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First Nations, Inuit, Métis and Urban Indigenous Cancer Strategy 2019–2023

Since 2004, multi-year provincial Indigenous cancer strategies have addressed and led to improvements in cancer care for Indigenous people in Ontario. The First Nations, Inuit, Métis and Urban Indigenous Cancer Strategy 2019 – 2023 continues the work set out in the first 3 strategies.

This strategy provides a road map for how Ontario Health (Cancer Care Ontario), Indigenous communities and individuals, and health system partners will work together to:

  • improve the performance of the cancer system for Indigenous people in Ontario in a way that honours Indigenous concepts of well-being
  • improve the well-being of Indigenous people in Ontario and reduce the burden of cancer in these communities
  • empower supportive and healthy environments that build on the strengths of Indigenous individuals, families, communities and organizations
  • Alethea Kewayosh

    To make real progress in addressing Indigenous cancer care needs, Indigenous people in Ontario must have a voice in shaping the work that addresses their unique issues and honours Indigenous concepts of well-being. Ontario Health (Cancer Care Ontario) is committed to partnering with Indigenous leadership, communities, patients, families, healthcare providers and administrators to create Indigenous solutions for Indigenous concerns.”

    Alethea Kewayosh,
    Director, Indigenous Cancer Care Unit, Ontario Health (Cancer Care Ontario)

  • Linda Rabeneck

    From our work together on the first three Indigenous cancer strategies, we understand the importance of seeking guidance, direction and approval through direct engagement with Indigenous leaders and communities. Following this approach will be critical in our ongoing work to build relationships and address cancer and other existing and emerging health issues among Indigenous people.”

    Dr. Linda Rabeneck,
    Vice-President, Prevention and Cancer Control, Ontario Health (Cancer Care Ontario)

Community Voice

Glen Hare

Glen Hare

Grand Council Chief, Anishinabek Nation

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We cannot forget that our people are suffering from a higher incidence of several types of cancer compared to other people in Ontario. Our people are continuing to die prematurely from certain preventable and treatable cancers. The important thing is prevention and getting screened to find cancer early, as opposed to trying to react when it is too late. We need to equip our Peoples with the information they need to take control of their health and well-being. ”

Glen Hare, Grand Council Chief, Anishinabek Nation

Alvin Fiddler

Alvin Fiddler

Grand Chief, Nishnawbe Aski Nation

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NAN First Nations face many challenges including lack of early diagnosis and access to related services due to remoteness and an inequitable healthcare system. By working with Cancer Care Ontario this strategy will allow us to develop effective planning for timely access and more effective screening and education in the delivery of cancer services in our communities.”

Alvin Fiddler, Grand Chief, Nishnawbe Aski Nation

Francis Kavanaugh

Francis Kavanaugh

Ogichidaa (Grand Chief), Grand Council Treaty #3

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I am very pleased with the strong partnership between Grand Council Treaty #3 Health Council and Cancer Care Ontario. This partnership has yielded the Grand Council Treaty #3 cancer report, which was developed through significant direction from our Grand Council Treaty #3 Cancer Surveillance Advisory Team that consisted of our Grand Council Treaty #3 Health Council and several representatives from our communities. It will help us properly plan programs and support services. Together, we will continue to work towards understanding and improving the impact of cancer in our communities.”

Francis Kavanaugh, Ogichidaa (Grand Chief), Grand Council Treaty #3

Sylvia Maracle

Sylvia Maracle

Executive Director, Ontario Federation of Indigenous Friendship Centres

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The relationship between Cancer Care Ontario and the Ontario Friendship Centres stands as an example of how urban Indigenous organizations should be engaged in the healthcare system. When we each respect and support the pivotal role we each play in Indigenous health and well-being, we can make even greater strides to collectively reduce the burden of cancer on Indigenous people.”

