# data[].attributes.attachment_link.title
Bestselling Virtual Author Talk with Angela Sterritt - MMIWG+

# data[].attributes.body
Applicable Role:

Applicable Module:

Applicable Domains:

# data[].attributes.headline
Truth and Reconciliation Commission of Canada: Calls to Action 

# data[].attributes.subject
Truth and Reconciliation Commission of Canada: Calls to Action 

# data[].attributes.attachment_link.title
Doctrine of Discovery: Stolen lands, Strong Hearts

# data[].attributes.headline
Nunami iliharniq (Learning from the land): Reflecting on relational accountability in land-based learning and cross-cultural research in Uqšuqtuuq (Gjoa Haven, Nunavut)

# data[].attributes.subject
Nunami iliharniq (Learning from the land): Reflecting on relational accountability in land-based learning and cross-cultural research in Uqšuqtuuq (Gjoa Haven, Nunavut)

# data[].attributes.headline
The Eight Ujarait (Rocks) Model: Supporting Inuit Adolescent Mental Health With an Intervention Model Based on Inuit Knowledge and Ways of Knowing

# data[].attributes.subject
The Eight Ujarait (Rocks) Model: Supporting Inuit Adolescent Mental Health With an Intervention Model Based on Inuit Knowledge and Ways of Knowing

# data[].attributes.attachment_link.title
View of The Eight Ujarait (Rocks) Model: Supporting Inuit Adolescent Mental Health With an Intervention Model Based on Inuit Ways of Knowing | International Journal of Indigenous Health

# data[].attributes.attachment_link.description
← Return to Article Details The Eight Ujarait (Rocks) Model: Supporting Inuit Adolescent Mental Health With an Intervention Model Based on Inuit Ways of Knowing

# data[].attributes.headline
Draft Principles that Guide the Province of British Columbia’s Relationship with Indigenous Peoples

# data[].attributes.subject
Draft Principles that Guide the Province of British Columbia’s Relationship with Indigenous Peoples

# data[].attributes.body
Also relevant to Inter-professional Communication

# data[].attributes.headline
BC Cultural Safety and Humility Standard

# data[].attributes.subject
BC Cultural Safety and Humility Standard

# data[].attributes.attachment_link.readable_text
What's covered

HSO standards are the foundation on which leading-edge accreditation programs and great public policy are built. Standards create a strong health care structure that the public, providers, and policy makers can rely on, assuring high quality health services where it matters most.

HSO's standards are formatted using the following structure:

Section Title: A section of the standard that relates to a specific topic.

: A thematic statement that introduces a set of criteria.

: Requirements based on evidence that describe what is needed by people to achieve a particular activity. Each criterion outlines intent, action, and accountability.

Guidelines: Provide additional information and evidence to support the implementation of each criterion.

This is the first edition of HSO 75000:2022(E) British Columbia Cultural Safety and Humility standard. The target audiences are governing bodies, organizational leaders, teams, and the workforce from health authorities and health and social services organizations in the province of British Columbia (BC), Canada. The standard helps governing body members and organizational leaders identify, measure, and achieve culturally safe systems and services that better respond to the health and wellness priorities of First Nations, Métis, and Inuit peoples and communities, regardless of where they are located. A number of foundational documents, including the following supporting documentation and legislative commitments, were used to inform the content of the standard.

Supporting documentation are significant reports pertaining to Indigenous-specific racism and/or discrimination as well as truth and reconciliation.

1. In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care (Full and Summary Reports) (2020a)

2. Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls (National Inquiry into Missing and Murdered Indigenous Women and Girls, 2019)

3. Truth and Reconciliation Commission of Canada Calls to Action (Truth and Reconciliation Commission of Canada, 2015a)

4. Report of the Royal Commission on Aboriginal Peoples (Canada et al.,1996)

Legislative commitments are based on Canadian and/or international legal commitments to which Canada has subscribed.

1. United Nations Declaration on the Rights of Indigenous Peoples (United Nations, 2007)

2. Canadian Human Rights Act (1985)

3. Constitution Act, Part II, Rights of the Aboriginal Peoples of Canada, Section 35 (1982)

The standard will be available to health and social services organizations as a resource document.

BC health organizations can contact HSO to have access to a copy at no cost. If enrolled in accreditation with Accreditation Canada, the standard is available on the client organization portal.

The standard will undergo periodic maintenance. HSO will review and re-publish the standard on a five-year schedule.

Who this standard is for

Purpose

This standard specifies the requirements for governing bodies, organizational leaders, teams, and the workforce from health authorities and health and social services organizations to address Indigenous-specific racism in service delivery and provide culturally safe services to First Nations, Métis, and Inuit peoples and communities in BC.

The standard applies to First Nations, Métis, and Inuit peoples' health and wellness journeys across the health system, including health promotion and disease prevention, access to health and social services, admission, assessment, treatment, discharge, and end-of-life care. The standard provides guidance as to the organizational structures and procedures that are required in governance, leadership, and service provision to support anti-racism and cultural safety and humility and ensure the delivery of health and social services that are aligned with Indigenous traditions and values.

Applicability

This standard is intended to be used by governing bodies, organizational leaders, teams, and the workforce from health authorities and health and social services organizations in the province of British Columbia (BC) to support the design, development, and implementation of health and social services and care delivery that respects cultural safety and humility principles.

BC health organizations can contact HSO to have access to a copy at no cost. If enrolled in accreditation with Accreditation Canada, the standard is available on the client organization portal.

Questions about this standard? Want more information?

← All Standards

# data[].attributes.attachment_link.title
British Columbia Cultural Safety and Humility Standard

# data[].attributes.attachment_link.description
HSO Standards: HSO's Leadership Standards for Health Service Providers. Full description and additional information.

# data[].attributes.wish_content.attachment_props.alternative_text
9725 Distinctions Based Approach Primer Report (gov.bc.ca)

# data[].attributes.headline
Declaration Act - Annual Report (Supports BC DRIPA)

# data[].attributes.subject
Declaration Act - Annual Report (Supports BC DRIPA)

# data[].attributes.body
Declaration Act Annual Report - Province of British Columbia (gov.bc.ca)

# data[].attributes.attachment_link.provider_name
Declaration Act - Government of British Columbia

# data[].attributes.attachment_link.readable_text
Joint message from the Premier of B.C. and the Minister of Indigenous Relations and Reconciliation and Declaration Act Secretariat

We are pleased to present the fourth Declaration Act Annual Report, which details our shared work between April 1, 2022 and March 31, 2023 to implement the UN Declaration on the Rights of Indigenous Peoples (UN Declaration) in the province - done in consultation and co-operation with Indigenous Peoples.

The 2022/23 Declaration Act Annual Report is an important milestone: it is the first report back since the launch of the Declaration Act Action Plan and the Declaration Act Secretariat.

The report includes a summary of work by the Declaration Act Secretariat - established in 2022 - and provides an update on progress to align provincial laws with the UN Declaration.

We're launching this year's Declaration Act Annual Report as part of a redesigned Declaration Act website. Our goal is to provide indicators and detailed reporting for the 32 Action Plan items initiated to date - showing the highlights, the challenges we face, and the transformational work ahead as we implement the plan. As we continue working on all 89 actions, a new dashboard will provide a snapshot of our status.

At the heart of the redesigned website are the words and voices of Indigenous Peoples, based on their lived experiences. Read about First Nations members who are restoring clam gardensthroughout the Nuu-chah-nulth territory. Or hear how the Okanagan Indian Band is reconnecting its members to their culture, language, and community with a new housing project.

On the website, you'll be able to listen to the voices of two Dakelh language revitalization experts. Or watch a video to understand how a historic agreement will transform the way the Province and First Nations work together to steward land, water and resources in the Northeast.

We hope you will take the time to explore the redesigned Declaration Act website and see how we are reporting on progress in a more accessible, transparent, cooperative and impactful way.

# data[].attributes.headline
BC Cultural Safety and Humility Standard Documentary

# data[].attributes.subject
BC Cultural Safety and Humility Standard Documentary

# data[].attributes.attachment_link.title
BC Cultural Safety and Humility Standard Documentary

# data[].attributes.body
Applicable Role: All

Applicable Modules: All

Applicable Domains: 1

# data[].attributes.attachment_link.description
The UBC Learning Circle welcomes everyone to be part of the learning journey! We welcome you to take part in the UBC Learning Circle, an ongoing video conference and computer webinar initiative that encourages sharing knowledge about our health and well-being. The UBC Learning Circle is a partnership between the Centre for [...]

# data[].attributes.headline
Course - PHSA Anti-Indigenous Racism Response Training

# data[].attributes.subject
Course - PHSA Anti-Indigenous Racism Response Training

# data[].attributes.attachment_link.title
PHSA - Anti-Indigenous Racism Response Training

# data[].attributes.attachment_link.description
This search is limited to only those courses that are available to the General Public and will not populate with the full course catalog. Please login or sign up for a LearningHub account to search the full course catalog.

# data[].attributes.headline
PHSA IH Self Directed Learning Resources

# data[].attributes.subject
PHSA IH Self Directed Learning Resources

# data[].attributes.body
Self-Directed Learning Resources (phsa.ca)

# data[].attributes.attachment_link.readable_text
Let's talk: Racism and health equity
Cette ressource est également disponible en français.
The seventh release in our Let's Talk series discusses racism as a critical factor that impacts health and wellbeing. It describes the concepts of race, racism and racialization and emphasizes settler colonialism and structural racism as the root causes of health and social inequities experienced by Indigenous and racialized peoples in Canada.

The resource includes discussion questions designed to help public health staff examine their work and consider how they can orient practice towards critical, decolonizing and anti-racist approaches. In addition, the questions ask practitioners to consider how beliefs and stereotypes may influence their practice.

This Let's Talk provides tips for embracing critical, decolonizing and anti-racist approaches in public health practice and discusses roles public health can engage in to address racism.

We've selected a number of tools and resources that public health practitioners can use in acting to eliminate racism. These can be found in "Key public health resources for racism and health equity: A curated list" (in publication)

Use this resource to:

describe key concepts related to race and racism;

explain the relationship between racism and wellbeing;

identify entry points for anti-racism work in public health; and

support a conversation in your organization about how to develop strategies to eliminate racism.

Related resources:

Companion document: Key public health resources for anti-racism action: A curated list
Learning from Practice: Advocacy for health equity - Environmental racism More from the Let's Talk Series
Reference

National Collaborating Centre for Determinants of Health. Let's Talk: Racism and health equity. (2018). Antigonish, NS: NCCDH, St. Francis Xavier University.

Tags: Community engagement, Cultural Safety, Healthy public policy, Indigenous health, Key concepts, Leadership & capacity building, Racism/racialization, Participate in policy development, Partner with other sectors, Document, Report / Document, Let's Talk

# data[].attributes.attachment_link.description
Encourages public health practitioners to act on racism as a key structural determinant of health inequities....

# data[].attributes.headline
IH Leadership Orientation to Aboriginal Partnerships

# data[].attributes.subject
IH Leadership Orientation to Aboriginal Partnerships

# data[].attributes.body
Applicable to all roles and modules. Domain 8

# data[].attributes.headline
BC Patient Safety and Quality Council. Culturally safe engagement: what matters to Indigenous Patient partners?

# data[].attributes.subject
BC Patient Safety and Quality Council. Culturally safe engagement: what matters to Indigenous Patient partners?

# data[].attributes.attachment_link.readable_text
New Companion Guide and Pamphlet

How do we know when we've achieved cultural safety? When both sides leave feeling content. This is one answer shared as we met with Indigenous patient partners during a recent project to develop resources about culturally safe patient engagement. It was co-created with Indigenous patient partners based on conversations at an event hosted by us in June 2021.
Companion Guide
The event was co-designed and co-facilitated by First Nations patient partner, the late Gitxsan Hereditary Chief Sim'oogit Ma'os, Bill Blackwater Jr., Tammy Hoefer, Director of Patient & Public Engagement and Cathy Almost, Engagement Leader. Indigenous (First Nations, Métis and Inuit) patient partners were asked what mattered to them when participating in culturally safe patient engagement opportunities. Health care partners were invited to attend as witnesses to the patient partners' stories by being compassionate and silent observers, giving attention to others without judgement and providing a space for partners to speak their truth.

It was held in celebration of International "What Matters to You?" Day in British Columbia. When providers have a conversation about what really matters to the people they care for, it helps ensure that care is aligned with patient preferences, builds trusting relationships between patients, families and their health care providers, and advances person- and family-centred care.

Following the event, discussion notes were themed and eight key principles emerged:

Awareness & Understanding

Learning & Education

Build Relationships

Prepare

Kindness & Empathy

Respect

Value

Listen

Themes were developed into key messages, recommendations and actions. Bert Azak, a Nisga'a graphic designer, contributed his artwork and designed two resources: an at-a-glance document which summarizes the principles, and a companion guide which provides further details about the conversation that took place during this event. These resources represent a moment in time when 13 patient partners gave their opinions about culturally safe patient engagement.

Indigenous perspectives must be included in health care decision-making to support the continued decolonizing of services and ensure equitable access to high-quality care. Meaningful engagement with Indigenous patient partners is foundational to obtaining this perspective, and many health care providers have expressed an interest in better understanding cultural safety (such as what's important to Indigenous Peoples and how does one act in a culturally safe way?).

We hope that you can take one more step towards reconciliation by utilizing these principles in your work, continuing to be a learner and asking questions.

We'd like to leave you with a quote from Hereditary Chief Bill Blackwater Jr. provided to Tammy and Cathy in an email following the event:

"Yes, time did fly by, but our message, important to the beginning of improving the relationship between Indigenous patients and health care providers, was brought forward through the work by BCPSQC and was successful. My biggest hope is that the witnesses and partners were convinced by the message to the extent that they continue seeking ways for their organizations to improve relationships with Indigenous patients, through collaboration with BCPSQC." Sim'oogit Ma'os, Bill Blackwater Jr.

# data[].attributes.attachment_link.title
Culturally Safe Engagement: What Matters to Indigenous (First Nations, Métis & Inuit) Patient Partners? - Health Quality BC

# data[].attributes.attachment_link.description
How do we know when we've achieved cultural safety? When both sides leave feeling content. This is one answer shared as we met with Indigenous patient

# data[].attributes.headline
Providing Culturally Safe Care and Eradicating Indigenous-specific Racism

# data[].attributes.subject
Providing Culturally Safe Care and Eradicating Indigenous-specific Racism

# data[].attributes.attachment_link.authors[].name
Provincial Health Services Authority (PHSA)

# data[].attributes.attachment_link.title
Webinar: Providing culturally safe care and eradicating Indigenous-specific racism

# data[].attributes.headline
Transformative Change: Advancing Cultural Safety Across BC

# data[].attributes.subject
Transformative Change: Advancing Cultural Safety Across BC

# data[].attributes.attachment_link.title
Transformative Change: Advancing Cultural Safety Across British Columbia Webinar

# data[].attributes.attachment_link.description
The First Nations Health Authority (FNHA) partnered with Health Standards Organization (HSO) to bring together a BC First Nations-led Cultural Safety and Humility Technical Committee to oversee the development of a HSO 75000:2022 (E) British Columbia Cultural Safety and Humility standard.

Listen to this webinar to hear from Indigenous leaders, patient partners, and health leaders and learn:

1. An understanding of the need for a system-wide cultural safety and humility standard;

2. An overview of the HSO 75000:2022 (E) British Columbia Cultural Safety and Humility standard and its unique development process; and

3. Examples of how you can put this standard into action today.

# data[].attributes.headline
First Nations Population Health and Wellness Agenda

# data[].attributes.subject
First Nations Population Health and Wellness Agenda

# data[].attributes.headline
Course - Respectful Relationships: Cultural Safety

# data[].attributes.subject
Course - Respectful Relationships: Cultural Safety

# data[].attributes.attachment_link.title
Respectful Relationships: Cultural Safety - LearningHub

# data[].attributes.attachment_link.description
This search is limited to only those courses that are available to the General Public and will not populate with the full course catalog. Please login or sign up for a LearningHub account to search the full course catalog.

# data[].attributes.body
DEVELOPMENT IN CANADA:

Current state of knowledge and future directions

Applicable Role: All

Applicable Module All

Applicable Domain: 1, 2, 3, 4

# data[].attributes.headline
EARLY YEARS INDIGENOUS CULTURAL SAFETY RESOURCE GUIDE

# data[].attributes.subject
EARLY YEARS INDIGENOUS CULTURAL SAFETY RESOURCE GUIDE

# data[].attributes.headline
Indigenous Cultural Safety, Cultural Humility and Anti-Racism. Practice Standard Companion Guide

# data[].attributes.subject
Indigenous Cultural Safety, Cultural Humility and Anti-Racism. Practice Standard Companion Guide

# data[].attributes.headline
CPS page - Indigenous Child and Youth Health

# data[].attributes.subject
CPS page - Indigenous Child and Youth Health

# data[].attributes.attachment_link.readable_text
One of the priorities in the Canadian Paediatric Society's strategic framework (2017-2022) is health equity for First Nations, Inuit and Métis children and youth. We advocate for policies and practices that address historic and systemic barriers to care and living conditions that have unfairly affected Indigenous children and youth in Canada.

