“COVID-19 and the Decolonization of Indigenous Public Health.” Canadian Association of Medicine Journal – First Nations, Inuit and Métis communities in Canada have had lower rates of COVID-19 overall and a lower case fatality rate than non- Indigenous Peoples despite structural inequities and social determinants that are generally related to poorer health outcomes. First Nations on-reserve have had a COVID-19 case rate:
- 4 times lower than that of the general Canadian population
- with 3 times fewer fatalities and
- a 30% higher recovery rate.
This is vastly different from outcomes during the H1N1 pandemic where rates of the infection were 1000 per 100 000 population among Inuit, and 24 per 100 000 population among non-Indigenous people in Canada Current strategies for Indigenous public health practice, grounded in self-determination, are an important reason for the relative resilience of Indigenous communities in Canada during COVID-19.
In Canada, almost all Indigenous communities have pre-existing emergency preparedness plans, and they have been updated and implemented to deal with the current pandemic. Furthermore, innovative educational materials and public health campaigns have been created by many different First Nations, Inuit and Métis communities. These materials build on prevention, isolation and containment measures put forward by public health institutions but are grounded in the local context of each community, including its language, culture, and physical and social environments.
Examples include the Qikiqtani Inuit Association’s educational materials, which illustrate hygiene practices, social distancing and isolation procedures in Inuktitut, using common examples from the daily lives of their local community members, as well as frameworks for wellness in the COVID era that draw on the knowledge of Elders and knowledge keepers from specific nations. The adaptation by the Centre for Wise Practices at Women’s College Hospital in Toronto of the Four Directions Medicine Wheel for a holistic approach to pre- venting and building physical, emotional, mental and spiritual resilience during COVID-19, is an example of the latter.
Anticipating further waves of COVID-19, it is important that the design, implementation and leadership of public health by First Nations, Inuit and Métis communities continue in Canada. At its foundation, Indigenous public health must be self-determined:
- adapted for the needs of specific nations and grounded in local Indigenous language, culture and ways of knowing;
- developed, implemented and led by Indigenous Peoples; and
- informed by ongoing monitoring of data as governed by appropriate data sovereignty agreements.
Moreover, all levels of government in Canada must address the social determinants of health both in the short term — to facilitate prevention, control and containment of COVID-19 — and in the long term through investments in infrastructure, food security and chronic disease prevention and management. This will require the decolonizing of health care at individual, organizational and policy levels. Governments, policy- makers and public health providers must embrace the know- ledge, expertise and strong leadership of Indigenous communities to face COVID-19.