1
School of Health in Social Science
Postgraduate: Clinical Psychology
Programme: CYPMHPP
Name of Course
Social Inequality and Child and Adolescent Mental Health
Name of
assignment
CLPS11046
Bridging the Gap: Reducing Social Inequality to Improve the
Well-Being of Mi’kmaw Children of Atlantic Canada
Exam number:
B139864
Date of
submission:
December 3rd, 2020
Word Count:
3560
2
This paper considers the different risk and protective factors that affect the health, well-being
and development of the Mi’kmaw children and youth of Atlantic Canada, focusing on two
ecological spheres of influence: formal institutions (schools and health services), as well as
the socio-political and cultural sphere. Moreover, there is an emphasis on the implications of
these for policy and intervention on both a regional and federal level in Canada.
Background
According to a 2016 census, there are almost one million Canadians in over 600 communities
across Canada who identify as First Nations (Gadacz et al., 2019). The Mi’kmaq are one of
those fifty nations, inhabiting several regions across Atlantic Canada.
The Atlantic region of Canada is comprised of four provinces on the eastern coast: New
Brunswick, Nova Scotia, Prince Edward Island, along with the easternmost province of
Newfoundland and Labrador. For the purpose of this study, the emphasis will be on the
province of Nova Scotia.
Nova Scotia has just under one million inhabitants (Statistics Canada, 2019) and is home to a
multitude of cultures and ethnicities from all over the world. “One of the first established
3
areas in Canada, Nova Scotia has a diverse history of Aboriginal, Celtic, Acadian, and
African cultures that dates back hundreds of years and, in the case of the Mi'kmaq, thousands
of years” (L’ immigration du gouvernement de la Nouvelle-Écosse, 2015).
Archaeological evidence has shown that Mi'kmaq have been present in the area for at least
11, 000 years (Cape Breton University, 2007). At present, Nova Scotia has 13 Mi'kmaq First
Nations communities, with populations ranging from the low hundreds in the Annapolis
Valley First Nation to over 4000 in the Eskasoni First Nation (Office of Aboriginal Affairs,
2015).
Unfortunately for the Mi’kmaw, they were not spared the countless adverse events that
impacted most Indigenous populations across Canada, as well as the Northern territories
(Allan & Smylie, 2015). Prior to the 20th century, the Indian Act, a consolidation and
amendment of previous laws, disintegrated Mi’kmaw society and affected every facet of their
lives (Allan & Smylie, 2015; Strange & Loo, 1997). The Indian Act of 1876 (Legislative
Services Branch, 2020), and the policies within this act, dictated the relationship that the
Government of Canada would maintain to present day with the First Nations peoples
(Belanger, 2014; Hanrahan, 2016).
Another critical amendment that was enacted on the Mi’kmaq was the Centralization Policy,
first in 1916, and again in 1942 (Allan & Smylie, 2015; Tobin, 1999; Union of Nova Scotia
Indians et al., 2015). Because the government found it too challenging to deliver services to
the smaller Mi’kmaw populations that were spread throughout the province, it was decided
that choosing to move to one of the larger reserves would allow for an improvement in their
standard of living through an increase in job opportunities and an improvement in housing,
4
but in actuality, it was a way to decrease administrative costs and cut relief expenditures
(Tesar, 2018; Tobin, 1999).
Instead of improving the lives of the Mi’kmaq, in addition to any proposed savings for
Department of Indian Affairs, it had the opposite effect. Centralization placed economic
strain on both those who moved into the large reserves, as well as on the Mi’kmaw people
who were already there, causing the need for government relief payments to increase
dramatically, and in the end, not being a very practical undertaking for anyone (Tobin, 1999).
Furthermore, this flawed arrangement dismantled communities’ self-governance (Reading &
Wein, 2009). “Centralization…took most of the control of Mi’kmaq affairs away from
individuals and Mi’kmaq leaders and placed it on the doorstep of government departments”
(Tobin, 1999, p. 42).