Events and education for health professionals

Providing culturally safe care for Indigenous children and youth (eCME, 2023): This 1.5 hour self-directed module examines key aspects of culturally safe care for First Nations, Inuit, and Métis children, youth, and families, and how culturally safe care for Indigenous Peoples is practiced.

International Meeting on Indigenous Child Health: A biennial joint conference with the American Academy of Pediatrics for health care providers and researchers who work with children, youth and families in American Indian, Alaska Native, First Nations, Inuit, and Métis communities.

Special Interest Group on First Nations, Inuit and Métis Health: Open to all CPS members.

Clinical guidance for health professionals

Curriculum for paediatric residents

The Canadian Paediatric Society and the National Collaborating Centre for Indigenous Health have produced a 4-part training program on Indigenous child and youth health, designed for paediatric residents and suitable for other health professionals. The curriculum, which should be delivered by physicians with experience providing care to Indigenous children and youth, covers:

Demographics, Data, and Federal Government Relations

Common Medical Conditions

History, Colonization and Social Determinants of Health

Providing Culturally Safe Care

In this webinar, principal author Dr. Kent Saylor presents an overview of the curriculum and how to use it.

Curriculum materials include slide decks, speaker notes, and reference handouts, and are available to Canadian Paediatric Society members at no cost. Visit the Member Centre to access the files. If you are not a member, considering joining the CPS.

Reconciliation

References and resources for health care professionals

This section includes references for health care professionals who want to learn more about First Nations, Inuit and Métis culture, history and current socio-political contexts, as well as resources to help providers deliver the best care possible to Indigenous children, youth and families.

Our thanks to Dr. Véronique Pelletier and Dr. Émilie Beaulieu for gathering and vetting this list.

Jordan's Principle and the Inuit Child First Initiative

Jordan's Principle is a child-first principle designed to ensure that First Nations children do not experience delays, disruptions or denials related to services ordinarily available to other children in Canada. The Inuit Child First Initiative is a similar, federally-funded program for Inuit children and youth. There is no comparable program for Métis children and youth.

# data[].attributes.attachment_link.title
Indigenous Child & Youth Health | Canadian Paediatric Society

# data[].attributes.attachment_link.description
Canadian Paediatric Society: Protecting and promoting the health and well-being of children and youth.

# data[].attributes.headline
FNHA - Sacred and Strong Perinatal and Infant Wellness

# data[].attributes.subject
FNHA - Sacred and Strong Perinatal and Infant Wellness

# data[].attributes.headline
Metis Public Health Surveillance Program Report

# data[].attributes.subject
Metis Public Health Surveillance Program Report

# data[].attributes.attachment_link.readable_text
Overview

In our Core Training courses, participants are introduced to key aspects of cultural safety and addressing anti-Indigenous racism. All of our courses are self-paced and facilitated. Course topics include:

Colonization in Canada

Racism, discrimination, stereotyping, and their impacts on Indigenous people

Taking action to strengthen Indigenous Cultural Safety in relationships, practices, and services

Key Course Goals

The curriculum and learning activities have been designed to help participants:

Strengthen their knowledge, awareness, and skills for working with and providing service to Indigenous people and communities

Work more safely and effectively with Indigenous people

Begin considering their role in correcting, rebuilding and transforming systems to uproot Indigenous-specific racism

Four of these courses are sector-specific and have been designed for people who work in societal systems. These include health care, mental health, justice, and child welfare (i.e., Core Health, Core Mental Health, Core Justice, and Core Child Welfare). The Core Foundations Course is suitable for people in any workplace.

# data[].attributes.attachment_link.title
British Columbia - San'yas Indigenous Cultural Safety Online Training

# data[].attributes.attachment_link.description
In our Core Training courses, participants are introduced to key aspects of cultural safety and addressing anti-Indigenous racism. All of our courses are self-paced and facilitated.

# data[].attributes.attachment_link.readable_text
S a n'yas also offers Advanced Training that is national in focus. Advanced Training is available to people who have completed a Core Training and want to learn more about Indigenous cultural safety and anti-Indigenous racism.

Pre-requisite - successful completion of a S a n'yas Core Training in the past 5-years with a minimum time lapse of

6-months since completing a S a n'yas Core Training.

For more information about complementary, region-specific training in BC, visit the following Health Authority websites:

The College of Family Physicians of Canada

The online From Bystander to Ally program meets the accreditation criteria of

The College of Family Physicians of Canada. This two-credit per-hour Self-Learning

program has been certified by the C ollege of Family Physicians of Canada for up to

1 0 Mainpro+ credits.
https://www.cfp.ca/
UBC CPD

The University of British Columbia Division of Continuing Professional Development (UBC CPD) is fully accredited by the Committee on Accreditation of Continuing Medical Education (CACME) to provide study credits for continuing medical education for physicians. This activity is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program (MOC) of the Royal College of Physicians and Surgeons of Canada, and has been approved by UBC CPD for up to 5.0 MOC Section 3 Self-Assessment hours (credits are automatically calculated). Each physician should claim only those credits accrued through participation in the activity.

https://ubccpd.ca/

# data[].attributes.attachment_link.title
Advanced Learning - San'yas Indigenous Cultural Safety Online Training

# data[].attributes.attachment_link.description
S a n'yas also offers Advanced Training that is national in focus. Advanced Training is available to people who have completed a Core Training and want to learn more about Indigenous cultural safety and anti-Indigenous racism.

# data[].attributes.headline
BCCN&M Indigenous Cultural Safety, Cultural Humility, and Anti-Racism

# data[].attributes.subject
BCCN&M Indigenous Cultural Safety, Cultural Humility, and Anti-Racism

# data[].attributes.headline
Sacred and Strong - Upholding Our Matriarches and Role 

# data[].attributes.subject
Sacred and Strong - Upholding Our Matriarches and Role 

# data[].attributes.headline
Measuring Cultural Safety in Health Systems 

# data[].attributes.subject
Measuring Cultural Safety in Health Systems 

# data[].attributes.headline
Indigenous Health in the ED: The Role of Implicit Bias

# data[].attributes.subject
Indigenous Health in the ED: The Role of Implicit Bias

# data[].attributes.attachment_link.title
Indigenous Health in the ED: The Role of Implicit Bias

# data[].attributes.headline
Jordan's Principle Youth Public Service Announcement

# data[].attributes.subject
Jordan's Principle Youth Public Service Announcement

# data[].attributes.attachment_link.title
Jordan's Principle Youth PSA - 90s seconds

# data[].attributes.attachment_link.readable_text
To find out who's covered under Jordan's Principle, visit Who is covered.

Available 24 hours, 7 days a week

On this page

Updates on Jordan's Principle

Jordan's Principle External Appeals Committee

From January to March 2021, Indigenous Services Canada (ISC) issued a call for proposals to seek services from professionals in the health, social and education fields to review appeals and issue recommendations as part of the new Jordan's Principle External Appeals Committee. The call is now closed. Thank you to all those who expressed an interest. ISC will communicate the results of the process to those who applied once the evaluation of the proposals is finished.

Other updates on Jordan's Principle

Under Jordan's Principle we are ensuring that First Nations children can access the products, services and supports they need, when they need them, while we work with First Nations partners, provinces and territories to develop long-term approaches to help better address the unique needs of First Nations children.

On September 29, 2021, the federal court upheld orders by the Canadian Human Rights Tribunal regarding eligibility under Jordan's Principle and compensation. The Government of Canada did not appeal the orders about Jordan's Principle eligibility for products and services.

This means that First Nations families can continue to access Jordan's Principle under the same eligibility criteria that has been in place since November 25, 2020. To find out more, visit:

To learn more about the latest federal court decision on child and family services and Jordan's Principle, or about other related decisions, consult:

Learn more about the agreements-in-principle related to the First Nations Child and Family Services program and Jordan's Principle:

About Jordan's Principle

Jordan's Principle makes sure all First Nations children living in Canada can access the products, services and supports they need, when they need them. Funding can help with a wide range of health, social and educational needs, including the unique needs that First Nations Two-Spirit and LGBTQQIA children and youth and those with disabilities may have.

Jordan's Principle is named in memory of Jordan River Anderson. He was a young boy from Norway House Cree Nation in Manitoba.

Requests for Inuit children can be made through the Inuit Child First Initiative.

Helping First Nations children

Text alternative: Helping First Nations children

Between July 2016 and August 31, 2023, more than 3.55 million products, services and supports were approved under Jordan's Principle. These included:

speech therapy

educational supports

medical equipment

mental health services

and more

A legal rule

In 2016, the Canadian Human Rights Tribunal (CHRT) determined the Government of Canada's approach to services for First Nations children was discriminatory. One way we are addressing this is through a renewed approach to Jordan's Principle.

Since the ruling, the CHRT has issued a number of follow-up orders about Jordan's Principle. In May 2017, the CHRT ordered that the needs of each individual child must be considered, to ensure the following is taken into account under Jordan's Principle:

This means giving extra help when it is needed so First Nations children have an equal chance to thrive.

What we are doing

We are supporting children who need help right away and are making long-term changes for the future, such as through reforming child and family services.

For the long-term, we are working to build better structures and funding models. These will make sure First Nations children living in Canada get the products, services and supports they need, when they need them. To do this, we are working closely with:

provinces

territories

First Nations partners

service organizations

Since 2016, the Government has committed $3.5 billion toward meeting the needs of First Nations children through Jordan's Principle.

Local service coordinators have been hired in communities across Canada. They can help families who:

have questions about Jordan's Principle

would like to submit a request for products, services or supports under Jordan's Principle

We fund these coordinators, who are staffed by:

local tribal councils

First Nations communities

regional health authorities

First Nations non-governmental organizations, etc.

We also have staff across the country dedicated full-time to Jordan's Principle. They work closely with the local coordinators to make sure all requests are processed as quickly as possible.

Related links

Thank you for your feedback

# data[].attributes.attachment_link.description
Jordan's Principle makes sure all First Nations children living in Canada can access the products, services and supports they need, when they need them. Funding can help with a wide range of health, social and educational needs.

# data[].attributes.headline
Indigenous Cultural Safety, Cultural Humilty and Anti-racism Practice Standard

# data[].attributes.subject
Indigenous Cultural Safety, Cultural Humilty and Anti-racism Practice Standard

# data[].attributes.body
Domains: 1,2,3

# data[].attributes.headline
Co-creating better healthcare experiences for First Nations children and youth: The FIRST approach emerges from Two-Eyed seeing

# data[].attributes.subject
Co-creating better healthcare experiences for First Nations children and youth: The FIRST approach emerges from Two-Eyed seeing

# data[].attributes.wish_content.attachment_props.alternative_text
Co‐creating better healthcare experiences for First Nations children and youth: The FIRST approach emerges from Two‐Eyed seeing (wiley.com)

# data[].attributes.headline
Exploring the perspectives of caregivers of urban Inuit children on child health knowledge

# data[].attributes.subject
Exploring the perspectives of caregivers of urban Inuit children on child health knowledge

# data[].attributes.headline
PHAC Indigenous cultural competency learning Road Map

# data[].attributes.subject
PHAC Indigenous cultural competency learning Road Map

# data[].attributes.attachment_link.readable_text
Becoming a culturally humble organization

Goose symbolism

The Canada goose visual was selected for the Indigenous cultural competency publications as a shared symbol for both Indigenous and non-Indigenous people of Canada, as we journey together.
The Canada goose (as well the crackling goose and six other subspecies) is found across turtle island and are one of the few animals that has a pervasive representation in Indigenous symbolism and communities. The Canada goose is not considered the most important animal, but holds a place of significance as it is one of the only birds that can soar as high as an eagle and is a key food source.

PHAC encourages employees to have a coordinated and strategic journey in the development of their Indigenous cultural competency with the expectation that acquired knowledge and skills be applied to create a culturally humble organization and public health system. This journey is much like the Canadian goose and its long and annual migration. It will require regular and consistent work and be a lifelong journey for us all.

When Canadian geese migrate in a v formation, they take turns in the position of leader representing that no one individual or group can get to the destination of reconciliation on their own, as it requires the sharing of the work, and relying on each other's collaboration and insights to move towards a culturally humble public health system.

The Canada goose is known for their clear communication, teamwork, equity, cooperation and shared leadership, as well as their commitment to their group and community. They persistently work together and represent our dependence on each other's strengths and importance.

Throughout Canadian history, the Canada goose has represented wilderness, however as the goose has adapted and integrated itself into urban centers, it has developed as a symbol of flexibility, adaptability and resilience.

We invite you to engage with this PHAC Indigenous learning Road Map as a Canada goose, with resolve and commitment and the wonder of flight.

PHAC Indigenous cultural competency learning Road Map

Becoming a culturally humble organization

The Indigenous cultural competency (ICC) learning Road Map (the Road Map) was designed to support the implementation of the public health agency of Canada's (PHAC) Indigenous cultural competency learning policy, which was created in response to the truth and reconciliation commission's call to action #57. The Road Map is used to demystify Indigenous cultural competency development by providing specific competencies defined as what PHAC employees need to know to make meaningful contributions to Indigenous related policies, programs, and engagement.

The Road Map has been specifically designed to the needs of PHAC and does not include all possible aspects of Indigenous cultural competency. What is thought to be important in the Indigenous public health domain may not be as useful in other contexts. The Road Map was developed through consultations with Indigenous cultural safety experts including the knowledge centre for Indigenous inclusion's national elder's advisory council, the national collaboration centre for Indigenous health, the Canadian Indigenous nurses association, and the University of Ottawa.

To request a copy of the PHAC Indigenous cultural competency learning Road Map, please contact the PHAC Indigenous relations team at Indigenousrelations-relationsautochtones@PHAC-aspc.gc.ca
What is the ICC learning Road Map
To provide structure and guidance, the Road Map has six knowledge pillars (topic areas) and four levels of knowledge which form a matrix or platform to support employees as they travel on their Indigenous learning journey. The Road Map has four primary functions:

1. To provide a pathway for Indigenous learning by having strategic competencies clustered into topic areas and placed in a recommended sequence of development.

2. To identify the level of knowledge to build toward (longer-term goals) according to the responsibilities of each employee. This individualized learning approach helps to focus employee's attention on either building a basic ICC awareness (for all employees), or for employees with either direct or indirect responsibility or influence on Indigenous related work, the specific competencies and levels they should attain.

3. To aid in the reflection process of what existing competencies one has developed, and what competencies should be identified as knowledge gaps and more immediate learning goals.

4. The option to set ICC goals and identify a team and/or branch level competency profile for corporate level planning.

How to use the ICC learning Road Map

The ICC Road Map is not meant to be a tick the box exercise, but rather an incremental and iterative process to understand and complete Indigenous learning objectives. The Road Map helps identify the building blocks of cultural competency that employees need to build.

The Road Map is a tool to be used interactively within the employee and manager relationship and dialogue.

Indigenous cultural competency is embedded in the PHAC performance management process (PMA) and will assist with the goal setting process for personal learning and development plans.

Employees can use the Road Map to identify their existing competencies and knowledge gaps and set specific and immediate learning goals.

Descriptions for each Road Map competency have been provided (accessed by clicking on each competency). Employees can review the description of each competency to help determine if they have reached a minimum level of understanding. Competency development can extend and deepen beyond the minimum level of understanding where needed.

It is generally recommended that employees start on the left-hand side of the ICC Road Map and move toward the right. Additionally, employees should explore a First Nations, Inuit, Métis and urban lens to each competency unless the competency specifies only one distinction group. There is no benefit to rushing through the completion of competencies and advancing too quickly. Indigenous cultural competency is a long-term and life-long process of learning, and one's learning pace will be influenced by existing competency levels versus responsibilities for Indigenous files.

Where do employees need to travel to on the ICC learning Road Map?

Managers, together with employees will discuss the level of understanding, of the four levels of knowledge, required for each employee according to their position and responsibilities.

Those that do not have responsibilities for, or influence on, Indigenous policy or programming are required to build a basic awareness level, the first level found on the Road Map.

After the basic awareness level has been developed employees should work towards the general knowledge level, the second level found on the Road Map.

Those employees that have influence, or indirect responsibilities related to Indigenous policies, programs or engagement are required to have a core understanding level, the third level found on the Road Map.

Those employees that have direct responsibilities related to Indigenous policies, programs or engagement are required to have an in-depth understanding level, the fourth level found on the Road Map.

Please note that a change of employee position may alter where on the Road Map one needs to work towards, and adjustments should be made.

Further details on the policy and ICC supports can be found in the PHAC Indigenous cultural competency manager and employee toolkit. There is also a PHAC ICC learning inventory, and the PHAC Indigenous learning calendar found on the PHAC mylearning portal, to assist in the identification of learning activities to support competency development.

PHAC Indigenous cultural competency learning Road Map

Unless specified, it is expected that each competency has a first nation, Inuit, Métis, urban and regional aspect that should be explored and understood.

The link beside each competency will take you to a description which also provides learners information on the minimum level of understanding for each competency.

