Key Research Gaps in Aboriginal Children's Health
Health Inequalities in Aboriginal Children in Canada
Colonialism during the 19th and 20th centuries has caused long-lasting damages to the health of Aboriginal Peoples in Canada. In residential schools, Aboriginal children were removed from their families, deprived of ancestral languages, sterilized, and exposed to physical and sexual abuses.(1) Such social, psychological and physical traumas pass on through generations, reflected by the high rates of acute and chronic diseases including depression, self-destructive behaviours, hostility, and chronic bereavement.(2) Poverty, lack of education, substandard housing, poor nutrition, lack of access to health and social services, and history of family, community and cultural breakdowns caused by residential school policies are all linked to the pervasive health inequalities experienced by the Aboriginal children in Northern Canada.(3) Compared to other Canadian children, Aboriginal children are at least 2 to 3 times more likely to live in poverty, receive incomplete vaccinations, suffer from malnutrition and hunger, die in infancy, live with depression and other chronic illnesses, and commit suicide.(4) Furthermore, they are also much less likely to have access to adequate health and social services.
Despite the Canadian government’s efforts in developing Aboriginal policies and program funding, the health of Aboriginal Canadians has not noticeably improved. This stagnation is likely due to the ineffectiveness of policies and health programs that are implemented without an adequate research foundation. In order to create and sustain a holistic system that will truly foster better health in Aboriginal children living in Northern Canada, I will discuss two research gaps in this essay: 1) lack of data availability and limitations in existing data and 2) lack of context-specific research. Major sources of health data are derived from health surveys conducted by Statistics Canada and from administrative databases. I will address the issues of the lack of Aboriginal-ethnicity identifier and other limitations in these databases. Furthermore, effectively unveiling the root causes of the current health issues experienced by the Aboriginal children living in Northern Canada requires context-specific research with respect to childhood, Aboriginality, and geography..
Lack of Data Availability and Limitations to Existing Data
Limitations in Statistics Canada’s Surveys
In 2009, the Centre for Education Statistics (CESC) published a report summarizing all the surveys conducted by Statistics Canada and a number of other federal departments such as the Indian and Northern Affairs Canada (INAC) that contained information on Aboriginal ethnicity status.(6) Out of a total of 28 data sources identified, only 8 had information on Aboriginal children aged 0 to 14 years old, including the Census, APS, ESESP, SAEP, NLSCY, ACS, CCHS, and ICTSS (see Acronyms below). General data limitations for these surveys include the following:(6)
- Only the Census and the 1991/2001 APS survey include data from reserves,
- Data on Aboriginals only exists in three major sources including the Census, APS, and ACS,
- Many of these surveys lack sufficient sample size to provide reliable estimates for the overall Aboriginal population. Thus finer levels of analysis (such as by children, specific community, Aboriginal subgroups) were virtually impossible,
- Most of these surveys were based on Aboriginal self-identification without validation,
- None of the survey was representative to the entire Aboriginal population of Canada,
- There is a lack of consistency regarding the measured characteristics between surveys (ie: definitions of Aboriginal status by Aboriginal ancestry versus Aboriginal identity),
- Aboriginal identifiers used in Statistic Canada’s surveys were not consistent with the Council of Ministers of Education, Canada (CMEC) Working Group on the Aboriginal Education Action Plan’s recommendation of using “First Nations, Métis, and Inuit”.
These data limitations confine epidemiologic studies to a peripheral, disjointed, and minimalistic level, rendering infeasible an in-depth investigation aimed at unveiling context-specific health issues, disease patterns, and community needs.
Lack of Aboriginal Identifier in Administrative Databases
Beyond large population surveys, administrative health data often serve as economic and reliable data sources for estimating disease trends in Canada. However, the majority of the key health administrative datasets, including CIHI abstract data, physician billing databases, electronic medical records, and provincial/territorial health insurance registries, generally lack any racial (including Aboriginal) identifier. Thus, there is currently a huge data gap that tremendously hinders research efforts to understand specific Aboriginal children’s health issues and needs.
Lack of Context-specific Research
The recognition of children’s right and reconceptualization of children as active agents, affecting and being affected by the external environment, have reshaped our understanding and research methodology with children.(7) Specific ethical and methodological issues need to be considered when conducting qualitative research with Aboriginal children. These include: 1) power relations, 2) informed consent, and 3) confidentiality.(7) While these concerns are not exclusive to research on children, they are more critical in Aboriginal children research due to their inferiorly-skewed power dynamics with adults, variations in communication capacities, and general advocacy by their parents.
