Considerations for Indigenous peoples

Background

The aging of Canada’s population in general has been extensively documented and researched, however, the challenges of aging within First Nations, Métis and Inuit (Indigenous) communities are less researched. Although recent federal and provincial initiatives are seeking to address the social and physical dimensions of aging in urban and rural communities, age-friendly community research with Indigenous communities and by Indigenous researchers is relatively scarce. The demographic and policy significance of AFC planning is no less significant for Indigenous communities than it is for the larger Canadian population and may in fact be a more urgent policy issue. Although Indigenous people represent a relatively young (i.e. median age – 27) and small proportion (i.e. 4%) of the Canadian population, the Indigenous population has grown 25% since the 2001 census, relative to a 5% increase in the non-Indigenous population over the same period. Similarly, the number of people over the age of 65 that identified as Indigenous more than doubled between 2006 and 2016.^{footnote 1[1]}

In addition to changing demographics, the social and economic circumstances of elders living on reserve, in urban centres or in remote communities underscores the need to address and develop an AFC framework to address the needs of Indigenous older adults. For instance:

• Rates of chronic illness such as arthritis, cancer and cardiovascular disease are increasing among elders and are more prevalent than among the non-Indigenous older adult population. Research has documented that cardio- vascular disease is 77% more prevalent among Ontario’s Métis population than the rest of the province’s population.^{footnote 2[2]}
• For Indigenous older adults living in geographically isolated northern and reserve communities, preventive and treatment health services are undersupplied in terms of both organizational and human resources.^{footnote 3[3]} Indigenous seniors in larger rural and small urban communities do not face these challenges to the same extent. When considering the accessibility of health and social services it is important to consider available transportation options.
• Moreover, the lack of infrastructure (e.g. roads, broadband) in rural and remote regions of the province affects the ability of Indigenous older adults to access programs and services that improve their quality of life. This increases the likelihood of social isolation, poor health and employment outcomes.
• The challenge of access to health and social services is exacerbated with the out-migration of youth and middle- aged women seeking economic opportunities in larger communities. As a result, intergenerational traditions of caregiving (both for elders and by elders for small children), cultural knowledge exchange and respect have broken down and often cannot be replaced by external, non-Indigenous programs.^{footnote 4[4]}
• Many First Nations, Inuit, and Métis older adults are in poorer physical and mental health due to the disruption of their way of life caused by colonization, particularly the intergenerational effects and trauma of the residential school experience.
• The health needs of Indigenous seniors are magnified by determinants of health such as poverty, poor housing, racism, language barriers, and cultural differences.^{footnote 5[5]}
• The prevalence of low income for First Nations older adults in Ontario living off-reserve is 18.2% (15.1% for men, 20.7% for women), which is higher than the rate for non-Indigenous seniors at 12.0% (10.0% for men, 13.8% for women).^{footnote 6[6]}
• Non-Indigenous health care providers fail to appreciate how or the extent to which culture and health are inextricably linked. Frustration and dissatisfaction with social and health care services compels many Indigenous elders to avoid using the services that are available.^{footnote 7[7]}

Consistent with non-Indigenous older adults, Indigenous older adults largely seek to age-at-home among the family and community relationships that provide self-worth, an on-going capacity to function and contribute to one’s community.^{footnote 8[8]} The significance of AFC planning for Indigenous communities is growing. As the proportion of Indigenous older adults is projected to increase in the next five to ten years, geographic isolation and capacity issues for providing culturally relevant and safe care challenges the ability of Indigenous older adults to age well and age-in-place.

Engaging Indigenous communities, organizations or nations in AFC planning and implementation

COVID-19 advisory:

In-person activity may not be appropriate in your community while COVID-19 remains active in Ontario. All planning, implementation and evaluation activities and actions must follow local public health advice to prevent and stop the spread of COVID-19.

Read the Remote Events Planning Resource for information and tips on hosting safe and accessible virtual meetings.

Indigenous communities are not homogenous and have not been affected in the same ways by their environmental, social and economic circumstances.

