Indigenous KT and ways of knowing — what do they mean for public health?
Molly Peters of the Paq’tnkek Mi’kmaw First Nation: “It is your obligation as public health people to understand what the TRC [Truth and Reconciliation Commission] means. We need practitioners who are culturally competent.”
Over the past year, the NCCDH has been engaging in work to become an anti-racist organization, with distinct attention to racism against Indigenous peoples. This ongoing dialogue means that, when I attended the Public Health 2017 conference in Halifax, NS, on June 6–9, 2017, I had a greater appreciation for the relationship between racism and health equity, as well as the importance of Indigenous knowledge translation (KT) and Indigenous ways of knowing. For me, as a white non-Indigenous woman, this meant that I headed to the conference keenly intending to pay attention to the health impacts of racism and racialization, including racism affecting Indigenous people. Fortunately, Public Health 2017 presented lots of opportunities to expand my knowledge, and I learned more than I could have ever imagined.
In relation to applying Indigenous KT, I look forward to incorporating three key messages into my work in the future.
1. Indigenous KT practices need to be given respect and be taken seriously
Attending the plenary session titled “Mental Wellness: Learning from Indigenous Communities,” moderated by the National Collaborating Centre for Aboriginal Health (NCCAH), really supported my learning about Indigenous KT at this conference. The session featured a panel of Indigenous scholars and leaders who explored how, when non-Indigenous ways of thinking are used as the standard for measuring the health of entire populations, conventional knowledge systems can either intentionally or unintentionally oppress Indigenous peoples. Many of us in public health practice feel that like the “way of knowing” based on research evidence is the right way. Non-Indigenous public health practitioners need to also consider that the perspectives of Indigenous people are de-valued when public health relies on primarily non-Indigenous knowledge. Another change that is overdue is having Indigenous people better represented among the public health workforce.
Self-determination of Indigenous people involves the right to construct and reclaim knowledge. To do this, practitioners need to respect the value of Indigenous approaches to knowledge translation and their application to public health. One place to learn more is a report by the NCCAH that provides background information on knowledge synthesis, translation and exchange (KSTE) within the context of Indigenous knowledge. For non-Indigenous practitioners, it is important to deconstruct conventional knowledge standards and see the implicit biases and potential racism inherent in the language used in research and what types of knowledge are given more credence.
2. Indigenous KT strategies are effective and necessary to decolonize KT
Until just before the Public Health 2017 conference, I hadn’t given much thought about the need to decolonize knowledge sources and processes alongside their output. A year ago, I might have thought to include a scenario about working with Indigenous populations into a product or piece of writing, but I wouldn’t have thought about whether the source of information I drew on was informed by Indigenous knowledge systems. I also wouldn’t have thought about the need to evaluate the foundation of my own knowledge base, and how little of it has been informed by Indigenous wisdom. Mainstream KT activities can reinforce colonial practices because most researchers are non-Indigenous, meaning they rarely ask research questions that incorporate Indigenous ways of knowing. As a result, the sources that practitioners draw on to inform their work, even if this work is with Indigenous people, are most often not based on Indigenous knowledge systems.
One presentation at the conference brought to my attention a 2017 systematic review protocol on KT approaches for Indigenous health research. This protocol outlines that, while Indigenous methods of KT are shown to be very effective, they are not often integrated into health research, which has implications for public health programming and decision making. As a way to decolonize the research process, this protocol has been designed so that the research team includes the following:
- Senior Indigenous researchers
- Non-indexed literature sources where there are often more Indigenous authorship will be included
- Screening/appraisal tools will be adapted to meet Indigenous health research principles
In more than one conference session, speakers talked about how Indigenous perspectives need to be “hardwired” into service plans and policies across the health system, including public health, for the benefit of Indigenous people and all Canadians. To help with this, one presenter suggested that public health establish Indigenous health and wellness population health indicators. Indeed, the very definition of a population level indicator for Indigenous people may need to be defined differently than it currently is in public health to better reflect Indigenous concepts and priorities for health and wellness.
3. To make a greater effort to put and keep Indigenous issues on the table, it is time for white and non-Indigenous people to educate themselves on these issues
A session on “Interventions for interrupting Indigenous specific stereotyping and discrimination” by BC organization San’yas Indigenous Cultural Safety Training taught me a lot about the importance of recognizing that non-Indigenous people benefit from colonialism. Unlike more familiar terms such as “cultural awareness” or “cultural sensitivity,” which focus on the differences between cultures, San’yas uses the term “cultural safety” to describe its training program for health care workers, a concept more geared toward deconstructing the roots of racism. This expression helps to acknowledge the implicit biases that influence healthcare and health outcomes for Indigenous people. It also recognizes the greater responsibility that non-Indigenous people must take to create safe public health spaces for Indigenous people, culture and knowledge.
By recognizing this responsibility, non-Indigenous people can take meaningful — and necessary — action to reduce racism against Indigenous Peoples. During the closing plenary on racism, facilitated by Sume Ndumbe-Eyoh of the NCCDH, one of the speakers, Molly Peters of the Paq’tnkek Mi’kmaw First Nation, said it best: “It is your obligation as public health people to understand what the TRC [Truth and Reconciliation Commission] means. We need practitioners who are culturally competent.” In other words, we cannot expect Indigenous peoples to be the only ones to challenge racism; white people like me have a responsibility to work to keep these topics on the table for discussion and to help find solutions.
What would population health strategies look like if they emerged from an Indigenous Health paradigm? What would the role of non-Indigenous public health practitioners look like if they were allies and champions for de-colonized systems and approaches? We’d like to hear from you! E-mail me, or start a conversation on our Health Equity Clicks community.
In continuation of the ongoing anti-racist development being undertaken by the NCCDH, this post will be one in a series of three to be written by our staff related to Indigenous themes explored at Public Health 2017. One piece will document a new resource from the First Nations Health Council (BC) on social determinants of health, while another will explore the concept of “lateral kindness” as it relates to lateral violence stemming from colonization.