Sylvia Maracle, Executive Director, Ontario Federation of Indigenous Friendship Centres

Jason LeBlanc

Jason LeBlanc

Executive Director, Tungasuvvingat Inuit

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Tungasuvvingat Inuit is pleased to continue to work in partnership with Cancer Care Ontario and ensure the voices and specific needs of Inuit and their families are represented throughout the cancer care system of Ontario. As we build upon our past successes, we see a future where Inuit are empowered in their own healthcare journeys and are able to support and influence the healthcare system to be inclusive and equitable for our people.”

Jason LeBlanc, Executive Director, Tungasuvvingat Inuit

Margaret Froh

Margaret Froh

President, Métis Nation of Ontario

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The Métis Nation of Ontario are proud of our ongoing collaboration with Cancer Care Ontario towards a healthier and increasingly empowered quality of life for Métis citizens and families in Ontario. The relationship we have forged together continues to build upon solid research, education and programming goals -- created by and for Métis -- that will ultimately allow our communities to better understand and address the complexities of cancer in their lives. We look forward to creating new and innovative initiatives under this strategy that will create greater awareness, support and prevention of cancer through a holistic lens unique to the Métis experience.”

Margaret Froh, President, Métis Nation of Ontario

Strategic Priorities, Objectives and Actions

Building Productive Relationships

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Building Productive Relationships

Build and promote relationships with Indigenous partners based on trust and mutual respect

Productive, respectful relationships are the foundation of all our work. To accomplish our mutual objectives, we must take the time to build meaningful relationships among the Indigenous Cancer Care Unit, Regional Cancer Programs and Indigenous partners.

OBJECTIVES AND ACTIONS BY 2023

Build, grow, strengthen and sustain relationships
  • Continue to work with Indigenous leadership, governance structures, health networks, communities and other health system partners to implement the First Nations, Inuit, Métis and Urban Indigenous Cancer Strategy 2019–2023
  • Develop new relationships and partnerships with Indigenous groups
  • Continue to evaluate and refine ways to build relationships between the health system and Indigenous people, and measure the productivity of these relationships
  • Ensure emerging health system partners understand the four pillars approach to developing relationships with Indigenous people and addressing their health needs
Support Indigenous health priorities throughout health system transition
  • Support development of existing or new community health priorities, as directed by communities (including urban Indigenous community partners)
  • Support and engage Indigenous partners as the work of Cancer Care Ontario moves to Ontario Health
  • Help health system partners respond to evolving Indigenous health priorities and direction
Promote respect for and understanding of Indigenous knowledge and traditional practice
  • Determine how Ontario’s health system can support Indigenous knowledge and traditional practices in the context of healthcare
  • Support Indigenous and health system partners in developing and evaluating culturally relevant protocols and processes that respect Indigenous knowledge and traditional practices in healthcare settings

The Anishinabek Nation has enjoyed a long-standing and mutually beneficial relationship with Cancer Care Ontario, which is reflected in our Relationship Protocol. Because of this solid working relationship, much has been accomplished in a relatively short time. While much progress has been made, both parties acknowledge there is still much to do.”

Tony Jocko,
Federal Health Policy Analyst, Anishinabek Nation

Measurement, Monitoring and Evaluation

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Measurement, Monitoring and Evaluation

Compile and develop information to improve the quality of the cancer experience for patients, families and healthcare providers

We will build on the research and surveillance work conducted under the third strategy. That period created baseline and foundational products. The body of work from the third strategy, while substantive, supports the necessity to do more. We are positioned to continue to respond to research questions that are important to our community partners.

While much of our work to date has focused on First Nations people in the province because of available databases, we want to continue that work and expand to better appreciate the experiences of Inuit, Métis and urban Indigenous groups. Expanding our approach and partners will facilitate a better understanding of how the cancer and healthcare systems are working and where opportunities for improvements remain.

