The Northwest Territories (NWT) is more than one million square kilometers, with a population of 43,000 people spread among 33 remote communities, many without road access. Indigenous people (First Nations Dene, Metis and Inuvialuit) are 50% of the NWT population, with nine recognized official languages.
A History of Colonization
Since the 1970’s, the political landscape of the NWT has been transformed by the negotiation of Indigenous land and self government agreements with the federal and territorial governments. These agreements recognize Indigenous peoples’ authorities over lands, resources, and social programs, including health-related initiatives.
Indigenous peoples in the NWT share a recent history of colonization and massive social dislocation. Many made the transition from nomadic land-based cultures to permanent settlement during the early 1900s. From the mid 1800s to the early 1980s, Indigenous children were removed from families to attend church and state-run residential schools. This forced dislocation deepened colonization’s traumatic impacts, and disrupted psychological, social and family health on an individual and community level. Many children were physically, sexually and psychologically abused at the schools, the purpose of which was to “kill the Indian to save the child.” This experience lasted well into the second half of the 20th century and continues to have a profound impact on individual and community well-being.
A Need for Change
Due to this history, there are sharp differences in social determinants of health outcomes between Indigenous and non-Indigenous residents of the NWT. These indicators show that a universal untargeted approach to health care delivery, prevention and promotion simply is not enough to address many of the specific needs of Indigenous people. Without cultural understanding and approaches informed by the history of colonization and the multi-generational trauma of residential schooling, the system is failing to connect with many Indigenous residents.
Health research is critical to improving the NWT health system. However, the literature shows that health needs of Indigenous peoples are under-researched. This evidence gap means not enough is known to fully understand Indigenous health disparities and potential remedies (Young, 2003). Communities tend to have low trust levels in relation to the health system and research, due to a colonial legacy of vulnerable Indigenous adults and children being subjected to experimental, outmoded and degrading health research and treatment (Mosby, 2013; Drees, 2013). While many of these occurred years ago, there continue to be recent examples that support an ongoing widespread distrust in health systems (Smylie, 2015; Hildebrandt, 2015).
Indigenous communities and governments in the NWT have expressed the need to ground health and wellness programs in community priorities, Indigenous culture, and land-based traditions.
This demands an approach based on:
- Listening to the wisdom of the communities and the elders, incorporating this wisdom into the design and delivery of programs and services, and acknowledging the important role that the land and land-based traditional activities plays in health and well-being for Indigenous people;
- Building health promotion programs and approaches based in local culture and priorities, by partnering with Indigenous communities, governments and stakeholders; and,
- Focusing on building cultural competence among NWT health and social services professionals, ensuring a culturally safe environment for Indigenous patients and clients.
The Health Research Landscape
Health research has the potential to create transformative partnerships with communities to understand and communicate root causes, risk and protective factors and programming best practices in individual and population health. Specifically, patient-oriented research grounded in approaches that meaningfully and respectfully engage with communities, including knowledge translation and capacity building, is critical.
While the NWT does not have a university, there are several research and educational institutions that can provide institutional homes and supports for health research projects. Indigenous research institutes include the Inuvialuit Cultural Resource Centre, the Gwich’in Social and Cultural Institute, and Dedats’eetsaa: Tlicho Research Institute. Most communities have adult-focused learning centers, and Indigenous communities’ health and research priorities inform health and social program offerings of Aurora College. Organizations such as the Aurora Research Institute and the Institute for Circumpolar Health Research provide places for health researchers to conduct their research. Individual communities, Indigenous governments and organizations and regional health authorities review research license applications and often partner with researchers as they conduct their studies.
While the NWT has a vibrant health research landscape, Hotıì ts'eeda believes more focus needs to be placed on meaningful engagement with individuals and communities at the outset of projects and ensuring the knowledge created by research benefits the communities. More collaborations and capacity-building among research stakeholders across the NWT will lead to excellence in Northern health research and, ultimately, better health outcomes for all residents of the NWT.