feel safe because they are
urgently needed when the health status of Canada’s Aboriginal population is so dire. Overall,
Aboriginal people need to feel more comfortable when accessing healthcare so they will feel
access health services more frequently.
Racism
The findings support the literature in identifying that Aboriginal people are still dealing
with racism in healthcare today and that stereotypes held by healthcare providers has a negative
effect on the quality of care and outcomes for Aboriginal patients. For example, Aboriginal
patients’ experiences of racism included attending the Emergency hospital room due to being
seriously ill, but not being treated properly because they were mistaken for being under the
influence due to their Aboriginal ancestry, and therefore did not receive adequate healthcare
(Health Council of Canada 2012). The literature also states that Aboriginal patients frequently
did not receive proper medication because their attending physician stereotypically assumed that
they were suffering from addictions (Health Council of Canada 2012). In reality, many
Aboriginal patients who do attend healthcare services actually live addiction free lifestyles
(Health Council of Canada 2012).

56

The findings add to the literature mentioned above where an Aboriginal community
member, as cited above, stated an experience where she was caring for her brother, who was
dying of alcoholism in the hospital at the age of 25, and feared being judged because of these
circumstances. Overall, the results indicate that Aboriginal people do still experience racism
within healthcare. These findings are significant because they indicate that stereotypical biases
affect the care provided to Aboriginal patients. This racism and consequent poor quality of
treatment is affecting Aboriginal patient quality of care in an adverse manner. The findings
presented here indicate that relationships and rapport need to be rebuilt between Aboriginal
patients and healthcare providers to improve the disastrous health problems among Canada’s
Aboriginal people. For example, it was noted that communication lines must be increased with
Aboriginal people in a manner that they feel most comfortable with to improve their quality of
care. Overall, racism in healthcare must be diminished for the benefit of all involved.
Lack of Resources
The findings support the literature identifying that there is a significant lack of resources
within Aboriginal healthcare to adequately care for Aboriginal patients. Both healthcare
providers and community members understood the impacts of having inadequate resources to
provide adequate care for the Aboriginal population. These include cleaner drinking water,
increased educational opportunities for Aboriginal people, improved medical travel, increased
communication, enhanced nutrition and decreased waiting times to see physicians.
The findings of requiring cleaner drinking water and improved nutrition as mentioned by
participants, support the research of Todd & Thornton (2001) who suggest a restorative practice
of improving the living conditions among Aboriginal patients to improve their health status.
Areas to improve on include providing increased amounts of water, increasing cleanliness, and
57

improving the quality of home accommodations that Aboriginal people live in (Todd & Thornton
2001). The findings also support the literature that found limited access to healthcare services in
remote areas due to the lack of transportation available to and from healthcare facilities, and an
inability of many Canadian rural Aboriginal people to speak the English language (NCCAH
2011). Aboriginal patient navigators, physicians and other healthcare staff all indicated that the
main resources needed are increased medical services, improved living conditions, removal of
communication barriers, and an increased number of housing opportunities for Aboriginal
patients. These findings are significant because they shed light on the fact that healthcare leaders
must increasingly improve the quality of care towards Aboriginal patients, by being more
communicative and working to decrease the language barriers with Aboriginal patients. These
findings are also important because they indicate providers must increasingly focus on the needs
of specific communities to provide adequate care.
Restorative Practices
Participants in this project had their own perspectives on the restorative practices required
to increase the quality of healthcare leadership and care provided to the Canadian Aboriginal
population. The findings suggest that delivering increased counselling services to Aboriginal
patients, providing more assistance for family members who are caring for children, introducing
Aboriginal people to broader exposure of mainstream healthcare processes, and delivering
increased job opportunities for new healthcare graduates are crucial to improving Aboriginal
healthcare outcomes. These findings add new insights to the literature in that it did not mention
providing increased assistance to those caring for children or offering more counselling services
to Aboriginal patients. The findings of delivering increased job opportunities to new healthcare
graduates adds to the literature in which Warry & Robson (2000), state that a restorative practice
58