Indigenous people of Canada, culture & general learning

Historical and systemic impacts and responses

Treaties and Indigenous rights

Reconciliation

Indigenous ways of knowing and concepts of health

Indigenous engagement and relationships

Basic awareness

introduction to First Nations people introduction to Inuit introduction to the Métis introduction to urban Indigenous people concepts of bias, racism, prejudice, and discrimination

the true history of Canada:

understanding treaties and the promises that were made we are all treaty people the Indian act constitution act the United Nations declaration on the rights of Indigenous people (UNDRIP)Inuit Nunangat Policy

General knowledge

current experiences impacting Indigenous well-being

Concepts of:
Understanding the difference between historical, numbered and unceded regions
How to effectively participate in a sharing/talking circle The concept of crown and nation-to-nation relationships Importance of co-development Key national Indigenous organizations Underrepresented Indigenous groups Engagement, reporting, and accountability burden Principles of engagement with Indigenous people Duty to consult

Core understanding

recommended approaches and program principles which support Indigenous people

Importance of:
understanding how current systems, programs and polices create barriers for Indigenous people internalization of racism
self-governance agreements compared to land claim agreements and other alternatives implementation of the principles of the UNDRIP declaration & framework Assessment of Modern Treaties Implications Process research and co-development requirements with Indigenous people how to implement the Inuit Nunangat Policy

different approaches and expectations of what reconciliation looks like how to promote and encourage work that contributes to reconciliation

effective ways to engage with Indigenous people and communities principles for effective cross-cultural communication setting realistic expectations for engagement and reporting national Indigenous organization politics current distinctions-based priorities self-determination and engagement

In-depth understanding

Concepts of:
Understanding how to create barrier free systems, programs, and policies with Indigenous people
What nation to nation relationships should look like Expectations of PHAC staff to uphold a rights-based and co-development approach

How to apply formal and informal actions of reconciliation and key components

Informal:

Formal:

Competency descriptions

Indigenous people of Canada, culture & general learning

Basic awareness level

Introduction to First Nations people: any learning activity that provides a broad overview of First Nations people in Canada. Learners should be able to explain who a First Nations person is and, in broad terms, the difference between status First Nations and non-status First Nations identity, as well as their distinction from Inuit and Métis people, and across First Nations throughout Canada

Introduction to Inuit: any learning activity that provides a broad overview of Inuit who live in Canada. Learners should be able to explain who Inuit are and in broad terms, how their cultures differ across land claim regions within Inuit Nunangat, and their distinction from First Nations and Métis people.

Introduction to the Métis: any learning activity that provides a broad overview of Métis people in Canada. Learners should be able to explain who the Métis are in broad terms, including the significant distinction between the Métis and metis, as well as their distinction from Inuit and First Nations people.

Introduction to urban Indigenous people: any learning opportunity that provides a broad overview or experiences of urban Indigenous people. Learners should be able to explain what makes a person a member of an urban Indigenous population and why this distinction group often faces unique challenges compared to members of their community that do not live in an urban setting.

Concepts of bias, racism, prejudice, and discrimination: activities that explore bias, racism, prejudice, and discrimination against Indigenous people. Learners should know how to identify their own conscious and unconscious biases, privilege, and prejudices and how to work to address them.

General knowledge level

The diversity that exists within each distinct group: activities that explore subsets within First Nations Peoples, Inuit, and Métis people and other unique Indigenous identities. Learners should be able to describe at least two different demographics/populations/communities for each distinct group, including their traditional territory, key traditional foods, traditional language(s) spoken, and cultural practices compared to other members of the same distinct group. Priority should be placed on the specific communities and regions where one resides or works. Employees should work to broaden their knowledge of regions and distinct communities throughout their time in the public service.

Traditional concepts of gender and 2SLGBTQQIAAP identities: activities that explore gender roles, concepts of gender, and traditional interpretations of 2SLGBTQQIAAP identities within an Indigenous context. Learners should understand general concepts and the traditional roles of gender for each distinct group and be aware of traditional views around 2SLGBTQQIAAP identities.

PHAC and other federal department's Indigenous mandate: activities that explore the Indigenous mandate of PHAC and other federal departments. Learners should understand the role that PHAC plays in Indigenous public health and that it is inappropriate to solely rely on ISC/CIRNAC to create, administer, or respond to Indigenous concerns, as well as be aware that an overlap in responsibilities does not mean PHAC does not have a role to play.

How to apply an Indigenous lens to your work: activities that help learners explore how to apply an Indigenous lens to their work. Due to the specific needs of issues and files, it is recommended that learners continuously build their capacity. Events can be found in the PHAC Indigenous learning calendar and learners may identify activities that are specifically tailored to the needs of individual files. Learners should know what the Indigenous aspects to their work are, how to ensure that their work is being performed in a culturally humble way, how to work towards making and keeping their work culturally safe, and how to ensure that an Indigenous lens and perspective is applied.

Core understanding level

Learning about what is sacred in an Indigenous context: activities which explore items, locations or ceremonies that are considered sacred within an Indigenous context, how to show respect, how to avoid cultural taboos and what is expected when interacting with what is considered sacred. Learners should understand what different distinct groups or regional groups/communities, if applicable, consider sacred, how definitions of sacred might differ from their own beliefs, and demonstrate that they are able to act, as an outsider, in a culturally humble manner.

Applying a gender-based lens to Indigenous analysis and understanding: activities that explore SGBA+ lenses as an Indigenous concept; priority should be placed on a SGBA framework developed by Indigenous groups. Learners should know how to apply an SGBA+ lens in an Indigenous context, common Indigenous SGBA considerations, and that Indigenous communities and organizations may have a preferred SGBA framework to be used on projects that apply to their work.

Concept of compounding and intersecting identities: activities which explore how different identities can compound or exacerbate inequities experienced by Indigenous people, for example a First Nations woman who has a disability will experience different inequities than a non-disabled First Nations man. Learners should be aware that Indigenous people can belong to other equity deserving groups and can be uniquely affected by these compounding identities compared to other Indigenous people, and how these multiple identities do not make them any less Indigenous.

In-depth understanding level

Understanding the differences between cultural appropriation and cultural appreciation: activities that explore the differences between cultural appropriation and cultural appreciation. Employees should know what appropriation and appreciation looks like, how to ask the right questions to determine if something is appropriation or appreciation, common signs of appropriation, and how to be an enthusiastic appreciator and supporter without appropriating Indigenous culture.

Identity appropriation and self-identification politics: activities that explore the complex discussions around Indigenous identity and identity appropriation. Employees should be able to understand why self-identification of Indigenous people is such a complicated topic, what identity appropriation is, why it is such a major problem, and best practices to address it.

Participation in ceremony: activities that look at what it means to participate in a ceremony. Employees should know what is generally expected of them to be involved in ceremonies, how to prepare for participation in a ceremony, and how to be respectful of the ceremony.

Historical and systemic impacts and responses

Basic awareness level

The true history of Canada: activities that discuss Indigenous people's position and role in Canadian history, policies of the Canadian government towards Indigenous people, and the events that have lasting impacts for Indigenous people. Many topics can be explored based on interests, but all employees must explore residential schools, the 60's scoop, Indian hospitals, missing and murdered Indigenous women and girls, systemic racism against Indigenous Peoples in the health system, relocation of Indigenous Peoples, and Métis scripts.

Residential schools: activities that discuss the policies, laws, or experiences/impacts on Indigenous people who attended residential schools, or day schools. The multi-generational impacts of residential schools and day schools continue to affect the health of Indigenous people today. Employees should understand the objectives and systemic nature of residential schools and day schools, realities of the conditions children faced, relationship of schools to the Indian hospital system, how residential school and day school experiences are still impacting Indigenous health, the prevalence of unmarked graves, and why Canadians might never know how many children died.

The 60's scoop: activities that discuss the 60's scoop period in which a series of Canadian government policies enabled child welfare authorities to remove Indigenous children from their families and communities for placement in foster homes for adoption by white families. Employees should know the 60's scoop policies that enabled Indigenous children to be apprehended by the state into the foster system more frequently than other demographics and the impacts on the children who were removed from their families, communities, culture, and language.

Indian hospitals: activities that discuss the history of Indian hospitals, reserve hospitals, or Indian sanatoriums. Learners need to know about the questionable diagnosis process at Indian hospitals, the forcible removal of patients from their communities for TB treatment, conditions that existed in the hospitals, and use of surgery, drugs, and experimentation in these institutions. They should also explore beliefs in alleged'Indian' specific variants of diseases, such as "Indian TB", and how the existence of Indian hospitals has influenced and shaped many challenges facing Indigenous public health and health today.

Missing and murdered Indigenous women and girls: activities that discuss the epidemic of violence towards Indigenous women and girls, and the genocide of Indigenous women and girls due to systemic racism within policing and investigation organizations, which often respond inappropriately to cases of violence and murdered or missing Indigenous women and girls. Learners should understand the factors that contribute to Indigenous women and girls being uniquely vulnerable to violence, PHAC's role in addressing violence against Indigenous women and girls, and the role of systemic racism and personal bias when addressing unsolved cases.

Systemic racism against Indigenous Peoples in the health system : activities that discuss the epidemic of mistreatment, stereotyping, racism, discrimination, and violence towards Indigenous Peoples in Canada's health systems. Learners should understand the pervasiveness of mistreatment, stereotyping, racism, discrimination, and violence committed towards Indigenous Peoples by health systems and health practitioners, and how this contributes to a lack of Indigenous people's trust in health systems ultimately impacting their health. Learners should also know the experiences of Joyce Echaquan and Brian Sinclair, and other contemporary Indigenous Peoples' experiences of racism, stigma, and discrimination, such as those documented in British Columbia's health care report,'In Plain Sight'.

Relocation of Indigenous communities : activities that explore the government forced relocation of Indigenous Peoples. Learners should know that the government has a history of forcibly relocating Indigenous Peoples from their traditional lands and communities, the distinct experiences and contexts for the relocation of First Nations, Inuit and Métis Peoples, and how these relocations have impacted the wellbeing of these communities.

Métis scripts : activities that explore the history of Métis scripts and road allowances. Learners should know about the system of Métis scripts, the challenges that scripts posed on the Métis, and how road allowances compounded inequities in Métis communities.

General knowledge level

Current experiences impacting Indigenous well-being: activities that discuss experiences that have inter-generational or direct impacts on Indigenous well-being. Additional topics can be explore based on interests or file needs, but learners must explore intergenerational trauma, language, community, and cultural identity, as well as the foster care system, the social determinant of health, Indigenous racism, lateral violence, and lack of trust in the government.

Intergenerational trauma: activities that discuss what intergenerational trauma is, why it is so prevalent in Indigenous communities, and how it impacts the well-being of individuals, families, and communities. Learners should understand what intergenerational trauma is, its root causes, its resulting impacts on the well-being of Indigenous people, and how Indigenous communities are working to address the effects of intergenerational trauma.

Language, community, and cultural identity: activities that explore the importance of traditional languages and community and cultural identities, how and why many Indigenous people feel separated from their cultural heritage, and how communities are working to address this separation and restore capacity. Learners should understand how traditional languages, community, cultural practices, and identity impact the well-being of Indigenous people, the factors, policies, and programs that separated many Indigenous people from their cultural heritage, and the importance for Indigenous communities to preserve their culture in a way that is meaningful to them.

Social determinants of health: activities that explore the social determinants of health from an Indigenous perspective. Learners should know the social determinants of health, generally how Indigenous populations compare to non-Indigenous populations, indicators that are of particular interest to Indigenous organizations, and how to apply an Indigenous lens to the social determinants of health.

Anti-Indigenous racism: activities that build on the concepts of bias, racism, prejudice, and discrimination from an Indigenous perspective. Learners should understand how and why Indigenous racism remains an issue in Canada, the forms it can take and its impact, the difference between systemic and individual racism, how to identify blatant and inherent racism, and how to counter the issue through anti-Indigenous racism approaches.

Lateral kindness: activities explore the importance of lateral kindness in Indigenous communities, and the role that limited and competitive government funding has played in contributing to lateral violence. Learners should be able to explain what lateral violence is and understand how it impacts communities, how the government has contributed to lateral violence, and actions that they can take to promote an environment of lateral kindness in the workplace and public health system.

Indigenous people's lack of trust in federal, provincial/territorial, and local governments: activities explore why many Indigenous people do not trust federal, provincial/territorial, or local governments, especially within a health context, as a result of, but not limited to, the inequitable treatment of Indigenous Peoples in the health system, individual experiences of racism or by friends/family members, forced sterilizations, lack of/poor responses to public health emergencies, medical experimentation, and the killing of hunting dogs. Learners should be able to describe the events and issues that led to many Indigenous people's mistrust of government, recognize how this can affect Indigenous/government relationships, and know how to work toward an open and transparent relationship that respects the rights of Indigenous Peoples.

Core understanding level

Recommended approaches and program principles which support Indigenous people: activities that explore current best practices for programming and policies which support Indigenous people. There are many best practices that can be explored based on interest, but employees must ensure they understand how to utilize community-based approaches, the need to utilize co-development principles and approaches, and why Indigenous-led programming is vital to addressing Indigenous public health.

Community-based: activities that explore how to use and support community-based approaches in programming and policies, with a focus on operational program or policy needs. Learners should know what community-based health promotion approaches look like and how to effectively respect and utilize community-based approaches when interacting with communities and managing programs.

Co-development: activities that explore co-development approaches with Indigenous partners and why and when to use the approaches as determined by best practice and the interest of Indigenous partners. Learners should know what co-development looks like, why co-development is an important approach for Indigenous engagement, and how to effectively plan and implement a co-development process (who, what, where and when).

Indigenous-led programming: activities that explore the model and benefits of Indigenous-led programming from a rights-based perspective. Learners should understand the vital importance of Indigenous-led programming when addressing Indigenous public health, what it can look like, and how to design processes and remove barriers that impede Indigenous-led programming.

Understanding how systems, programs and policies create barriers for Indigenous people: activities which explore how current systems, programs and policies have created, either implicitly or explicitly, barriers for Indigenous people. These barriers can include, but are not limited to, departmental interpretation of treasury board policies, program objectives and eligibilities; burdensome application and reporting requirements; and the inability to apply flexibility. Learners should know how systems, programs, and polices related to one's work create barriers for Indigenous people and be actively working, where possible, to identify, advise on, minimize, or eliminate barriers for Indigenous people.

Internalization of racism : activities that explore the effects of colonisation and anti-Indigenous racism had on developing and promoting internalized racism in Indigenous communities. Learners should be able to explain what internalized racism is, how colonization and anti-Indigenous racism cause internalized racism in Indigenous communities, and how internalized racism affects Indigenous well-being.

In-depth understanding level

White dominant culture: activities that explore the impacts of white-dominant culture and white-privilege on Indigenous communities and Canadian society. Employees should understand what white-dominant culture and white-privilege is, how it has impacted both Indigenous and non-Indigenous people, what it has meant for Indigenous communities and cultures, and how to actively work to address white cultural dominance in society.

Settler guilt: activities that explore the concept of settler guilt. Employees should understand what settler guilt is, what it can look like, how remorse for the past can be productive, but can also cause tokenism or stunt healing and growth in both Indigenous and non-Indigenous communities, and how to work to move beyond settler guilt in reconciliation.

Strengths-based approaches and narratives: activities that explore the importance of using strengths-based approaches, language, and narratives. Employees should know how to use strengths-based approaches when discussing Indigenous Peoples, the risks to people and communities by failing to do so, and how to tell if something is a strengths-based approach.

Understanding how to create barrier free systems, programs, and policies with Indigenous people: activities that explore how to address barriers to Indigenous health equity that currently exist within PHAC and how to create barrier-free public health environments, programs, and policies for Indigenous people. Employees should know the barriers for Indigenous people related to their work, how other departments are addressing these barriers, things that can be done to remove barriers at PHAC, and how to develop systems, programs and policies that create barrier-free public health environments for Indigenous people.

Treaties and Indigenous rights

Basic awareness level

Understanding treaties and the promises that were made: activities which cover historical and modern treaties in Canada, the general promises made, especially in the numbered treaties, and Canada's willingness to keep these promises. Learners should know the various kinds of treaties in Canada, the primary promises and agreements of each treaty type for both the crown and Indigenous people, and which treaties affect the land where employees work.

We are all treaty people: activities which strengthen understanding that regardless of whether someone is Indigenous, a settler, or a recent immigrant to Canada, we are all treaty people, as the lives of everyone who lives in Canada have been shaped by treaties and how the federal government has chosen to'keep' these promises. Learners should understand how their lives have been impacted by treaties and what part of the treaties where they work have or have not been upheld.

The Indian act: activities that discuss the Indian act and its past and current impacts on Canadian society. Learners should be able to explain the historical context that led to the creation of the Indian act, the role of the catholic church in shaping ideas about Indigenous people, the policy's goals to terminate the cultural, social, economic, and political distinctiveness of Indigenous Peoples, the 21 restrictions imposed at some point by the Indian act, and how and why the Indian act is still applied in Canada today.

Constitution act: activities that explore section 35 of the constitution act, and the existing rights of Indigenous Peoples that section 35 affirms. Learners should know in broad terms the background of the constitution act, and the rights that were affirmed for First Nations, Inuit and Métis Peoples, the impacts of these rights being affirmed, and the additional treaty rights given to treaties and land claims for Indigenous Peoples.

The United Nations Declaration on The Rights of Indigenous People (UNDRIP): activities that discuss UNDRIP, its creation, and its place in Canadian law. Learners should be able to explain what UNDRIP is, understand why it is being implemented in Canada, and have a general understanding of the rights of Indigenous people contained in UNDRIP.

Inuit Nunangat Policy: activities that discuss the Inuit Nunangat Policy and its creation. Learners should be aware of the Inuit Nunangat Policy, its purpose, and why it is being implemented in Canada, and have a broad understanding of how it impacts the future of federal programs and policies.

