Concepts

An essential part of the FHD conciliation journey requires a shared understanding of key concepts and terms related to indigenous history, health, and education. These definitions were developed using literature, a variety of indigenous resources, and working group discussions.

Conciliation (kwayskahsatsowin)

There is a lack of consensus about the terms reconciliation and conciliation, and both are used in discourses about relationships between settler/colonial populations and Indigenous Peoples in Canada. However, the concept reconciliation implies a return to a previous state of positive relationship. Some argue that the term reconciliation also falls short of requiring actual and substantive restitutions for the past and ongoing harms of colonization. The term conciliation, although also debated, does not imply return to a previous state. Rather, it suggests new pathways must be forged to build, for the first time, trusting, harmonious, and equitable relationships that honour Indigenous rights, ways of knowing, languages, worldviews, spirituality, relationality and relationships to land.

Truth

One of the primary foci of the TRC is on “truth-telling,” specifically about (a) the history and culture of Indigenous Peoples that pre-dates contact with European colonialists; (b) the violence of colonization which involved both the literal genocide of Indigenous Peoples, along with the cultural genocide of their languages, spirituality, families and communities, land and ways of knowing; (c) the ongoing process of colonialization and the intergenerational historical trauma that perpetuates the loss of cultural identity and relationality and poses barriers to health, self-determination and restoration of Indigenous cultures in Canada. Health and healing includes recovery from, and resistance to, the lasting, intergenerational and community effects of colonization; and the restoration of land and rights to self-determination.

Indigenous Ways of Knowing

There is no singular way of knowing everything that characterizes all Indigenous Peoples. The portion of Turtle Island that we now call Canada comprises the traditional lands of many nations, each with their own unique culture. Working in partnership requires stepping outside of ethnocentric systems of knowledge to appreciate and privilege Indigenous ways of constructing and communicating knowledge. Indigenous ways of knowing are grounded in relationship. Knowledge is transmitted through ancestors across generations, from the spirit world, from the natural world, and from Elders and other Knowledge Keepers. Knowledge is embedded within Indigenous spirituality and oral storytelling traditions and is often expressed through stories, dance, ceremony, ritual, and other cultural and healing practices. The interconnectedness of mind, heart, spirit and body positions knowledge as multidimension, fluid and contextualized. Honouring and respecting Indigenous worldviews involves both recognizing the unique ways of knowing shared across Indigenous populations as well as being aware of specific teachings of particular Indigenous Peoples.

Indigenous Views of Health and Healing

The provision of culturally safe and responsive health care to Indigenous persons and peoples necessitates stepping outside of the individualist worldview of Euro-Western health disciplines, to welcome and honour Indigenous views of health and healing. There are considerable within-group differences among those who self-identify as Indigenous People; however, there are often common threads in their views of health and healing. Many Indigenous Peoples view health and healing from a holistic perspective, focused on balancing spirit–heart–body–mind in-relation. Health and healing are rooted in relationship, to community, to the Creator, to ancestors, to other creatures and to the land. Health and healing are often illustrated in the form of a circle, such as the medicine wheel, which reflects the interrelatedness and interconnectedness of all things. The health of individuals is intimately connected to the health of communities. Healing is often facilitated by Indigenous Healers or Ceremonialists, who draw on cultural healing practices, teachings and ways of knowing.

Cultural Responsiveness

Cultural responsiveness is a measure of the degree to which the response of healthcare practitioners is influenced by active attention to the worldviews, ways of knowing, view of health and healing, strengths and resiliency, and other relevant aspect of the culture of service recipients. Cultural awareness and cultural sensitivity form a foundation for cultural responsiveness, because health care providers must first be open to understanding and valuing cultural differences and then tailor their responses to the specific needs, values and perspectives of service recipients. Cultural humility also forms an important foundation for the collaborative and relational processes inherent to responsiveness. Cultural responsiveness extends beyond interactions with individuals to careful examination of health care conventions, practices, contexts and policies with a view to increasing cultural safety, accessibility and equity in health services and outcomes.

Cultural Safety

Cultural safety is defined from the perspective of service recipients, based on their experience of respectful, culturally responsive, anti-oppressive and egalitarian relationships, services and health care environments. Establishing cultural safety with Indigenous People involves openly addressing power imbalances, including acknowledgement of the ways in which privilege and marginalization play out both in society as a whole and within health care systems. Cultural safety is built upon respect for Indigenous clients’ rights to self-determination, honouring of Indigenous ways of knowing and views of health and healing, as well as the fostering of self-determination in decision-making related to health care. In an environment free of overt and covert discrimination, the cultural strengths of Indigenous People and communities are recognized as healing resources.

Cultural Humility

Cultural humility acknowledges that it is not possible fully understand another person’s culture. Instead, the focus of cultural humility is on self-awareness and active engagement in reflective practice about our own cultural assumptions and biases, as well as those embedded within the health care systems in which we participate. Assuming a stance of cultural humility also necessitates approaching other persons and peoples from a place of cultural curiosity, being willing to own what we do not know, engaging in dialogue to increase our understanding and positioning ourselves as life-long learners. Cultural humility involves a willingness to set aside one’s own cultural assumptions and to embrace other worldviews, ways of knowing, and views of health and healing.

Social Determinants of Health

According to the World Health Organization, “The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics” (WHO, 2019, para. 6). All people and peoples are influenced by social determinants in either health-enhancing or health-limiting ways. Health-limiting factors include social injustices and inequities that avoidably and unfairly impact the health and well-being of certain people or peoples. These social determinants differ from community to community, based on factors like income distribution, working conditions, poverty, inadequate housing, barriers to work and education, social exclusion, prejudice and discrimination, and limited access to preventative and remedial mental health services. It is incumbent upon the health care system to attend to, and remediate, social determinants of health within communities as well as health care services.