would be to allocate health care services to the Aboriginal population themselves. In providing
Aboriginal people with full control and authority over their healthcare resources there would be
increased job opportunities and improved Aboriginal healthcare outcomes. The findings which
identified having healthcare resources linked in one centre, increasing learning opportunities for
providers, delivering mentorship programs which would expose healthcare workers to varying
styles of leadership, increasing opportunities for graduates to participate in practicums all
support the literature of Warry & Robson’s (2000) recommendation of providing the allocation
of healthcare delivery to Aboriginal people. There would be more mentorship opportunities for
healthcare staff, and it would be similar to having healthcare resources linked in one health
authority.
Of particular significance is the finding that the introduction of cultural competency
training would be a significant restorative practice. The requirement of cultural competency
training supports the literature review section, when Beavis et al. (2015), for example, suggest
that a restorative practice would be to teach healthcare staff cultural competency and safety
training to assist them in understanding the impacts of colonialism in the Aboriginal population.
As mentioned above, there is much ill treatment and health inequities among Canadian
Aboriginal people due to the impacts of colonization (Beavis et al. 2015) and the findings that
Aboriginal healthcare providers experience difficulties working with non-Aboriginal teams
support the literature that increased cultural competency training is needed. The findings
indicated that Aboriginal people think, and practice healing in a different manner than
westernized medicine and that non-Aboriginal providers do not understand the ways of
Aboriginal people enough to provide adequate care. This supports the literature that providers
need to learn about Aboriginal culture, traditions and issues to provide quality care to Canada’s
59

Aboriginal population in order to reduce the effects of colonization towards Aboriginal people
and improve the quality of Aboriginal healthcare (Beavis et al. 2015). Healthcare staff would
need to be trained to pay attention to how their own biases and life experiences impact the care
they provide to Canadian Aboriginal people (Beavis et al 2015).
The findings identifying the need for improved communication between healthcare staff
and Aboriginal patients support the literature that states relationships between Aboriginal and
non-Aboriginal people would also be improved if cultural competency training were taught in
partnership with those from Aboriginal backgrounds (Beavis et al 2015). Overall, increased
awareness of Aboriginal history, culture, and existing biases among healthcare staff, would assist
in decreasing the adverse colonial impacts that are devastatingly prevalent in many areas of
healthcare today. Therefore, participant results and the literature support a need for increased
education among healthcare staff, particularly around the topics of cultural competency and
cultural safety. Healthcare providers have the responsibility to increase their knowledge, and
monitor their frame of mind about the cultural groups they come into contact with. A committed
healthcare provider will not let racism, bias or stereotypical thinking interfere with the quality of
care they provide to all patients.

Recommendations
In conclusion, both aboriginal and non-Aboriginal participants had similar ideas of what
constitutes successful Aboriginal leadership in healthcare. Examples include having humility,
knowing Aboriginal culture, traditions, history and ways of leading. Aboriginal leaders in
healthcare should also be compassionate, ethical, have excellent communication skills and be
trustworthy. Participants had not had enough experience with Aboriginal healthcare providers to
comment on their experiences with them. Referring to colonization, healthcare providers found
60

it challenging to work with the intergenerational trauma common among Aboriginal patients as a
result of colonization through the Indian Act, residential schools, and the Sixties Scoop.
Aboriginal people, as a result of these events, experience a loss of self and may not comprehend
their culture and frequently engage in harmful activities. Many Aboriginal people do not trust
the healthcare system due to the racism they experience while accessing healthcare facilities and
consequently avoid them even when they are required.
It was found that many non-Aboriginal providers have biases and do not understand the
culture, history or issues that Aboriginal people deal with. Referring to resources, there is a
profound lack of assets to provide Aboriginal patients with adequate care. Examples of
resources that are lacking include medical travel, there is miscommunication existing between
healthcare providers and Aboriginal patients, housing resources are missing and finances are not
available. Aboriginal people also frequently experience poor living conditions and there is a lack
of cultural competency education for healthcare staff. Participants had their own idea of
restorative practices required to increase the quality of care for Aboriginal patients. Examples of
restorative practices mentioned by participants are to provide more counselling services, deliver
increased employment opportunities for new Aboriginal healthcare graduates, provide increased
mentoring options for healthcare staff, improve Aboriginal living conditions and introduce
healthcare staff to increased cultural competency training. Cultural competency education is
significant because it would assist healthcare staff in learning about Aboriginal culture, history,
colonization, and becoming aware of their own stereotypes towards Aboriginal people.
Consequently, the following recommendations came out of the research:
1. To conduct more research to gain further information regarding participant
experiences with Aboriginal healthcare providers
61