Ontario’s Indigenous peoples are exceptionally diverse in many respects including culture, language, governance and history. The recognition and acceptance of such diversity is essential for meaningful and effective engagement with Indigenous communities, which can only be acquired through direct dialogue and communication. Beyond social and cultural diversity, Indigenous communities have differing conceptions of meaningful engagement and degrees of commitment to research and policy making processes. Results from the 2018 AFC Outreach Program annual survey show that 27 AFCs in Ontario have engaged Indigenous communities, organizations, or nations in their local AFC planning and implementation. Their strategies for successful engagement include: focusing on relationship building, conducting an engagement process, directly engaging with Indigenous communities, organizations or nations, and participating in information sharing.

Focus on relationship building

Relationship building takes time; trust is an important factor in building authentic relationships. Begin early to reach out to local Indigenous communities, organizations or nations and focus on establishing long-term relationships. A first step to building effective relationships involves developing an understanding of Indigenous communities’ priorities and their expectations for relationship building with federal, provincial and municipal governments. Explicitly build your relationship on the basis of mutually respectful dialogue and collaboration, and recognize that Indigenous communities, organization and nations wish to lead or directly influence decisions that will impact the well-being of their community members/citizens.

Conduct an engagement process

Share your AFC initiatives/activities with Indigenous communities, organization, or nations and request feedback or comments. Work collaboratively with Indigenous partners to find ways to identify and deliberately and authentically hear from Indigenous elders and older adults. Work closely with key knowledge holders and community leaders to identify appropriate methods – in addition to interviews, focus groups and surveys – and settings for obtaining information, as well as protocols for compensating Indigenous older adults and elders for the information that they share. It is also useful to have a document that explicitly outlines the objectives and scope of your engagement process (i.e. a memorandum of understanding). In addition to clearly articulating the principles that will guide your engagement process, such documents recognize that governments change (both Indigenous and municipal) and can limit disruption of your process.

Directly engage with Indigenous communities, organizations or nations

Establish processes to ensure continued feedback and input from Indigenous communities, organizations or nations by inviting Indigenous partners to sit on your local AFC committee or task force. Meaningful engagement will establish long- term partnerships to help move forward age-friendly solutions. Recognize that engagement takes time, and that building meaningful relationship and trust may not occur within the defined scope of your project schedule. Engagement with a community will be impacted by prior experiences with researchers and government agencies seeking data or reactions to new policies, and will be affected by seasonal activities, events and ceremonies. For many communities, the willingness to invest time, demonstrate flexibility and be respectful of culturally-based protocols can be the litmus test for demonstrating sincerity and integrity.

Participate in information sharing

Participate in information sharing with your local Indigenous communities, organization, or nations by communicating the AFC initiatives or activities that are happening. Extend invitations to Indigenous communities, organization, or nations to participate in events, or consider partnering with your local Indigenous communities, organization, or nations to host a joint workshop or event. Effective communication is based on the expectation that there will be clear, transparent and regular information exchange at all stages of your engagement process.

Provide opportunities to communicate in traditional languages

In many regions of the province, effective information sharing may require producing engagement materials in the traditional languages of Indigenous communities. Language plays a central role in everything that we do and in all our interactions. In addition to conveying information to Indigenous older adults who are less comfortable communicating in either English or French, language is the heart of any culture. Empowering Indigenous older adults to communicate in traditional languages is not only a respectful approach to community engagement, it is also the most effective way for older adults and elders to convey cultural values, worldviews and experiences that cannot be expressed through either settler language.

In addition to these principles, provincial agencies and municipal governments undertaking research or engagement with Indigenous communities are encouraged to consider the Ownership, Control, Access and Possession (OCAP) principles for conducting research with First Nations. Developed to support the work of the First Nations Regional Longitudinal Health Survey, the OCAP principles were a response to culturally inappropriate research and engagement strategies by non-Indigenous scholars and governments. Developed to address research in First Nations communities, the principles that are embodied by OCAP are relevant to engagement and research conducted with any Indigenous community or organization – i.e. First Nations, Métis or Inuit. The fundamental concept of OCAP is the collective ownership and control of, access to and possession of information that is generated through either academic or government research. In effect, OCAP empowers Indigenous communities and peoples to make decisions about how, why and by whom information collected through research or community engagement is collected, used and disseminated. Some researchers may see the OCAP principles as an impediment to the timely collection of data and publication of research findings. Similarly, government agencies may be uncomfortable with the degree of collaborative effort and shared decision making represented by the OCAP principles. However, both academic institutions and government agencies ought to recognize that the time and effort invested in building meaningful engagement will ultimately impact the quality and sustainability of engagement with Indigenous communities.