What was implicit, was that the force for these changes was discrimination. “Since the time
of first contact with Europeans, Indigenous peoples in Canada have experienced several
forms of racism, which have negatively affected all aspects of their lives and well-being”
(National Collaborating Centre for Aboriginal Health, 2013, p. 1).
What is Social Inequality?
In defining social inequality, one must first recognize what it is that is unequal, which is
frequently not as easy a task as identifying only one disparity, such as wealth. “Inequalities in
different dimensions tend to move together and reinforce each other. In the large literature on
multidimensional inequality a commonly used label for such inequalities is social inequality”
(Binelli et al., 2015, p. 239). Social inequality can be defined as the comparative status of
5
individuals involving numerous elements that measure attained outcomes and opportunities
for future outcomes (Binelli et al., 2015). An example of these factors are attributes such as
gender, age, ethnicity, race, area of housing, etc. (Hoffman, 2008). Although the influence of
social determinants is reflected in different ways amongst individual Aboriginal divisions in
Canada, there are a number of comparable and modern-day social determinants that affect all
Aboriginal groups: “colonization and the imposition of colonial institutions, systems, and
lifestyles disruptions” (Loppie & Wien, 2007, p. 2).
Formal Institutions
Health Care in Canada
For several decades Canada’s publicly funded health-care system has been a source of
ceaseless nationwide pride. And the appreciation of our universal health coverage becomes
even more robust during those occasions we look to our southern neighbors, the United States
of America, “which has the most expensive and inequitable health-care system in the
developed world” (Martin et al., 2018, p. 1718). But that sense of security and satisfaction is
frequently overshadowed by the fact that there are many areas of our health-care system in
Canada that are not as equal as was originally planned.
In September of this year, a news story was released concerning an Indigenous woman being
ridiculed by nurses in a Quebec hospital. Before she died from her ailments, she used her
phone to video record what was happening to her:
6
Toward the end of the video, two female hospital staff can be seen entering her room
and are heard making insulting comments, saying she's "stupid as hell," that she's only
good for sex and better off dead. Amid protests from Echaquan, a staff member tells
her she made poor choices and asks what her children would think to see her in that
state. “That’s why I came here," Echaquan can be heard replying quietly (Marin,
2020, paras. 4-5).
While this is an acute example of racism in health-care, it does reveal that to this day, there
remains an undercurrent of intolerance, misconceptions, and bias, which all lead to an
imbalance in health care services for Indigenous people (Allan & Smylie, 2015). The three
separate groups that represent Canadian Indigenous people, First Nations, Inuit and Metis,
each experience health disparities when compared to the rest of the country’s population
(Martin et al., 2018; Polzer et al., 2016).
The Wellbeing of Mi’kmaw Children
There are numerous factors that impact the welfare of children, but social environment has
been found to be a major contributor to the health of children globally (Cohen et al., 2003;
Coombes et al., 2018; Mestaz, 2014). Because of the historic disruptions to their land access,
which include food pathways/food security (Berneshawi, 1997; Richmond et al., 2020), as
well as employment opportunities, high levels of poverty have left Mi’kmaw children at a
social disadvantage (Loppie & Wien, 2007). These risk factors are intensified when
combined with the issue of health-care access.
7
While Mi’kmaw communities in Atlantic Canada do not have to cope with the remote access
challenges that Inuit people in Canada’s northern regions encounter (Polzer et al., 2016), as
there are several forms of easily accessible health-care facilities in the province of Nova
Scotia, geographical matters are only one of the many barriers faced by First Nations people.
In a Western-based Canadian system, achieving health does not always encompass the
“mental, spiritual, emotional, and physical wellness” that play a major role in the balanced
Mi’kmaw idea of well-being (Latimer et al., 2020, p. 1).
And although being acquainted with, and sensitive to Indigenous culture and history would
be a step closer to ideal health-care services for all Mi’kmaq in Nova Scotia, it would still not
completely supplant the level of care that patient-physician concordance brings (LaVeist et
al., 2003). In Nova Scotia, and across Canada, there have been many financial incentives to
increase the number of doctors in order to better represent African Canadian, Mi’kmaq and
other Indigenous communities (Communications Nova Scotia, 2019; Martin et al., 2018).