2. To assist Aboriginal people in becoming more fully educated in healthcare
programs
3. To provide Aboriginal healthcare providers with more opportunities for
advancement in healthcare organizations
My first recommendation for further improving Aboriginal healthcare leadership in
Canada is to conduct increased research to ask more individuals about their experiences with
Aboriginal healthcare providers. There was not enough participant experience with Aboriginal
providers in this study to generate enough data. There also needs to be more information
provided of experiences with Aboriginal providers to assist the Aboriginal community in refining
their healthcare processes.
My second recommendation is to more fully assist Aboriginal people in becoming
educated in healthcare programs. The findings revealed that there is not enough Aboriginal
healthcare staff and indicated that Aboriginal people face more barriers that prevent them from
becoming educated in comparison to other cultures. Therefore, Aboriginal people urgently need
assistance in becoming educated in healthcare programs of interest to better serve Aboriginal
patients in their community.
My third recommendation is to provide Aboriginal healthcare employees with increased
opportunities for advancement in healthcare organizations. The findings indicated that
Aboriginal healthcare staff frequently pursue employment elsewhere because there are not
enough opportunities available within their organizations. I have first hand experience with this
issue in having worked within Vancouver Coastal Health for almost 8 years and in having
experienced little opportunity for advancement. Aboriginal patients will experience increased
62

quality of healthcare and more positive healthcare outcome through working with providers of a
similar culture or with those who have an enhanced understanding of their needs. Rapport and
relationships would ultimately be enhanced if more Aboriginal providers were introduced and
maintained in the healthcare system.

Chapter 5: Conclusion
I have argued that Aboriginal healthcare leadership requires improvement to increase the
quality of care provided to Aboriginal patients in Canada. The Canadian Aboriginal population
has lower health determinants in comparison to the rest of Canada and this needs to be reversed.
It appears both Aboriginal and non-Aboriginal participants cited similar characteristics of what a
successful leader should entail. These personality traits included having respect, compassion, an
understanding of the population that serving, being truthful, trustworthy, and having experience
working with Aboriginal people. Other examples of Aboriginal healthcare leadership
characteristics mentioned in interviews included healthcare staff being humble, knowing
Aboriginal traditions, having ethics, and ensuring Aboriginal patients assisted by providers were
of Aboriginal ancestry. There was a gap in the findings, in that literature also discovered that
Aboriginal leaders are more focused on culture, spirituality, the whole person, and the
community more than mainstream providers are (Julien, Wright & Zinni 2010). It is imperative
that Canada’s healthcare system implement Aboriginal ways of leadership and culture into their
care when dealing with Aboriginal patients. Aboriginal people also become educated in
healthcare programs at lower rates in comparison to the rest of Canada and this lack of education
is one factor in why Aboriginal people do not have much experience with Aboriginal healthcare
providers.

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Colonization was meant to establish control over Aboriginal people and assimilate them.
The findings demonstrate that colonization has created challenges in the quality of Aboriginal
healthcare due to the on going effects of the Indian Act, the residential school system, and the
sixties scoop. Healthcare leaders indicate that it is challenging working with the
intergenerational trauma that patients have as a result of colonization and Aboriginal patients do
not feel comfortable accessing care because they fear being treated poorly.
Colonization has fostered racism in healthcare providers and this has adversely affected
the care they provide to Aboriginal patients in Canada. Aboriginal patients are frequently
misdiagnosed, provided with improper care or medicine due to stereotypes and biases of
healthcare providers leading them to assume that Aboriginal patients are under the influence of
drug and alcohol and not ill.
It was concluded that there is a significant lack of resources available to adequately care
for Aboriginal people. Examples of resources that are lacking for proper care of Aboriginal
patients, as mentioned in findings and the literature review, include housing, transportation, and
communication. Finances are also lacking and it is difficult to care for patients in rural areas
because of technological barriers such as not having the Internet as mentioned, Canada’s
Aboriginal population fairs more poorly in almost every determinant of health when compared to
other cultural groups in Canada. The Canadian Aboriginal population has high rates of diabetes,
suicide, violent deaths, addictions, etc. An increased amount of resources are significantly
needed to reduce the devastating health statistics among the Aboriginal population. Furthermore,
resources are poor in that Aboriginal people live in substandard living conditions. There is
unsanitary water, poor nutrition and less than standard housing conditions that have further
contributed to the ill health status among Canada’s Aboriginal population. Findings indicate that
64

