Case 9 : Achieving Health Equity in Ontario: Increasing Capacity for Relationship Building with Indigenous Communities
Paul Green is concerned that his organization is not meeting the requirements of the modernized Ontario Public Health Standards’ Health Equity Standard after his colleagues ask for direction on working with local Indigenous communities. Under the third requirement of the new Health Equity Standard, all boards of health must engage with Indigenous communities and organizations, which must include the “fostering and creation of meaningful relationships”. As the new Health Equity Manager at Turtle Creek Public Health (TCPH), Paul is tasked with developing a set of recommendations for organizational action. After receiving advice from a colleague, Paul decides that the next step for his organization is to conduct a situational assessment to explore how it may effectively, appropriately, and meaningfully build relationships with local Indigenous communities. However, Paul is unsure about where to begin. What questions should be asked? What important considerations need to be made? By developing an understanding of community histories, current contexts, colonial policies, historical events, social determinants of Indigenous health, and the foundational principles for relationship building with First Nations communities, meaningful partnerships may be cultivated with stakeholders and organizations in Indigenous communities across the province.
1. Identify existing barriers to relationship building with Indigenous communities from the perspective of public health units in the province of Ontario.
2. Discuss the means by which historical events and colonial policies undermine Indigenous health and create challenges to achieving health equity at organizational, community, and societal levels.
3. Identify and differentiate between the proximal, intermediate, and distal determinants of health that affect Indigenous peoples in Canada.
4. Develop an understanding of what a meaningful relationship might look like and how a meaningful relationship may be cultivated with Indigenous peoples.
5. Develop a context-specific situational assessment plan for a public health unit wanting to create an Indigenous Relationship Building Strategy.
Case Study Questions
1. What were some of the barriers encountered by Ontario public health units when attempting to build relationships with Indigenous communities? Have you ever encountered any of these barriers during a volunteer or work experience? Were you able to overcome this barrier? If so, how?
2. List the social determinants of health that are present in the case. In which categories do each of these determinants fit?
3. Explain the link between the social determinants of Indigenous health and the colonial policies and historical events outlined in the Case Note/required readings.
4. Define each of the four foundational principles to relationship building with First Nations communities.
5. What is a meaningful relationship? What might a meaningful relationship look like? How might a meaningful relationship be fostered?
6. What is a situational assessment? Why might a situational assessment be conducted? How might a situational assessment support engagement and the development of meaningful relationships?
7. Can a situational assessment plan that is developed for working with a particular Indigenous community be utilized to work with another Indigenous community? Why or why not?
8. Some Indigenous peoples are hesitant to participate in research initiatives due to the mistreatment of their ancestors and family members in previous studies. How could you appropriately and respectfully engage Indigenous communities to encourage their participation?
9. Describe the achievements or challenges that your learning team experienced during the situational assessment planning activity. 10. Highlight a key aspect of another learning team’s situational assessment plan that your learning team did not consider during the activity. How might this aspect or element have strengthened your learning team’s plan?
Health equity; Indigenous communities; relationship building; social determinants of health; situational assessment
McConnell, R. & Wylie, L. (2019). Achieving Health Equity in Ontario: Increasing Capacity for Relationship Building with Indigenous Communities. In: Sibbald, S.L. & McKinley, G. [eds] Western Public Health Casebook 2019. London, ON: Public Health Casebook Publishing.