Two key methodological issues in developing research with children are: 1) epistemological issue related to different cultures of childhood and adulthood; and 2) the heterogeneous nature of children.(7) Some researchers argue that it is not possible for adult researchers to accurately represent the perspectives of children.(8-10) Children were perceived as a homogenous group, but researchers have since recognized the complexity of childhood, which is comprised of intertwined relationships, interactions, and perceptions.(11) Some researchers further account for children’s macrosocial characteristics (e.g., sex, age, race, and disability) as well as differences in their cognitive development, life experiences, and communication competence.(12, 13)
In the traditional Western positivist research paradigm, researchers are cast as expert, distant, and value free.(2) This paradigm is based on the concept of a single truth to be discovered and that scientific knowledge is more valuable than subjective or experiential knowledge.(14)
In contrast to the Western research paradigm, the Indigenous research paradigm places value on subjective or experiential knowledge “from within” that can only be captured by unconventional methodology including multiethnic data sets, Indigenous data sets, standardized tools, qualitative methods, life-course perspectives, participatory approaches, and decolonizing and critical perspectives.(2)
The last context-specific research gap relates to the geographic isolation and extreme weather that presents unique health challenges to many Aboriginal children living in the Northern regions of Canada.(15) For example, adequate supply of fresh and healthy foods is frequently inaccessible to Inuit living in Nunavut, resulting in 68% of Inuit children experienced being hungry, as well as high prevalence of hunger and malnutrition.(16, 17)
Current State of Body of Knowledge
The prolonged state of health inequities experienced by Aboriginal children living in Northern Canada is evidence that current government policies and health promotion programs are, as a whole, ineffective. This ineffectiveness is due to the lack of interventions directed to the underlying context-specific root causes of inequalities. An intersectionality-based research and policy analysis framework is needed to uncover, understand and map out the complex relationships of the critical components which play a role in the underlying root causes.(18)
Currently, Canada does not have a standardized method to identify Aboriginal status across major survey and administrative data sources; it lacks available data sources containing in-depth context-specific information. As a result, research conducted on Canadian Aboriginal children using a comprehensive, context-specific, and culturally-and-children-appropriate approach is a scarcity rather than a norm. Unless these critical research gaps are addressed, research on Aboriginal children of Canada will remain one-dimensional, repetitive, overly-simplistic, and incapable of uncovering the root causes of the prevailing social and health problems.
- Dreamcatcher child: http://weheartit.com/entry/77060142
- ACS = Aboriginal Children’s Survey
- APS = Aboriginal People Survey
- CCHS = Canadian Community Health Survey
- CIHI = Canadian Institute for Health Information
- ESESP = Elementary Secondary Education Statistics Project
- ICTSS = Information and Communications Technologies in Schools Survey
- NLSCY = National Longitudinal Survey of Children and Youth
- SAEP = Survey of Approaches to Educational Planning
- Residential schools in Canada research paper. 2011 [cited 2014 20-1-2014]; Available from: http://www.omfrc.org/newsletter/specialedition7.pdf.
- Braun K, Browne C, Ka’opua L, Kim B, Mokuau N. Special issue: remembering our roots. The Gerontologist. 2013;54(1):117-26.
- UNICEF Canada. Leaving no child behind. Toronto. [cited 2014 20-1-2014]; Available from: http://www.unicef.ca/en/policy-advocacy-for-children/leaving-no-child-behind.
- Canadian UNICEF Committee. Canadian Supplement to The State of The World’s Children 2009 – Aboriginal children’s health: Leaving no child behind. Toronto: 2009.
- A long-awaited apology for residential schools. 2008 [cited 2012 20-1-2014]; Available from: http://www.cbc.ca/archives/categories/society/education/a-lost-heritage-canadas-residential-schools/a-long-awaited-apology.html.
- Centre for Education Statistics. Federal data scan: Aboriginal data in Statistics Canada’s education data sources. 2009.
- Kirk S. Methodological and ethical issues in conducting qualitative research with children and young people: a literature review. International Journal of Nursing Studies. 2007;44:1250-60.
- Christensen P. Children’s participation in ethnographic research: issues of power and representation. Children and Society. 2004;18:165-76.
- Christensen P, James A. Research with children: perspectives and practices. Routledge/Falmer, London. 2000.
- Punch S. Research with Children – the same or different from research with adults? Childhood. 2002;9:321-41.
- Davis J. Understanding the meanings of children: a reflexive process. Children and Society. 1998;12:325-35.
- Hill M. Participatory research with children. Child and Family Social Work. 1997;2:171-83.
- Irwin L. The potential contribution of emancipatory research methodologies to the field of child health. Nursing Inquiry. 2006;13(2):94-102.
- Israel B, Schulz A, Parker E, Becker A. Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health. 1998;19:173-202.
- Irvine J, Kitty D, Pekeles G. Healing winds: Aboriginal child and youth health in Canada Paediatr Child Health. 2012;17(7):363-4.
- Sheppard A, Hetherington R. A decade of research in Inuit children, youth, and maternal health in Canada: areas of concentrations and scarcities. Int J Circumpolar Health. 2012;71(18383):1-13.
- Findlay L, Langlois K, Kohen D. Hunger among Inuit children in Canada. Int J Circumpolar Health. 2013;72(20324):1-9.
- Hankivsky O, Christoffersen A. Intersectionality and the determinants of health: a Canadian perspective. Critical Public Health. 2008;18(3):271-83.