Competencies for Indigenous Public Health, Evaluation and Research (CIPHER)

Background

Indigenous populations around the world struggle with considerable health inequities compared to their non-Indigenous counterparts. These inequities are caused by a complex combination of historic and socioeconomic factors, including but not limited to colonization, racism, poverty and cultural trauma. Among the Indigenous populations affected by health inequities are the First Nation, Inuit and Métis peoples recognized in the Constitution Act of Canada 1982, Section 35.

To meet the health needs of Indigenous people and reduce health inequities, there needs to be a public health workforce that is properly trained to be respectful and responsive to each Indigenous community’s cultural and social circumstances.

The CIPHER program aims to address this issue by developing a model of core competencies for Indigenous public health. CIPHER, or Competencies for Indigenous Public Health, Evaluation and Research, emerged from collaboration between CAHR and Aboriginal scholars from Australia, New Zealand, Canada and the United States.

The goal of CIPHER is to develop an internationally-recognized cultural safety approach to Indigenous public health, which is described by a set of core competencies. These core competencies can then be used to improve public health education, practices, services and policy, making both Indigenous health programs and the public health workforce more culturally safe.

As a result, the project team believes Indigenous health inequities in Canada and abroad can be reduced, because the CIPHER core competencies will teach public health professionals how to directly address the socially and culturally-influenced health needs of Indigenous communities, while also serving as a tool for communities to use while communicating with public health professionals and increasing their self-determination activities in health care.

Key concept: cultural safety

Cultural safety is a health care concept that:

  • acknowledges the historic tensions between Western and Aboriginal cultures
  • analyzes power imbalances, institutional discrimination and colonial relationships that affect health services
  • teaches health care providers to recognize, respect and integrate each individual’s cultural identity into the patient’s health care.

Key concept: core competencies

Core competencies for public health represent a set of skills, knowledge and attitudes necessary for providing effective health services. Competencies also inform education, training, research and governance.
The core competencies have the potential to:

  • inform curriculum, standards and accreditation for public health education
  • guide community research
  • inform Aboriginal health policy and legislation
  • promote a culturally competent workforce
  • create career ladders for Indigenous public health professionals
  • expand Indigenous public health capacity
  • improve health outcomes
  • inform the development of Indigenous health research and Indigenous cultural safety training modules.

Timeline

July 2011 – CIPHER was established at a planning meeting between scholars at the University of Hawaii. The meeting outcomes included: a consensus to develop Indigenous public health competencies, agreement to draft funding proposals to submit within each country and, plans to establish CIPHER as an international consortium.

Winter 2012 – An environmental scan funded by the NCCAH was conducted at CAHR. The environmental scan assessed current cultural safety practices and looks at existing public health programs, Indigenous health services and cultural safety initiatives in Canada.

June 2012 – Publication of the commentary article “Core competencies for Indigenous public health, evaluation and research (CIPHER): A health inequity mitigation strategy” by Lauren Y. Baba and Jeffrey L. Reading in the Canadian Journal of Nursing Research.

June 2012 – The NCCAH and CAHR co-hosted a meeting in Vancouver to discuss Indigenous-specific competencies for public health and how these competencies can become an integral part of cultural safety practices in public health in Canada. Participants had the opportunity to:

  • Describe and identify potential Indigenous-specific competencies in public health;
  • Explore possibilities for establishing national core competencies;
  • Examine the potential impact of Indigenous-specific competencies for public health curriculum, development of Indigenous Public Health specialists, and accreditation processes for Public Health programs;
  • Discuss a strategic vision and actions for moving forward;
  • Hear presentations panel discussions focused on the dialogue theme; and,
  • Articulate a vision for supporting the development of Indigenous-specific public health competencies and the actions required to move that vision forward.

July 2012 – A comprehensive report on public health education and Indigenous health curriculum in the four CIPHER countries was made available to the public by CAHR. The report describes Indigenous health services, public health competency models, Indigenous health curriculum and cultural safety education in each of the four CIPHER countries. The report also compares all the countries and discusses the potential impact of the CIPHER core competencies on an international level.

2012-2013 CAHR is planning an international meeting of CIPHER scholars and Canadian experts in Indigenous health and public health to discuss the results of the June 2012 meeting in Vancouver, the contents of the environmental scan and the comprehensive report, and establish an international research agenda and policy position.

Funding

  • CIHR Planning Grant, Fall 2011 Competition, “Developing Aboriginal Public Health Competencies”
  • CIHR Dissemination Grant, Winter 2012 Competition, “Aboriginal Public Health Competencies: Research Results and Knowledge Dissemination”

CIPHER scholars and contributors

  • Dr. Jeff Reading, Center Director, Center for Aboriginal Health Research, University of Victoria
  • Dr. Margo Greenwood, Academic Lead, National Collaborating Centre for Aboriginal Health
  • Dr. Evan Adams, Aboriginal Health Physician Advisor, Office of the Provincial Health Officer, BC
  • Dr. Janet Smylie, Research Scientist, Centre for Research on Inner City Health, affiliated with the Dalla Lana School of Public Health, University of Toronto
  • Dr. John O’Neil, Dean, Faculty of Health Sciences, Simon Fraser University
  • Dr. Sue Crengle, Senior Medical Lecturer, Department of Maori Health, School of Population Health, University of Auckland
  • Dr. Jacinta Elston, Dean, Indigenous Health Unit, James Cook University
  • Dr. Karina Walters, Director, Indigenous Wellness Research Institute, University of Washington
  • Ralph Forquera, Executive Director, Seattle Indian Health Board
  • Dr. Maile Taualii, Director, Native Hawaiian Epidemiology Center at Papa Ola Lokahi