It is more than just a matter of reassurance and harmony when children and families are
treated by members of their own community. In a recently published American study, their
findings suggest that “newborn-physician racial concordance is associated with a significant
improvement in infant mortality” (Greenwood et al., 2020, p. 21194). While this current
study exclusively examines inequality in the African American population, it does support
that the presence of patient-physician concordance affords advantages to populaces who
experience social inequality.
A minority of Mi’kmaw children and youths are affected by various chronic conditions, and
although the numbers have decreased appreciably over the last thirty years, they are still
8
overrepresented when compared to other Canadian children (Loppie & Wien, 2007). Many of
the chronic conditions that Mi’kmaw children suffer from are related to breathing problems,
such as asthma (Castleden et al., 2016; Loppie & Wien, 2007). Proximal determinants of
health, which incorporate physical environments, entail factors such as crowded and poorly
ventilated housing, or houses which have mold problems, contributing to the incidence of
asthma in their communities (Lawrence & Martin, 2017; Strachan, 2000). In addition to
environmental risks from inadequate housing, traditional Mi’kmaw cultural practices, such a
smudging and burning ceremonial tobacco, unintentionally exacerbate the problem
(Castleden et al., 2016). The rates of asthma for First Nations children remain comparable to
other Canadian children according to reported data (which also might not accurately represent
the true numbers) (First Nations Regional Health Survey (RHS), 2012). What is striking, is
that, due to health inequities, treatment and management of asthma is vastly different when
one compares Mi’kmaw children to other Canadian children (Castleden et al., 2016;
Coombes et al., 2018). This is yet one more element that places First Nations children and
youths in a disadvantaged position.
Research indicates that Aboriginal children experience high levels of pain related conditions
(e.g., dental, arthritic, musculoskeletal, and chest), which are known to affect growth,
learning and achievement (IWK Health Centre, 2016; Latimer et al., 2014). As with asthma,
it is not the prevalence of these maladies that set Mi’kmaw children apart from other
Canadian children, but it is the diagnosis and treatment that is an additional obstacle to their
attainment of well-being. Pain care for Mi’kmaw children in the Canadian medical system
has been complicated by the actuality that most health-care professionals globally, have not
consistently acknowledged that a certain degree of cultural sensitivity should be applied when
it comes to pain measurement and treatment of children (Finley et al., 2009). An
9
ethnographic study in a large Nova Scotian Mi’kmaq community reveals that Mi’kmaw
children do not readily reveal their pain through standard forms of communication, such as
crying, or other verbal expressions (Latimer et al., 2014). Instead, the investigation shows
that “participants described their pain experiences using stories, and stoicism was a main
theme throughout” (Latimer et al., 2014, p.136).
Safeguarding the wellbeing of Aboriginal Canadian children must be as vital to health-care
practitioners as it is with every other child in Canada. If Canada aims to uphold its global
status as emissaries of multiculturalism and inclusion, it must also acknowledge that when
examining the history of the Mi’kmaq of Nova Scotia, that there are distinctive circumstances
of a colonial inheritance that one must acknowledge: “low socioeconomic status,
intergenerational trauma associated with residential schooling, high rates of substance abuse,
increased incidence of interactions with the criminal justice system, and extensive loss of
language and culture” (Greenwood, 2005, p. 553). Health professionals, from hospital-based
nurses, to physiotherapists, to pharmacists, who care for the fitness of Mi’kmaw children,
must be mindful, and held accountable, that matters such as chronic physical illness, break
through the boundary of childhood, generating long lasting emotional and physical ailments
which have the potential to follow these individuals into adolescence and then adulthood
(Secinti et al., 2017).
