Reconciliation, public health and knowledge translation
In this blog post, Senior Knowledge Translation Specialist Sume Ndumbe-Eyoh explores how the NCCDH has sought to incorporate reconciliation in our organizational practice.
The NCCDH has been engaged in a multi-year racial equity initiative. As part of the initiative, staff have been participating in group readings and discussions.[1,2,3]
The first phase of readings focused on developing understanding of racism and organizational change. [4,5] Through the fall of 2018 and winter 2019, the team continued group learning with an emphasis on how we could transform our practice as a knowledge translation organization. We focused on readings related to knowledge production,  knowledge translation, reconciliation, network development and relationship-building. In each conversation, we discussed implications for our organizational practice.
Reconciliation and public health
After the launch of the Truth and Reconciliation Commission reports in 2015, our team invited Louis Sorin, then chair of the NCCDH Advisory Board to facilitate a conversation with us on the ten principles of reconciliation discussed in the Calls to Action.  To deepen our knowledge on reconciliation and public health, we watched a webinar on reconciliation and public health (in English, with French PowerPoint slides)  presented by Dr. Marcia Anderson to the staff of the National Collaborating Centres for Public Health, alongside reading the United Nations Declaration on the Rights of Indigenous Peoples (UNDPRIP). 
A leading voice in Indigenous health, reconciliation and anti-racism, Dr. Anderson discusses the Truth and Reconciliation Commission’s Call to Action 18 as a key action for public health. Call to Action 18 calls upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties. [7(pg2)]
Dr. Anderson emphasizes that public health approaches to improving Indigenous health have to be grounded in Indigenous notions of health.  These conceptualizations include Indigenous-specific historical experiences such as residential schools, dislocation from land, community and culture. In addition, contemporary experiences of racism, informed by racist ideology led to the creation and implementation of policies that have detrimental impacts on the health of Indigenous Peoples.
Later on in her presentation, Dr. Anderson shifts her focus to UNDRIP as the framework for reconciliation at all levels and in all sectors. She stresses that every organization has a responsibility to think about how UNDRIP guides their work.
As an international instrument, UNDRIP outlines four key interdependent themes, which Dr. Anderson discusses alongside examples that reflect their application:
- The right to self-determination
- The right to cultural identity
- The right to free, prior and informed consent
- The right to be free from discrimination
Dr. Anderson closes her presentation by stressing that reconciliation cannot coexist with systemic racism. She encourages us to:
- “walk with humility” and not be defensive when we receive feedback;
- “ask for and listen to feedback from existing relationships”; and
- “when you start to feel defensive and uncomfortable: lean in.”
Knowledge translation as reconciliation
After the presentation, the NCCDH team reflected on what reconciliation means in the context of public health and the possibilities it holds for transforming public health. Agreeing with Dr. Anderson’s assertion of some of the failings of the health system, we discussed that public health needs to actively relinquish power and control over Indigenous Peoples. The actions we engage in have to reflect the desires of diverse Indigenous communities. Moreover, we have to actively confront White privilege, which has been a challenge in past partnerships and relationships with Indigenous organizations.
To ground our discussion in organizational practice, we reflected on the experience of partnering with the Toronto Indigenous Health Advisory Council (TIHAC) and MUSKRAT Media to co-develop a case study titled The Toronto Indigenous Health Advisory Circle (TIHAC): Advancing self-determined Indigenous health. 
TIHAC is a Circle of eight Indigenous leaders whose goal is to help the Toronto Public Health (TPH) and the Toronto Central Local Health Integration Network (TC LHIN) incorporate strategies to improve the health outcomes of Toronto-based Indigenous Peoples. Advisors on the Circle are non-voting representatives of Toronto Public Health (TPH) and the Toronto Central Local Health Integration Network (TC LHIN). The Circle includes six permanent Advisors, an Elder and a youth representative, each chosen to represent a segment of TIHAC’s logo, the eight-pointed star blanket. 
Image: The logo for the Toronto Indigenous Health Advisory Circle, including the eight-pointed star blanket.