OBJECTIVES AND ACTIONS BY 2023

Identify, access and analyze health data
  • Identify data to measure, monitor and evaluate the determinants of health and well-being
  • Use data to measure, monitor and evaluate the performance of the Ontario health system for Indigenous people
  • Estimate the impact of cancer and chronic diseases on the health and well-being of Indigenous people
Address relevant health priorities using data
  • Integrate quantitative and qualitative methods for developing health products and data relevant to Indigenous peoples’ cancer and chronic disease experiences and priorities
Support communities in using health data for policy and program development and understanding the related implications
  • Address gaps in the health system by using and sharing knowledge exchange activities with partners
  • Enhance and support the development of measurement, monitoring and evaluating capacity activities in communities
Explore opportunities to partner with organizations with shared health data goals
  • Develop and formalize partnerships in Ontario and across Canada to improve the health and well-being of Indigenous people

Aamjiwnaang First Nation has been working with the Indigenous Cancer Care Unit (ICCU) for over a decade. The ICCU has been so helpful in guiding and supporting our project with their expertise. They respect the knowledge and experience that we have in our community and complement it with their own. It has been an enriching experience working with them on projects that are truly meaningful to our community.”

Sara Plain,
Health Director, Aamjiwnaang First Nation

Prevention

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Prevention

Reduce rates of cancer and other chronic diseases in Indigenous people

Indigenous people have higher rates of several risk factors for cancer and other chronic diseases, including:

  • commercial tobacco use
  • alcohol consumption
  • poor diet (and food insecurity)
  • physical inactivity

High rates of these risk factors are related to social determinants of health, and the historical and ongoing impacts of colonialism.

To reduce the effect of chronic diseases among Indigenous people, our health systems must build on the strengths of traditional Indigenous knowledge and approaches to health and wellness.

OBJECTIVES AND ACTIONS BY 2023

Reduce and prevent cancer and other chronic diseases
  • Provide training to healthcare providers with a focus on chronic disease prevention to build capacity at the community level
  • Provide Indigenous people with culturally specific customized workshops and education sessions on preventing chronic disease
  • Through the Path to Prevention Partnership Table, continue to implement the 22 recommendations from the Path to Prevention report to address behavioural risk factors related to cancer and other chronic diseases
Develop and use evidence to reduce the burden of cancer and other chronic diseases
  • Use chronic disease prevention and behavioural risk factor data, policies and partnerships to inform and develop new and culturally appropriate approaches to chronic disease prevention
  • Continue to collaborate and share knowledge with Indigenous and non-Indigenous partners about preventing cancer and other chronic diseases
Support prevention policies and develop programs to deal with emerging issues and trends
  • Ensure that Indigenous community members and healthcare providers have the knowledge and tools needed to deal with emerging trends (e.g., vaping and cannabis)

The collaboration between the Canadian Cancer Society and CCO’s Indigenous Cancer Care Unit has led to a partnership where chronic disease prevention initiatives are strengthened from the sharing of knowledge, experience and unique perspectives each organization brings to the table.”

John Atkinson,
Director, Cancer Prevention and Tobacco Control, Canadian Cancer Society

Screening

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Screening

Increase participation in cancer screening among Indigenous people across the province

Cancer screening finds cancer early when it is easier to treat. Screening may also prevent some cancers by finding cell changes before they develop into cancer. Indigenous people are less likely to have screening tests done than the general population. Through community engagement and research, we have begun to better understand and reduce the complex barriers to cancer screening among Indigenous people in Ontario.

We will work together to improve participation in cancer screening among Indigenous people by improving the awareness, cultural safety and accessibility of these services in Ontario. Every Indigenous person who is eligible for cancer screening should be supported in making an informed choice about participating in cancer screening.

OBJECTIVES AND ACTIONS BY 2023

Improve access and participation in screening
  • Review and put into practice evidence-informed recommendations to improve screening participation
  • Address barriers to help Indigenous people access screening in or closer to their communities
  • Address challenges for Indigenous people who need to travel for screening
  • Collaborate with community partners to improve access to screening
Improve coordination and integration of screening services
  • Continue to explore and support provider tools to improve the coordination of screening and follow up of results, reducing barriers to early cancer detection and treatment.
Support specific initiatives to improve organized screening programs
  • Improve colon cancer screening participation rates among Indigenous men
  • Support awareness and recruitment of Indigenous people to improve participation in high risk lung cancer screening
  • Develop culturally appropriate Indigenous-specific screening communication materials
  • Continue to inform organized screening programs for breast, colon and cervical cancer to ensure they are inclusive of Indigenous people and address their unique needs

Having a dedicated unit for Indigenous cancer priorities is a proactive way to work collaboratively and head in the direction towards an integrated healthcare system that addresses Indigenous peoples' healthcare needs comprehensively and provides the right tools to support cancer screening.”

