Health Service Needs for Urban Indigenous Women with Co-Occurring Health Concerns: Creating a Safe Place for Empowerment and Service Integration

Health Service Needs for Urban Indigenous Women with Co-Occurring Health Concerns

Creating a Safe Place for Empowerment and Service Integration

Hasu Ghosh, Cecilia Benoit, Ivy Lynn Bourgeault

Volume 15, Number 2 (2025) 15 (2): 5-25


Keywords Indigenous women, diabetes, mental health, health service access, intersectionality

Abstract

Addressing inequities in health service access and utilization among Indigenous Peoples is complex, especially for urban Indigenous women with co-occurring health conditions and addiction issues. Services for co-occurring health conditions are compartmentalized and disjointed. Urban Indigenous women are particularly at risk of falling through the cracks of the service system. With this in mind, we designed a study that would provide information about how best to provide services to urban Indigenous women with multiple health challenges. The paper reports from the first phase of the study which involved interviews with service providers and decision makers. Data were collected through in-depth interviews. All the key stakeholders expressed the view that services for co-occurring health needs should be based on Indigenous women’s understandings of culturally safe and responsive care. The results suggest that services for co-occurring health concerns must begin with ensuring Indigenous women’s safety. Women who experience safe health services are more likely to feel empowered throughout the process of their healing journey. The lack of safety in health services can be considered as a key factor in Indigenous Canadians’ inequitable access to health services.

Authors

Hasu Ghosh

Cecilia Benoit

Ivy Lynn Bourgeault

Published August 14, 2025

How to Cite

Health Service Needs for Urban Indigenous Women with Co-Occurring Health Concerns: Creating a Safe Place for Empowerment and Service Integration. (2025). Fourth World Journal, 15(2), 5-25. https://doi.org/10.63428/tdt00p97

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References

Andrews G, Slade T & Issakidis C (2002). Deconstructing current co-morbidity: data from the Australian National Survey of Mental Health and Well-Being. British Journal of Psychiatry, 181:306-14. https://doi.org/10.1192/bjp.181.4.306

Belanger, Y. D., Weasel Head, G., Awosoga, O. (2012). Housing and Aboriginal People in Urban Centres: A Quantitative Evaluation. Aboriginal Policy Studies, 2(1): 4-25. Accessed on Nov 7, 2016.

https://doi.org/10.5663/APS.V2IL.17705

Benning, T. (2016). Envisioning deep collaboration between psychiatry and traditional ways of knowing in a British Columbia First Nations setting: A personal reflection. Fourth World Journal, 15(1): 55-64.

Benoit, C., Carroll, D., Lawr, L., Chaudhry, M. (2001). Marginalized voices from the Downtown Eastside: Aboriginal women speak about their health experiences. Report prepared for Health Canada. York University: National Network on Environments and Women's Health.

Benoit, C., Carroll, D. & Chaudhry, M. (2003). In search of a healing place: Aboriginal women in Vancouver's Downtown Eastside. Social Science and Medicine, 56(4): 821-833.

https://doi.org/10.1016/S0277-9536(02)00081-3

Bombay, A., Matheson, K., Anisman, H. (2009). Intergenerational Trauma: Convergence of Multiple Processes among First Nations peoples in Canada. Journal of Aboriginal Health. Accessed on November 7, 2016 via http://www.naho.ca/documents/journal/jah05_03/05_03_01_Intergenerational.pdf

Broemeling, A. M., Watson, D. E., Prebtani, F. (2008). Population Patterns of Chronic Health Conditions, Co-morbidity and Healthcare Use in Canada: Implications for Policy and Practice. Healthcare Quarterly, 11(3): 70-76.

https://doi.org/10.12927/hcq.2008.19859

Browne, A. J., Varcoe, C., Lavoie, J., Smye, V., Wong, S. T., Krause, M., et al. (2016). Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study. BMC Health Services Research, 16:544. Accessed on November 2, 2016 via https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1707-9

https://doi.org/10.1186/s12913-016-1707-9

Burmeister, E. and Aitken, L. M. (2012). Sample size: How many is enough? Australian Critical Care, 25(4): 271-274.

https://doi.org/10.1016/j.aucc.2012.07.002

Cardinal, C. (2008). Should Aboriginal healing practices be integrated into conventional medical care. CrossCurrents, 11(3): 20.

