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Healing Intersectional Disparities | Steps to health & wellness inclusivity

       The previously discussed disparities in LQBTQ+ Indigenous health have been perpetuated during the COVID-19 pandemic. Members of intersectional minority communities are faced with numerous barriers to maintaining and improving their health conditions. However, many solutions exist to counter these disparities by focusing on underlying societal issues that allow them to persist. Improvement in health conditions for LGBTQ+ members of indigenous communities revolves around restoring their autonomy and must be supported by strategic action and implementation of policy.

       According to the World Health Organization, approaches for improving health must focus on the “process of enabling people to increase control over, and improve, their health,” that includes “a wide range of social and environmental interventions.” LGBTQ+ and indigenous communities have had this control taken from them via social exclusion and historical processes. As presented in the previous blog post, LGBTQ+ members of indigenous communities are in the intersectional crosshairs of social exclusion from western societies. Adding to the barriers to health that this exclusion creates, indigenous communities around the globe also struggle to maintain their lifestyles and harmony with surrounding environments due to issues that have arisen from colonization, displacement, and pollution of their land from external sources. Unable to obtain proper nutrition and maintain cultural practices that were previously available and utilized to maintain health, many find themselves forced to abandon tradition and begin to rely on store-bought foods. Some reservations have even been so polluted that they have been kept on external water supplies for decades. This is the case in Neskantaga, Ontario, where Indigenous families have been provided with minimal numbers of water bottles flown into the area each week since 1995 (Vice, 2015). Since the government refuses to fund proper, self-sustaining water purification plants in the area, the community suffers from a dependance on external sources for their survival, reportedly contributing to a peak in suicides in the community. This example illustrates the need for multi-level solutions that do not stop with topical fixes, but remedy root problems preventing prosperous life in intersectional minority communities.

       Multi-level solutions target the contexts which create disparities and are essential in restoring LBTQ+ and indigenous health. Topical fixes—such as sending water into communities –do not address deeper issues of wellness. Understanding indigenous practices and incorporating traditional ideas into normative society is imperative to give them back control of their health. The concept of “two-eyed seeing” is that of co-learning and co-analyzing Indigenous knowledges with western knowledge (Howard, 2018). Two-eyed seeing creates space for cultures to blend and provide opportunities for indigenous communities to support their ideals of wellness. Furthermore, this has been practiced in Guatemala and other Latin American countries, where local indigenous and western medicine have been used to create intercultural models of primary healthcare (Hernández et al., 2017).

       To promote intercultural policies and monitor improvements, we must move away from deficit/risk-focused research and replace it with cultural-specific resilience research. Risk-research has negative connotations in the healthcare industry and overlooks the capacity of communities to maintain their own health in spite of intercultural challenges (Colpitts and Gahagan 2016). Contrarily, resilience-focused methods to observe health progression can be adapted to intersectional perspectives and methods of maintaining and improving health. The term itself takes into account external factors presenting barriers to health and wellness. Additionally, Hernández et al. call for a “complexity-sensitive evaluation” approach test the logic behind programs being implemented, to ensure multi-level action. Policies that are therefore inclusive of Indigenous and LGBTQ+ perspectives will continuously and sustainably improve these communities, opposed to simply mitigating damages.

       Improvement in health conditions for LGBTQ+ members of indigenous communities revolves around their autonomy and must be supported by strategic action and implementation of policy. Opening the eyes of western medicine to accept Indigenous knowledges makes room for the implementation of intercultural policy and pro-equity reforms. Solving multi-level issues will resolve health issues exasperated by the COVID-19 pandemic and prevent further discrepancies in health.

Sources

World Health Organization. “Health Promotion.” World Health Organization, www.who.int/health-topics/health-promotion.

Vice. “Canada's Waterless Communities: Neskantaga.” YouTube, YouTube, 8 Oct. 2015, www.youtube.com/watch?v=Gsg6eUhFDDo.

Howard, Heather A. “Settler Colonial Biogovernance and the Logic of a Surgical Cure for Diabetes.” American Anthropologist, vol. 120, no. 4, Dec. 2018.

