Examples of Canadian Indigenous-led partnerships and health outcomes*
| Location; year of publication; model | Type of site | Year established | Services offered (beyond the biomedical) | Types of evidence | Health outcomes |
|---|---|---|---|---|---|
| Whitehorse General Hospital, Yukon; 2018; (17) fully integrated and inter-disciplinary | Northern urban hospital | 1993 | Traditional foods, plant medicines, healing room, Elder’s suite, cultural programs, liaison workers | Quality and cultural safety patient surveys, annual reports, website | Quality and cultural safety improvements unspecified |
| Haida Gwaii, BC; 1999; (18) integrated | Diabetes clinic | 1994 | Traditional diet, plant medicines, exercise program | Chart review, biomedical measurements, focus groups, community-based participatory action | Significant decrease in total cholesterol (0.45, p = 0.005). Increase in high-density lipoproteins or “good cholesterol” (−0.097, p = 0.05). |
| Six First Nations communities in northwestern Ontario; 2017; (19) integrated | Drug treatment centres | 2012 | Traditional healing, traditional counselling, land-based aftercare (e.g., fishing, hunting, memorial walks, community gardening), Elder-run healing sessions (individual and groups) | Retrospective cohort study, n = 526 | Retention rate = 84%. High rates of negative urine drug screening result. Dramatic reduction in suicides in all 6 communities after onset of program (p = 0.035). At 1 year after onset of buprenorphine–naloxone program, criminal charges decreased by 61.1%, child protection cases decreased by 58.3% and school attendance rates increased by 33.3%. Drug-related medical evacuations to hospital decreased by 30.0%. |
| Two cities in western Canada; 2019; (20) integrated | Centres for women who have experienced violence | 2018 | Elder-led health promotion circles partnered with nursing | Longitudinal study, pre–post and at 6 months, n = 152. Indigenous women self-report on quality of life and trauma symptoms. Depressive symptoms, social support, personal and interpersonal agency, chronic pain disability. | Quality of life and trauma symptoms improved significantly both immediately postintervention and at 6 months. Improvements in 5 of 6 secondary psychological outcomes. |
| Vancouver, BC; 2016; (21) integrated | In community | 2012 | Women’s heart health group (2 h/wk for 8 wk), Sacred Blanket ceremony, Talking Circle, partnered with nursing | Mixed-methods pre–post program evaluation | Most improved diet. Some improved activity level and emotional health. Women reported program as a success because it was both women-centred and appropriate to Indigenous culture. |
| Puvirnituq Hospital and surrounding birth centres in Inukjuak and Salluit, Nunavut; 2004 (22) and 2007; (23) fully integrated and interdisciplinary | Northern remote hospital maternity ward and birth centres | 1990 | Prenatal, birth and postpartum services by Inuit midwives (with medical and traditional training) supported by doctors and nurses both on-site and through remote service technology; specialists available by phone, electronic communication and transport | Five-year retrospective study including review of birth registrations, antenatal records in Inukjuak and records of evacuations. External evaluation of maternity data with regional cohorts. | Since the midwifery program started, evacuations, inductions, cesarean deliveries and episiotomies are drastically reduced. Perinatal mortality equal to Canadian average (0.9%), better than comparable populations, e.g., Northwest Territories (1.9%) and Nunavut (1.1%). |
| Noojmowin Teg Health Centre, Manitoulin Island, Ontario; 2009 (13) and 2013; (24) interdisciplinary and multidisciplinary | Community health access centres on northern reserves | 1998 | Traditional healers, Elders and coordinator, home visits, land-based medicines, plant medicines, ceremonies, lifestyle teachings, counselling, chronic illness care, psychiatry | Retrospective case study on 10 years of contextualized experience: in-depth interviews and focus groups with 17 providers and 23 clients, and document reviews (e.g., policies and program descriptions). Community-initiated study including 43 semistructured interviews with clients from 7 communities. | Faster, better coordinated response times in urgent care and crisis. Integrated care positive for providers and clients. Clinical mental health and traditional services successfully integrated. |
| Meno Ya Win Health Centre, Sioux Lookout, Ontario; 2010 (7) and 2010; (25) interdisciplinary and multidisciplinary | Rural hospital | 2002 | Traditional practitioners, foods, plant medicines, ceremonial room, 24/7 language interpreters with expanded roles as advocates, navigators and cultural translators, Elders-in-residence, all staff trained in cultural sensitivity | Patient surveys, needs assessments via 4 community consultations, including First Nations Chiefs, spiritual leaders and 50 Elders, site visits to 16 organizations including document reviews and key informant interviews, phenomenological study on end-of-life care | Confirmed Elders advisory council is essential in governance and decision-making. Succeeding in providing culturally safe treatment options and advancing integrated care. Significant improvements to end-of-life care and culturally responsive care. |