As described in the case study,
… in the early days of TIHAC’s planning, the Advisors set an intention to share their story. TIHAC Advisors wanted to share their insights into the tensions that exist for Indigenous Peoples seeking to change health systems that too often disregard them. After the Strategy had been published, the NCCDH — one of six Canadian public health knowledge centres — approached TIHAC anticipating that its experience would help the public health sector respond to the Truth and Reconciliation Commission’s 94 Calls to Action. The NCCDH wanted to share TIHAC’s story because it demonstrates a fundamental shift in ways to approach Indigenous health, and offers a framework for Canada’s mainstream public health sector to glean wise practices for improving Indigenous health opportunities and outcomes. …
In agreeing to publish this story together, TIHAC Advisors requested that the NCCDH co-write the story with Indigenous writers, which led to a partnership with MUSKRAT Media. TIHAC, the NCCDH and MUSKRAT Media are delighted to have partnered in its creation. [11(p5-6)]
This partnership has been a shift for the NCCDH, one in which we have learned more than we have given. In rightfully having TIHAC and Indigenous voices be central and in control of the writing and content of the story, we have rethought observer strategies during data gathering, writing styles, project timelines, approval processes, use of images, relationships and much more.
We share this experience not to suggest that we have figured this out or that we “got it right.” We share this to demonstrate that it is possible to shift organizational practices which respect self-determination.
As Dr. Anderson notes in her presentation, we have to approach reconciliation with humility and an openness to listen. In our experience, this has to be negotiated in every interaction and at every decision-making point. To this end, we continue to invest in our own learning, development and organizational change. We continue to work with TIHAC advisors and MUSKRAT Media as we support sharing and uptake of the wise strategies and practices12 adopted by TIHAC, which serve as a model for health system organizations.
Reconciliation requires structural change and developing new ways of working and engaging. It calls on us to critically examine our practices and let go of those that are not aligned. Addressing epistemic racism and fully valuing Indigenous Knowledge and partnerships remains a central commitment for us. To close off our team discussion, staff reflected on the question, “What parts of the way I work are incompatible with reconciliation?” We offer the same question to you as we all move towards meaningful reconciliation.
Resources: Organizational reconciliation plans
- Back pocket reconciliation action plan
Reconciliation Canada 
- City of Ottawa reconciliation plan
City of Ottawa Aboriginal Working Committee and City of Ottawa 
- North East LHIN Aboriginal health care reconciliation action plan
North East Local Health Integrated Network 
- Taking action for reconciliation: An prganizational plan for Middlesex-London Health Unit
Middlesex-London Health Unit 
- Bringing reconciliation to healthcare in Canada: Wise practices for healthcare leaders
- Caring for our people: Cultural safety action plan
Northwest Territories 
- Reconciliation action plan 2013-2015
VicHealth (Australia) 
Photo credit: Eyepix
[1.] Clement C. Becoming anti-racist: small steps along the way [blog on the internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2017 [cited 2020 February 3]; [3 screens]. Available from: http://nccdh.ca/blog/entry/becoming-anti-racist-small-steps-along-the-way.
[2.] Clement C. Becoming anti-racist: an NCCDH initiative [blog on the internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2017 [cited 2020 February 3]; [3 screens]. Available from: http://nccdh.ca/blog/entry/becoming-anti-racist-an-nccdh-initiative.
[3.] Ndumbe-Eyoh S. Insights from the NCCDH’s racial equity journey [blog on the internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2019 [cited 2020 February 3]; [3 screens]. Available from: http://nccdh.ca/blog/entry/insights-from-the-nccdhs-racial-equity-journey.
[4.] Clement C. NCCDH staff becoming anti-racist through informed dialogue: 1 of 2 [blog on the internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2018 [cited 2020 February 3]; [3 screens]. Available from: http://nccdh.ca/blog/entry/nccdh-staff-becoming-anti-racist-through-informed-dialogue-1-of-2.
[5.] Clement C. NCCDH staff becoming anti-racist through informed dialogue: 2 of 2 [blog on the internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2018 [cited 2020 February 3]; [3 screens]. Available from: http://nccdh.ca/blog/entry/nccdh-staff-becoming-anti-racist-through-informed-dialogue-2-of-2.
[6.] Ndumbe-Eyoh S. On knowledge and racism: how do we know what we know? [blog on the internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2019 [cited 2020 February 3]; [3 screens]. Available from: http://nccdh.ca/blog/entry/on-knowledge-and-racism-how-do-we-know-what-we-know.