Hernández, A., Ruano, A.L., Marchal, B. et al. Engaging with complexity to improve the health of indigenous people: a call for the use of systems thinking to tackle health inequity. Int J Equity Health 16, 26 (2017). https://doi.org/10.1186/s12939-017-0521-2

Colpitts, E., Gahagan, J. The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health. Int J Equity Health 15, 60 (2016). https://doi.org/10.1186/s12939-016-0349-1

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We need to move beyond the reductionist tendency to frame indigenous health as a problem of poor health indicators to be solved through targeted service delivery tactics and move towards holistic, integrated approaches that address the causes of inequalities both inside and outside the health sector.

Hernández, A., Ruano, A.L., Marchal, B. et al. Engaging with complexity to improve the health of indigenous people: a call for the use of systems thinking to tackle health inequity. Int J Equity Health 16, 26 (2017). https://doi.org/10.1186/s12939-017-0521-2

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COVID-19 and Identity| LGBTQ+ members of indigenous communities face intersecting barriers to wellness.

      In order to contextualize the issues surrounding LGBTQ+ indigenous health, it is necessary to understand the perception of sexual identities among indigenous communities, the clash of these identities in surrounding cultures, and the consequences that result. Among indigenous communities, the perception of sexual identities varies. Spiritual and societal roles can become enmeshed with sexual expression, leading to unique experiences for LGBTQ+ members of indigenous communities. However, when surrounding cultures impose homophobic and exclusionary standards, members of these intersecting communities are confronted with intersecting barriers to health and wellness. These barriers are exasperated during pandemics and pose serious threats to these communities.

      In the Smithsonian blog, National Museum of the American Indian, Dennis Zotigh relays statements made by members of indigenous communities relating to sexuality and LGBTQ+ roles in their societies. A variety of responses are reported ranging from indifference to acceptance and celebration of their LGBTQ+ members. Importantly noted in the collection of statements is the difference in perception of non-heteronormative sexualities. A common term used for those who take up roles typically occupied by those of the opposite sex is Two Spirit, and often used to people identifying as part of the LGBTQ+ community within indigenous communities. Many interviewees shared that these people were respected and contributed greatly to their communities and as many as twenty-four American tribes were identified as recognizing gay marriage (Zotigh, 2020).

      This level of integration of non-heteronormative roles is not, however, found in the history of western culture. Zotigh’s blog notes, “European contact, conquest, and expansion disrupted the community and ceremonial roles of LGBTQ Natives, along with other cultural traditions, and imposed new values through Christian religion.” Among numerous difficulties in clashing cultures, the development of western values marginalized those of Two Spirit, or LGBTQ+ communities, found in indigenous societies.

      Currently, members of LGBTQ+ communities face numerous health disparities and challenges to wellness. Members of the LGBTQ+ community are five percent more likely to be without health insurance and six percent more likely to face poverty than their non-LGBTQ+ counterparts (Salerno et al., 2020). Furthermore, LGBTQ+ members of intersecting marginalized groups statistically have worse living conditions than those outside the community (Salerno et al., 2020). This includes low-income housing and little access to relevant technologies that have been used to provide online support for those suffering psychological harm during the pandemic (e.g. online counseling or therapy). These conditions leave those in intersectional marginalized communities more vulnerable to the negative impacts of the COVID-19 pandemic.

Sources:

Zotigh, Dennis. “Pride Month 2020: Perspectives on LGBTQ Native Americans in Traditional Culture.” Smithsonian.com, Smithsonian Institution, 16 June 2020, www.smithsonianmag.com/blogs/national-museum-american-indian/2020/06/17/pride-2020/.

https://www.smithsonianmag.com/blogs/national-museum-american-indian/2020/06/17/pride-2020/

Salerno, John P., et al. “LGBTQ Populations: Psychologically Vulnerable Communities in the COVID-19 Pandemic.” Psychological Trauma: Theory, Research, Practice, and Policy, vol. 12, no. S1, 2020, doi:10.1037/tra0000837.

https://psycnet.apa.org/fulltext/2020-41743-001.html

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Quote Source: 

Zotigh, Dennis. “Pride Month 2020: Perspectives on LGBTQ Native Americans in Traditional Culture.” Smithsonian.com, Smithsonian Institution, 16 June 2020, https://www.smithsonianmag.com/blogs/national-museum-american-indian/2020/06/17/pride-2020/ . 