First Nations Education in Canada
As previously noted, the chronicle of Indigenous populations in Canada as been fraught with
many wrongdoings, and the residential school system was an especially painful chapter of
Indigenous history (Murray, 2017). “Indigenous children were historically removed from the
10
care of their families and communities to residential schools, a system of institutionalized
education and care that lasted well over 100 years” (Allan & Smylie, 2015, p. 13). Even
though residential institutes no longer exist anywhere in Canada, their painful vestiges still
live in the minds and hearts of those who were touched by them, supporting the motivation to
ensure that colonial assimilation is no longer a feature of today’s schooling for any Mi’kmaq
child or youth in Nova Scotia (Bombay et al., 2011; Gone, 2013). Mi’kmaw education has
undergone numerous transformations since band-controlled schooling was implemented in
various communities in Nova Scotia in the 1980s, but for many parents and community
members, the changes have still not been enough to make certain that Mi’kmaw knowledge
and identity is nurtured and maintained for generations to come (Loppie & Wien, 2007;
Tinkham, 2013).
Protective Factors
Establishing better health care measures
For many decades now it has been recognized that the health-care needs of Indigenous
populations have not been sufficiently met across Canada, and there has been “an urgent need
to develop programs and processes to facilitate access to appropriate health care that are
inclusive of the cultural needs of First Nation children” (Coombes et al., 2018, p.1).
Indigenous traditional knowledge dates back thousands of years, long before Canada even
established itself as a new country, so it would seem to make perfect sense for Western
health- care practices to merge with Indigenous expertise (Latimer et al., 2014).
11
One such collaboration, called Two-eyed Seeing, was brought forth by a Mi’kmaw elder
Albert Marshall in the autumn of 2004 (Bartlett et al., 2012). Albert explains that Two-eyed
seeing “refers to learning to see from one eye with the strengths of Indigenous knowledge
and ways of knowing, and from the other eye with the strengths of Western knowledges and
ways of knowing, and to using both eyes together for the benefit of all” (Bartlett et al., 2012,
p. 335). The ACHH initiative is doing just that: ACHH stands for the Aboriginal Children’s
Hurt & Healing Initiative, with the goal of “working with communities and clinicians to
bridge the gap in our understanding of Indigenous children’s pain and hurt” (ACHH | About,
2020, para. 1). The project was conceived out of a need to improve the well-being of First
Nations children by reducing the cultural divide between children in pain and the caretakers
who are tasked with enhancing and protecting their welfare (IWK Health Centre, 2016).
As earlier mentioned, clinicians in Nova Scotia’s health care system have referred to
Mi’kmaw children’s responses to pain as stoic (Latimer et al., 2014). But aside from these
cultural misconceptions, there is also a linguistic barrier, as the first language for many First
Nations children from local Mi’kmaw communities may be Mi’kmaq. Not only would
problems arise when attempting to communicate the symptoms of an illness to a health-care
worker, but there would be just as many challenges faced in obtaining information from
clinicians (Latimer et al., 2020). What arose from these observations, experiences, Indigenous
community input and extensive research, is a unique approach, as well as a modern
technology, that aids both the children and the clinicians. One of the initial measures, which
is still in development, involves a communicative tool in the form of an app, called The Kids
Hurt App (ACHH | The Kids Hurt App, 2020). While the app is not meant to replace the
diagnostic processes undertaken by clinicians, it is being designed to “allow children and
youth to articulate their pain and hurt through stories and descriptions, while remaining stoic
12
in their pain expression” (ACHH | The Kids Hurt App, 2020, para. 3). The next ACHH
initiative that has already been developed is the FIRST approach; the FIRST approach
(Family, Information, Relationship, Culturally Safe-Space, and Two-Eyed treatment) is a
guide which was designed to improve the interactions between health care workers, and
Aboriginal children and youth (ACHH | The FIRST Approach, 2020; Latimer et al., 2020).
Educating non-Aboriginal health-care professionals, in order to aid them in understanding the
lives and experiences of Aboriginal children and youths, is one positive step towards
ameliorating some of the current issues that Mi’kmaw community members face when
seeking treatment at Nova Scotian health-care facilities, but there is another pathway
(Castleden et al., 2016). In April of this year, the Eskasoni Health Centre in Cape Breton,
Nova Scotia, welcomed a new nurse practitioner and new doctor to their community clinic.