Janet Gordon,
Chief Operating Officer, Sioux Lookout First Nations Health Authority

Palliative and End-of-Life Care

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Palliative and End-of-Life Care

Help take care of the palliative and end-of-life needs of Indigenous people with cancer

Palliative care involves helping patients and their families manage the emotional, spiritual, functional, practical, nutritional and rehabilitative challenges associated with cancer.

Palliative and end-of-life care services vary significantly for Indigenous people in Ontario depending on where they live.

To serve the unique needs of Indigenous people, we must continue to educate healthcare providers on culturally safe care, and increase the availability of supports and access to traditional practices.

OBJECTIVES AND ACTIONS BY 2023

Support timely and culturally safe palliative and end-of-life care
  • Continue to work with the Ontario Palliative Care Network and regional palliative care leadership to ensure Indigenous people have a voice in the delivery of palliative and end-of-life care services
  • Bridge gaps in discharge planning and transitions in care
  • Continue to collaborate and support Indigenous and non-Indigenous palliative and end-of-life-care networks and groups
Improve capacity of system to provide high-quality palliative and end-of-life care
  • Continue to support pain and symptom management through the use of the Edmonton Symptom Assessment System by community-level healthcare providers
  • Continue to explore culturally safe tools and methods for collecting patient-reported outcome measures and patient-reported experience measures
  • Continue to work with Indigenous people and health system partners to improve the coordination and integration of palliative and end-of-life care
Support strategies to improve and enhance patient and family experience
  • Continue to support patient navigation
  • Continue to explore innovative approaches to support the palliative and end-of-life care needs of Indigenous people
  • Support the development of tools, resources, networking and training to provide caregivers with additional support

An Indigenous Navigator played an important role in my mother’s care. Traditional practices such as singing, drumming, praying and smudging provided comfort and powerful healing to both my mother and me.”

Tiffany W,
belongs to the Champagne and Aishihik First Nations band and cared for her mother, Meta B. when she was being treated for stage 4 lung cancer in Vancouver.

Education

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Education

Increase the knowledge and awareness among Indigenous people about cancer and other chronic diseases, and among healthcare providers about cultural safety

To date, the Indigenous Cancer Care Unit has focused on developing culturally relevant material for Indigenous people to help them learn more about cancer and other chronic diseases. We have published many culturally relevant resources to encourage Indigenous people to accept and participate in cancer education, screening, prevention and treatment programs. We will continue to develop and share information to improve Indigenous peoples’ understanding of cancer, and support them as they navigate the healthcare system.

While we continue that work, we will also aim to improve healthcare providers’ understanding of the historical and cultural factors that contribute to Indigenous experiences of cancer, other chronic diseases and the healthcare system.

OBJECTIVES AND ACTIONS BY 2023

Address gaps in education and programming
  • Measure the impact of resources to address gaps in education and programming through the Indigenous Cancer Care Unit’s education framework
  • Increase Indigenous youth audience and engagement with cancer education initiatives
Support and increase culturally safe education and programming
Support education and training for providers and Indigenous people
  • Inform and adapt resources, training and tools for providers working with Indigenous people
  • Continue to develop and disseminate culturally appropriate chronic disease, prevention, screening, and palliative and end-of-life education resources for Indigenous people
Collaborate with partners to engage in knowledge transfer and exchange
  • Compile and share information to respond to Indigenous peoples’ emerging health education needs and priorities
  • Continue to support knowledge sharing and dissemination with Indigenous partners

Historically, medical and nursing schools have not provided adequate education about the history, culture and health of Indigenous people. Doctors and nurses then carried that lack of awareness forward into their practices. With the introduction of the Indigenous Relationship and Cultural Safety courses, we are starting to see a shift in the curriculum and recognition that more needs to be done to address these gaps in learning.”

