Conclusions

Socioeconomic Conditions

• Due to a lack of funding and access to services, there is a disparity when comparing the social determinants of health for First Nations people to the general population. Factors such as education, employment, income and housing are a part of this.
• Income and employment disparities between First Nations adults and the general population in Canada also persist
• In terms of issues surrounding safe drinking water access, the current Canadian government has pledged to end boil-water advisories on First Nations reserves by 2021 (The Canadian Press, 2015), and future research should evaluate the degree to which these current efforts are implemented and, if they are, how successful they have been in increasing access to safe drinking water
• Finally, the migration patterns of First Nations people are an avenue where there is potential for further research, especially when it comes to the economic and social impacts (positive and negative) of migration on households. Furthermore, those who live outside of their communities, especially  for economical or educational reasons, may face additional challenges, which government policy or community efforts might support but currently lie outside the scope of the RHS.

Chronic Health Conditions

• Despite positive trends in terms of reduced prevalence of some chronic health conditions, significant health disparities between First Nations communities and the general population remain an area of concern. Key findings point to the need for timely access to screening, treatment, and monitoring of chronic health conditions. This is particularly evident for First Nations adults with diabetes and CKD.
• The findings of this study also provide additional evidence that First Nations women tend to carry a higher burden of chronic illness and co-morbidity compared to First Nations men. This speaks to the continued importance of programming that supports timely access to safe, adequate care that addresses the health needs and concerns of First Nations women.

• The findings also indicate the importance of addressing and supporting the mental, emotional and spiritual well-being of First Nations youth. It was suggested in the RHS Phase 2 report that the mental health experiences of First Nations youth diagnosed with chronic health conditions be considered by health professionals. Arguably, this still remains the case.
• Access to safe, clean drinking water and homes free of mould and mildew continue to be a pressing priority on First Nations reserves.
• Although evidence is limited at this stage, the findings suggest that further investigation is warranted into the relationship between sharing traditional foods and how this may serve to support community members experiencing health challenges.

Mental Health and Substance Abuse

• Too little is known about the mental health of First Nations children, youth and adults. The RHS Phase 3 fills many statistical gaps by tracking self-reported mental health, specific mental health diagnoses (anxiety, mood disorders, ADD/ADHD, ASD) and substance use-related neurocognitive disorders (FASD). But further knowledge needs to be developed for a broader spectrum of diagnoses including PTSD, schizophrenia and intergenerational trauma.
  • Implementing the TRC’s Call to Action to establish measurable goals to identify and close the gaps in health outcomes between Indigenous and non- Indigenous communities, to publish annual progress reports and assess long-term trends including, but not limited to, mental health and addictions would address this gap.
  • Enhanced Indigenous data governance and management, culturally relevant health measurement, clarification of provincial, federal and First Nations jurisdictional responsibilities for health data collection and enhanced dissemination to Indigenous leadership are other possible solutions

• The medical model driving the broader mental health sector often focuses on deficits and illness which contradicts the wellness focus of most culturally based program
• The funding base for many of these interventions is too often project-based and time-limited, which makes sustainability a constant challenge. The TRC called for sustained funding for healing lodges devoted to the treatment of IRS trauma. Similarly, funding for promising community- driven initiatives may enhance their sustainability.

Oral Health

• First Nations on reserve and Northern communities are more likely to report their oral health as being fair or poor and to present higher prevalence estimates of edentulism, dental pain, baby bottle tooth decay (early childhood caries) and perceived dental treatment needs than their counterparts in the general population.
• Poor oral health among First Nations most often starts in childhood and continues throughout the life course. Thus, it is encouraging that access to dental care has increased among children and seniors.
• However, for youth and children, the decline in treatment needs started in RHS Phase 2. Gaps still remain, and future research should address the social and cultural determinants of oral health that are fundamental to a First Nations holistic approach to health and well-being.

Indian Residential Schools

1. The current findings highlight a number of the long-term negative consequences of the IRS legacy on physical and mental health as well as social outcomes, while also highlighting the strengths of the First Nations peoples despite Residential Schools and other aspects of colonization.
2. Considering the large proportion of the Indigenous population that has been affected by Residential Schools and colonization, combined with insufficient healing and wellness resources and ongoing inequities, it should not be surprising that many of the health inequities faced by Indigenous peoples documented twenty years ago are still present today
3. Intergenerational exposure has, in some instances, resulted in effects more consequential than the direct effects observed among those who attended themselves. These analyses also emphasize how the effects of Residential School influence First Nations peoples across the lifespan and that prevention and intervention strategies need to be implemented at each stage of life, particularly in early development when environmental exposures can have the most enduring consequences

Strengths inherent in First Nations cultures and communities can act as protective factors and pathways for healing among those whose cultures were attacked by the IRS system and other aspects of historical trauma. There is a clear need for continued healing and wellness services for those directly and intergenerationally affected by Residential Schools, the Sixties Scoop and other aspects of historical trauma that are rooted in local traditional cultures.