Chansonneuve, D. (2009). Presentation to the Select Committee on Mental Health and Addictions. Accessed on Jan 10, 2016 via http://minlodge.com/images/Presentation%20to%20the%20Select%20Committee%20on%20Mental%20Health%20and%20Addictions%20C%20(2)%20(2).pdf

Cook, Catherine (2012). Creating cultural safety for aboriginal people in urban health care. Deeply entrenched stereotypes about aboriginal people exist throughout Canadian society. Accessed on February 26, 2014 via http://www.thestar.com/opinion/editorialopinion/2012/12/23/creating_cultural_safety_for_aboriginal_people_in_urban_health_care.html

CCPA (Canadian Centre for Policy Alternatives) FAST FACTS, We All Work Together To Help One Another: The Story of Ma Mawi. Accessed on Nov 7, 2016 via https://www.policyalternatives.ca/sites/default/files/uploads/publications/Manitoba_Pubs/2009/FF_mamawi_091009.pdf

CCSA (Canadian Centre on Substance Abuse) (2013). When Mental Health and Substance Abuse Problems Collide. Accessed on Nov 7, 2016 via http://www.ccsa.ca/Resource%20Library/CCSA-Mental-Health-and-Substance-Abuse-2013-en.pdf

Crane, M. and Joly, L. (2014). Older homeless people: increasing numbers and changing needs. Reviews in Clinical Gerontology, 24(4): 255-268.

https://doi.org/10.1017/S095925981400015X

CIHI (Canadian Institute for Health Information), (2008). A Framework for Health Outcomes Analysis: Diabetes and Depression Case Studies (Ottawa: CIHI, 2008).

Coulehan, K., Brown, I., Christie, M., Gorham, G., Lowell, A., Marrnanyin, B., et al. (2005). Sharing the true stories: evaluating strategies to improve communication between health staff and Aboriginal patients: Stage 2 report. Darwin: Cooperative Research Centre for Aboriginal Health. Accessed on November 2, 2016 via http://www.lowitja.org.au/lowitja-publishing/C019.

CMHA (Canadian Mental Health Association) (2008a). Backgrounder: The Relationship between Mental Health, Mental Illness and Chronic Physical Conditions. Available via http://ontario.cmha.ca/public_policy/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/#.Uai5XECTiT4

CMHA (Canadian Mental Health Association) (2008b). What Is the Fit Between Mental Health, Mental Illness and Ontario's Approach to Chronic Disease Prevention and Management? Discussion Paper. Available via www.ontario.cmha.ca

CMHA (Canadian Mental Health Association) (2008c). Position Paper: Recommendations for Preventing and Managing Co-Existing Chronic Physical Conditions and Mental Illnesses. Available via http://ontario.cmha.ca/public_policy/recommendations-for-preventing-and-managing-co-existing-chronic-physical-conditions-and-mental-illnesses/#.Uai6QkCTiT4

CMHA (Canadian Mental Health Association) (2009). Diabetes and Serious Mental Illness: Future Directions for Ontario. Think Tank on Diabetes and Serious Mental Illness. Available via www.ontario.cmha.ca

Coodin, S. (2001). "Body Mass Index in Persons with Schizophrenia," Canadian Journal of Psychiatry, 46(6): 549‐555.

https://doi.org/10.1177/070674370104600610

Davis LL, Frazier E, Husain M, Warden D, Trivedi M, Fava M, et al. (2006). Substance use disorder comorbidity in major depressive disorder: A confirmatory analysis of the STAR*D cohort. American Journal on Addictions, 15(4):278-85.

https://doi.org/10.1080/10550490600754317

De Leeuw, S. and Greenwood, M. (2011). Beyond Borders and Boundaries: Addressing Indigenous Health Inequities in Canada through Theories of Social Determinants of Health and Intersectionality, in Olena Hankivsky, Sarah De Leeuw, Jo-Anne Lee, Bilkis Vissandjee and Nazilla Khanlou (eds) Health Inequities in Canada: Intersectional Frameworks and Practices. UBC Press: Vancouver, Toronto.