non-Aboriginal patients also have difficulties with healthcare access but they voice their needs
more than Aboriginal people do.
Restorative practices are required to reverse the effects of colonialism and improve the
health among Canadian Aboriginal people and participant had their own ideas of restorative
practices required to increase the quality of care provided to Aboriginal patients. Various
restorative practices mentioned in the findings and literature to reverse the effects of colonization
include cultural competency training where physicians are taught the history of Aboriginal
people, how colonialism affects the healthcare provided to Aboriginal patients today, and are
made aware of their own biases. Implications for healthcare providers are that they need to
realize how their own experiences, biases and stereotypes affect the quality of care they provide
to Aboriginal patients. Other restorative practices mentioned by participants include creating
increased numbers of leadership positions for Aboriginal providers and new graduates.
Aboriginal healthcare leaders would more likely understand the culture, traditions,
communication styles, experiences, and healthcare needs of Aboriginal patients. A last
restorative practice that became significant, as mentioned in the findings and literature review,
was to improve the living conditions that many Aboriginal people reside in today. Resources
mentioned to improve include the quality of drinking water, provide enhanced nutrition,
increasing educational opportunities, providing improved housing, and easing access to
healthcare.
My first recommendation for further improving Aboriginal healthcare leadership in
Canada is to ask more individuals about their experiences with Aboriginal healthcare providers.
There was not enough participant experience with Aboriginal providers in this study gain enough
data and more information is needed. My second recommendation is to more fully assist
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Aboriginal people in becoming educated in healthcare programs. And lastly, my third
recommendation is to provide Aboriginal healthcare employees increasing opportunities for
advancement in healthcare organizations.

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Appendices
Definition of terms taken from the Government of Canada 2012, Indigenous and Northern
Affairs Canada Terminology (Indigenous and Northern Affairs Canada 2012)
Table 3 Terminology

Aboriginal People
First Nations
Inuit
Métis
Status Indian
Indian Act
Non-status Indian
Cultural
Competency

A term that describes 3 categories of Aboriginal people: First Nations, Inuit, and Metis
people.
Substituted the term “Indian” in the 1970’s after individuals felt insulted.
A term used to describe Aboriginal individuals who live in Nunavut, the Northwest
Territories, Northern Quebec and Northern Labrador.
Individuals who have both European and First Nation heritage. Origins usually come from
Ojibway, Cree, Scottish and French.
An Aboriginal individual whose name is recorded in the Indian Act.
The Indian Act came into effect during 1876, and was developed to oversee “Indian”
resources.
An Aboriginal Individual not recorded under the Indian Act.
Defined as increasing one’s understanding of another’s culture/tradition, and an acceptance
of the large variability of ethnicities that that individuals bring forth in the workplace
(Aboriginal Health Strategic Initiatives 2016).

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References
Aboriginal Health Strategic Initiatives. (2016) Aboriginal Terminology. [Online] Available from:
http://aboriginalhealth.vch.ca/working-together/aboriginal-terminology/aboriginal-terminology.
[Accessed: 8th October 2016].
Adams, J. et al. (2007) Research Methods for Graduate Business and Social Science Students.
New Delhi: Response Books.
Allan, B. & Smylie, J. (2015) First Peoples, Second Class Treatment: The role of racism in the
health and well-being of Indigenous peoples in Canada. [Online] Wellesley Institute. Available
from: http://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Summary-First-PeoplesSecond-Class-Treatment-Final.pdf. [Accessed: 8th October 2016].
Baker, R.G. (2003) Identifying and Assessing Competencies: A Strategy to Improve Healthcare
Leadership Commentary. HealthcarePapers. [Online] 4(1). p.49-58. Available from:
https://www.researchgate.net/profile/G_Baker/publication/8971626_Identifying_and_Assessing_
Competencies_A_Strategy_to_Improve_Healthcare_Leadership_COMMENTARY/links/02bfe5
10096d42941b000000.pdf. [Accessed: 8th October 2016].
Beavis, A.S. et al. (2015) What all students in healthcare training programs should learn to
increase health equity: perspectives on postcolonialism and the health of Aboriginal Peoples in
Canada. BMC Medical Education. 15. p.155.
Biswal, B. (2008) Literacy Performance of Working-Age Aboriginal People in Canada: Findings
Based on the International Adult Literacy and Skills Survey (IALSS) 2003. Gatineau: Human
Resources and Social Development Canada.
Burnard, P. et al. (2008) Analysing and presenting qualitative data. British Dental Journal.
[Online] 204. p.429-432. Available from:
http://www.nature.com/bdj/journal/v204/n8/full/sj.bdj.2008.292.html. [Accessed: 8th October
2016].
Burrows, J. (2008) Seven Generations, Seven Teachings: Ending the Indian Act. Victoria:
National Centre for First Nations Governance.
Cahana, A. & Hurst, S.A. (2008) Voluntary informed consent in research and clinical care: An
update. Pain Practice. 8(6). p.446-451.
Cassell, C. & Symon, G. (2004) Essential Guide to Qualitative Methods in Organizational
Research. London: SAGE Publications Ltd.
Chidiac, G. (2016) Healing the scars left by residential schools. The Hamilton Spectator.
[Online] 23rd September. Available from: http://www.thespec.com/opinion-story/6874969healing-the-scars-left-by-residential-schools/. [Accessed: 8th October 2016].
68

