Barriers in Physical Literacy, Education, and Healthcare Access in Indigenous Communities
Edited By: Naomi Abayomi
Many members of indigenous communities lack access to safe drinking water and proper sanitation (2) Indigenous Canadians also have a higher proportion of chronic diseases than non-indigenous Canadians (3) Disproportioned healthcare outcomes may be due to barriers to healthcare, intergenerational trauma, interrupted cultural continuity, and poor physical literacy. It has been suggested that physical literacy/education in indigenous youths be intertwined with tradition, family, and community participation in holistic activities/program (3) Awareness of barriers and discrimination faced by indigenous youths and cultural competency/sensitivity are crucial at a systemic level.
The Urban Youth Perspective of Physical Education
A study evaluating the perspectives of indigenous urban youths on physical education through talking groups and community evenings revealed four common themes. Firstly, financial costs of athletic activities act as a barrier to those of lower socioeconomic status. This barrier includes participation fees, cost of travel, and the cost of equipment. Youths also reported discrimination because of their financial situations. Secondly, youths reported racism and discrimination as a major deterrent from participating in sports. Overt racial slurs and stereotypes (e.g. being considered lazy or unmotivated) contribute to feelings of alienation. Thirdly, youths knew the benefits and confidence-boost from being physically active, stemming from developing mastery of skills and making friends in sports. Finally, it was noted that youths with parents that supported physical literacy were more likely to participate. Some solutions proposed by participants of the study included: more funded programs (minimize financial barriers) and indigenous specific/sensitive programs (safe from discrimination) (4).
A systematic review explored the effects of traditional physical activity experiences on Indigenous youths in North America, Australia, and New Zealand. Across the world, youths acknowledged the value of participating in traditional activities, noting them as ways of connecting with their land, ancestry, community, and maintaining healthy habits. Youth participants also emphasized the value of intergenerational family involvement in traditional activities, so they can learn from parents, relatives, and elders (3).
The Educator Perspective of Physical Literacy
To improve sport policy and practice in Canada, it is important to note the experiences and understanding of indigenous educators. A community based participatory research study consulting 11 indigenous educators, coaches, and mentors through one-on-one and sharing circle interviews identified five themes. Firstly, wisdom sharing is crucial to share the knowledge/history of physical activity with youths. Teaching can be through pictures, stories, and role modeling, with the goal being encouraging youths to take responsibility for their physical health. Secondly, it is important to be mindful of various responsibilities often carried by indigenous youth (e.g. housework, babysitting, etc.), which may limit their participation in activities. Thirdly, it is important to take a youth-centered approach, in which the role of educator is to remove barriers towards physical activities the youths autonomously choose. It was suggested to connect with the youth with humor and humility. Fourthly, relational support from family and friends champion physical literacy (also addressed in youth perspective). Finally, culture competency and spirituality intwine with physical literacy (5). Through questionnaires, cultural connectedness was proposed to be a determinant and protective factor of physical activity in First Nations and Cree/Nehiyaw individuals (6).
Another study evaluated strategies to promote nutrition/activity in young children in two Indigenous communities. A persisting theme was that “traditional Indigenous ways of life are the primary pathway to health and well-being for young children and families” and that healing of intergenerational trauma occurs at a family/community level. Cultural continuity may be achieved through the passing down of knowledge/understanding in family/elder teachings, community programming, school curricula, and multigenerational participation in traditional activities. In workshops, community leaders discussed prioritizing traditional non-processed foods over sugar-laden ready-to-eat foods, and accessible physical activities that require minimal financial costs (e.g. walking, running, school sports) (7).