General knowledge level

Enfranchisement & disenfranchisement: activities explore the approach of the Canadian government to enfranchise and disenfranchise Indigenous people and Indigenous responses. Learners should know what enfranchisement and disenfranchisement means and looks like and have a broad understanding of major historical policies with enfranchised or disenfranchised Indigenous people.

"Inherent" rights & self-determination: activities that explore the inherent rights of Indigenous Peoples. Learners should be able to explain the inherent rights of Indigenous Peoples, understand what self-determination means and looks like, and know why these concept matter and are currently applied in Canada.

Indigenous self-government: activities that explore the inherent rights of Indigenous Peoples to self-governance. Learners should know what Indigenous governance looks like and the distinction between Indigenous, local and federal government's roles and responsibilities.

Understanding the differences between historical, numbered and unceded regions: activities explore the differences between historical, numbered and unceded regions. Learners should know how modern treaties/self-governance/land claim agreements differ from historical treaties and why there are disputes on the validity of some historical treaties, as well as have a general understanding of the complexity involved with unceded regions.

Core understanding level

Self-governance agreements, compared to land claim agreements and other alternatives: activities that explore the difference between self-government agreements compared to land claim agreements and other alternative arrangements with Indigenous people and the crown, such as the creation of Nunavut as a territory. Learners should know the difference between self-government agreements and land claim agreements, how they differ, what makes Nunavut unique as neither a self-government or land agreement, and any other specific alternative agreements that are required to effectively work on one's files.

Implementation of the principles of the UNDRIP declaration & framework: activities that explore how to implement the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) in Canada, including Canada's commitment in bill c-15, with a focus on articles that impact the work of PHAC. Learners should have a general understanding of the articles, the articles that are relevant to PHAC, expectations around how they are to be implemented, and PHAC's current progress in implementing the declaration's principles.

Assessment of Modern Treaties Implications Process: activities that explore the process of Assessments of Modern Treaties Implications (AMTI). Learners should understand what an AMTI is, when an AMTI is to be completed, what expectations are required prior to and during the completion of an AMTI process, who needs to be involved, and if required, how to properly complete.

Research and co-development requirements with Indigenous Peoples: activities that explore best practices and requirements when conducting research or using a co-development process involving Indigenous Peoples and the responsibility to establish an ethical space for dialogue on common interests and points of difference between researchers and Indigenous communities. Learners should know the risks and benefits of conducting research with Indigenous people, the need to respect Indigenous people's knowledge systems and ensure the various world views of distinct groups are represented in planning and decision making, that there may be additional expectations and processes when conducting research involving or impacting Indigenous people, the expectation of co-development and ownership of research results/data, and how to perform research and co-development processes respectfully.

How to implement the Inuit Nunangat Policy : activities that explore how to implement the Inuit Nunangat Policy, how the policy specifically affects their work, and how to encourage work to be in line with the spirit of the policy. Learners should understand how the Inuit Nunangat Policy affects their work, how to effectively implement the Inuit Nunangat Policy, and how to support and encourage others to ensure their work is in line with the spirit of the policy.

In-depth understanding level

What nation-to-nation relationships should look like: activities that explore the elements of a nation-to-nation relationship between the crown and Indigenous governments. Employees should know what a nation-to-nation relationship should look like, how to create and sustain these relationships, and how to model this type of relationship when engaging with Indigenous people.

Expectations of PHAC employees to uphold a rights-based and co-development approach: activities that explore the treaty and relationship expectations of PHAC employees to uphold a rights-based and co-development approach. Learners should understand the expectation of Indigenous partners and communities in ensuring that policies and programs uphold a rights-based approach and are co-developed. PHAC employees should learn about best practices and know how to implement rights-based and co-development approaches.

Reconciliation

Basic awareness level

The need for reconciliation: activities that explore what reconciliation is, why it is needed in Canada, and why as Canadians we need to ensure that reconciliation takes place. Learners should be able to meaningfully explain what reconciliation is and why Canada is committed to advance the process of reconciliation.

What is the Truth and Reconciliation Commission (TRC) process and resulting calls to action: activities that explore the Truth and Reconciliation Commission (TRC) process and resulting calls to action (CTA). Learners should be able to explain why the TRC took place, who was involved, and the commission's major findings.

The National Inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG) process and resulting Calls for Justice: activities that explore the national inquiry into MMIWG process and the resulting Calls for Justice (CFJ). Learners should be able to explain why the national inquiry took place, who was involved, the findings of the inquiry, and why the inquiry used the term genocide.

Everyone has a role to play in reconciliation: activities that explore the role and importance of individuals in reconciliation. Learners should be able to meaningfully explain what reconciliation means to them and their role both personally and professionally in advancing reconciliation, as well as identify specific actions that can be taken.

General knowledge level

TRC calls to action and MMIWG Calls for Justice that impact health and are relevant to PHAC's mandate : activities that discuss CTA and CFJ that impact health or have implications for PHAC involvement and contribution. Learners should be able to identify the relevant CTA and CFJ to PHAC, what actions are supposed to be taken to improve Indigenous health overall, and if one's files are implicated or could be contributing to the CTA or CFJ.

What is colonization and decolonization: activities which discuss colonization, colonial systems, and what it means to decolonize. Learners should be able to explain how Canada was colonized, provide examples of colonial systems in Canada, understand that decolonization is an ongoing process, and know why there are different perspectives on what decolonization should look like in Canada.

How to situate your work within reconciliation: activities that explore how to meaningfully contribute to reconciliation for individual files. Learners should be able to discuss how to meaningfully contribute to reconciliation in their work files and obligations and know how PHAC is involved in reconciliation at the organizational level.

Core understanding level

Different approaches and expectations of what reconciliation looks like: activities that explore the different views and expectations Indigenous and non-Indigenous people have around reconciliation, and how asking one person their view on reconciliation is not representative of all Indigenous Peoples. Employees should understand that there is a spectrum of opinions that exist regarding what reconciliation should look like and be like, that no one person can speak on behalf any group, and how this variation of perspectives on reconciliation can impact the process of reconciliation.

How to promote and encourage work that contributes to reconciliation: activities that explore within the colonial system of the federal government how to support and encourage work that will contribute to reconciliation and how to identify where more work could be achieved. Employees should be able to support efforts that contribute to reconciliation, understand TRCs, MMIWG, and UNDRIP, and know how to encourage others to collaborate and expand efforts towards reconciliation.

In-depth understanding level

How to apply formal and informal reconciliation actions and their key components: activities that explore what meaningful reconciliation looks like. Employees must have a meaningful commitment to reconciliation and demonstrate informal and formal actions towards reconciliation, as appropriate.

Informal

Personal commitment to reconciliation: activities that explore how we as Canadians can contribute towards reconciliation, why efforts need to take place, and how to make activities meaningful. Employees should explore personal ways to engage in reconciliation. This can include, but is not limited to, exploring traditional cuisine/restaurants, supporting Indigenous artists, attending community events, supporting Indigenous businesses, or holding their elected officials accountable to reconciliation and addressing racism.

Informal

Policy and program adjustments: activities that challenge and explore how we as public servants can ensure we are contributing towards reconciliation. Employees should know their role in reconciliation and formal actions they can take.

Indigenous ways of knowing and concepts of health

Basic awareness level

Traditional roles in Indigenous health and ways of knowing: activities that discuss various traditional roles that elders, knowledge keepers, medicine men/women, pipe keepers, family members, etc. Might hold in Indigenous health and how they contribute to supporting the health of Indigenous people and their communities. Learners should be familiar with the primary traditional roles that support Indigenous health and be able to explain how these traditional roles can support the well-being of Indigenous people at the individual, programmatic, and overall community health levels.

Holistic health approaches: activities that explore different Indigenous perspectives and tools for health and well-being. This can include but is not limited to spiritual, emotional and physical well-being, the need for cultural connection, language, and traditional medicines. Learners should understand health concepts and approaches for each distinct group, how interconnectedness and other world views improve the health of Indigenous people, and the importance of these approaches being led by Indigenous people.

Inequities experienced by Indigenous people: activities that explore the current health inequities experienced by Indigenous populations, and factors that contribute to these inequities. Addressing health inequities is a PHAC priority. Learners should be able to explain key public health inequities experienced by Indigenous people, how systemic racism and policies contribute to these inequities, and how communities are working to address these inequities.

The environment and land's connection to health and well-being: activities that highlight the importance of land and how the strong connection to the land affects Indigenous health and well-being, including environmental health, climate change's impacts on Indigenous health, the health of animal populations, and the ability of Indigenous people to access and use their traditional land, plants, and animals. Learners should understand the vital Indigenous connectiveness to the land, the land as provider, and the responsibility to care for the land, its plants, and animals.

General knowledge level

Distinction-based views on what it means to be healthy: activities that explores Indigenous perspectives of what it means to be healthy from a distinctions-based lens. Learners should be able to discuss common indicators of healthy living for each distinct group, including key animal population health, and have an understanding of the different perspectives and views of distinct groups on health and areas of concern.

Historical and current Indigenous-focused health policies: activities that explore the historical and current health and public health policies and programs that are and were directed toward Indigenous people and how and why Indigenous health and public health programs evolved over time. Learners should understand key historical Indigenous health and public health policies and programs, how they have changed over the years, what characterises quality Indigenous health and public health policies and programs, and how these impact Indigenous well-being.

Determinants of health and their influence on Indigenous health and well-being: activities that explore the determinants of health and how these factors contribute to the current state of Indigenous health and well-being. Learners should understand how each determinant of health influences the health and well-being of Indigenous people, where the determinants of health align or do not align with Indigenous perspectives on health and well-being, and how the determinants of health and their root causes need to be addressed in order to make meaningful change.

Importance of cultural humility when working on Indigenous health: activities that explain the difference between cultural competency knowledge and cultural humility, and how and why to act in a culturally humble way, especially in health systems. Learners should understand what it means to be humble, and what culturally humble attitudes and actions look like, as well as demonstrate through their actions that employees are not experts in another's experience and they are open to co-development approaches with Indigenous people to ensure their meaningful involvement in addressing issues that impact their health.

Core understanding level

The value of using "two-eyed seeing" approaches: activities that explore etuaptmumk, two-eyed seeing or similar concepts, approaches, and methods of using Indigenous knowledge in tandem with western knowledge. Employees should know what two-eyed seeing is, how a braided approach strengthens PHAC's work, what makes something a product of a two-eyed seeing processes, and how to apply two-eyed seeing concepts, approaches, and methods to one's work.

Indigenous population health: activities that explore the health of Indigenous populations, particularly the context and social determinants of health of Indigenous communities. Employees should know the context and social determinants of health of Indigenous communities and of Indigenous population health regionally, the contributing factors to these health outcomes, and Indigenous Peoples' identification of current public health priorities.

Cultural safety model in research and health services: activities that explore what the cultural safety model is and how to apply the concept into research and health services. Employees should know what the cultural safety model is, how it applies to PHAC's work, and how to use the model.

Public health data and self-determination of Indigenous Peoples: activities that look at Indigenous data, data sovereignty and the rights of Indigenous people's ownership of their data. Employees should be aware of the principles of data sovereignty, Indigenous data best practices, and Indigenous people's right of ownership over their data, knowing that the federal government might never own Indigenous data and that is okay.

In-depth understanding level

Systemic racism in science, policies, and programs: activities that explore systemic racism in science, policies, and programs, and how systemic biases can impact the information used to inform decision making. Employees should know that systemic racism is a major problem that exists in science, best practices in addressing these biases, implications of using information or policies that are enforced by systemic racism, and how to ensure products are not being influenced by racism.

The value of culturally relevant health services, information, and programming: activities that explore the benefits of culturally relevant health services, information and programming and the risks of not advancing culturally relevant activities. Employees should know the benefits of culturally relevant health services, information and programming, the risks of these not being culturally relevant, that ISC should not be the only department creating culturally relevant supports, and the role of PHAC in encouraging culturally relevant supports.

How to design culturally safe and humble programs and policies: activities that explore best practices in the creation of policies and programs that are culturally safe and culturally humble. Employees should know best practises in the development and administration of culturally safe and humble programs and policies, how to apply these to one's work, the differences between a culturally humble activity and a culturally safe activity, and when it is most important that an activity be culturally safe or humble.

Indigenous engagement and relationships

Basic awareness level

Common Indigenous interaction protocols: activities that explore common Indigenous protocols, including, but not limited to distinction based practise of: tobacco offerings, offering of tea or arctic cotton, laws of reciprocity, how to address and show respect for elders/knowledge keepers, use of honorariums, and common expectations during prayers, smudges, and other opening and closing ceremonies. Learners should know why specific kinds of tobacco or other gifts are offered, generally when to offer tobacco/other offerings, how to offer tobacco/other offerings, what an honorarium means to Indigenous people, laws, principles of reciprocity, and how one should and should not act during sacred ceremonies being conducted by elders and knowledge keepers.

Traditional and elected leaders and their roles: activities that explore traditional and elected leaders in Indigenous communities, why there is no universal system of governance in Indigenous communities, and the internal politics that can be in play when there are both traditional and elected leaders in a community. Learners should know about the representation of traditional and elected community leaders, why a community might have one or both systems of leadership, and how to find out which leaders need to be involved in consultations, engagements, and co-development.

Use of and principles for meaningful land acknowledgements: activities that build learner's knowledge about land acknowledgements, what they mean, their purpose, why they may result in a sense of discomfort, and how to properly give one. Learners should be able create their own meaningful land acknowledgements for any city in Canada which are unique to the areas, draw attention to the realities that traditional territories and Indigenous people were nations taken over by colonialism, and develop meaningful personal commitments that demonstrate how one wants to be held accountable in their role in reconciliation.

Spectrum of engagement : activities that explore the evolution of engagement from inform, to consult, to involve, to co-development, to empowerment and self-determination. Learners should understand what qualifies an engagement at each level of the spectrum, understand why it is now expected that the federal government engage at a co-development and empowerment level, and considerations needed of these more in-depth engagement approaches including the allowance of time and the sharing of power.

General knowledge level

How to effectively participate in a sharing/talking circle: activities that explore diverse types of Indigenous sharing and talking circles, how and why they are used, and what is expected of circle participants. Employees should understand how Indigenous talking and sharing circles differ from non-Indigenous talking and sharing circles, the diverse types of circles, and one's responsibilities and expectations when participating in virtual or in-person circles.

The concept of crown and nation-to-nation relationships: activities that discuss the importance of crown and nation-to-nation relationships with Indigenous people. Learners should understand why nation-to-nation relationships exist, how to determine if one has a file/activity that might require nation-to-nation engagement, and the dangers and risks of policy or program development in the absence of nation-to-nation relationships.

Importance of co-development: activities that explore what it means to co-develop a program/project/policy, best practices in co-development, when engagement with Indigenous partners should be initiated, and with who. Learners should know the process of co-development, the need to engage with partners early into the program/project/policy development process, and principles of best practices in the co-development process.

Key national Indigenous organizations: activities that explore national and regional Indigenous organizations, especially organizations that are not a part of the permanent bilateral mechanism (PBM) process. Learners should know and understand the functions of Indigenous PBM members, as well as know about other key national and regional Indigenous organizations that either focus on public health issues or significantly contribute towards Indigenous public health priorities.

Underrepresented Indigenous groups: activities that explore Indigenous organizations which represent underrepresented Indigenous groups and groups that are not represented in national Indigenous organizations, for example a regional First Nations group which has left the assembly of First Nations. Learners should know who is not represented through national Indigenous organizations and that because an organization is not represented, it does not mean that PHAC is not obligated to engage with them on issues that affect their health and well-being.

Engagement, reporting, and accountability burden: activities which discuss capacity/resource limitations of Indigenous organizations, the demands and reporting/deadline expectations of local, regional, and federal governments, and best practices when engaging with Indigenous people to ensure that governments set expectations that do not negatively impact Indigenous organizational well-being. Learners should understand the extent of burden and cumulative demands that multiple funders place on Indigenous partners, ensure that requested timelines are negotiated with Indigenous partners, work to set expectations on engagement, and set streamline reporting and accountability requirements to the fullest extent possible.

Principles of engagement with Indigenous people: activities that explore the government of Canada's 10 principles for respecting a positive relationship with Indigenous people (justice Canada), the spirit behind these principles, how to apply them to one's work, and best practices when engaging with Indigenous communities. Learners should understand the 10 principles, current best practices of engagement with Indigenous people, and how to incorporate them into engagement and relationship building.

Duty to consult: activities that explore the crown's duty to consult, what that looks like, and best principles to ensure consultation is being done with free, prior, and informed consent. Learners should know about one's duty to consult, when to consult, how to ensure one is consulting properly, what free, prior, and informed consent means, and best practices when consulting with Indigenous Peoples.

Core understanding level

Effective ways to engage with Indigenous people and communities: activities that explore best practices when engaging with Indigenous people, organizations, and communities, and how to build meaningful relationships. Employees should know how to build meaningful relationships with Indigenous people/organizations, best practices for planning and conducting engagements, what to avoid, and how to apply these skills to their work.