https://doi.org/10.59962/9780774819770-005

Denison, J., Varcoe, C., Brown, A. J. (2014). Aboriginal women's experiences of accessing health care when state apprehension of children is being threatened. Journal of Advanced Nursing, 70(5): 105-1116.

https://doi.org/10.1111/jan.12271

Deer, S. (2009). Decolonizing rape law: A Native feminist synthesis of safety and sovereignty. Wicazo Sa Review. Available via https://scholar.google.com/citations?view_op=view_citation&hl=en&user=5xCQInoAAAAJ&citation_for_view=5xCQInoAAAAJ:Y0pCki6q_DkC

Environic Institute. (2010). Urban Aboriginal Peoples Study: Main Report. Available via http://uaps.ca/wp-content/uploads/2010/03/UAPS-Main-Report_Dec.pdf

Feinstein AR: The pre-therapeutic classification of co-morbidity in chronic disease. J Chron Dis 1970, 23:455-469.

https://doi.org/10.1016/0021-9681(70)90054-8

Ghosh, H. (2013). Diversity, Disparity and Diabetes: Voices of Urban First Nations and Métis People, Health Service Providers and Policy Makers. Unpublished PhD Dissertation, University of Ottawa, Canada.

Goodwin, I. (2011). Diabetes, Mental Health & Aboriginal People Literature Review. Accessed on November 9, 2016 via https://www.nwac.ca/wp-content/uploads/2015/05/2011-NWAC-Diabetes-Mental-Health-and-Aboriginal-People-Literature-Review.pdf

Halseth, R. (2013). Aboriginal Women in Canada: Gender, socio-economic determinants of health, and initiatives to close the wellness-gap. Prince George, BC: National Collaborating Centre for Aboriginal Health.

Hiiye'yu Lelum House of Friendship (2016). Healthy Children Healthy Futures Program. Accessed on November 7, 2016 via http://hofduncan.org/?page_id=85

INAC (Indigenous and Northern Affairs Canada) (2016a). Urban Indigenous Peoples. Accessed on Nov 2, 2016 via https://www.aadnc-aandc.gc.ca/eng/1100100014265/1369225120949

INAC (Indigenous and Northern Affairs Canada) (2016b). Urban Aboriginal Strategy. Accessed on November 10, 2016 via https://www.aadnc-aandc.gc.ca/eng/1432837046128/1432837073962

Kraemer HC (1995). Statistical issues in assessing comorbidity. Stat Med 14:721-723.

https://doi.org/10.1002/sim.4780140803

Kirmayer, L., Brass, G. M. and Tait, C. L. (2000). The mental health of aboriginal peoples: transformations of identity and community. Canadian Journal of Psychiatry, 45:607-16.

https://doi.org/10.1177/070674370004500702

Kirmayer, L., Simpson, C., and Cargo, M. (2003). Healing traditions: Culture, community and mental health promotion with Canadian Aboriginal peoples. Australasian Psychiatry, 11:18.

https://doi.org/10.1046/j.1038-5282.2003.02010.x

Lavallée, L.F. & Howard, H.A. (2011). Urban Aboriginal Diabetes Research Project Report. Anishnawbe Health Toronto. Toronto, ON.

McEvoy et al. (2005). Prevalence of the Metabolic Syndrome in Patients with Schizophrenia: Baseline Results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial and Comparison with National Estimates from NHANES III. Schizophrenia Research, 80(1): 19‐32.

https://doi.org/10.1016/j.schres.2005.07.014

NAHO (National Aboriginal Health Organization) (2005). Ownership, Control, Access and Possession (OCAP) or Self-Determination Applied to Research: A Critical Analysis of Contemporary First Nations Research and Some Options for First Nations Communities. Available via http://www.naho.ca/documents/fnc/english/FNC_OCAPCriticalAnalysis.pdf.

