“They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver's inner city

Abstract

There is growing evidence that Aboriginal peoples often experience healthcare inequalities due to racism. However, research exploring the healthcare experiences of Aboriginal peoples who use illicit substances is limited, and research rarely accounts for how multiple accounts of stigma intersect and contribute to the experiences of marginalized populations. Our research aimed to explore the healthcare experiences of Aboriginal peoples who use illicit drugs and or illicit alcohol (APWUID/A) living in Vancouver’s inner city. Using Indigenous methodologies, a community research team comprised of APWUID/A led the study design, data collection and analysis. Peer-facilitated talking circles explored community members’ experiences accessing healthcare services and patient-provider encounters. Using an intersectionality framework, our research demonstrated how healthcare inequalities among Aboriginal peoples are perpetuated by systemic racism and discrimination. Stigmatizing racial stereotypes were perceived to negatively influence individual attitudes and clinical practice. Participants’ experiences of medical dismissal often resulted in disengagement from care or delay in care. The findings suggest healthcare providers must understand the structural and historical forces that influence racial disparities in healthcare and personal attitudes in clinical practice. Adequate clinical protocols for pain management within the context of illicit substance use are urgently needed. The valuation of Aboriginal peoples and cultures within healthcare is paramount to addressing the health gap between Aboriginal and non-Aboriginal Canadians.

The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey

“…These experiences Research have a significant impact on health. [29][30][31][32] These routine experiences of discomfort and shame when interacting with the health care system can contribute to higher rates of cost-related nonadherence, for example, because Indigenous patients may avoid consultations with physicians and pharmacists or may cut visits short without obtaining the necessary information. 33 The prevalence of cost-related nonadherence in our study, 8.2%, is slightly lower than comparable past estimates: we previously found that 9.6% of those with a prescription in 2007 experienced cost-related nonadherence.…”

“All my relations”: experiences and perceptions of Indigenous patients connecting with Indigenous Elders in an inner city primary care partnership for mental health and well-being

“…[1][2][3][4][5][6] Therefore, disproportionate rates of mental illness and suicidality must be understood in context, not as intrinsic predispositions of Indigenous people but instead as reflecting persistent inequities. 2,[7][8][9][10] This is evident for many Indigenous people living in inner cities where the effects of poverty, racism, and other layers of discrimination and marginalization on mental health are impossible to overlook. 8,9,11,12 In general, mental health services in urban settings have not been adapted to serve the needs of Indigenous patients, and this is reflected in the comparatively low rates of voluntary utilization, 13,14 and much higher rates of acute admissions to hospital for suicidality and other mental health crises.…”

“…2,[7][8][9][10] This is evident for many Indigenous people living in inner cities where the effects of poverty, racism, and other layers of discrimination and marginalization on mental health are impossible to overlook. 8,9,11,12 In general, mental health services in urban settings have not been adapted to serve the needs of Indigenous patients, and this is reflected in the comparatively low rates of voluntary utilization, 13,14 and much higher rates of acute admissions to hospital for suicidality and other mental health crises. 15 Qualitative studies point to numerous reasons why Indigenous people express reluctance to engage with mainstream health care services: including racism, "being treated as a second-class citizen," and lack of Indigenous staff and cultural practices.…”

“…15 Qualitative studies point to numerous reasons why Indigenous people express reluctance to engage with mainstream health care services: including racism, "being treated as a second-class citizen," and lack of Indigenous staff and cultural practices. 8,[16][17][18][19][20] Ethnographic data suggest that Indigenous people living in the inner city may seek out recognized Elders as informal sources of mental health care in lieu of mainstream services. and might not necessarily be old.…”

“We’ve Been Researched to Death”: Exploring the Research Experiences of Urban Indigenous Peoples in Vancouver, Canada

“…The methods used in this study have been described in detail elsewhere (Goodman et al, 2017). Indigenous knowledge is premised upon oral traditions so the community research team selected talking circles as a culturally appropriate conversational research method (Kovach, 2010).…”