Principles for effective cross-cultural communication: activities that explore the principles of cross-cultural communication, particularly in an Indigenous context, and how to limit miscommunication. Employees should know their communication style, common styles among Indigenous people, the influence of culture and personality in communication styles, how one's communication style might be perceived by Indigenous people, and how to ensure that one is communicating intentionally, effectively, and work to avoid most misunderstandings.

Setting realistic expectations for engagement and reporting: activities that explore the capacity and priorities of Indigenous partners, particularly the reality of the size of the government/organization and the negative effects of uncoordinated and poorly planned engagements with Indigenous partners, as well as best practices in determining expectations for engagement and reporting. Employees should know that Indigenous partners often have limited employee capacity, that flexibility in engagement and reporting timelines and content are recommended, how to co-set reasonable reporting and engagement expectations, and the risks to the federal government and Indigenous partners in not doing so.

National Indigenous organization politics: activities that explore current politics around Indigenous organizations, changes within the organizations, and how this might affect PHAC's engagement approaches. Employees should be aware of changes in the landscape of national Indigenous organizations, including the creation, splitting, division or changing directions of organizations. Employees should be aware of how these changes might impact their work, such as needing to engage additional groups, or affect the organization's ability to prioritize engagement and partnership, as they have a broad array of priorities and focus.

Current distinction-based priorities: activities that explore the current public health priorities as defined by First Nations, Inuit and Métis organizations and communities. Learners should be aware of the current public health priorities that First Nations, Inuit and Métis organizations have identified as they apply to public health issues, social determinants of health, and the functions of research, surveillance, programing, policies, and engagement, learners should refresh their knowledge on these priorities annually and not attempt to re-engage Indigenous organizations or communities without confirming what current priorities have been shared.

Self-determination and engagement: activities that explain the importance of Indigenous people determining what they want and need for the health and well-being of their community, and how government needs to respect the right of Indigenous people to self-determination. Learners should know that Indigenous people have the right to self-determination and what self-determination, paternalism, and effective engagement look like.

In-depth understanding level

How to use a sharing/talking circles in engagement: activities that explore how to use Indigenous sharing or talking circles as part of an engagement process. Employees should know the implications of using a sharing or talking circle as part of engagement, the planning requirements for holding a sharing circle (appropriate amount of time and discussion), who needs to participate, how to determine if an elder/knowledge keeper/other Indigenous leaders should be involved and the roles they should play, the need for two-way interchange and active participation by all involved, and how to determine if this method is the most appropriate approach for an engagement.

How to enter a community respectfully: activities that explore how to prepare prior to entering a community. Employees should learn about conducting prior research to know about the specific community context they are entering as well as community expectations. This can include, but is not limited to, knowing the traditional name of the community, the demographics of the people in the community, the type of relationship they have with the government (for example, modern treaty or numbered treaty holder), recent interactions with PHAC or other departments, recent points of contention with local, provincial, and federal governments, leadership structures, and the context and current status of the social determinates of health in their community.

Sharing the burden of co-development: activities that explore the limited capacity of Indigenous partners to engage actively in co-development and when a department or government has uncoordinated engagement activities. Employees should be aware of the need to share the burden of co-development, work to ensure that engagement and co-development activities are co-ordinated with other branches to ensure that PHAC is not engaging multiple times on the same or related topics, working to ensure the co-development workload is split fairly, and not expecting Indigenous partners to educate public servants on competencies they should have developed prior to meeting.

Flexible models of engagement, reporting, and accountability: activities that explore best practices on flexible models of engagement, reporting, and accountability. Employees should know about the importance of flexible models of engagement, reporting, and accountability when working with Indigenous people, what this looks like and how to apply it to one's files.

# data[].attributes.attachment_link.title
Indigenous cultural competency learning road map - Canada.ca

# data[].attributes.attachment_link.description
The Indigenous cultural competency learning road map supports the implementation of the Indigenous cultural competency learning policy

# data[].attributes.headline
Systematic Review and Meta-analysis: First Nations, Inuit, and Metis Youth Mental Health 

# data[].attributes.subject
Systematic Review and Meta-analysis: First Nations, Inuit, and Metis Youth Mental Health 

# data[].attributes.attachment_link.title
A Life Promotion Toolkit by Indigenous Youth - Wise Practices

# data[].attributes.attachment_link.description
Our youth team is inviting you to explore and reform the wisdom from our ancestors to once again lead you to live healthier and longer lives.

# data[].attributes.headline
2-Spirit Indigenous Health Care and Cultural Humility

# data[].attributes.subject
2-Spirit Indigenous Health Care and Cultural Humility

# data[].attributes.body
Applicable role: All

Applicable modules: All

Domain: 1

# data[].attributes.attachment_link.readable_text
In the spotlight:

End Inequalities in Public Services for First Nations Children, Youth and Families

First Nations children and families living on reserve and in the Territories receive public services funded by the federal government. Since confederation, these services have fallen significantly short of what other Canadians receive. This injustice needs to end and Spirit Bear's Plan will do just that.
Spirit Bear calls on:

1. CANADA to immediately comply with all rulings by the Canadian Human Rights Tribunal ordering it to immediately cease its discriminatory funding of First Nations child and family services. The order further requires Canada to fully and properly implement Jordan's Principle ( www.jordansprinciple.ca).

2. PARLIAMENT to ask the Parliamentary Budget Officer to publicly cost out the shortfalls in all federally funded public services provided to First Nations children, youth and families (education, health, water, child welfare, etc.) and propose solutions to fix it.

3. GOVERNMENT to consult with First Nations to co-create a holistic Spirit Bear Plan to end all of the inequalities (with dates and confirmed investments) in a short period of time sensitive to children's best interests, development and distinct community needs.

4. GOVERNMENT DEPARTMENTS providing services to First Nations children and families to undergo a thorough and independent 360° evaluation to identify any ongoing discriminatory ideologies, policies or practices and address them. These evaluation must be publicly available.

5. ALL PUBLIC SERVANTS including those at a senior level, to receive mandatory training to identify and address government ideology, policies and practices that fetter the implementation of the Truth and Reconciliation Commission's Calls to Action.

# data[].attributes.attachment_link.description
In the spotlight: End Inequalities in Public Services for First Nations Children, Youth and Families First Nations children and families living on reserve and in the Territories receive public services funded by the federal government. Since confederation, these services have fallen significantly short of what other Canadians receive.

# data[].attributes.headline
Supporting Healthy Families - MetisNationBC

# data[].attributes.subject
Supporting Healthy Families - MetisNationBC

# data[].attributes.headline
The Scars that We Carry: Forced And Coerced Sterilization of Persons in Canada - Part II

# data[].attributes.subject
The Scars that We Carry: Forced And Coerced Sterilization of Persons in Canada - Part II

# data[].attributes.headline
The Words of Our Ancestors: An Introduction to Michif and Indigenous Language Revitalization

# data[].attributes.subject
The Words of Our Ancestors: An Introduction to Michif and Indigenous Language Revitalization

# data[].attributes.headline
Metis Residential School Survivors Series

# data[].attributes.subject
Metis Residential School Survivors Series

# data[].attributes.body
Season 3 of the speaker series podcast, are words specifically from Metis Residential School Survivors

# data[].attributes.attachment_link.readable_text
Partner with the Métis Speaker Series

By partnering with the series, you are not only connecting your brand to a well-respected voice in the community but also helping to generate visibility for Métis issues.

# data[].attributes.attachment_link.description
By partnering with the series, you are not only connecting your brand to a well-respected voice in the community but also helping to generate visibility for Métis issues.

# data[].attributes.attachment_link.description
Wellness SupportsWe provide free and culturally informed wellness supports on the topics of mental health and substance use issues. Thunderbird WellnessOur culturally grounded app is free, and user friendly! The app promotes a strengths-based, trauma informed approach to supporting First Nations wellness. Download Resource LibraryWe offer many culturally informed resources...

# data[].attributes.attachment_link.description
Faculty of Medicine UBC Learning Circle | Centre for Excellence in Indigenous Health

# data[].attributes.headline
National Indigenous Cultural Safety Learning Series

# data[].attributes.subject
National Indigenous Cultural Safety Learning Series

# data[].attributes.attachment_link.title
National Indigenous Cultural Safety Learning Series

# data[].attributes.attachment_link.description
This national webinar series provides an opportunity to share knowledge, experiences and perspectives in support of collective efforts to strengthen Indigenous cultural safety in health and social services.

# data[].attributes.attachment_link.title
Thunderbird Resource Library - Thunderbird Partnership Foundation

# data[].attributes.attachment_link.description
Find all of our documents, guidebooks, fact sheets, annual reports and more in our redesigned resource library.

# data[].attributes.headline
Île-à-la-Crosse Residential School | Métis School

# data[].attributes.subject
Île-à-la-Crosse Residential School | Métis School

# data[].attributes.attachment_link.readable_text
Île-à-la-Crosse Residential School | Métis School

From 1889 to 1937, the federal government's admission policy for non-Indian students at residential schools had been far from consistent. There were two institutions during this period-the Île-à-la-Crosse school in northern Saskatchewan, and St. Paul's Hostel in Dawson City in the Yukon-that further demonstrate this lack of consistency. Both institutions received federal funding at various points in their history, even though most of the students who attended them were of mixed descent. (The Métis Experience, Vol. 3, p. 29)

In 1860, three Sisters of Charity arrived at Île-à-la-Crosse and took ownership of the newly built Le Couvent Saint-Bruno.8 According to Oblate officials, the majority of students at the school were Métis.9 In the mornings, both girls and boys were taught lessons in spoken and written French and in basic arithmetic. They also attended catechism class.10 The lessons in the common room were preceded and followed by work routines. The girls were being prepared for service as homemakers, and worked daily in the school kitchen.11 The boys did not sleep in the dormitory at the convent, but, instead, at the Oblate house, under the supervision of a lay brother.12 At 5:30 a.m., he escorted them to Saint-Bruno, where they would work, eat, and receive lessons.They spent the afternoons on farm work.13 (The Métis Experience, Vol. 3, p. 31) In 1906, the school moved to Lac la Plonge ( Beauval Indian Residential School).

In 1917, the Sisters of Charity returned [from Lac la Plonge] to Île-à-la-Crosse, where a new convent, the School of the Holy Family, had been constructed on higher ground. The dormitory housed four boarders, and classes were attended by twenty-two day students.29 The school continued to be accompanied by disaster. Fire destroyed the convent on April 1, 1920. A replacement building, completed in October 1921, burned in 1925.30 Three boys and one of the teaching sisters drowned in a boating accident in September 1923.31(The Metis Experience, Vol. 3, p. 32)

Survivor Stories

Mike Durocher, a student at Île-à-la-Crosse for nine years, said life was governed by "a regimental time clock dictated by Church functions."20 On the regimented life, a student from a different school said, "We were trained like dogs-clap you get up-two claps you go eat-three claps maybe you go outside."21 Punishment for breaking rules was humiliating. (The Métis Experience, Vol. 3, p. 49)

Robert Derocher said that some staff preyed on the students' loneliness: "It seemed that he knew how to pick the, the children that were hurting and to give them any kind of attention that we were all looking for; even if it was not good."32 (The Métis Experience, Vol. 3, p. 49)

According to Robert Derocher, at Île-à-la-Crosse, bedwetters were required to "wear a diaper in front of everyone all day long."24 (The Métis Experience, Vol. 3, p. 48)

Allen Morin said that Île-à-la-Crosse was a world run by non-Aboriginal people.

I remember the teachers used to come there from September to June, and then they'd leave, and then a new pack of teachers would come in, and they were all non-Native, and to me, I was thinking how come, how come they're coming in and leaving? And I thought, well, I guess that's because we're Indians and they're, and they're non-Native, and then only non-Natives can be teachers, or professionals, or priests, or stuff like that. And they were kind of, I think they were kind of, they separated themselves from the community, we, we didn't mingle with them.28 (The Métis Experience, Vol. 3, p. 49)

In speaking about the life at Île-à-la-Crosse, one former student, Mary Jacobson, said that although she thought the nuns treated the students well, the students were disciplined for poor performance in the classroom. Jacobson said that "we didn't learn, that is our fault if we get a licking. Because we got to try to learn and they want us to learn something."42 (The Métis Experience, Vol. 3, p. 51)

Because boys and girls were kept separate, families were broken up. This was a practice that continued into the 1950s. Alphonse Janvier recalled that at Île-à-la-Crosse, "you were not allowed to talk to them because this playground had an imaginary boundary that we could not cross. We talk about it now and we wonder why we had to put up with that. We used to eat in the same dormitory with a wall dividing us and two doors and we used to wave at each other and that was the only way of communication with my nieces."56 (The Métis Experience, Vol. 3, p. 53)

Over time, there was an increase in the number of Métis people who worked at the schools. Thérèse Arcand, who became the first Métis graduate from Île-à-la-Crosse to enter the order of the Sisters of Charity, returned as the result of a bittersweet inspiration. As she prepared to leave the school in March 1929, she came across a girl who had just arrived. "She was crying. I then said to myself. 'I will go in training and come back to help my people.' that was my last thought while in Ile-à-la-Crosse."61 (The Métis Experience, Vol. 3, p. 54)
Click to read about Sara Riel
New Documentary
https://www.cbc.ca/news/canada/saskatchewan/old-residential-school-to-be-torn-down-in-ile-a-la-crosse-1.3761840
Métis reflect on Residential School experiences
CBC News Posted: Mar 28, 2012 9:43 PM CT Last Updated: Mar 28, 2012 10:13 PM CT
https://www.cbc.ca/news/canada/saskatchewan/m%C3%A9tis-reflect-on-residential-school-experiences-1.1277152

(Source: http://metis.tripod.com/flora.html )

"Marie-Rose Piwapiskus (also known as Marie-Rose Petit-Fer or Marie-Rose Iron). Descended from a Plains Cree family settled at Canoe Lake (approximately forty kilometres southwest of Île-à-la-Crosse), Marie-Rose had been catechized by Taché in the early 1850s and had subsequently acquired a reputation among Oblates for intelligence and piety. She began providing Oblates with Cree-language instruction in 1869 and continued this service for nearly fifty years. During the same period, Marie-Rose also ran a small day school at the mission of Canoe Lake - la Bienheureuse-Marguerite-Marie (founded in 1871). There she taught prayers, hymns and catechism in Cree to local children in exchange for an annual stipend disbursed by the Oblate superior of Saint-Jean Baptiste. Her efforts produced impressive results and garnered high praise from the Oblates. In spring 1876, Father Prosper Légeard reported - with evident admiration - that many of Marie-Rose's pupils knew the catechism by heart. 'C'est la première fois,' noted Légeard, 'que nous voyons dans nos missions des enfants sauvages parfaitement instruits du catéchisme. Personne même n'aurait songé à entreprendre cette tâche difficile ; notre petite maîtresse d'école, avec sa bonne volonté et sa persévérance, en est venue à bout.'" Marie-Rose Piwapiskus lived into her nineties and died in the Grey Nuns' hospital at Île-àla-Crosse on June 5, 1931 (Source: Timothy Paul Foran's thesis: "LES GENS DE CETTE PLACE": OBLATES AND THE EVOLVING CONCEPT OF MÉTIS AT ÎLE-À-LA-CROSSE, 1845-1898 and https://www.jkcc.com/robes.html

# data[].attributes.attachment_link.title
Île-à-la-Crosse Residential School | Métis School

# data[].attributes.attachment_link.description
From 1889 to 1937, the federal government's admission policy for non-Indian students at residential schools had been far from consistent. There were two institutions during this period-the Île-à-la-Crosse school in northern Saskatchewan, and St. Paul's Hostel in Dawson City in the Yukon-that further demonstrate this lack of consistency.

# data[].attributes.headline
Unlearning and Undoing systemic white supremacy and Indigenous -Specific Racism 

# data[].attributes.subject
Unlearning and Undoing systemic white supremacy and Indigenous -Specific Racism 

# data[].attributes.attachment_link.title
Unlearning & undoing systemic white supremacy & Indigenous-specific racism within the BC OPH Officer

# data[].attributes.headline
Introduction to Unlearning & Undoing White Supremacy and Racism in the Office of the Provincial Health Officer

# data[].attributes.subject
Introduction to Unlearning & Undoing White Supremacy and Racism in the Office of the Provincial Health Officer

# data[].attributes.attachment_link.readable_text
At the Office of the Provincial Health Officer (OPHO), we are committed to upholding the inherent rights of Indigenous Peoples (First Nations, Métis, and Inuit) in BC, as well as anti-racist approaches, and truth and reconciliation. We are committed to seeing the ways that anti-Indigenous racism and white supremacy show up in our day-to-day work (i.e., policies, practices, processes), and deliberately taking anti-racist approaches to arrest white supremacy and racism. We are also beginning work to pay particular attention to the rights and needs of Indigenous elders, women, 2SLGBTQIA+, youth, children and persons with disabilities throughout this work.

The Unlearning and Undoing White Supremacy Project began a two-year initiative that has transitioned to ongoing efforts to embed Indigenous rights, truth, and reconciliation across the OPHO.

Land Acknowledgement

We acknowledge with great respect the territories of the lək̓ʷəŋən peoples which the Office of the Provincial Health Officer stands, and the Songhees, Esquimalt (Xwsepsum) and W̱SÁNEĆ peoples whose historical relationships with the land continue to this day. We recognize and express our gratitude for the medicines within these territories, and the First Nations territories that stretch across every inch of the province of British Columbia.

