An exploratory study on how structural racism influences chronic disease and health and wellness of First Nations in Canada

Background: Indigenous peoples in Canada experience disproportionately higher rates of chronic disease than their non-Indigenous counterparts. Previous research has identified structural racism as a powerful determinant of health and well-being. Mounting evidence demonstrates First Nations are disproportionately overrepresented, compared to other Canadians, in several domains that have been used to measure structural racism in other countries. Despite growing concern of the impact of structural racism on health, there remains little empirical evidence on the impact structural racism has on chronic disease health outcomes of First Nations. Purpose: The purpose of this study is to examine the complex and intersecting ways in which structural racism can influence chronic disease health outcomes and overall health and wellness of First Nations in Canada. Methods: In-depth semi-structured interviews were conducted with twenty-five participants including subject matter experts in health, justice, education, child welfare, politics, and researchers in racism scholarship and First Nations who have lived experience with a chronic condition(s). Thematic analysis was used to analyze data collected. Results: The findings highlight the ways in which structural racism is pervasive across all domains within Canadian society. Six themes emerged on how structural racism influences chronic disease and the health of First Nations: (1) multiple and intersecting pathways; (2) systems of failure, harm, and indifference; (3) impacts access to healthcare; (4) colonial policies of structural deprivation; (5) increases risk factors for chronic disease and poor health; and (6) structural burden leading to individual level outcomes. To address structural racism, five themes emerged: (1) accountability and consequences; (2) Indigenous authority and representation; (3) anti-racism praxis; (4) education and training; and (5) legislative and policy reform. Approaches to measure progress towards addressing structural racism and types of measures were identified. Potential indicators that could be used to measure experiences of structural racism affecting First Nations are presented. Conclusions: Structural racism creates an ecosystem that negatively impacts chronic disease and health of First Nations. This study identifies Indigenous-specific approaches to addressing and measuring structural racism in Canada. Future research into the development of evidence-based interventions and testing the reliability and validity of structural racism indicators is required.