Enhanced Skills Program: Indigenous Health Program Rationale

Canada’s indigenous peoples have rich and unique histories and cultures that must be recognized by every health care provider. Colonization, racism, and inequity disproportionately affect their current political, health and social circumstances (1). It is important for healthcare providers to become familiar with this information in order to work with indigenous peoples in a safe, respectful, and knowledgeable way.

In 2011, there were approximately 1.4 million indigenous people living in Canada, about 62% of whom lived off reserve (2). Canada was home to 859,970 First Nations people, 451,795 Métis, and 59,445 Inuit, with the rest reporting other indigenous identities (26,485) or more than one indigenous identity (11,415). From 2006 to 2011, the First Nations population in Canada increased by 23%, while the Métis population rose by 16%, and the Inuit population by 18%. According to 2011 Census data, off-reserve indigenous people constitute the fastest growing segment of Canadian society. In 2011, 56% of Aboriginal people lived in urban areas, up from 49% in 1996 (3).

By many standards, life for indigenous Canadians is more difficult than for non-indigenous Canadians. Their life span is 5-10 years less than the average Canadian (4), they suffer a greater incidence of ill health throughout their lifespan when compared with non-indigenous Canadians (5), and they are less likely to enjoy many of the privileges and amenities the majority of Canadians take for granted (1).

There are many significant health and social challenges facing indigenous communities and their health care providers including poverty, chronic disease, mental illness, suicide and substance abuse. People living on reserve often are challenged with inadequate and crowded housing and unsafe water (1). There also exists the phenomenon of circular migration, where indigenous individuals are pushed to migrate more than the general population in order to access resources such as employment, education, health care services, housing, etc. (Francoise Juneau, personal communication, 6). Throughout the years, indigenous peoples have endured these conditions with a resiliency seldom seen elsewhere in Canada (1).

Physicians interested in working with indigenous populations need to be better prepared. They should be competent clinically, which includes knowledge of and experience in cross-cultural communication including non-verbal cues (7). It is imperative that they are also aware of and sensitive to the historical, political and cultural issues that impact on Indigenous peoples’ health. They should be familiar with indigenous concepts of health and healing to ensure the inclusion of spiritual practices and relationship with the community.

The Indigenous Health Enhanced Skills Program strives to improve the knowledge, skills and attitudes of the trainee with respect to determinants of health, health status, and concepts of health and healing specific to indigenous populations.  In addition, the program will allow the trainee to improve clinical and advocacy skills to prepare them to practice with, and advocate for and with indigenous peoples in urban and/or rural/remote areas of Canada.

This residency program can be either six or twelve month long.



  1. J. Smylie et. al. A Guide for Health Professionals Working with Aboriginal Peoples. Journal of the Society of Obstetricians and Gynaecologists of Canada, December 2000 (100)
  2. Statistics Canada 2011 http://www.statcan.gc.ca/pub/89-656-x/89-656-x2015001-eng.htm#a2 
  3. Statistics Canada 2011 https://www.aadnc-aandc.gc.ca/eng/1100100014265/1369225120949
  4. Canadian Population Health Initiative, Improving the Health of Canadians (Ottawa: Canadian Institute for Health Information, 2004) at 80[CPHI]
  5. Y. Boyer October 2004 National Aboriginal Health Organization - Discussion Paper Series in Aboriginal Health: Legal Issues No.3 The International Right to Health for Indigenous Peoples in Canada
  6. Bird, M. 2002. Clinicians’ guide:  working with Native Americans living with HIV. National Native American AIDS Prevention Center. Oakland, CA (pp. 78)
  7. Kelly and Brown, Canadian Family Physician October 2002 48:1645. http://meds.queensu.ca/familymedicine/residency/index.php/aboriginal_health