Rethinking the way we approach the issue of improving the oral health of Indigenous Canadians—that was the mandate of Drs. Mary McNally, Robert J. Schroth, and Rosamund Harrison when they hosted the Pathway to Oral Health Equity for First Nations, Métis, and Inuit Canadians: Knowledge Exchange Workshop in early 2014.
The event was in response to the launch of one of the Canadian Institutes of Health Research's (CIHR) signature initiatives, Pathways to Health Equity for Aboriginal Peoples, which identifies oral health as a priority area for Canadian First Nations, Métis and Inuit communities.
The workshop was framed within the "two-eyed seeing" approach, a principle brought forward by Elder Albert Marshall of the Eskasoni Mi'kmaq First Nation, in Cape Breton, Nova Scotia. It refers to "learning to see from one eye with the strengths of Indigenous ways of knowing and from the other eye with the strengths of Western ways of knowing, and learning to use both eyes together for the benefit of all."
The organizers wanted the focus to be on Indigenous people and the inequities they face regarding oral health. Representatives from First Nations, Métis and Inuit communities led off the event. "In keeping with the 'two-eyed seeing' approach, it was important to hear first and foremost from the voices of Indigenous people, to bring them together with Canadian oral health researchers," says Dr. McNally.
The event participants also included clinicians, health promoters, health service program managers and decision-makers, and academics.
"We opted for a non-typical research meeting," explains Dr. Schroth. The idea was to foster open conversations between stakeholders to reach a better, common understanding of the current gaps and challenges in oral health care delivery. Attendees were able to exchange and share their perspectives on 4 key themes—communities, measurement, approaches, and providers—during facilitated panel discussions.
"I think many Canadian dentists are keen and sensitive to the specific oral health needs of Indigenous people," says Dr. Schroth. "And I think many are now realizing that having access to the Non-Insured Health Benefits (NIHB) program doesn't always translate into improved oral health status. Many other factors are at play. If you live in a remove community where professionals aren't visiting very often, NIHB isn't necessarily going to change your outcome."
Partnerships and capacity building
The phrase "nothing about us without us" resonated strongly with the Indigenous representatives who attended the workshop. "The former concept of a researcher parachuting into communities, gathering data and leaving is no longer acceptable," Dr. Schroth explains. Research has to lead to concrete benefits for the communities, and research endeavours have to focus on building capacity within communities, echoes Dr. McNally.
As Dr. McNally points out, another way to build capacity is to get into an interdisciplinary network and draw on other areas of expertise. "We share the same social determinants. We have to be creative about how we network not only with the communities but also with our interdisciplinary colleagues." Dr. Schroth mentions the possibility of tapping into existing prevention programs. "We've never evaluated the impacts that a breastfeeding program, a preschool nutrition program or an obesity prevention project may have on oral health. We are excited to see there are other avenues to explore."
The workshop organizers are thrilled with the positive feedback they received from the participants. "Attendees were willing to move this agenda forward, realizing that it will take time," says Dr. Schroth. "A lot of people, including some outside the dental community, felt that way. It's encouraging for me as a dentist to know we're not alone, and neither are the communities."
The benefits of hosting this event can already be seen. "A few of us are moving forward with proposals to CIHR for team-building operating grants," mentions Dr. Schroth. "Participants showed interest in being part of an ongoing collaborative research network focused on Indigenous peoples' oral health. I think that's a clear sign that the workshop wasn't perceived as a being researcher-driven event."