Athanasius Tanas Sylliboy, and Dr. Carl Marshall are both members of Nova Scotian
Mi’kmaw communities. “Marshall and Sylliboy both said they are proud of their heritage and
proud to make a difference by helping people in their own community” (Moore, 2020, para.
23). In Nova Scotia’s 2020-21 budget address, an allocation of funds to “provide opportunity
to our African Nova Scotian and Mi’kmaq students” will help ensure that there are continued
investments that support future Indigenous specialists who can one day support and give back
to the communities that shaped them (Finance and Treasury Board & Casey, 2020). Although
these measures will not fix everything that ails Canada’s current health-care system, they are
nonetheless positive advances towards reducing social inequality for children and youths in
Mi’kmaw communities across Nova Scotia.
Improving education for Mi’kmaw children and youth
13
“Education, which is a component of SES, determines health through a number of avenues”
(Loppie & Wien, 2007, p. 12). For the most part, the responsibility of education in Canada,
from elementary to post-secondary, has fallen under provincial and territorial jurisdiction
(Council of Ministers of Education, Canada, 2014). In Nova Scotia, Mi’kmaw education,
which was once wholly controlled by the federal government, was in part transferred in 1997
to a school board called “Mi'kmaw Kina'matnewey, which seeks to create a holistic education
rooted in community values and Mi’kmaw language and cultures” (Tinkham, 2013. p. 9).
Since 1997, Mi'kmaw Kina'matnewey (MK), has been representing “the educational interests
of 12 Mi’kmaw communities in Nova Scotia” (Simon, 2014, p. 4). Of the many positive
outcomes over the last twenty years, one of the more notable ones is an increased high school
graduation rate of almost 90%, which is above the national average (Simon, 2014). MK has
made great strides in reducing the disparity in education for Mi’kmaw students, and it plans
to keep fostering and building upon these improvements “in its efforts to empower youth and,
in turn, empower the Mi’kmaw nation” (Simon, 2014, p. 16).
In Queens County, Nova Scotia, Mi’kmaw artist Melissa Labrador is a parent and cultural
advocates who admits that although there have been significant developments regarding
representation of Mi’kmaq peoples in its curriculum, that there is still work to be done in
order for it to reach the standards that she still holds the Nova Scotia Department of
Education to (Burke, 2018). Labrador is “determined to immerse her children in Mi’kmaq
culture. She teaches them the Mi’kmaq language, traditional arts, music, and medicines all
interwoven with lessons on reading, writing, math and science” (Burke, 2018, para. 7).
Labrador’s act of home-schooling her children exemplifies a form of autonomy, which
Schissel and Wotherspoon (2003) postulate, is a way to break away from “Eurocentric
thought and institutions” (pg. 27). Tinkham (2013) supports this philosophy through her
14
examination of the role of curriculum in the lives of Mi’kmaw students in Nova Scotia and
recommends that “a reconceptualization of curriculum…will allow for a privileging of
student voice, for all students…” (pg. 311).
Conclusion
First Nations, Inuit and Metis people of Canada have walked a long dark road to get to their
current destination, and they bear the scars that disclose the negative consequences of a
colonial past, transgenerational trauma, and the continued misconceptions and biases that
endure, maintaining social inequality in their communities from north to south and east to
west, in the vast country that is Canada (Allan & Smylie, 2015; Bombay et al., 2011; Gone,
2013; Schissel & Wotherspoon, 2003). Healthcare and public-school education are free to all
Canadians, but First Nations groups, such as the Mi’kmaq of Nova Scotia, have paid a price
in attempting to access these services. Too many Mi’kmaw children have lost touch with
their culture, language and identity while attending educational institutions that were never
designed to meet their holistic needs, and their mental health and well-being was also put at
risk due to a lack of Indigenous knowledge and cultural sensitivity in Canada’s health-care
system (Greenwood, 2005). But there are encouraging prospects that the contemporary
generations of Mi’kmaw children and youth will successfully break the cycle that has
burdened their people for too many generations. Every time that the Canadian government
admits to the atrocities of the past, and hands governance back to the First Nations people,
such as the Mi’kmaq, they get one step closer to equality, which gives us all hope that one
day the numerous stories of social inequality in First Nations communities will stop being
current headlines, and only be found in the pages of our history books.