Factors that impact Métis elders and older adults in Ontario

A note on engagement to date

There is a clear need to address what it means to age well for Indigenous older adults and elders. To begin addressing this need, the Ministry for Seniors and Accessibility conducted engagement meetings with citizens and representatives of the Métis Nation of Ontario (MNO) in 2017 and 2018. There are noteworthy examples of age-friendly community planning processes where there has been explicit consideration and inclusion of Indigenous voices in municipal action planning processes. Those voices are largely represented by First Nations people and organizations, based on the assumption that Indigenous (i.e. First Nations, Métis and Inuit) perspectives are homogeneous. Although the challenges of aging for First Nations older adults are relatively well researched and documented, the needs of Ontario’s Métis older adults are less understood.

The following case study documents what has been learned through the engagement meetings with the MNO. It is not intended to represent the viewpoints of all Métis people in Ontario, or all Indigenous people, on these topics. It is intended in part to inform communities that are engaged in AFC action planning, as well as to motivate those communities to reach out and engage local Métis, First Nations and Inuit people and organizations that would benefit from their work.

Who are Ontario’s Métis people?

For 25 years, the Métis Nation of Ontario (MNO) has represented over 20,000 Métis people (citizens) throughout Ontario who are recognized as one of the three “Aboriginal peoples of Canada” under section 35 of the Constitution Act, 1982. There are many and often incorrect conceptions of what/ who a Métis person is in popular culture and among settler residents.

The Métis are a distinct Indigenous people with a unique history, culture, language, and way of life. Distinct Métis settlements emerged as an outgrowth of the fur trade, along freighting waterways and watersheds. In Ontario, these settlements were part of larger regional communities, interconnected by the highly mobile lifestyle of the Métis, the fur trade network, seasonal rounds, extensive kinship connections and a shared collective history and identity^{footnote 9[9]}.

Ontario’s Métis are descended from people who were born from mixed marriages between European men and First Nations women during the height of the Fur Trade era of the late 18^th and 19^th centuries. These first generations of mixed-race people did not self-identify as Métis and were not considered as such by settler society. A distinctive culture that was neither European nor First Nations did not appear until after successive generations of marriage between mixed ancestry people. Over time, the hallmarks of a culture emerged that were characterized by a unique language (i.e. Michif), spirituality, seasonal rounds, distinctive settlements (referred to as the Métis Nation “homeland”) and economic relationships, which became a shared collective history and identity.

The MNO also emphasizes that the mere identification of a mixed Aboriginal ancestry individual in the historic record does not make that individual a Métis^{footnote 10[10]}

Ontario’s contemporary Métis citizens (i.e. those who are registered as Métis by the MNO) refers to any individual who demonstrates through valid genealogical documentation that they are descended from Métis “root ancestors” who resided within the historic Métis Nation homeland. Métis people continue to live in the homeland, which extends from the Ottawa valley around the Great Lakes and into the western Prairie provinces. However, Métis people also live and are active participants in communities that are outside the traditional homeland – i.e. throughout much of southern Ontario. Today, Métis citizens are represented by the MNO across Ontario through 30 community councils and nine regional councils. Through the MNO, or in collaboration between the MNO and federal/provincial agencies, citizens can access programs and services in areas including housing, education, economic development and health and wellness that recognize and are attuned to the distinctive cultural, spiritual and social needs of Ontario’s Métis people.

Engagement process

The Ministry for Seniors and Accessibility (MSAA) began an engagement process with the Métis Nation of Ontario in the fall of 2017 to address two related objectives. The first was to convene an initial ‘scoping’ meeting of MSAA and MNO staff, facilitated by Dr. John Lewis (an MNO citizen and University of Waterloo professor), to discuss and establish the need for a Métis perspective in the Province’s AFC framework and municipal AFC action plans. From this meeting, it was agreed that the MNO would like to see greater recognition of the distinctive needs of Métis elders, and a consideration of those needs in municipal age-friendly action plans. In addition, participants in the scoping meeting agreed that a follow-up meeting with a panel of Métis elders and representatives of the MNO would be warranted to begin to articu- late Métis elders’ needs (i.e. objective 2).