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Pandemics | An Intersectional Issue

Although we are in the midst of a pandemic, and research is still being conducted on how this new disease is impacting the world, we need not look far into our past to see patterns of disproportional health impacts on Indigenous communities. In 1918, the Spanish Influenza pandemic caused devastations in Indigenous communities across the world. The mortality rate of the Māori people in New Zealand was seven times higher than that of their European population (Power, Tamara, et al., 2020). In Canada, the First Nations people experienced eight times the loss of non-First Nations (Power, Tamara, et al., 2020). Similar figures were reported for the 2009 H1N1 Influenza pandemic. Indigenous peoples of Australia, Pacific Islands, America (including Alaska), and Canada were three to seven times more likely to be hospitalized and three and a half to seven times more likely to die than non-Indigenous people (Power, Tamara, et al., 2020).

The roots of such large discrepancies in health can be traced back to colonialism and the long-lasting impact of cultural oppression and erasure. Colonization has been widely proven to be the instigator of many negative health determinants and issues experienced by Indigenous peoples. Among these are “poverty, poor physical and mental health, transport and housing issues, increased rates of domestic and family violence, shorter life expectancy and inadequate access to culturally safe care” (Power, Tamara, et al., 2020). These health determinants lead to increased exposure and risk of hospitalizations/death during public health crises, such as the COVID-19 pandemic.

However, some members of Indigenous communities are faced with additional challenges. Just as a dominant culture and political body can subject Indigenous peoples to intolerance and racism, LGBTQ+ members of Indigenous communities also face intersecting discrimination based on their sexual identity. Facing additional barriers to wellness and care, members of this community often have higher risks of harm and isolation (Péta Phelan, 2020).

Health discrepancies in health are causing numerous preventable deaths of Indigenous peoples around the world. Autonomy is needed to promote wellness in Indigenous communities who have been forced into societies that have long histories of neglecting and abusing native land and people.  Aiding LGBTQ+ members of Indigenous communities requires initiatives that are headed by members of these communities, with ample national support and resources. In Australia, it has already been proven that Indigenous communities fare much better when deciding for themselves their response to the COVID-19 pandemic (Péta Phelan, 2020). With the same regard, making space for LGBTQ+ Indigenous voices in discussions involving their communities can greatly improve their situation and prevent health disparities from continuing. Attend their stories, accept their council, and acknowledge their strength to prevail.

Sources

Power, Tamara, et al. “COVID‐19 and Indigenous Peoples: An Imperative for Action.” Journal of Clinical Nursing, vol. 29, no. 15-16, 2020, pp. 2737–2741., doi:10.1111/jocn.15320.

https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.15320

Péta Phelan, University of Melbourne. “Multiple Jeopardy: COVID-19 and Indigenous LGBTIQ+ Lives.” Pursuit, The University of Melbourne, 21 Oct. 2020, pursuit.unimelb.edu.au/articles/multiple-jeopardy-covid-19-and-indigenous-lgbtiq-lives.

https://pursuit.unimelb.edu.au/articles/multiple-jeopardy-covid-19-and-indigenous-lgbtiq-lives

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Information Source: 

Power, Tamara, et al. “COVID‐19 and Indigenous Peoples: An Imperative for Action.” Journal of Clinical Nursing, vol. 29, no. 15-16, 2020, pp. 2737–2741., doi:10.1111/jocn.15320. https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.15320

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COVID-19 & The LGBTQ Indigenous Community

The impacts of COVID-19 have been devastating for communities around the globe. Although many of us now share similar stories of loss and isolation, Indigenous communities around the globe have been experiencing these tragedies for generations, the virus presenting yet another threat to their health and being. Ongoing battles for access to healthcare, differences in definitions of health/wellbeing, and racism have posed severe barriers to care for many Indigenous communities. The goal of this blog is to bring to light the health disparities that exist in this marginalized community. Focusing on members of the LGBTQ community, Health for Humans aims to compile individual experiences as well as review policy which impacts this group of people.