15
References
ACHH | About. (2020). Achh.Ca. https://achh.ca/about-us/
ACHH | The FIRST Approach. (2020). Achh.Ca. https://achh.ca/knowledge-research/our-progress/
ACHH | The Kids Hurt App. (2020). Achh.Ca. https://achh.ca/knowledge-research/research-inaction-the-achh-app/
Allan, B., & Smylie, J. (2015). First peoples, second-class treatment: The role of racism in the
health and well-being of Indigenous peoples in Canada (The Well Living House Action
Research Centre for Indigenous Infant, Child, and Family Health and Wellbeing, Ed.).
Wellesley Institute. https://sac-oac.ca/sites/default/files/resources/Report-First-PeoplesSecond-Class-Treatment.pdf
Bartlett, C., Marshall, M., & Marshall, A. (2012). Two-eyed seeing and other lessons learned within
a co-learning journey of bringing together indigenous and mainstream knowledges and ways
of knowing. Journal of Environmental Studies and Sciences, 2(4), 331–340.
https://doi.org/10.1007/s13412-012-0086-8
16
Belanger, Y. (2014). Ways of knowing: An introduction to Native studies in Canada. Nelson
Education.
Berneshawi, S. (1997). Resource management and the Mi’kmaq nation. The Canadian Journal of
Native Studies XVII, 1, 115–148. http://www3.brandonu.ca/cjns/17.1/cjnsv17no1_pg115148.pdf
Binelli, C., Loveless, M., & Whitefield, S. (2015). What is social inequality and why does it matter?
Evidence from Central and Eastern Europe. World Development, 70, 239–248.
https://doi.org/10.1016/j.worlddev.2015.02.007
Bombay, A., Matheson, K., & Anisman, H. (2011). The impact of stressors on second generation
Indian residential school survivors. Transcultural Psychiatry, 48(4), 367–391.
https://doi.org/10.1177/1363461511410240
Burke, D. (2018, March 6). Lack of Mi’kmaq education in public schools drives family to homeschool. CBC. https://www.cbc.ca/news/canada/nova-scotia/mi-kmaq-education-schoollearning-students-nova-scotia-1.4562889
Cape Breton University. (2007). Historical Overview. Cape Breton University.
https://www.cbu.ca/indigenous-affairs/mikmaq-resource-centre/mikmaq-resourceguide/historical-overview/
Castleden, H., Watson, R., Bennett, E., Masuda, J., King, M., & Stewart, M. (2016). Asthma
prevention and management for Aboriginal people: Lessons from Mi’kmaq communities,
Unama’ki, Canada, 2012. Preventing Chronic Disease, 13(E06).
https://doi.org/10.5888/pcd13.150244
Cohen, D. A., Farley, T. A., & Mason, K. (2003). Why is poverty unhealthy? Social and physical
mediators. Social Science & Medicine (1982), 57(9), 1631–1641.
https://doi.org/10.1016/s0277-9536(03)00015-7
17
Communications Nova Scotia. (2019, August 8). Sixteen New Seats at Dalhousie Medical School.
News Releases. https://novascotia.ca/news/release/?id=20190808001
Coombes, J., Hunter, K., Mackean, T., Holland, A. J. A., Sullivan, E., & Ivers, R. (2018). Factors
that impact access to ongoing health care for First Nation children with a chronic
condition. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3263-y
Council of Ministers of Education, Canada. (2014). CMEC. https://www.cmec.ca/299/education-incanada-an-overview/index.html
Finance and Treasury Board, & Casey, K. (2020). Budget 2020-21: Better together. Province of
Nova Scotia. https://beta.novascotia.ca/sites/default/files/documents/7-2045/budget-2020-21government-business-plan.pdf
Finley, G. A., Kristjánsdóttir, O., & Forgeron, P. A. (2009). Cultural influences on the assessment of
children’s pain. Pain Research & Management, 14(1), 33–37.
https://doi.org/10.1155/2009/763031
First Nations Regional Health Survey (RHS). (2012). National report on the adult, youth and
children living in First Nations communities FIRST NATIONS REGIONAL HEALTH
SURVEY (RHS) 2008/10. First Nations Information Governance Centre.
https://fnigc.ca/sites/default/files/First_Nations_Regional_Health_Survey_200810_National_Report.pdf
Gadacz, R., Parrott, Z., & Gallant, D. (2019, August 6). First Nations | The Canadian Encyclopedia.
