I am on a journey of self-reflection and education about Canada’s treatment of Indigenous people. It has been humbling to discover the multitude of ways that I have been oblivious to the harmful traditions of colonialism and my role within them. My complicity could be passed off as unwitting, but that would be too generous. I have learned that it’s my responsibility to actively look for ways to improve myself and our systems in order to do better.

Moving away from the use of deficit-based language in articles that discuss Indigenous people is one thing the Editorial Board has been working on. Deficit-based language like vulnerable or at risk tends to blame the victim for their predicament and “fails to acknowledge that they live within coercive systems that cause harm with no accountability.”[1] When certain language or problems are repeatedly associated with a specific population in the absence of context, stigmatization can occur.[2]

In a 2019 article for the Canadian Journal of Bioethics, Hyett and colleagues explain that health care research is inherently deficit-based because it is often designed to highlight poorer outcomes in one group compared with another.[2] This research may be well intentioned; however, historically, Indigenous people have been made into research subjects and described in ways that perpetuate harmful stereotypes.[2] For example, our implicit biases (and our overt medical education) might lead us to believe that Indigeneity is a “risk factor” for health outcomes like alcohol use disorder or diabetes. Stereotypes can become especially dangerous when they impact care. Hyett and colleagues recount the powerful examples of Brian Sinclair and Hugh Papik, whose fatal diagnoses were missed because they were falsely assumed to be drunk.

Strengths-based approaches consider the capacities and capabilities of Indigenous people—both within the person and in their environment—and how they might contribute to their well-being.[3,4] Bryant and colleagues suggest that sociocultural approaches are better able to capture Indigenous ways of knowing because strengths go beyond those of an individual to consider social relations, collective practices, and identities.[4]

Considering both the people and the context, a population typically called at risk might be more appropriately referred to as oppressed or underserved. Indigeneity is a validated protective factor that has been demonstrated to improve health outcomes if appropriately recognized and supported.[5,6]

I am learning about the various ways investigators can engage Indigenous stakeholders on health care research, such as through Elders’ teachings.[1,7,8] Colonialized institutions and research practices may impede our own progress, however. In an article recently published in Nature, University of British Columbia researcher Dr Jennifer Grenz writes about how “[u]niversity ethics boards are not ready for Indigenous scholars.”[9] In her own academic experience, she found the “current standard requirements of ethics committees—such as providing the exact questions that [Indigenous researchers] will ask Elders and knowledge keepers, and having fixed research objectives and methodologies—are not consistent with [Indigenous] ways of knowing. But this led to challenges with [the] ethics board. . . . [Her] research was seemingly held hostage until [she] complied to colonizing it.”[9]

As I write this editorial, an article in the Globe and Mail highlights the staggering rates of youth suicide in Canada’s Indigenous communities.[10] Tanya Talaga asks readers, “How have we grown numb to the suicide of Indigenous children?” I hope we have not. I believe there are many thousands of caring and thoughtful physicians in British Columbia who want to be part of the solution. Clearly, we need research to address the health care inequities we’ve created, but it is also apparent that a change in research methodology is critical if we want to achieve meaningful change.
—Caitlin Dunne, MD, FRCSC

Acknowledgments

I would like to thank Dr Terri Aldred for her assistance in editing this work.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Davis LP, Museus SD. Identifying and disrupting deficit thinking. Medium. 19 July 2019. Accessed 13 December 2023. https://medium.com/national-center-for-institutional-diversity/identifying-and-disrupting-deficit-thinking-cbc6da326995.

2.    Hyett SL, Gabel C, Marjerrison S, Schwartz L. Deficit-based Indigenous health research and the stereotyping of Indigenous people. Can J Bioeth 2019;2:102-109.

3.    First Nations Information Governance Centre. Strengths-based approaches to Indigenous research and the development of well-being indicators. Ottawa: First Nations Information Governance Centre, 2020. Accessed 13 December 2023. https://fnigc.ca/wp-content/uploads/2021/05/FNIGC-Research-Series-SBA_v04.pdf.

4.    Bryant J, Bolt R, Botfield JR, et al. Beyond deficit: ‘Strengths-based approaches’ in Indigenous health research. Sociol Health Illn 2021;43:1405-1421.

5.    Whalen DH, Lewis ME, Gillson S, et al. Health effects of Indigenous language use and revitalization: A realist review. Int J Equity Health 2022;21:169.

6.    Barker B, Goodman A, DeBeck K. Reclaiming Indigenous identities: Culture as strength against suicide among Indigenous youth in Canada. Can J Public Health 2017;108:e208-e210.

7.    Kennedy A, Sehgal A, Szabo J, et al. Indigenous strengths-based approaches to healthcare and health professions education—Recognising the value of Elders’ teachings. Health Educ J 2022;81:423-438.

8.    Okpalauwaekwe U, Ballantyne C, Tunison S, Ramsden VR. Enhancing health and wellness by, for and with Indigenous youth in Canada: A scoping review. BMC Public Health 2022;22:1630.

9.    Grenz J. University ethics boards are not ready for Indigenous scholars. Nature 2023;616:221.

10.    Talaga T. How have we grown numb to the suicide of Indigenous children? The Globe and Mail. Updated 28 November 2023. Accessed 13 December 2023. www.theglobeandmail.com/opinion/article-how-have-we-grown-numb-to-the-suicide-of-indigenous-children.