Rights Acknowledgement

We acknowledge with respect the inherent rights of the First Nations whose ancestral territories cover every inch of the province now known as British Columbia, including their unextinguished land rights and rights to self-determination, health, and wellness within these territories. Laws and governance systems rooted in the land have upheld the sovereignty of these diverse Nations for thousands of years. The rights and responsibilities of First Nations to their ancestral territories have never been ceded or surrendered, and are upheld in provincial, national, and international law.

We also recognize that many Indigenous Peoples (First Nations, Métis, and Inuit) from elsewhere in what is now known as Canada and beyond also call these lands and waters home, and they too have inherent Indigenous rights to self-determination, health, and wellness. This includes Métis Nation British Columbia and its Chartered Communities across BC, as well as those whose ancestral territories are outside of BC.

Introducing Ourselves
Bonnie Henry, MD, MPH, FRCPC Danièle Behn Smith, MD, CCFP, MPH (she/her) Kate Jongbloed, PhD (she/her)
I am a 5th generation Canadian settler of Scottish Highland and Welsh ancestry, born and raised on Mi'kmaq territory (PEI/NB). I acknowledge with gratitude that I live, work, and play on lək̓ʷəŋən territory (Songhees and Esquimalt Nations). I have the privilege of working as BC's Provincial Health Officer. Our office is learning how to better honour Indigenous Peoples and ways of knowing in our work. We have committed to disrupting anti-Indigenous racism in the health-care system with the guidance of First Nations, Métis, and Inuit teachers.
We recognize with tremendous gratitude the other staff, leaders, and trainees within the OPHO who contribute their hands, hearts, and minds to this work.
Taanshi, Dágǫndı́h, Greetings with gratitude on the territories of the lək̓ʷəŋən (Lekwungen) peoples of the Songhees and Esquimalt Nations! I'm Métis from the Red River Valley and Eh Cho Dene from Fort Nelson First Nation. I am a mama to two beautiful kids and one little black dog. I have the honour and privilege of working as the Deputy Provincial Health Officer, Indigenous Health. At the BC OPHO, we are working towards an environment of cultural safety, anti-racism, and trustworthiness. Mussi cho/Maarsi.

I am a white occupier living on the territories of the xʷməθkwəy̓əm (Musqueam), Sḵwx̱wú7mesh Úxwumixw (Squamish), and Səl̓ílwətaɬ (Tsleil-Waututh) Nations. I am an epidemiologist and mixed methods health researcher with 12+ years of experience working in the field of Indigenous health and wellness. I am lucky to be working with Danièle and the OPHO team during a two-year CIHR Health Systems Impact Post-Doctoral Fellowship (2021-2023).

OPHO Vision on Indigenous Rights, Truth, and Reconciliation

We envision an OPHO that:

1. Recognizes the inherent rights and title of BC First Nations and the inherent rights of all First Nations, Métis, and Inuit living in BC.

2. Acknowledges that these rights can only be fully exercised when the ecosystems in which they are embedded are vibrant, biodiverse, and loved and cared for, and that we therefore share a collective responsibility to the health and wellness of these territories.

3. Recognizes the truth that Indigenous-specific racism is perpetuated through white supremacist policies and practices that remain hardwired into our systems and processes, and that impede the health and wellness of Indigenous Peoples.

4. Actively works to uphold the inherent rights of Indigenous Peoples by taking action on specific Foundational Commitments made to Indigenous Peoples (e.g., United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Commission Calls to Action, the National Inquiry into Missing and Murdered Indigenous Women and Girls, and the In Plain Sight report), being trustworthy in relationships with Indigenous partners, and taking anti-racist actions in all aspects of OPHO work.

WHY are we doing this work?

Our obligation to uphold inherent Indigenous rights, anti-racist approaches, and truth and reconciliation is articulated in provincial, federal, and international laws and initiatives:

WHAT framework guides our reconciliation work?

The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) has been established as the province's guide for reconciliation with the BC Declaration on the Rights of Indigenous Peoples Act. Principles for reconciliation are provided within the 10 Draft Principles that Guide the Province's Relationship with Indigenous Peoples.

HOW will we meet our obligations?

The solutions have been provided. Indigenous Peoples have provided nearly 1000 clear and detailed instructions on how to uphold inherent rights, anti-racist approaches, and truth and reconciliation in the following foundational documents:

ACTION: So, what do we do?

We have a responsibility to act on the instructions provided by Indigenous Peoples within the foundational commitments. Despite having clear obligations and frameworks, our accountabilities and actions are incomplete. We must ask ourselves:

LEARN: What homework have I (and my team) done to LEARN from the original inhabitants of these lands and waters about their laws and teachings, as well as the truths of settler colonial harms and how they continue to manifest in the present day?

UNDERSTAND: What homework have I (and my team) done to UNDERSTAND what must be done in our sphere of obligations to meet these foundational obligations?

ACT: How have I (and my team) begun to ACT in ways that challenge, elevate and advance true reconciliation, including hardwiring accountability and marathon actions towards meeting these foundational obligations?

# data[].attributes.attachment_link.keywords[]
introduction to unlearning & undoing white supremacy and racism in the office of the provincial health officer

# data[].attributes.attachment_link.title
Introduction to Unlearning & Undoing White Supremacy and Racism in the Office of the Provincial Health Officer

# data[].attributes.attachment_link.description
Introduction to Unlearning & Undoing White Supremacy and Racism in the Office of the Provincial Health Officer

# data[].attributes.attachment_link.description
Listen to this episode from The Harbour on Spotify. There has been a shift in health sciences to lead with empathy and compassion amongst health professionals and leadership. Caesar-Chavannes, Stephanie Nixon (Vice Dean and Director of the School of Rehabilitation Therapy), and EDIIA student researcher Ben Carroll (Nursing) engage in an insightful dialogue on how to engage in the practice of empathy and compassion.

# data[].attributes.headline
Understanding the role and priledge in realtion to public helath ethics and practice 

# data[].attributes.subject
Understanding the role and priledge in realtion to public helath ethics and practice 

# data[].attributes.attachment_link.title
Understanding the role of privilege in relation to public health ethics and practice

# data[].attributes.attachment_link.description
In this video, see Dr. Stephanie Nixon (University of Toronto) discuss: How do you think about the role of privilege in relation to public health ethics and practice? How do you understand allyship and its role in public health?

# data[].attributes.headline
The coin model of priviledge in relation to public health ethics and practice 

# data[].attributes.subject
The coin model of priviledge in relation to public health ethics and practice 

# data[].attributes.attachment_link.readable_text
BMC Public Health 19, Article number: 1637 (2019) Cite this article

114k Accesses

150 Citations

370 Altmetric

Metrics

Abstract

Health inequities are widespread and persistent, and the root causes are social, political and economic as opposed to exclusively behavioural or genetic. A barrier to transformative change is the tendency to frame these inequities as unfair consequences of social structures that result in disadvantage, without also considering how these same structures give unearned advantage, or privilege, to others. Eclipsing privilege in discussions of health equity is a crucial shortcoming, because how one frames the problem sets the range of possible solutions that will follow. If inequity is framed exclusively as a problem facing people who are disadvantaged, then responses will only ever target the needs of these groups without redressing the social structures causing disadvantages. Furthermore, responses will ignore the complicity of the corollary groups who receive unearned and unfair advantage from these same structures. In other words, we are missing the bigger picture. In this conceptualization of health inequity, we have limited the potential for disruptive action to end these enduring patterns.

The goal of this article is to advance understanding and action on health inequities and the social determinants of health by introducing a framework for transformative change: the Coin Model of Privilege and Critical Allyship. First, I introduce the model, which explains how social structures produce both unearned advantage and disadvantage. The model embraces an intersectional approach to understand how systems of inequality, such as sexism, racism and ableism, interact with each other to produce complex patterns of privilege and oppression. Second, I describe principles for practicing critical allyship to guide the actions of people in positions of privilege for resisting the unjust structures that produce health inequities. The article is a call to action for all working in health to (1) recognize their positions of privilege, and (2) use this understanding to reorient their approach from saving unfortunate people to working in solidarity and collective action on systems of inequality.

Peer Review reports

Background

The narrator at the start of a YouTube video instructs, "Count how many times the team wearing white passes the ball" [ 1]. Six people enter the screen: three wearing white shirts, and three wearing black. They stand in a circle and pass basketballs to each other for 90 seconds. At the end of the video, the narrator says, "The correct answer is 16 passes. Did you spot the gorilla?" A portion of the audience typically misses the gorilla and is baffled by the question [ 2]. The video then repeats to show again that in the midst of the basketball passing, an adult dressed as a gorilla walks into scene, looks at the camera thumping his chest, then leaves. This short exercise demonstrates how it is possible to miss something as obvious as a gorilla, but also invites the audience to imagine how it could be otherwise. That is, the audience had their capacity built to count the number of passes by the team wearing white whereas the narrator could have built the capacity of the audience to spot the gorilla. So it is with privilege: that it is possible to miss something as obvious as an adult in a gorilla suit walking into the screen. It follows that if one missed the gorilla (or privilege), then there is no possibility of engaging in conversation about the gorilla. One might even question the legitimacy of other people's claims about the existence of a gorilla (or privilege). However, the narrator could have built the capacity of the audience to see the gorilla, and so too can people build their capacity to see privilege [ 3]. Building this capacity requires both learning and unlearning, and is the aim of this article.

This article provides a framework, the Coin Model of Privilege and Critical Allyship, for conceptualizing privilege in order to address the even more important question of what to do about it, which is termed practicing critical allyship. In particular, I explore how privilege and allyship are related to health inequity - that is, disparities that are systemic, avoidable, and unfair [ 4]. Efforts to address inequities tend to frame concerns as unfair consequences of social structures that result in poor health, without consideration of the ways in which these same social structures give unearned advantage to others. Unearned advantage, or privilege, is the gorilla. Practicing critical allyship is the orientation to guide action for people who find themselves in positions of privilege in relation to a particular system of inequality.

Disappearing privilege from discussions of health equity is an important shortcoming, because the framing of a problem sets the universe of possible solutions that will follow. If inequity is framed exclusively as a problem facing people who are marginalized, then responses will only attempt to address the needs of these groups, without redressing the social structures causing this disadvantage, or the complicity of the corollary groups who receive unearned (and unfair) advantage from these same structures [ 5 , 6]. This approach, often called anti-oppression [ 7], is well developed in other fields [ 8, 9, 10, 11] but less so within health research [ 12]. To be clear, the ideas presented in this article about privilege and oppression are not new; they have been articulated, advanced and argued for decades, largely by "marginalized" groups to people in positions of privilege who have not been ready or willing to listen. In this article, I seek to translate these ideas in a new way for a general health audience, and it is noteworthy that successful uptake of the ideas in this version must be understood as inextricably linked to my position as someone "on the top of many coins".

The first part of this article introduces the metaphor of the coin, a framework for understanding how social structures offer both unearned advantage ('privilege') and disadvantage ('oppression'). I adapted the coin metaphor from the schematic of privilege, domination and oppression presented by Kathryn Pauly Morgan in "Describing the Emperor's New Clothes: Three Myths of Educational (In)Equality" [ 13]. The Coin Model of Privilege and Critical Allyship aims to inform action to resist and dismantle the unjust structures that produce inequities. The model embraces an intersectional approach to consider how systems of inequality, such as racism, heterosexism and ableism, interact to produce complex patterns of unearned disadvantage and advantage. The second part of this article introduces principles for practicing critical allyship and their implications for mitigating health inequities.

The coin model

The coin

There are norms, patterns and structures in society that work for or against certain groups of people, which are unrelated to their individual merit or behaviour. Put another way, there are (often invisible) systemic forces at play that privilege some social groups over others, such as sexism, heterosexism, racism, ableism, settler colonialism, and classism [ 14]. These unfair social structures have profound effects on health, producing inequities in morbidity and mortality.

Racism is well demonstrated to adversely affect the health of non-white people through interconnected structural, institutional, cultural and psychosocial pathways [ 15, 16]. For instance, there is a breadth of evidence in the American context demonstrating that people who are racialized receive lower quality health services and are less likely to receive routine medical procedures than white Americans [ 17]. Racism and its interconnection with colonialism have created profound health inequities for Indigenous Peoples, including lower life expectancy (by more than 5 years) than the non-Indigenous population in the United States [ 18, 19, 20]. Women and girls have worsened health outcomes, diminished capacity to realize health-related human rights, and reduced access to healthcare, which are related to sexism, and its intersections with class, race and ability [ 21, 22, 23]. People who are gay, lesbian or bisexual face health inequities related to heteronormativity and homophobia [ 24, 25]. Furthermore, there is worsened health among transgender people due to cisnormativity and transphobia, which is exacerbated by other systems of oppression [ 23, 26- 27]. A study in the Canadian province of Ontario found that one in ten trans people who had accessed an emergency room had been refused care or had care terminated prematurely because they were trans, and 40% had experienced discriminatory behaviour from a family doctor [ 27]. A final example is health disparities among people with disabilities related to ableism and its intersections with other systems of inequality [ 28, 29]. Census data from 2015 demonstrated that nearly 14% of Australians with a disability reported disability-based discrimination in the previous year; that disability-based discrimination was more common among people who were unemployed or poor; and, that disability-based discrimination was associated with higher levels of psychological distress and poorer self-reported health [ 29]. These systems of inequality are bad for health.

In the Coin Model, each system of inequality is conceptualized as a coin. Coins do not reflect the individual behaviour of good or bad people. Rather, they are society-level norms or structures that give advantage or disadvantage regardless of whether individuals want it or are even aware of it. Each coin represents a different system of inequality.

These social structures, or coins, give unearned advantage or disadvantage according to one's relationship to that particular system of inequality. For instance, one may consider the coin (or system of inequality) of heterosexism. Heterosexuality is romantic or sexual attraction to people of the opposite sex. Heterosexism, a dominant norm in many societies, views being heterosexual as the only normal and right way to be. People who happen to fit this norm because they are straight (i.e., heterosexual) enjoy advantages from this social structure. For instance, they can openly express affection without fear of discrimination or violence. They see their way of life validated and valued through its regular, positive, and default position as the normal way of being reflected in legal frameworks and popular culture. However, straight people did not choose to be straight; they just are. They did not earn this advantage; rather, they lucked into it by their natural preference for whom they love being in alignment with this broader social norm. They likely did not ask for these benefits, but they receive them all the same. They may not even be aware that they are receiving unearned advantage, but they receive it nonetheless [ 30].

Conversely, people who are not straight do not enjoy this freedom from discrimination and violence, or the sense of inclusion and belonging that results from this social structure. People who are not straight, such as people who identify as gay, lesbian, bisexual, asexual, or two-spirit, did not choose to be that way; they just are. However, their natural preference for whom they love is not in alignment with the dominant norm of heterosexism and, as such, they receive unearned disadvantage. They did nothing to earn it, but they receive it nonetheless. Furthermore, while unearned advantage can be difficult to see, unearned disadvantage is often highly visible to those who experience it.

The bottom and top of the coin: oppression and privilege

It is the same social structure, or coin, that gives unearned disadvantage to some and unearned advantage to others. Groups of people who are disadvantaged by this social structure are viewed as being on the bottom of the coin (see Fig. 1). In this model, I call this side of the coin oppression. Because of the dire health effects resulting from this unfair disadvantage, these are the groups commonly targeted in health promotion research and interventions. The names for these groups are many and familiar, including marginalized populations, disadvantaged groups, vulnerable communities, high-risk groups, priority neighbourhoods, or hard-to-reach populations.

Other groups of people receive advantage from these same social structures, and are viewed as being on the top of the coin. These groups receive benefits from the structures that others do not, which they did not earn. Rather, they receive the benefit because they luck into being in alignment with the norms of that particular social structure. In this model, I call the position on the top of the coin privilege.

Terms used to describe groups of people who enjoy unearned health benefits as a result of systems of inequality are uncommon and hard to imagine (e.g., unfairly advantaged groups, free-lift populations). To view those on the top of the coin as "normal" or "average patients" is erroneous since, by definition, the top of the coin represents people who are the recipients of unearned and unfair benefits because their way of being is valued over others. The goal is not to move people from the bottom of the coin to the top, because both positions are unfair. Rather, the goal is to dismantle the systems (i.e., coins) causing these inequities.

Drawing attention to the top of the coin is important because inequity is relational: the bottom of the coin is disadvantaged compared to the top. Yet, issues of health equity are often framed exclusively as problems facing people on the bottom of the coin. Disappearing the top of the coin, and often the coin itself, functions to maintain the status quo because what one frames as the problem sets the universe of conceivable actions to address it. When the problem is framed as challenges faced by the members of a "vulnerable group" (i.e., bottom of the coin), then potential solutions will focus exclusively on interventions to address their issues. Should actions address the needs of these groups? Of course; these responses are deeply important for redressing existing inequities. However, the bottom of the coin is commonly framed as the entire story of health equity as opposed to just one part. If the problem was viewed not only as the bottom of the coin, but also the coin itself (i.e., the unjust social structure that gives unearned disadvantage to people on the bottom), then a different set of solutions could follow, such as changes to policy and law to create safeguards against discrimination produced by the system of inequality. Indigenous physician and public health leader, Marcia J. Anderson, succinctly captures this point as follows:

"From now on instead of 'vulnerable people' I'm going to use the phrase 'people we oppress through policy choices and discourses of racial inferiority.' It's a bit longer but I think will help us focus on where the problems actually lie." [ 31]

For instance, the coin of ableism reflects the social structure that discriminates against disabled people in favour of people who fit a socially-constructed norm of able-bodiedness [ 32]. In an ableist worldview, there is a particular version of ability that is assumed to be normal or natural (top of the coin), and people who cannot meet this expectation (bottom of the coin) are viewed as a problem who should strive to become, or assimilate to, the norm. Ableism views disability as a mistake or failing rather than a simple consequence of human diversity, like sexual orientation or gender.