Www.Thecanadianencyclopedia.Ca. https://www.thecanadianencyclopedia.ca/en/article/firstnations#:~:text=Section%2035%20of%20the%20Constitution
Gone, J. P. (2013). Redressing First Nations historical trauma: Theorizing mechanisms for
Indigenous culture as mental health treatment. Transcultural Psychiatry, 50(5), 683–706.
https://doi.org/10.1177/1363461513487669
18
Greenwood, B., Hardeman, R., Huang, L., & Sojourner, A. (2020). Physician–patient racial
concordance and disparities in birthing mortality for newborns. Proceedings of the National
Academy of Sciences, 117(35). https://doi.org/10.1073/pnas.1913405117
Greenwood, M. (2005). Children as citizens of First Nations: Linking Indigenous health to early
childhood development. Paediatrics & Child Health, 10(9), 553–555.
https://doi.org/10.1093/pch/10.9.553
Hanrahan, M. (2016). Making Indigenous culture the foundation of Indigenous governance today:
The Mi’kmaq Rights Initiative of Nova Scotia, Canada. Native American and Indigenous
Studies, 3(1), 75. https://doi.org/10.5749/natiindistudj.3.1.0075
Hoffman, R. (2008). Concepts of social inequality. In R. Hoffman (Ed.), Socioeconomic Differences
in Old Age Mortality (pp. 29–55). Springer.
IWK Health Centre. (2016, August 25). Enriching the well-being of First Nations children. Hospital
News. https://hospitalnews.com/enriching-well-first-nations-children-iwk/
L’ immigration du gouvernement de la Nouvelle-Écosse. (2015). – History and culture.
Novascotiaimmigration.com. https://novascotiaimmigration.com/choose-nova-scotia/historyand-culture/#:~:text=One%20of%20the%20first%20established
Latimer, M., Finley, G. A., Rudderham, S., Inglis, S., Francis, J., Young, S., & Hutt-MacLeod, D.
(2014). Expression of pain among Mi’kmaq children in one Atlantic Canadian community: A
qualitative study. CMAJ Open, 2(3), E133–E138. https://doi.org/10.9778/cmajo.20130086
Latimer, Margot, Sylliboy, J. R., Francis, J., Amey, S., Rudderham, S., Finley, G. Allen., MacLeod,
E., & Paul, K. (2020). Co‐creating better healthcare experiences for First Nations children
and youth: The FIRST approach emerges from Two‐Eyed seeing. Paediatric and Neonatal
Pain, 2(4). https://doi.org/10.1002/pne2.12024
19
LaVeist, T. A., Nuru-Jeter, A., & Jones, K. E. (2003). The association of doctor-patient race
concordance with health services utilization. Journal of Public Health Policy, 24(3/4), 312.
https://doi.org/10.2307/3343378
Lawrence, R., & Martin, D. (2017). Moulds, moisture and microbial contamination of First Nations
housing in British Columbia, Canada. International Journal of Circumpolar Health, 60(2).
https://pubmed.ncbi.nlm.nih.gov/11507964/
Legislative Services Branch. (2020). Indian Act. Justice.Gc.Ca. https://lawslois.justice.gc.ca/eng/acts/i-5/page-1.html
Loppie, C., & Wien, F. (2007). The Health of the Nova Scotia Mi’kmaq Population. Mi’kmaq Health
Research Group.
Marin, S. (2020, September 29). Que. nurse fired, coroner to investigate after dying Indigenous
woman taunted in hospital. Montreal. https://montreal.ctvnews.ca/que-nurse-fired-coroner-toinvestigate-after-dying-indigenous-woman-taunted-in-hospital-1.5125145
Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P.