Dr. Bernice Downey,
Assistant Professor, School of Nursing, Department of Psychiatry and Behavioural Neurosciences, McMaster University

Equitable Access

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Equitable Access

Reduce barriers in the health system and service delivery

Indigenous people face significant challenges in accessing and navigating the healthcare system. These challenges range from a lack of basic health services, to limited and culturally inappropriate care, to geographic barriers. Many people have to bear the financial and time-consuming burden of travelling long distances to receive care.

We will work with Indigenous partners to support a simpler, easier-to-understand path for people navigating and transitioning in and out of the cancer system. This unified process will help reduce barriers and improve experiences and access to equitable healthcare for Indigenous people.

OBJECTIVES AND ACTIONS BY 2023

Improve navigation and access
  • Develop evidence-based recommendations to advise the Ministry of Health on improving wait times and access to services for Indigenous people
  • Improve tools and support for successful transitions through the cancer system, from screening to diagnosis to treatment to survivorship or palliative care
  • Work with other provinces to address barriers between jurisdictions
  • Find additional navigational support to help Indigenous patients navigate through the health system
Enhance quality and improve experience of services
  • Develop a process to improve accountability and trigger action in support of Indigenous patient rights within the health system
  • Work with First Nations partners and Indigenous Services Canada to ensure the Non-Insured Health Benefits Program supports access to timely care
  • Promote shared decision-making between Indigenous people and healthcare providers
Increase the provision of culturally safe care
  • Help health system partners develop relationships with Indigenous partners so they can create culturally safe and supportive environments that consider the unique needs of Indigenous people

Cancer is an emotional roller coaster that you wish you could get off. Everyone has a story about their family member, friend or love one (who has had cancer), but until you have experienced this for yourself you will never understand how it feels. The only person who can understand what you are going through is yourself.”

Jayne Chatterton ,
was diagnosed with colon cancer in 2017 at the age of 32. Although she still undergoing treatment, she is very positive about her future.

Cancer in Indigenous Communities

Why Ontario needs an Indigenous cancer strategy

There is an urgent need for action to prevent cancer and other chronic diseases among Indigenous people.

  • Ontario is home to the largest Indigenous population in Canada, with an estimated 236,680 First Nations,* 120,585 Métis peoples and 3,360 Inuit.
  • Rates of cancer, diabetes, heart disease and respiratory diseases are rising in Indigenous peoples.
  • First Nations people have more new cases of certain cancers than other people in Ontario.
  • Death rates from cancer are also significantly higher in First Nations people than in other people in Ontario.
  • Obesity, which raises the risk of developing cancer and other chronic diseases, is markedly more common in Indigenous people than in the general population.

These facts point towards a future of dramatically increased rates of cancer and other chronic diseases among Indigenous people.

For more information about cancer risk factors and screening for Indigenous people, see the following resources:

First Nations People: Cancer Risk Factors and Screening Infographic

Inuit Cancer Risk Factors and Screening Infographic

Metis People: Cancer Risk Factors and Screening Infographic

Beyond cancer

Rates of some other chronic diseases and mental health conditions are also significantly higher in Indigenous people than in the general Ontario population. The death rate for Indigenous people with a chronic disease is far greater as well.

On average, in Canada Indigenous men live 4 years less than non-Indigenous men do. Indigenous women live an average of 6 years less than non-Indigenous women do.

These inequalities can, in part, be explained by determinants of health that disproportionately affect Indigenous people:

  • Geographic, financial, cultural and language barriers to accessing care
  • Higher rates of risk factors such as:
    • commercial tobacco use
    • alcohol consumption
    • diet (and food insecurity)
    • physical inactivity

In addition, Canada's historic policies of colonization – including residential schooling, loss of culture, marginalization and discrimination – have also shaped the health of Indigenous people.

