Improving access to cancer care together with Indigenous peoples
Authors: Pam Tobin, Usman Aslam, Craig Earle, Alethea Kewayosh
Journal: The Lancet Global Health (2018)

Under the Canada Health Act, all Canadians are given access to universal health care, including cancer care. However, many First Nations, Inuit, and Métis peoples have poor quality health care and outcomes. Several factors affect this, but the most relevant is equitable access to care. Following the Truth and Reconciliation Commission, there is growing attention to the role of reconciliation in programme and policy development and in implementation of health services, particularly of cancer services. Here we discuss opportunities to incorporate reconciliation practices across the continuum of care that supports the diversity of Indigenous communities, geography, and stakeholders throughout Canada, and relate them to other Indigenous populations worldwide. Guided by the essential component of building productive working relationships with First Nations, Inuit, and Métis leadership, health networks, and communities based on trust and mutual respect, Cancer Care Ontario's Aboriginal Cancer Strategy can be seen as a best practice. Other examples include those to meet the calls to action from the Truth and Reconciliation Commission that have been implemented within the Canadian Strategy for Cancer Control. In 2002, Cancer Care Ontario completed a needs assessment to further understand the growing disparities in cancer care among Ontario's First Nations people. This work led to the development of Cancer Care Ontario's first Aboriginal Cancer Strategy (2004–09) that identified key strategic priorities to improve cancer care. With the launch of the second Aboriginal Cancer Strategy in 2012, Cancer Care Ontario's Aboriginal Cancer Control Unit recognised the need to develop relationships with all of Ontario's First Nations, Inuit, and Métis peoples to become more effective in improving care. Since the Aboriginal Cancer Strategy II (2012–15), Cancer Care Ontario has been formalising these relationships by signing agreements with First Nations, Inuit, and Métis leadership that outline Cancer Care Ontario's commitment to improving cancer control with and for Ontario's First Nations, Inuit, and Métis communities through its successive Aboriginal Cancer Strategies. Through the working relationships established with First Nations, Inuit, and Métis communities and organisations, built on mutual trust and understanding, Cancer Care Ontario has jointly published reports detailing the prevalence of modifiable cancer risk factors (eg, commercial tobacco and alcohol use, healthy eating, and physical activity) and cancer screening participation in First Nations,1Chiefs of Ontario, Cancer Care Ontario. Cancer in First Nations in Ontario: risk factors and screening. Toronto, ON, 2016.Google Scholar Inuit,2Tungasuvvingat InuitCancer Care OntarioCancer risk factors and screening among Inuit in Ontario and other Canadian regions. Cancer Care Ontario, Toronto, ON2017Google Scholar and Métis3Métis Nation of OntarioCancer Care OntarioCancer in the Métis people of Ontario. Cancer Care Ontario, Toronto, ON2015Google Scholar populations in Ontario. The findings show that First Nations, Inuit, and Métis peoples had a higher prevalence of exposure to cancer risk factors and lower participation in some screening programmes than non-Aboriginal people in Ontario. This work continues to guide Cancer Care Ontario in its current Aboriginal Cancer Strategy III (2015–19) to further improve cancer control initiatives working with and for Ontario's First Nations, Inuit, and Métis communities. As steward of the Canadian Strategy for Cancer Control, the Canadian Partnership Against Cancer (the Partnership) has a strong commitment to cancer care improvement for First Nations, Inuit, and Métis peoples in its pan-Canadian programming. From 2014–17, ten provinces and territories participated in a large-scale, multimillion dollar initiative funded and led by the Partnership to identify the barriers to accessing the cancer system, from diagnosis delivery through to transitions in care, and to examine opportunities to close the gaps. Knowledge mobilisation was an important component of this work, in which jurisdictions had ongoing opportunities to share methods and results and to learn from one another. Shared efforts such as these have yielded results and key learnings related to effecting systemic change through unique modes of collaboration to improve the cancer experience for First Nations, Inuit, and Métis partners, patients, and families. Efforts to embed reconciliation in cancer care must go beyond education about Canada's history and colonial legacy. Work to ameliorate the cancer challenges faced by First Nations, Inuit, and Métis peoples must be two-fold: (1) Indigenous partners must guide the priorities that are relevant on a regional and local basis to patients and families going through a cancer journey; and (2) cancer agencies and organisations must be involved in initiatives to effect system change that is relevant to and guided by Indigenous knowledge. Formal agreements between agencies and communities will enable the improvement of access to, and enhance the efficacy of, the cancer system for First Nations, Inuit, and Métis peoples. Access to cancer care is an ongoing challenge for First Nations, Inuit, and Métis peoples in Canada. We know that Indigenous knowledge must guide change in the cancer system for change to be sustainable. Further ameliorating cancer control will continue to rely on meaningful partnerships with shared goals and innovative approaches that address population-level health inequities and community-level priorities. We declare no competing interests.