[7.] Truth and Reconciliation Commission of Canada. Calls to action [Internet]. Winnipeg (MB): TRC; 2015 [cited 2020 Feb 12]. 11 p. Available from: http://trc.ca/assets/pdf/Calls_to_Action_English2.pdf.
[8.] Anderson M. Reconciliation and public health. Prince George (BC): National Collaborating Centre for Aboriginal Health; 2017 [cited 2020 February 3]. 51 minutes. Available from: https://www.nccah-ccnsa.ca/495/Webinar__Reconciliation_and_Public_Health.nccah?id=245.
[9.] United Nations. UN declaration on the rights of Indigenous peoples [Internet]. New York: UN; 2008 [cited 2020 Feb 12]. 15 p. Available from: https://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf.
[10.] Greenwood M, de Leeuw S. Social determinants of health and the future well-being of Aboriginal children in Canada. Paediat Child Health [Internet]. 2012;17(7):381-4. Figure 1, Web of being: social determinants and Aboriginal peoples' well-being; [cited 2020 Feb 12]; p. 382. Available from: https://www.researchgate.net/publication/254262096_Social_determinants_of_health_and_the_future_well-being_of_Aboriginal_children_in_Canada.
[11.] Toronto Indigenous Health Advisory Circle, National Collaborating Centre for Determinants of Health, MUSKRAT Media. The Toronto Indigenous Health Advisory Circle (TIHAC): advancing self-determined Indigenous health [Internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2019 [cited 2020 February 3]. 46 p. Available from: http://nccdh.ca/resources/entry/tihac.
[12.] Toronto Indigenous Health Advisory Circle, Toronto Public Health, Toronto Central Local Health Integration Network. A reclamation of wellbeing: visioning a thriving and healthy urban Indigenous community. Toronto’s first Indigenous health strategy 2016-2021 [Internet]. Toronto (ON): TIHAC; 2016 [cited 2020 Feb 12]. 35 p. Available from: https://www.toronto.ca/wp-content/uploads/2018/02/9457-tph-tihac-health-strategy-2016-2021.pdf.
[13.] Reconciliation Canada. Back pocket reconciliation action plan [Internet]. Skwxwú7mesh (Squamish) nation land, Vancouver (BC): Reconciliation Canada; 2016 [cited 2020 Feb 13]; [about 2 screens]. Available from: https://reconciliationcanada.ca/back-pocket-plan/.
[14.] City of Ottawa. City of Ottawa reconciliation plan [Internet]. Ottawa (ON): City of Ottawa; c2001-2020 [cited 2020 Feb 13]; [about 4 screens]. Available from: https://ottawa.ca/en/city-hall/inclusion-and-equality/city-ottawa-reconciliation-action-plan.
[15.] North East Local Health Integration Network, Local Aboriginal Health Committee. North East LHIN Aboriginal health care reconciliation action plan [Internet]. ON: NELHIN; 2016 [cited 2020 Feb 13]. 35 p. Available from: http://www.nelhin.on.ca/indigenous.aspx.
[16.] Middlesex-London Health Unit. Taking action for reconciliation: an organizational plan for Middlesex-London Health Unit [Internet]. London (ON): MLHU; 2018 [cited 2020 Feb 13]. 57 p. Available from: https://www.healthunit.com/indigenous-reconciliation.
[17.] Richardson L, Murphy T. Bringing reconciliation to healthcare in Canada: wise practices for healthcare leaders [Internet]. Ottawa (ON): HealthCareCan; 2018 [cited 2020 Feb 13]. 28 p. Available from: https://www.healthcarecan.ca/wp-content/themes/camyno/assets/document/Reports/2018/HCC/EN/TRCC_EN.pdf.
[18.] Government of the North West Territories. Caring for our people: cultural safety action plan [Internet]. Government NWT; 2019 Feb [cited 2020 Feb 13]. 31 p. Available from: https://www.hss.gov.nt.ca/en/services/cultural-safety.
[19.] VicHealth. Reconciliation action plan 2013-2015 [Internet]. Victoria (AU): Victorian Health Promotion Foundation; 2013 [cited 2020 Feb 13]. 15 p. Available from: https://www.vichealth.vic.gov.au/search/reconciliation-action-plan.