The First Nations, Inuit, Métis and Urban Indigenous Cancer Strategy 2019 – 2023 provides a road map for the Ontario Health (Cancer Care Ontario), Indigenous communities and individuals, and health system partners, will work together to improve health equity and reduce the unique burden of cancer and other chronic diseases on Indigenous people.

This strategy puts forward actions to address cancer care gaps in a holistic approach. It takes into consideration the unique circumstances and needs of Indigenous people living in Ontario, including their distinct sociopolitical, historical and geographical contexts.

FOR MORE INFORMATION

Progress to date

Since 2004, multi-year Indigenous cancer strategies have addressed and led to improvements in cancer care for Indigenous people in Ontario.

This strategy, the fourth, builds on the progress achieved under its predecessors.

The third Aboriginal Cancer Strategy, 2015 – 2019, outlined 41 action items under 6 strategic priorities. Forty of these action items have been completed. Highlights of this work include:

  • Building productive relationships: The signing of 10 Relationship Protocols has strengthened relationships between Cancer Care Ontario and Indigenous partners.
  • Measurement, monitoring and evaluation: Provincial, regional and community-specific risk factor and cancer burden reports are providing a clearer picture of cancer and factors affecting cancer risk in Indigenous people.
  • Prevention: Path to Prevention – Recommendations for Reducing Chronic Disease in First Nations, Inuit and Métis provides evidence-based policy recommendations on 4 key chronic disease risk factors in First Nations, Inuit and Métis communities.
  • Screening: The development of community Screening Activity Reports helps healthcare providers in remote communities improve cancer screening rates and appropriate follow-up.
  • Palliative and end-of-life care: Cultural competencies embedded into provincial education for service providers is helping to ensure Indigenous patients receive culturally safe palliative care.
  • Education: Healthcare professionals are learning about cultural safety, Indigenous history, rights, governance structures and issues, and anti-racism from 13 Indigenous Relationship and Cultural Safety courses.

About Us

Ontario Health is a new government agency that, once fully established, will be responsible for ensuring Ontarians receive high-quality health care services where and when they need them.

Effective December 2, 2019, Cancer Care Ontario is part of Ontario Health. Cancer Care Ontario’s programs and services, including the work of the Indigenous Cancer Care Unit and Regional Cancer Programs, remain unchanged.

The Indigenous Cancer Care Unit of Ontario Health (Cancer Care Ontario) collaborates with regional, provincial and national Indigenous and non-Indigenous partners and organizations to develop and implement Indigenous cancer strategies. Working together, the Indigenous Cancer Care Unit and Indigenous partners make sure proposed programs and strategies are relevant and have the potential to be highly effective at individual, family and community levels.

The Joint Ontario Indigenous Cancer Committee guides and advises Ontario Health (Cancer Care Ontario) on Indigenous cancer care issues and needs including the development and implementation of the Indigenous cancer strategies . The committee includes representatives from Indigenous organizations and other partners.

Ontario’s 14 Regional Cancer Programs and the Indigenous Cancer Care Unit work closely to understand and serve the unique needs of Indigenous people in each of Ontario’s regions. The Regional Cancer Programs:

  • deliver cancer prevention services and care
  • make sure standards are met
  • listen and respond to local concerns and issues

About this Plan

To create this plan, the Indigenous Cancer Care Unit began by reviewing progress made under third Aboriginal Cancer Strategy 2015 – 2019.

The Joint Ontario Indigenous Cancer Committee, Indigenous patients, families and partners, staff across Cancer Care Ontario and a network of partners, including the Regional Cancer Programs, provided insights and expertise.

The review and engagements confirmed the direction set by previous Indigenous cancer strategies. This strategy continues in the same direction and builds on progress to date. It identifies work that needs to advance, new opportunities for improvement and emerging areas within the healthcare environment that will require attention in coming years.

Acknowledgements

Many individuals and organizations contributed to the development of this strategy. We are grateful for their wisdom and interest in advancing the health of Indigenous people in Ontario.