The second objective was addressed in January 2018 where 30 elders and representatives of the MNO attended an engagement meeting to review:

• the Province of Ontario’s definition of and purposes for age-friendly community planning,
• the Province’s seniors’ strategy and the policy case for a Métis focused AFC planning framework,
• research conducted by MNO that broadly addresses the health and wellbeing needs of MNO citizens across the life spectrum.

From the discussion with engagement participants, five broad themes emerged that reflected the challenges of ageing well for Ontario’s Métis people: transportation, mental health, ‘we are not First Nations’, trust, and community capacity and self-governance.

Transportation

We have small outlying areas that don’t have access to transportation and that is one of the biggest problems, to get people to the services needed such as doctors’ appointments.

Access to medical services, particularly specialized medical services in particular, can be a significant issue for any older adult living in rural or remote areas of Ontario. A significant proportion of the MNO’s citizens reside in Ontario’s north and near north where diminished access to local and regional transportation networks can not only challenge elders’ capacity to reach medical services, but also their ability to travel to community events and participate in the social fabric of the Métis community. Social engagement is a critical factor for maintaining/enhancing the quality of life of older adults. Whenever possible, MNO citizens will step into the rural transportation services gap, either informally as friends, or more formally through voluntary service arrangements.

Mental health

There is a legacy to the abuse and mistreatment that has not only been inflicted on the present generation, but through our parents and grandparents. What was done to them has been passed down and still affects people today.

The MNO participants expressed that, along with First Nations and Inuit peoples, the history of Métis people with settler Canadians includes a legacy of forced assimilation and near cultural erasure, which can be attributed to racist conceptions of Indigenous peoples, their cultures and ways of life. Government funded and church-led residential schools were the clearest expression of a systematic assault on Indigenous cultures as children were separated from families to be stripped of culture, language and traditions. In addition to the cultural, emotional and physical trauma associated with residential schools, generations of Métis people have suppressed their identity due to the shame and social isolation that has been associated with being neither First Nations nor European. In effect, to be Métis has historically meant to be something less than or inferior to other Indigenous peoples, and settler Europeans in particular, and has often been expressed through forms of economic and social exclusion, or physical aggression. The consequences of cultural repression and violence have had profound impacts on the mental health of Métis elders who have lived through the worst expressions of cultural violence. That legacy has been passed to younger and future generations of Métis (i.e. inter-generational trauma). The depression, anxiety and aggression that manifests from experiencing and attempting to cope with cultural repression can have profound and negative consequences for the children and grandchildren of Métis elders.

‘We are not First Nations’

We need to have our own healing circles, we need to have our own elders, we need to have that as a part of age-friendly communities and it’s not there.

There is a deep misunderstanding within settler society about who Métis people are, particularly in relation to other Indigenous peoples. This misunderstanding can be commonly expressed in a service setting in one of two ways. First, when a Métis older adult presents themselves to a health or social services provider and is asked if they are “Aboriginal.” From the engagement sessions, there were participants who recounted experiences where, upon informing the provider that they are Métis, they were told that that doesn’t count. On other occasions, where the provider’s intentions are to provide culturally appropriate support, a First Nations elder is contacted and introduced to a Métis older adult.

There is a widespread conception that Métis people, as people of mixed-race Indigenous origins, ought to understand and relate to the traditions and world views of First Nations peoples. However, to be Métis is to belong to a unique culture. The expectation of Métis people is that they will be respected and recognized for being an Indigenous people, but not a people whose culture is synonymous with another.

Trust

It’s a challenge to have faith in institutions and governments that have either not recognized who you are or, when they do, try their utmost to erase it and turn you into something else.

A legacy of cultural repression and, more recently, cultural misapprehension, affects the relationship between Métis people and the non-Indigenous institutions and service providers that seek to address their needs. Communicating and engaging with Métis people or community councils to address the needs of the older citizens is an essential means of building cultural understanding and developing age-friendly plans that reflect what it means to be a Métis older adult/elder.

Community capacity and self-governance

We take care of our own, that has always been a Métis tradition.

Recognizing the presence of Métis communities throughout Ontario and building meaningful communication is a first step. The hope and expectation is that Métis councils and service providers will work with their counterparts in provincial and federal agencies to deliver and evaluate the programs that are provided to older citizens. Building cultural understanding and a better appreciation of the needs of Métis older adults is a gradual process, one that ought to proceed in collaboration with those who best appreciate the needs of older citizens.