NCCAH (National Collaborating Centre for Aboriginal Health). (2012). Challenging Hidden Assumptions: Colonial Norms as Determinants of Aboriginal Mental Health. Accessed on March 15, 2014 via http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/70/colonial_norms_EN_web.pdf

NCCAH (National Collaborating Centre for Aboriginal Health) (2013). Strengthening Urban Aboriginal Families: Exploring Promising Practices. Accessed on November 7, 2016 via http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/87/Urban_Families_EN_web.pdf

Newhouse, D. and Peters, E. (2003). Not Strangers in These Parts: Urban Aboriginal Peoples. Policy Research Initiative.

North East LHIN (2011). NE LHIN Aboriginal/First Nations and Métis Mental Health and Addictions Framework. Available via http://www.nelhin.on.ca/WorkArea/showcontent.aspx?id=12188

Reading, J. (2009). A Life Course Approach to the Social Determinants of Health for Aboriginal Peoples. Available via http://www.parl.gc.ca/Content/SEN/Committee/402/popu/rep/appendixAjun09-e.pdf

RCAP (Royal Commission on Aboriginal Peoples) (1996). Report of the Royal Commission on Aboriginal Peoples. Ottawa: Minister of Supply and Services Canada.

Shadid, S., Durey, A., Bessarab, D., Aoun, S. M., Thompson, S. C. (2013). Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Service Research, 13:460.

https://doi.org/10.1186/1472-6963-13-460

Schwandt, T. A. (2001). Qualitative inquiry: A dictionary of terms (2nd ed.). Thousand Oaks, CA: Sage.

Smye, V. (2008). Research Summary: Aboriginal Peoples' Experiences of Mental Health and Addictions Care. Accessed Jan 23, 2013 via http://www.heretohelp.bc.ca/visions/aboriginal-people-vol5/research-summary

Spence, D. (2001). Hermeneutic notions illuminate cross cultural nursing experiences. Journal of Advanced Nursing, 35(4):624-630.

https://doi.org/10.1046/j.1365-2648.2001.01879.x

Starfield B. (2011). Challenges to primary care from co- and multi-morbidity. Primary Health Care Research and Development, 12(1):1-2.

https://doi.org/10.1017/S1463423610000484

Tait, C. (2013). Resituating the Ethical Gaze: Government Morality and the Local Worlds of Impoverished Indigenous Women. International Journal of Circumpolar Health, 72. Accessed on November 2, 2016 via http://www.circumpolarhealthjournal.net/index.php/ijch/article/view/21207?trendmd-shared=0

https://doi.org/10.3402/ijch.v72i0.21207

TCPS (Tri-Council Policy Statement) (2010). Ethical Conduct for Research Involving Humans. Available via http://www.pre.ethics.gc.ca/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf

UAKN (Urban Aboriginal Knowledge Network) (2012). The Urban Aboriginal Middle Income Groups in Canada: A Demographic Profile. Available via http://uakn.org/wp-content/uploads/2014/05/2012-UAKN-Research-Paper-Series_The-Urban-Aboriginal-Middle-Class-in-Canada_Dr.-Amanda-Parriag-and-Paul-Chaulk1.pdf

Varcoe, C. (2004). Context/Culture: Unpublished Collaborative Nursing Program in BC Curriculum Guide. Vancouver: Collaborative Nursing Program in British Columbia.

Ware, V-A. (2013). Improving the accessibility of health services in urban and regional settings for Indigenous people. Australian Institute of Health and Welfare, Canberra. Accessed on November 2, 2016 via https://www.aihw.gov.au/getmedia/7a8484b3-5c43-4aa2-9228-72cba0ca7f94/ctg-ip08.pdf.aspx?inline=true

Wesley-Esquimaux, C. C. & Smolewski, M. (2004). Historic trauma and Aboriginal healing. Ottawa: Aboriginal Healing Foundation.

Wilson, K. (2003). Therapeutic landscapes and First Nations peoples: an exploration of culture, health and place. Health & Place, 9(2): 83-93.

https://doi.org/10.1016/S1353-8292(02)00016-3

Wylie, L. & McConkey, S. (2014). Insiders' Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals. Journal of Racial and Ethnic Health Disparities, 1(4): 1-10

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