Consider the different solutions that become imaginable depending on whether one views the problem as the bottom of the coin (i.e., disabled people) or the coin itself (i.e., ableism). Solutions addressing the bottom of the coin strive to support disabled people to achieve the norm of able-bodied people, including medical care and rehabilitation to fix disability within the body. Conversely, if one views the problem as the unfair social structure of ableism, then the cause of disability shifts: instead of being located within an individual's body, disability is understood as resulting from the social, attitudinal and political environment. Responses become focused on social change to achieve equity for people with disabilities in the same light as equity for other disadvantaged groups where prejudice, segregation, and inaccessibility are viewed as the problem. Responses might focus on rights-based approaches aligned with the United Nations Convention on the Rights of Persons with Disabilities. Actions would shift from focusing on disability as a mistake to instead celebrating difference by creating flexible systems (e.g., through policies, the built environment) that enable and liberate as opposed to disable and exclude.

Problematizing the coin of ableism also shines a spotlight on the profoundly disabling effects of stigmatizing attitudes commonly held by able-bodied people. In many cases, such effects are unintended and unknown to those reproducing them, but profoundly impactful all the same, which brings us to the top of the coin.

Seeing the gorilla: recognizing the effects of invisiblizing privilege

The coin of settler colonialism in the context of Canada provides another useful illustration. If the coin is settler colonialism, then the group receiving unearned disadvantage on the bottom of that coin is Indigenous Peoples. Since the Idle No More movement and 2015 report of the Truth and Reconciliation Commission of Canada, the history and legacy of colonization are starting to be recognized within Canadian society [ 33, 34]. For instance, there is greater attention to the ongoing, devastating effects of Indian Residential Schools on Indigenous Peoples, the harmful effects of the Government of Canada's Indian Act, and the rights-violations embedded in the inequitable provision of public funding to ensure basic determinants of health (e.g., clean drinking water, quality primary education) within Indigenous communities. These examples draw attention to the coin (i.e., settler colonialism) as the source of profound health inequities between Indigenous and non-Indigenous people in Canada. The problem has been relocated from Indigenous People (the bottom of this coin) to the structures (the coin) that create the conditions that produce unearned and unfair disadvantages. The growing ability to see, and thereby devise solutions to address, the coin is an important marker of progress toward dismantling this inequity.

But Indigenous People and settler colonialism are not the complete picture. Similarly, disabled people (bottom of the coin) and ableism (the coin), are not the complete picture. What about the people on the tops of these coins? Who are they? What is their role in dismantling, or as is often the case, unintentionally strengthening the coin?

A key task for people who find themselves on the top of a coin is to see the gorilla; that is, to understand that there is a coin, that it has two sides, and that they occupy the position of unearned advantage (i.e., privilege) on the top. For instance, if Indigenous People are on the bottom of the coin, it is non-Indigenous people (often referred to as settlers) who receive unearned and unfair advantage from these same structures. Seeing the gorilla in this instance means developing the capacity to ask and answer questions such as, "In which ways did I benefit from settler privilege today?" and "In what ways did my actions today reflect and thereby reinforce the coin of settler colonialism?"

In many cases, people on the top of a coin did not ask for the unearned advantage that they receive. However, people are rarely on the top of the coin because of merit or worth (commonly referred to as the myth of meritocracy [ 35]). Rather, they are there, by definition, because they happen to be able-bodied, settlers, white, straight, cisgender, or other aspects of their social identity that they did not choose, but which nonetheless align with historic planes of domination and subordination [ 13].

Just as the disadvantage received by people on the bottom of the coin is unearned and unfair, so too, the advantage received by people on the top of the coin is unearned and unfair. However, these opposite effects of the coin are not evenly understood.

The contradiction of who holds expertise vs who holds power regarding systems of inequality

The unfair disadvantage associated with the bottom of the coin is frequently in plain view - to clinicians and researchers working to address these challenges, and especially to people on the bottom of the coin themselves who may confront these disadvantages daily. Regardless of whether people on the bottom of the coin are fluent in the language of anti-oppression, they typically are expert in the many ways that the coin operates to create disadvantage, dehumanization, lack of safety and social exclusion. Moreover, it is these groups who have historically led movements to dismantle the coins, such as Indigenous Peoples leading movements to redress the harmful effects of colonization on First Peoples and the environment, or Black people leading anti-racism civil rights movements.

However, the unearned advantage associated with being on the top of the coin is often invisible - in health promotion interventions, in health equity research, and especially to the people themselves who occupy positions on the top of coins. Some have argued that the obliviousness of people about their positions of privilege is a key strategy required to sustain the hegemony of systems of inequality [ 36]. Learning to see the gorilla is a strategy for becoming less oblivious and less harmful.

Lack of awareness about the top of the coin has serious implications for meaningfully addressing health equity. This is because lack of recognition of the societal influences that have helped elevate people on the top of coins to reach their professional, economic or social positions commonly leads those same people to presume that they are there exclusively because of their individual merit. Put another way, where privilege is unchecked, it can lead to an irrational sense of entitlement, expertise and access. It then seems logical and, indeed, a moral imperative for those on the top of the coin to be guided by an altruistic urge to save or fix people on the bottom of the coin. However, this logic no longer holds when one considers who possesses expertise regarding the coin and its effects; that is, people on the bottom of coins.

Furthermore, invisibilizing the top of the coin allows people in positions of privilege to view themselves as unconnected to, or outside of, the systems of inequality they are trying to address, as opposed to understanding their direct relationship to people on the bottom of the coin. Instead of understanding their complicity within systems of inequality, disappearing the top of the coin allows people on the top to frame their role in health equity work as neutral, selfless and altruistic. This positioning logically leads to action that (exclusively) assists people on the bottom of the coin as opposed to targeting oppressive systems that are bad for all.

Within the health sphere, the people who typically hold the power to allocate resources, design programs, and draft policy to address the needs of people on the bottom of the coin often find themselves on the top of multiple coins. But who are the real experts in understanding how the coin operates in society? When people in privilege do not realize the powerful implications of that position, they may unwittingly - and with the best of intentions - devote themselves to trying to help people on the bottom without ever understanding: (1) the impact of the coin on their own individual position, (2) how this lack of understanding vastly compromises their insight about the oppressive social structure, and (3) how this lack of insight can lead to actions that serve not to dismantle the coin, but to strengthen the status quo. For instance, the assumed expertise of people on the top of the coin to solve the problems of inequity becomes reinforced, while the assumed neediness and lack of expertise of people on the bottom of coins is further entrenched. Materials resources (e.g., salaries, grant funding) to address health equity commonly flow to people on the top of the coin to design and administer programs for people on the bottom of the coin, thus reinforcing inequities.

In summary, lack of awareness about one's position on the top of coins is dangerous for health equity. Indeed, the invisibility of privilege is central to the functioning and sustainability of the system of inequality. Invisiblilizing the top of the coin, and frequently the coin itself, ensures that the coin remains strong. This is the gorilla, and why movement toward dismantling systems of inequality requires everyone, and especially people on the top of coins, to learn how to see the gorilla.

Recognizing the intersecting nature of multiple coins

A single coin does not represent all privilege or all oppression. Rather, each coin represents a specific system of inequality (e.g., sexism, racism, ableism). Each person typically occupies the position on the top of some coins and the bottom of other coins at the same time. A common pattern is for people to have a well-developed understanding of the system of inequality for which they find themselves on the bottom and, perhaps, frustration, anger or sadness that this unjust system is not better understood by people on the top of that same coin. This insight can be helpful for then considering one's (often limited) knowledge about the systems of inequality where they find themselves on the top.

Furthermore, it is important to recognize that while each coin represents a different system of inequality, the coins do not operate in isolation. Rather, the coins intersect to create complex inter-relating systems of inequality (see Fig. 2). The result is not additive; finding oneself on the same side of two coins does not mean that one is twice as privileged or twice as oppressed. Rather, intersecting systems of inequality produce new and complex patterns of advantage and disadvantage. The relevance and impact of these positions varies according to context, and so one's positions on these multiple coins need to be analyzed together. The term, intersectionality, was introduced by legal scholar and critical race theorist, Kimberlé Crenshaw, and further understood as the matrix of domination by Black feminist scholar, Patricia Hill Collins, in order to characterize the unique forms of oppression faced by women who are Black [ 37, 38]. Intersectionality has been taken up widely, including within the health sphere [ 39, 40].

The intersecting nature of the coins, which produces complex patterns of advantage and disadvantage

Analysis requires the precision of clarifying one's position on the top or bottom of each particular coin, with special attention to those coins for which one is on top, and how these individual positions may amplify each other in different contexts. Importantly, not all coins are the same size; that is, different systems of inequality will matter more or less in different contexts, and depending on their intersection with other patterns of inequality.

Another key insight offered by an intersectional analysis is how experiences of oppression in one system of inequality do not negate positions of privilege in others. For instance, a white person who is poor may clearly understand the oppressive effects of classism, but may not also appreciate the ways they simultaneously benefit from being on the top of the coin of racism. A racialized person who is considered able-bodied may understand the devastating effects of racism while being unaware of how their ableist privilege serves to regularly give them unearned advantage. An intersectional analysis reminds us that the effects of these different positions cannot be understood through a mathematical approach whereby the position on the bottom of one coin cancels out the position on the top of another. This is how even the most articulate activists on certain systems of inequality can unintentionally strengthen other coins where they find themselves on top because of their unrecognized positions of privilege, i.e., their lack of capacity to see that particular gorilla.

This is not about innocence or guilt

Discussions of privilege can lead to faulty assumptions of innocence, and counterproductive attention to guilt. The coin model is premised on an analysis that rejects both of these unhelpful patterns.

Framing people on the top of the coin as oblivious about their unearned privilege does not equate to innocence among those individuals. For the most part, people within the health sphere who are in positions of privilege do not intend to cause harm; however, these coins were created very intentionally by people on the top of the coin. These systems were designed to oppress, and they are sustained, intentionally by some and unintentionally by others, who are on top of the coin. It is not the intent of one's actions that matters but the impact, and the impact of oblivion among people on the top of the coin can be deeply harmful, dehumanizing and violent to people on the bottom of the coin. Indeed, these systems of inequality are harmful to whole societies because they diminish the contributions and talents of people on the bottom of coins through the barriers they face.

Another common narrative is the feeling of guilt among people when considering the unearned benefits they receive because of being on the top of a coin. Feelings of guilt can lead to discomfort, distancing from the issue, denial, or intellectual paralysis. In the context of racism, white academic Robin DiAngelo calls this phenomenon "white fragility" [ 41]. Guilt can become the primary focus of discussion and analysis among people who share positions on the top of a coin. However, the coin model invites analysis of how focusing on guilt serves to strengthen vs dismantle systems of inequality. Guilt leads to feelings of distress among people through reflecting on the unearned advantages and free lifts that make their lives easier. This distress must be understood in contrast to the (often daily) distress, dehumanization, and violence experienced by people on the bottom of the coin. Furthermore, focusing on the guilt born of discovering unearned benefits serves to centre the needs and feelings of people on the top of the coin, which reinforces the coin by crowding out the needs and feelings of people on bottom. In the words of the Black, lesbian poet and philosopher, Audre Lorde:

"Guilt is not a response to anger; it is a response to one's own actions or lack of action. If it leads to change then it can be useful, since it is then no longer guilt but the beginning of knowledge. Yet all too often, guilt is just another name for impotence, for defensiveness destructive of communication; it becomes a device to protect ignorance and the continuation of things the way they are, the ultimate protection for changelessness."[ 42]

If guilt is an unproductive strategy for people on the top of the coin who wish to dismantle inequities, then what might be alternatives? A more productive strategy is to recognize feelings of guilt, and swiftly reframe guilt as responsibility deriving from complicity [ 43]. Embracing responsibility gives rise to action to resist the dominant norms that sustain systems of inequality, which I refer to as practicing critical allyship.

Principles for practicing critical allyship

To work toward dismantling a system of inequality, different orientations are appropriate depending on one's position in relation to that social structure; that is, the side one is on of a particular coin. This article is written for people who find themselves on the top of a coin that they wish to dismantle (i.e., in a position of privilege), and I call this orientation practicing critical allyship.

Within this approach, allyship is not an identity, but an ongoing practice. The focus on critical allyship as a practice aligns with the focus by others on becoming an ally [ 44, 45, 46], or what queer Black author Mia McKenzie describes as "currently acting in solidarity with" to focus on actions in the present [ 47]. This approach learns from the Anti-Oppression Network, which defines allyship as an "active, consistent, and arduous practice of unlearning and re-evaluating in which a person of privilege seeks to operate in solidarity with a marginalized group of people" [ 48].

Practicing critical allyship requires a reorientation from the dominant way of thinking about how people in positions of privilege should address inequities, which assumes that the most ethical and effective way to address health disparities is for people on the top of the coin to use their expertise to help marginalized groups with their problems. "Their problems" are typically framed as caused by the behaviours of individuals or groups, as opposed to the being linked to unearned disadvantage resulting from systems of inequality (i.e., the coin). It follows that appropriate responses involve people on the top of the coin going into communities (locally and overseas) to bring their expertise and solutions to needy individuals. Although often well-intentioned, people on the top of the coin have been socialized to have little understanding of their relationship to social structures, or the contradiction between who holds power versus who holds expertise. This flawed approach strengthens the system of inequality by reinforcing the assumption that people on the top are experts, unconnected to the system of inequality, and that people on the bottom need rescuing. If the goal is to dismantle the systems of inequality that result in health disparities, a reorientation is required whereby people on the top of the coin reorient their motivation from:

This reframing reverses who is presumed to be more expert on dismantling the inequity (i.e., from people on the top of the coin to people on the bottom), and whose thinking and behaviour need to change in order for the inequity to be dismantled (i.e., from people on the bottom of the coin to people on the top). Reframing the problem as the ineffective and unhelpful orientation of people in positions of unearned advantage allows new possibilities for action to come to light. Below I introduce several principles as an entry point for guiding such action, i.e., for practicing critical allyship.

Stop trying to save or fix people on the bottom of the coin

An initial step is to recognize and resist the everyday ways that people on the top of a coin unintentionally strengthen, as opposed to dismantle, the coin; that is, the things we say or do that unwittingly reflect and therefore reproduce the system of inequality. A key step in this practice is to reject the dangerous and misguided urge to save people on the oppression side of the coin, driven by the irrational sense of expertise, entitlement and access [ 49]. Rather, the aim of critical allyship is to operate in solidarity with people on the bottom of the coin. This principle applies to students, researchers or clinicians developing health promotion programs for or conducting research with marginalized communities locally or globally [ 50], without understanding their personal relationship to the systems of inequality that marginalize these communities in the first place [ 51].

This invitation to recognize the harmful effects of a fixing or saving mentality is particularly complex for those involved in clinical care, which is often defined as fixing or saving patients. The challenge is to consider how to meet individual clinical needs without reproducing systems of inequality. How might one deliver health care in a way that resists these systems and rewrites dominant narratives about power? Rehabilitation science researchers Roush and Sharby call on clinicians to consider this paradox for people with disabilities; that is, how to fix impairments while simultaneously celebrating disability as diversity [ 52]. Another approach is cultural safety, developed by Maori nurse, Irihapeti Ramsden, in response to the inability of the mainstream health system to meet the needs of Maori People in Aotearoa/New Zealand [ 53]. Cultural safety requires clinicians to understand their roles within the power differentials inherent in healthcare, including institutional discrimination, and aims to address inequities through both education and systemic change [ 54].

Take active steps to learn about the systems of inequality for which one is in a position of privilege

Practicing critical allyship focuses not on the intent but impact of one's actions, which requires deepened capacity to understand the multifaceted effects (positive and negative) of action or inaction. Thus far, I have emphasized the similarities across systems of inequality; however, the strategies by which each of these systems operate are unique. As such, a crucial step in practicing critical allyship is to actively acknowledge one's positions of privilege and develop understanding of the logics of oppression that sustain and reproduce these inequalities; that is, the ideologies and assumptions that pervade law, policy, norms, attitudes and our everyday actions [ 55, 56].

A starting point for resistance is naming and discussing privilege with others on the top of that coin to diminish oblivion (i.e., to see the gorilla) and collectively build capacity for change. Examples include straight people discussing how they benefit from and reproduce heteronormativity [ 57], able-bodied people considering the unearned advantages they receive from ableism [ 58], white people learning about their role in perpetuating racism [ 41, 59], or settlers exploring settler identity in the context of colonialism [ 60, 61], with careful attention to how these structures simultaneously intersect. Each of these systems requires deep learning and, moreover, unlearning of entrenched assumptions to guide individual and collective action for transformative social change [ 62].