Denison, J., Varcoe, C. & Browne, A.J. (2014) Aboriginal women’s experiences of accessing
health care when state apprehension of children is being threatened. JAN. 70(5). p.1105-1116.
Durst. D. (2006) Aboriginal Governance and Leadership: Volunteers in the Friendship Centres
of Canada. Imagine Canada. [Online] Available from:
http://sectorsource.ca/sites/default/files/resources/files/report_aboriginal_governance_leadership.
pdf. [Accessed: 8th October 2016].
Glauser, W., Tepper, J. & Konkin, J. (2016) 8 steps toward addressing indigenous health
inequities. Healthy Debate. [Online] Available from: http://healthydebate.ca/2016/01/topic/8steps-toward-addressing-indigenous-health-inequities. [Accessed: 8th October 2016].
Haig-Brown, C. (2002) Resistance and Renewal: Surviving the Indian Residential School.
Vancouver: Arsenal Pulp Press.
Health Council of Canada. (2012) Empathy, dignity and respect: Creating cultural safety for
Aboriginal people in urban health care. [Online] Available from:
http://www.healthcouncilcanada.ca/n3w11n3/Aboriginal_Report_EN_web_final.pdf. [Accessed:
8th October 2016].
Health Research Funding. (2014) Pros and Cons of Quantitative Research. [Online] Available
from: http://healthresearchfunding.org/pros-cons-quantitative-research/. [Accessed: 8th October
2016].
Herring, D.A., Waldram, J.B. & Young, T.K. (2000) Aboriginal Health in Canada: Historical,
Cultural, and Epidemiological Perspectives, Second Edition (2). Toronto: University of Toronto
Press.
Hoe, J. & Hoare, Z. (2012) Understanding quantitative research: part 1. Nursing Standard.
27(15-17). p.52-57.
Hurley, M.C. (2009) The Indian Act. Library of Parliament. [Online] Available from:
http://www.lop.parl.gc.ca/content/lop/ResearchPublications/prb0912-e.htm. [Accessed: 20th
October 2016].
Indigenous and Northern Affairs Canada. (2010) How do the New Legislative Changes to the
Indian Act Affect Me? [Online] Available from: https://www.aadncaandc.gc.ca/eng/1100100032501/1100100032506. [Accessed: 8th October 2016].
Indigenous and Northern Affairs Canada. (2012) Terminology. [Online] Available from:
http://www.aadnc-aandc.gc.ca/eng/1100100014642/1100100014643. [Accessed: 8th October
2016].
Julien, M., Wright, B. & Zinni, D.M. (2010) Stories from the circle: Leadership lessons learned
from aboriginal leaders. The Leadership Quarterly 21(1). p.114-126.
69