(2018). Canada’s universal health-care system: achieving its potential. The
Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/s0140-6736(18)30181-8
Mestaz, T. (2014). Identifying factors that affect children’s health [Project Report for MSc
Dissertation].
Moore, M. (2020, August 24). Eskasoni embraces new Mi’kmaw doctor, nurse practitioner. CBC.
https://www.cbc.ca/news/canada/nova-scotia/eskasoni-health-centre-welcomes-new-doctornurse-practitioner-1.5697958
Murray, K. B. (2017). The violence within: Canadian modern statehood and the pan-territorial
residential school system ideal. Canadian Journal of Political Science, 50(3), 747–772.
https://doi.org/10.1017/s0008423916001189
20
National Collaborating Centre for Aboriginal Health. (2013). Social determinants of health:
Understanding racism. University of Northern British Columbia.
Office of Aboriginal Affairs. (2015, May 6). Aboriginal People in Nova Scotia | Government of
Nova Scotia. Novascotia.Ca. https://novascotia.ca/abor/aboriginal-people/
Polzer, J., Power, E. M., & Mcgill-Queen’s University Press. (2016). Neoliberal governance and
health: Duties, risks, and vulnerabilities. Mcgill-Queen’s University Press, Cop.
Reading, C., & Wein, F. (2009). Health Inequalities and Social Determinants of Aboriginal People’s
Health. National Collaborating Centre for Aboriginal Health. https://www.ccnsanccah.ca/docs/determinants/RPT-HealthInequalities-Reading-Wien-EN.pdf
Richmond, C., Steckley, M., Neufeld, H., Kerr, R. B., Wilson, K., & Dokis, B. (2020b). First Nations
food environments: Exploring the role of place, income, and social connection. Current
Developments in Nutrition, 4(8). https://doi.org/10.1093/cdn/nzaa108
Schissel, B., & Wotherspoon, T. (2003). The legacy of school for Aboriginal people: Education,
oppression, and emancipation. Oxford University Press.
Secinti, E., Thompson, E. J., Richards, M., & Gaysina, D. (2017). Research Review: Childhood
chronic physical illness and adult emotional health - a systematic review and metaanalysis. Journal of Child Psychology and Psychiatry, 58(7), 753–769.
https://doi.org/10.1111/jcpp.12727
Simon, L. (2014). Mi’kmaw Kina’matnewey supporting student success. https://indspire.ca/wpcontent/uploads/2019/10/indspire-nurturing-capacity-mk-2014-en-v2.pdf
Statistics Canada. (2019). Population estimates, quarterly. Statcan.Gc.Ca.
https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000901
Strachan, D. (2000). The role of environmental factors in asthma. British Medical Bulletin, 56(4),
865–882. https://doi.org/10.1258/0007142001903562
21
Strange, C., & Loo, T. (1997). Making good: Law and moral regulation in Canada, 1867-1939.
University of Toronto Press.
Tesar, A. (2018). Reserves in Nova Scotia | The Canadian Encyclopedia.
Thecanadianencyclopedia.Ca. https://www.thecanadianencyclopedia.ca/en/article/reservesin-nova-scotia
Tinkham, J. (2013). That’s not my history! Examining the role of personal counter-narratives in
decolonizing Canadian history for Mi’kmaw students [Thesis].
https://era.library.ualberta.ca/items/f82f6346-6b86-49fc-824b-2ee6e249ff37
Tobin, A. (1999). The Effect of Centralization on the Social and Political Systems of the Mainland
Nova Scotia Mi’kmaq (Case Studies: Millbrook - 1916 and Indian Brook - 1914) [Thesis].
http://m.library2.smu.ca/handle/01/22665#.X7oXL2gzZPZ
Union of Nova Scotia Indians, The Confederacy of Mainland Mi’kmaq, & Native Council of Nova
Scotia. (2015). The Mi’kmaw Resource Guide. Eastern Woodland Publishing.
https://www.mikmaweydebert.ca/home/wpcontent/uploads/2015/06/Pg_94_DOC_MikmawResourceGuide.pdf