Step back

Systems of inequality centre the presence, voices, needs, feelings, and worldviews of people in positions of privilege. A key step in redressing these power imbalances is for people on the top of the coin to de-centre themselves or to step back. This includes stepping back physically, such as decentring one's privilege by literally making space for people on the oppression side of the coin at a meeting.

There is also transformative potential in stepping back metaphorically. This is the invitation to listen more and speak less. Those in positions of influence can step back to reallocate power to people who have historically been pushed to the margins. This includes making room for - and recognizing as legitimate - the feelings, approaches, and worldviews of people on the bottom of the coin. This requires those on the top of coins to demonstrate humility regarding the assumed rightness of certain ways of doing, communicating, and thinking, and stepping back to make room for alternatives.

This form of stepping back is exemplified by responses to the egregious history of Western-oriented research on Indigenous Peoples. The emergence of Indigenous research methodologies, which are consistent with an Indigenous worldview, recognize the profound violence perpetrated on Indigenous Peoples through the institutions of healthcare and research, and re-imagine research as a transformative process of cultural reclamation that is driven and controlled by Indigenous People [ 63, 64, 65]. This shift calls on non-Indigenous people to step back in terms of the taken-for-granted 'truths' embedded in a Western worldview about research and health. Following centuries of presumed entitlement and access to Indigenous bodies by non-Indigenous people, practicing critical allyship means asking oneself: What is my research to do and, importantly, what is not? [ 66] This reframing invites a shift from studying Indigenous people to studying whiteness, settler identity, and the roles of racism and colonialism in creating health inequities. It also calls for non-Indigenous people to only engage in research with Indigenous Peoples in the spirit of solidarity, which requires a transformative shift among non-Indigenous People who, by definition, find themselves on the top of the coin of settler colonialism [ 46, 67].

The goal of critical allyship is not only to change the behaviour of individuals, but to fundamentally shift the institutional arrangements that keep people up or down. To this end, stepping back involves giving up both symbolic and material power. In many cases, people on the top of the coin have the power to make material changes immediately, such as redirecting a paid speaking invitation to, or choosing to hire, a person on the bottom of the coin. Practicing allyship means looking at the material resources within one's control (personally and professionally) and intentionally finding ways to shift those resources into the pockets of people on the bottom of the coin. This focus on redistribution of material power invites those on the top of coins to reflect critically on how far back one is prepared to step back in order to share the space and comforts accrued through unearned advantages.

Recognize the need for action at the systemic, institutional, interpersonal and internal levels

Interpersonal interactions, in which one uses their power to intervene in moments of discrimination, are important, and often the focus of calls to "be an ally" [ 68]. However, practicing critical allyship requires analysis and change at multiple levels. The "critical" in critical allyship draws explicit attention to systems of power to emphasize that change at the interpersonal level is important but should not eclipse the goal of structural change.

Social structures play out through institutions like science, health care, and education, which are therefore key sites for practicing critical allyship [ 69, 70]. Practicing critical allyship encourages individuals to transform their own institutions [ 71]. For example, this approach invites reflection on how one's academic department, professional body, or hospital may have day-to-day practices that unintentionally reflect and thereby reinforce systems of inequality. This practice requires rejecting the assumption that, for example, sexism or racism are not replicated in one's lab, classroom or clinic, and instead proactively seeking to understand the ways that they are, so that the harmful effects can be mitigated [ 72].

Structures are deeply entrenched throughout society and embodied in its individuals. As such, a further target for analysis and change within critical allyship is the emotional, psychological and spiritual work required to deepen understanding of the intimate connections individuals hold to these systems of inequality. In other words, practicing critical allyship is more than intellectual. For people in positions of privilege, this internal work can be deeply uncomfortable but it rarely leads to lack of safety, which can be a daily threat to members of historically oppressed groups. Furthermore, this internal work is rarely role-modelled within the spheres of science and health; embracing this aspect of practicing critical allyship is therefore particularly important among influential figures within these fields.

Do not use allyship to enhance personal power

Being in a position of privilege offers an iterative cycle of benefit: if one does nothing to dismantle the system offering unearned advantage, one continues to reap these benefits. Ironically, when one recognizes unfairness and strives to address this injustice, it is common for one's personal or professional position to be advanced. Benefits can include approval from people on the bottom of the coin, acclaim for one's expertise, awards for advocacy, praise for courage and selflessness (i.e., the courage to talk about issues that others have to live with daily), being hired for health equity positions, or academic promotion based on achievements in advancing health among marginalized groups.

In some cases, reward for practicing critical allyship is justified, such as publishing peer-reviewed articles or attracting grant funding based on innovative ideas or health-related interventions developed in solidarity with people on the bottom of the coin. Working in solidarity does not preclude the achievement of academic benchmarks, although there is work to be done within promotions processes to recognize the invisible, long-term and often gendered work of trust-earning that underpins equitable partnerships.

A key principle is to recognize and resist the urge to use allyship to advance one's own power. One should not practice allyship to be seen performing the practice of allyship. On the contrary, one should actively resist special recognition for confronting issues that others live with every day.

This principle rejects allyship motivated by altruism, which depends on the work of oppressed groups to praise or affirm the "aspiring ally", and which pursues justice for people on the bottom of the coin [ 26]. Rather, practicing critical allyship seeks justice for all by addressing the systems of inequality that harm everyone [ 73, 74]. A sign of allyship fueled by altruism (vs solidarity) is a defensive response when confronted about one's actions or missteps [ 22]. Practicing critical allyship involves seeing critique as a gift, humbly admitting mistakes, and honouring the critique as a teaching to further uncover one's own entrenched assumptions. Practicing critical allyship "sees illumination of privilege as liberating and consciously uses unearned privilege against itself" [ 45].

Conclusions

The goal of this article is to help people fine-tune their capacity to see the gorilla (i.e., unearned advantage received from unfair systems of inequality) and to offer initial principles for resisting these systems. While these ideas may not yet be mainstream within the health sphere [ 12, 75], insights regarding systems of inequality and anti-oppression are well developed in activist communities [ 76, 77, 78] and in other academic fields [ 8, 9, 10, 11, 79, 80]. For instance, those looking to better understand sexism, heterosexism and cisgenderism can turn to gender studies [ 81, 82]. Those seeking to better understand ableism and ableist privilege can turn to disability studies [ 32, 83]. Those seeking to learn more about racism (including anti-Black racism) and white privilege can turn to the fields of critical race studies, critical ethnic studies, Black studies, and white studies [ 84, 85]. Scholarship on the intersection of racism and sexism is well-developed [ 86], including the seminal work of Crenshaw and Collins on intersectionality [ 37, 38]. Those working in global health can learn from the fields of postcolonialism/anti-colonialism, and feminist postcolonialism in particular, which calls into question the exclusion of non-white, non-Western perspectives within feminism [ 87, 88]. Furthermore, much is to be learned about the Eurocentric orientation of science and health care from the fields of Indigenous studies and Indigenous feminism [ 89, 90]. While these fields may not always centre health and illness as a focus of inquiry, they are crucial because these systems of inequality are such powerful determinants of health.

Limits of and potential for the coin model

While a strength of the coin model is the simplicity of its framework for introducing complex concepts, this simplicity is also a weakness. First is the shortcoming of framing power, a complex phenomenon, in terms of simple binaries. Second, the model risks misrepresenting the intersectional and co-constituting nature of systems of inequality [ 44] by erroneously being construed as a simple stacking of coins. Third is the risk of assuming that all coins are the same size and have the same impact, which is not the intent of this model. For instance, racism and colonization are profoundly powerful in shaping other coins. Others have argued that classism is a system of inequality unlike all others [ 91]; the metaphor of the coin is helpful in reinforcing the primacy of material disparities within all systems of inequality.

A key concern is that the coin model is at risk of delinking history from these systems of inequality; that is, it does not explicitly link people in positions of privilege to their ancestors who intentionally created these systems of inequality. For instance, the coin model does not explicitly require white North Americans of Western European descent to reflect on statements such as, "I live on the traditional lands of Indigenous people that was stolen by my ancestors," or "My wealth of today is also the result of the enslavement of Black people by my ancestors." [ 92] The principles of practicing critical allyship require learning (and unlearning) about systems of inequality, including historic origins, and this important point is not foregrounded as clearly as others by this model.

A further limitation is use of the term 'allyship'. While this term may be new to some in the health sphere, others have critiqued and moved beyond this language [ 93, 94, 95]. Given the audience for this model, the phrase 'practicing critical allyship' was deemed the least worst option, rejecting use of the noun 'ally', and inserting 'critical' to explicitly draw connection to systems of power. More important than the term are the concepts that underpin it, and the action they inform. Some will critique the principles of practicing critical allyship introduced in this article for not going far enough, and those critiques are welcome.

Finally, the coin model seeks to make visible positions of privilege, and offers principles for action for those on top of the coin. Following the tenet of stepping back, the critique rightly follows that this model centres the needs and concerns of people in positions of privilege, which stands to marginalize the oppressed. However, more than centring the needs of people in positions of privilege, this article aims to problematize the unearned advantages received by people in positions of privilege and the dire health impacts of ignoring these injustices. Further, this article is a call to action to recognize one's positions of privilege and the imperative for reorienting one's approach from helping unfortunate people, to working in solidarity on systems of inequality. The principles for practicing critical allyship introduced in this article offer an entry point to this reorientation; however, the practice is neither neat nor easy. Practicing allyship is fraught, messy, ongoing, and laden with missteps [ 46, 67, 96, 97], - but the alternative of reinforcing the status quo is far worse.

In closing

Identifying and transcending widespread, willful oblivion regarding the harms of privilege within the health sphere is a crucial step in the path toward transformative change. As advocated by Freire over four decades ago, systems of oppression ultimately harm those on both sides of the coin (albeit in different ways) [ 73]. We all lose by precluding and compromising the societal contributions of talented and creative people on the bottom of the coin. Working in solidarity across the coin seeks to advance the liberation of those on both the bottom and the top. This requires a shift in orientation in line with this oft-cited quote from Indigenous elder, Lilla Watson: [ 98]

"If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together."

Availability of data and materials

References

Download references

Acknowledgments

This article was written in Toronto, which is on the territory of the Huron-Wendat, Petun, Seneca, and most recently, the Mississaugas of the Credit. This territory is covered by the Dish with One Spoon Wampum Belt Covenant, an agreement between the Haudenosaunee Confederacy and the Anishnaabe and allied nations to peaceably share and care for the lands and the resources around the Great Lakes. The ideas presented in this article about privilege and oppression are not new; they have been articulated, advanced and argued for decades, largely by people on the bottom of the coin to people on the top of the coin who have not been ready or willing to listen. In this article, I seek to translate these ideas in a new way for a general health audience, and successful uptake of the ideas in this version must be understood as inextricably linked to my position as someone on the top of most coins. My understanding of the ideas in this article has been informed by the experience and expertise of thinkers who inhabit positions on the bottom of coins, and especially by teachings I have received from people who are racialized, disabled, queer and trans. In particular, I acknowledge the powerful ways that my insights have been developed by the following Black and/or Indigenous women: Atik Bird, Tracy Blake, Lisa Boivin, Dionne Falconer, Katie Gasparelli, LLana James, Stephanie Lurch, Dawn Maracle, Renee Masching, MeLisa Moore, Onyenyechukwu Nnorom, Angie Phenix, Sherri Pooyak, Jackie Schleifer Taylor, Meredith Smith and Ciann Wilson. I thank Muriel Mac-Seing, Pulchérie Mukangwije and Mathieu Simard for leading dissemination of the Coin Model in French. I recognize the important contributions of two blinded and two non-blinded reviewers. I thank Sarah Flicker, LLana James and Barbara Radecki for helpful input on drafts of this article. Any shortcomings with this material are my own.

Funding

Stephanie A. Nixon was funded by a Canadian Institutes of Health Research New Investigator Award during an early stage of developing this manuscript. The funder had no role in the design of the study, in collection, analysis, and interpretation of data, or in writing the manuscript.

Author information

Authors and Affiliations

1. Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada

Stephanie A. Nixon

2. Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada

Stephanie A. Nixon

Contributions

This manuscript was conceived and written by SAN. The author read and approved the manuscript.

Author's information

Stephanie A. Nixon is a white, straight, cisgender, able-bodied, middle class woman raised in Toronto, Canada, in a family of settler descent.

Corresponding author

Correspondence to Stephanie A. Nixon.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

I have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Reprints and Permissions

About this article

Cite this article

Nixon, S.A. The coin model of privilege and critical allyship: implications for health. BMC Public Health 19, 1637 (2019). https://doi.org/10.1186/s12889-019-7884-9
Download citation

Received:

Accepted:

Published:

DOI: https://doi.org/10.1186/s12889-019-7884-9

Keywords

# data[].attributes.attachment_link.title
The coin model of privilege and critical allyship: implications for health - BMC Public Health

# data[].attributes.attachment_link.description
Health inequities are widespread and persistent, and the root causes are social, political and economic as opposed to exclusively behavioural or genetic. A barrier to transformative change is the tendency to frame these inequities as unfair consequences of social structures that result in disadvantage, without also considering how these same structures give unearned advantage, or privilege, to others.

# data[].attributes.headline
Unpacking Privilege: An Introduction to Anti-oppression Using the Coin Model

# data[].attributes.subject
Unpacking Privilege: An Introduction to Anti-oppression Using the Coin Model

# data[].attributes.attachment_link.title
Unpacking Privilege: An Introduction to Anti-oppression Using the Coin Model

# data[].attributes.body
Applicable domains: 3,4

# data[].attributes.attachment_link.readable_text
Positive wellness outcomes

Pilot testing of the NWA™ revealed that clients who knew their own language reported higher overall levels of wellness.

This tool is proving that culture is the key to restoring and maintaining wellness, which is something First Nations people have long known.

The NWA™ provides culturally-based information to guide treatment services which can include:

spending time on the land,

learning from traditional teachers and healers, and

joining in storytelling and dancing.

As more program services use the NWA™, an evidence base is being built that shows the vital role of Indigenous culture in treatment plans for substance use and wellness promotion.

# data[].attributes.attachment_link.title
Native Wellness Assessment - Thunderbird

# data[].attributes.attachment_link.description
Native Wellness Assessment (NWA)™ Much of what we do in health research focuses on examining deficits and weaknesses. But now, for the first time, Indigenous treatment programs and centres across Canada will be able to measure wellness of the whole person based on their strengths. Carol Hopkins CEO - Thunderbird...

# data[].attributes.headline
Gathering to Heal - Gender Based Violence

# data[].attributes.subject
Gathering to Heal - Gender Based Violence

# data[].attributes.headline
You Tube Video: The Community is the Medicine: A culturally- rooted post colonial  approach to Healing and Wellness

# data[].attributes.subject
You Tube Video: The Community is the Medicine: A culturally- rooted post colonial  approach to Healing and Wellness

# data[].attributes.attachment_link.title
The Community is the Medicine: A Culturally-Rooted Postcolonial Approach to Healing and Wellness

# data[].attributes.headline
The Rights of First Nations Children in Canada

# data[].attributes.subject
The Rights of First Nations Children in Canada

# data[].attributes.attachment_link.readable_text
The Rights of First Nations Children in Canada

The fact sheet highlights the reality that First Nations children continue to experience unacceptable and disproportionate levels of risk due to a combination of historical trauma, intergenerational poverty, and discriminatory and underfunded child welfare policies.

# data[].attributes.attachment_link.authors[].name
The National Collaborating Centre for Indigenous Health (NCCIH)

# data[].attributes.attachment_link.title
NCCIH - National Collaborating Centre for Indigenous Health > Home > NCCIH PUBLICATIONS

# data[].attributes.headline
Witnessing Métis Women & Girls Experiences of Violence

& Pathways to Healing

# data[].attributes.subject
Witnessing Métis Women & Girls Experiences of Violence

& Pathways to Healing

# data[].attributes.headline
Towards untying colonial knots in Canadian health systems: A net metaphor for settler-colonialism

# data[].attributes.subject
Towards untying colonial knots in Canadian health systems: A net metaphor for settler-colonialism

# data[].attributes.headline
TA SAANTII DEU/NESO: A Profile of Métis Youth Health in BC

# data[].attributes.subject
TA SAANTII DEU/NESO: A Profile of Métis Youth Health in BC

# data[].attributes.attachment_link.title
Inuit Child First Initiative - Inuit Tapiriit Kanatami

# data[].attributes.attachment_link.description
The Inuit Child First Initiative (ICFI) ensures Inuit children have access to essential health, social and educational products, services and supports as needed.

# data[].attributes.headline
Changing Systems, Transforming Lives: Canada's Anti-Racism Strategy 2024-2028

# data[].attributes.subject
Changing Systems, Transforming Lives: Canada's Anti-Racism Strategy 2024-2028

# data[].attributes.attachment_link.title
Changing Systems, Transforming Lives: Canada’s Anti-Racism Strategy 2024-2028 - Canada.ca

# data[].attributes.attachment_link.description
In the spirit of and based on the principles of truth and reconciliation, the Government of Canada commits to working in partnership with Indigenous Peoples. This means meaningfully addressing the ongoing impacts of colonization as we attempt to support an increased understanding of First Nations, Inuit, and Métis worldviews. It also requires an expanded awareness of the responsibilities all people on this land have for repairing and forging more equitable relationships with First Nations, Inuit, and Métis communities across this land.