King, T. (2008) Fostering Aboriginal Leadership: Increasing Enrollment and Completion Rates
in Canadian Post-Secondary Institutions. College Quarterly. 11(1). p.1-16.
Kirmayer, L.J., Valaskakis, G.G. & Erasmus, G.H. (2014) Healing Traditions: The Mental
Health of Aboriginal Peoples in Canada. Vancouver: UBC Press.
Makarenko, J. (2008) The Indian Act: Historical Overview. Mapleleafweb. [Online] 2nd June.
Available from: http://www.mapleleafweb.com/features/the-indian-act-historical-overview.html.
[Accessed: 8th October 2016].
McCue, D. (2015) Racism against aboriginal people in health-care system ‘pervasive’: study.
CBC News. [Online] 3rd February. Available from: http://www.cbc.ca/news/aboriginal/racismagainst-aboriginal-people-in-health-care-system-pervasive-study-1.2942644. [Accessed: 8th
October 2016].
Milner, A. (2001) The Sixties Scoop thirty years later. Inroads. 10. p.154-165.
Monchalin, L. (2016) The Colonial Problem: An Indigenous Perspective on Crime and Injustice
in Canada. North York: University of Toronto Press.
National Collaborating Centre for Aboriginal Health. (2011) Access to Health Services as a
Social Determinant of First Nations, Inuit, and Métis Health. [Online] Available from:
http://www.nccahccnsa.ca/docs/fact%20sheets/social%20determinates/Access%20to%20Health%20Services_Eng
%202010.pdf. [Accessed: 8th October 2016].
National Collaborating Centre for Aboriginal Health. (2013) An Overview of Aboriginal Health
in Canada. [Online] Available from: http://www.nccahccnsa.ca/en/publications.aspx?sortcode=2.8.10&publication=101. [Accessed: 8th October 2016].
National Collaborating Centre for Aboriginal Health (2012). Federal Budget Impacts to
Aboriginal Health. [Online] Available from: http://www.nccahccnsa.ca/338/Federal_Budget_Impacts_to_Aboriginal_Health.nccah. [Accessed: 20th October
2016].
Newbold, K. (1998) Problems in Search of Solutions: Health and Canadian Aboriginals. Journal
of Community Health. 23(1). p.59.
Panel on Research Ethics. (2015) Research Involving the First Nations, Inuit, and Métis Peoples
of Canada. [Online] Available from: http://www.pre.ethics.gc.ca/eng/policypolitique/initiatives/tcps2-eptc2/chapter9-chapitre9/. [Accessed: 8th October 2016].
Partridge, C. (2010) Residential Schools: The Intergenerational Impacts on Aboriginal Peoples.
Native Social Work Journal. 7. p.33-62.
70

Reading, J. & Farber, B. (2015) Why is Canada ignoring the health of aboriginal peoples? The
Globe and Mail. [Online] 9th April. Available from:
http://www.theglobeandmail.com/opinion/why-is-canada-ignoring-the-health-of-aboriginalpeoples/article23856403/. [Accessed: 8th October 2016].
Sewell, M. (2016) The Use of Qualitative Interviews in Evaluation. The University of Arizona.
[Online] Available from: http://ag.arizona.edu/sfcs/cyfernet/cyfar/Intervu5.htm. [Accessed: 8th
October 2016].
Shah, C.P. & Reeves, A. (2012) Increasing Aboriginal Cultural Safety Among Health Care
Practitioners, Canadian Journal of Public Health. Sept/Oct 2012. p.397.
Smylie, J. & Anderson, M. (2006) Understanding the health of Indigenous peoples in Canada:
key methodological and conceptual challenges. CMAJ. [Online] 175(6). Available from:
http://www.cmaj.ca/content/175/6/602.short. [Accessed: 8th October 2016].
Toews, I. et al. (2016) Extent, Awareness and Perception of Dissemination Bias in Qualitative
Research: An Exploratory Survey. PLOS One. [Online] Available from:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159290. [Accessed: 8th
October 2016].
Todd, R., Thornton, M. & Collins, D.N. (2001) Aboriginal people and other Canadians: Shaping
new relationships. Ottawa: University of Ottawa Press.
Truth and Reconciliation Commission of Canada. (2016) Reconciliation…towards a new
relationship. [Online] Available from:
http://www.trc.ca/websites/reconciliation/index.php?p=312. [Accessed: 8th October 2016].
Waldram, J. (2013) Transformative and Restorative Processes: Revisiting the Question of
Efficacy of Indigenous Healing. Medical Anthropology. 32(3). p.191-207.
Warry, W. & Robson, J.M. (2000) Unfinished Dreams: Community Healing and the Reality of
Aboriginal Self-Government. Toronto: University of Toronto Press.
Webster, P.C. (2012) Canada curbs Aboriginal health leadership. The Lancet. [Online] 9th June.
Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)609283/fulltext?rss%3Dyes. [Accessed: 8th October 2016].
Zhou, A.W. et al. (2011) Efficacy of a 3-hour Aboriginal health teaching in the medical
curriculum: Are we changing student knowledge and attitudes. Health Education Journal. 71(2).
p.180-188.

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