| Unnamed clinic, Vancouver Native Health Society, BC; 2016; (26) multidisciplinary | Urban primary health care clinic | 1993 | Indigenous-friendly space, culturally appropriate chronic care model | Retrospective cohort pre–post evaluation for intervention data from 2007 to 2012 | All-cause mortality rates were significantly reduced from 10.00 per 100 person years in exposed group to 5.00 per 100 person years (p = 0.023). HIV-cause mortality rates were significantly reduced from 5.56 per 100 person years to 1.80 per person years (p = 0.005) between 2007 and 2012. |
| Sheway, Vancouver Native Health Society, Vancouver Downtown Eastside, BC; 2003; (14) multidisciplinary | Urban clinic and drop-in centre | 1993 | Emergency services, hot lunches, baby supplies, counselling, partnerships with Elders, access to ceremonies and cultural teaching circles for substance-using pregnant women | Case study with participatory observation, 3 focus groups (46 people total) and 25 semistructured interviews with staff, providers, government and community leaders | Improved access to prenatal care, maternal nutrition and infant birth weights (from 33% to 24% low birth weight in first 5 yr). Reduced isolation, substance use, fetal alcohol syndrome, neonatal abstinence syndrome and child apprehensions (from 100% to 42% in first 5 yr). Improved interpersonal and problem-solving skills. |
| Anishnawbe Mushkiki Aboriginal Health Centre, Thunder Bay, Ontario; 2019; (27) multidisciplinary | Primary care clinic | 1990 | Traditional healing program includes ceremonies (e.g., feasts, sweat lodge, naming and grieving), cultural teachings (e.g., medicine wheel, seven grandfathers, clan, parenting, women’s, sacred medicines), traditional wellness coordinator, access to Elders and traditional healers | Annual reports, website, staff reports | Quality and cultural safety improvements unspecified |
| Anishnawbe Health Toronto, Ontario; 2006 (28) and 2013; (11) multidisciplinary and coordinated | Urban clinic | 1989 | Traditional family services, Elders, healers, counsellors, teaching circles and ceremonies (e.g., naming, shake tent, pipe, full moon, clan feasts and vision quests) | Mixed methods using 42 intake questionnaires, 12 interviews participatory observation and narrative inquiry | Quality and cultural safety improvements unspecified. Thematic analysis summary: identity reclamation is crucial step in healing Indigenous psyche, and mental health services must be culturally relevant and trauma-informed. |
| Unnamed inner-city clinic, western Canada; 2019; (29) coordinated and co-located | Primary care clinic | 1991 | Mental health patients had regular contact with an Elder over 6 months | Mixed-methods study designed with Elders advisory council, including quantitative prospective cohort | Patients who at study onset reported moderate to severe depression (Patient Health Questionnaire score of 10 or greater) and high risk for suicide (Revised Suicide Behaviours Questionnaire score of 7 or greater) improved by 5 points (p = 0.001) and 2 points (p = 0.005), respectively. Emergency department mental health visits decreased by 56% for the total sample population, for a year on either side of the intervention. |
| Turtle Lodge and Giigewigamig Traditional Healing Center, Sagkeeng First Nation, Manitoba; 2019; (9) autonomous | Healing lodge | 2002 | Traditional healers, Elders, cultural teachings, ceremonies, round tables, land-based activities, sacred gathering place. “Medicine Mondays” held at the sacred fire and sweat lodge onsite at hospital. Referrals from doctors to traditional healers. | Descriptive, analysis, dialogical | Early evidence emerging from conversations with patients, families and Elders show improved access to culturally safe care and holistic health outcomes. Elders at Giigewigamig also take the lead at building partnerships with doctors and hospital staff through regular invitations to learn about local medicines and experience traditional healing ceremonies. |
↵* In this analysis, we reviewed qualitative, quantitative and mixed-methods research. Although Indigenous-led statistics is an emerging area, literature on traditional Indigenous knowledge is largely qualitative to date; thus, we included studies involving interviews, focus groups and community-based participatory processes alongside quantitative studies. Literature searches through medical and social science databases, academic journal articles, published theses and relevant grey literature (e.g., websites, annual reports, organizational statements) from Indigenous organizations, health care facilities and health research institutions were conducted. About 150 articles were reviewed by selecting for relevancy, analyzing for themes and synthesizing for succinctness. These 14 examples were chosen for the strength of the partnerships outlined, the clarity of evidence presented, and the degree to which Indigenous communities or traditional Indigenous knowledge was central to or leading the research and clinical process. We worked together as a team inclusive of Indigenous Elders, a physician and scholars in discussion, in ceremony and in the writing process.