Access to Healthcare
Though Canada’s universal healthcare system aims to improve the health of every individual, inequities influenced by racial, socioeconomic, and cultural factors can lead to large disparities in outcomes. For example, indigenous people have shorter life expectancy and lower population percentage in “very good/excellent” health compared to non-indigenous people. Geographically, people living in remote/isolated reserves must often travel long distance as to cities access equipment and facilities, which may significantly impact outcome in emergent situations (8). In a study that surveyed 84 indigenous communities across Canada, it was found that 13.1% have a nursing station, 19.0% has a health office, 83.3% has a health center, and only 3.8% has a community hospital (9). Secondly, difficulty navigating the healthcare system may be further complicated by language barriers. On a systemic level, improving travel infrastructure, funding education programs, and increasing indigenous navigators may reduce these disparities. Thirdly, negative bias on the part of the healthcare professional (e.g. negative stereotypes of laziness and alcoholism) may also decrease interaction and quality of care for these patients. Finally, many indigenous communities lack full-time healthcare practitioners. These last two barriers may be partially mitigated by increasing cultural competency education and rural recruitment incentives during healthcare professional training (8).
Take Home Points
Indigenous youths may face many barriers to sport programs, including finances, transportation, responsibilities at home, racism/discrimination, etc.
Cultural connectedness is important in promoting physical activity; intergenerational participation in traditional activities was suggested to holistically engage youths.
Barriers to healthcare access faced by many indigenous individuals include geography, difficulty navigating the healthcare system, negative bias, and poor retention of professionals.
These may be partially mitigated by increasing cultural competency education and rural recruitment incentives during healthcare professional training (8)
O'Gorman M. Mental and physical health impacts of water/sanitation infrastructure in First Nations communities in Canada: An analysis of the Regional Health Survey. World Development. 2021 Sept;145:105517.
Akbar L, Zuk AM, Tsuji LJS. Health and Wellness Impacts of Traditional Physical Activity Experiences on Indigenous Youth: A Systematic Review. Int J Environ Res Public Health. 2020 Nov 9;17(21):8275.
Mason CW, McHugh TF, Strachan L, Boule K. Urban indigenous youth perspectives on access to physical activity programmes in Canada. Qualitative Research in Sport, Exercise and Health. 2019 11:4, 543-558.
Nesdoly A, Gleddie G, McHugh TF. An exploration of indigenous peoples’ perspectives of physical literacy. Sport, Education and Society. 2021 26:3, 295-308.
Ironside A, Ferguson LJ, Katapally TR, Foulds HJA. Cultural connectedness as a determinant of physical activity among Indigenous adults in Saskatchewan. Appl Physiol Nutr Metab. 2020 Sep;45(9):937-947.
Wahi G, Wilson J, Oster R, Rain P, Jack SM, Gittelsohn J, Kandasamy S, de Souza RJ, Martin CL, Toth E, Anand SS. Strategies for Promoting Healthy Nutrition and Physical Activity Among Young Children: Priorities of Two Indigenous Communities in Canada. Curr Dev Nutr. 2019 Nov 28;4(1):nzz137.
Nguyen NH, Subhan FB, Williams K, Chan CB. Barriers and Mitigating Strategies to Healthcare Access in Indigenous Communities of Canada: A Narrative Review. Healthcare (Basel). 2020 Apr 26;8(2):112.
Tompkins JW, Mequanint S, Barre DE, Fournie M, Green ME, Hanley AJ, Hayward MN, Zwarenstein M, Harris SB; FORGE AHEAD Program Team. National Survey of Indigenous primary healthcare capacity and delivery models in Canada: the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) community profile survey. BMC Health Serv Res. 2018 Nov 1;18(1):828.
Artwork 3: https://www.google.com/imgres?imgurl=https%3A%2F%2Fi.ytimg.com%2Fvi%2FQeLwBDdbEJc%2Fmaxresdefault.jpg&imgrefurl=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DQeLwBDdbEJc&tbnid=sfbTLNOQ4jhScM&vet=12ahUKEwjaz5P6m6DyAhXfgXIEHa74CBgQMygBegUIARC7AQ..i&docid=sMYUPDBXsrMnHM&w=1280&h=720&q=indigenous%20health&ved=2ahUKEwjaz5P6m6DyAhXfgXIEHa74CBgQMygBegUIARC7AQ