DECOLONISING PUBLIC HEALTH: AVENUES FOR SOCIAL WORK RESISTANCE,
ADVOCACY, AND ALLYSHIP
by
Stacey de la Rey
Bachelor of Arts Psychology (Hons), Simon Fraser University 2018
MAJOR PAPER SUBMITTED IN THE PARTIAL
FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SOCIAL WORK
in the
School of Social Work and Human Services
© Stacey de la Rey 2022
UNIVERSITY OF THE FRASER VALLEY
WINTER 2022
All rights reserved. This work may not be
reproduced in whole or in part, by photocopy
or other means, without permission of the authors.

i

Approval
Name: Stacey de la Rey
Degree: Master of Social Work
Title: Decolonising Public Health: Avenues for Social Work Resistance, Advocacy, and
Allyship
Examining Committee:
Dr. Leah Douglas. BSW, MSW, Ph.D., RCSW
MSW Committee Chair
Associate Professor, School of Social Work and Human Services
Dr. Amanda LaVallee. BISW, MSW, PhD, RSW
Senior Supervisor
Assistant Professor, School of Social Work & Human Services
Dr. Evan Taylor, BSW, MSW, Ph.D., RSW
Second Reader
Assistant Professor, School of Social Work and Human Services
Date Defended/Approved: April 2022

ii
Contents

Acknowledgements ........................................................................................................ iii
List of Acronyms ........................................................................................................... iv
Abstract ........................................................................................................................... v
Social Location ............................................................................................................... 1
Introduction ..................................................................................................................... 2
Methods........................................................................................................................... 6
Social Work and its Colonial Roots ................................................................................ 7
Indian Act.................................................................................................................... 9
Forced Removal of Indigenous Children .................................................................. 10
Indian Hospitals ........................................................................................................ 13
Literature Review: Thematic Findings ......................................................................... 14
Social Work and Public Health ................................................................................. 14
Opportunities for Decolonizing Social Work and Public Health.............................. 18
Implications for Social Work Practice, Policy, Research, and Education .................... 33
Conclusion .................................................................................................................... 35
References ..................................................................................................................... 38

iii
Acknowledgements
I would like to acknowledge that I am honoured to be able to live, work, play, and learn
on the land of the Coast Salish people. I also acknowledge that I am a settler on this land, and it
is not mine to own or claim, or simply reap the benefits of. I have a responsibility to honour this
land and the people that have resided here long before settlers arrived. I write this literature
review in the hope that I can contribute to a body of knowledge in a meaningful, purposeful, and
respectful way.
When I started this grad program, I never thought that a global pandemic would occur
just a few months later. With our school, work, and everyday life becoming chaotic and
unpredictable, continuing a higher education was challenging. However, with the support,
kindness, and understanding of the UFV faculty and staff, I was able to continue my program. I
would like to particularly acknowledge the support of Dr. Amanda LaVallee and Dr. Leah
Douglas whose understanding and motivation allowed me to reach my goal. Echoing this, I am
grateful for the constant support of my partner, family, and friends. They provided many a latenight caffeine boost and a kind shoulder to cry on when those deadlines seemed endless and
overwhelming. The learning, growth, and achievements that I have made over the last few years
would not have been possible without this.

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List of Acronyms
SDOH

Social Determinants of Health

AOP

Anti-oppressive Practice

BCCSW

British Columbia College of Social Workers

WHO

World Health Organisation

v
Abstract
The universal healthcare system in Canada has become an integral part of national identity.
However, for those on the margins of society, universal healthcare is largely a myth. There is a
significant gap in health equity between Indigenous and non-Indigenous peoples. However, this
gap in health outcomes is not due to individual health behaviours or pathologies. Rather, public
health in Canada, and health inequities among Indigenous peoples, are intricately connected to a
history of colonialism and assimilation strategies. This settler history, that aimed to eradicate
Indigenous cultures, deeply impacted traditional healing practices and knowledge systems. It
also affected integral social determinants of health and key cultural protective factors that
maintained health and well-being among Indigenous peoples and communities, both in the past
and the present. Social workers played a key part in this history and have a responsibility to
engage in the decolonization of public health. Due to their diverse roles, and biopsychosocial and
ecological practice models that value social justice and allyship, they are equipped to effectively
support Indigenous peoples as allies. This review highlights several avenues for social workers to
engage in decolonization in social work practice, policy, research, and education.
Keywords: [Social Work, Indigenous, Colonization, Public Health, Social Determinants]

1
Social Location
As a white, cisgender, middle-class, post-secondary educated woman, my social location
is one that mirrors dominant society. As such, I occupy a position that confers many privileges.
While my gender and immigrant status as a South African decrease my social power and
privileges to some extent, my overall identity, particularly my ‘race’, provides social protection.
The power and privilege that I possess came about as the direct result of the suffering and
oppression of others. My heritage is tied to South Africa and stretches back to the late 1700s
when my family settled there on stolen land. We directly reaped the benefits of the land and
people through the forced removal of communities, war, and slavery. For centuries onward, my
people would use race as a justification for the continued violence, oppression, and
discrimination against South Africa’s first peoples and nations. This accumulated power and
privilege would afford me many social protections. I realise that it is my responsibility to address
the systems that my people put in place to oppress others and to be accountable for my actions in
the present moment. This is why I undertake social work as a profession. Social justice, allyship,
and reconciliation are values that I strive to uphold, and having my profession echo those values,
is one way in which I resist these systems.
Due to my privileged social location, I know that I will never experience the kinds of
barriers to equitable health, or racism and discrimination, that many Indigenous peoples will
likely incur. I also have never experienced the intergenerational trauma that place additional
burdens on Indigenous health and wellness. Consequently, my understanding of Indigenous
experiences of colonialism, intergenerational trauma, health inequities, and traditional healing
practices and knowledge systems is limited. This limited understanding, together with my social
location, may lead to bias and influence the kinds of interpretations and inferences I make in this

2
review. However, this bias may be mitigated to some extent by gathering studies led and
informed by Indigenous peoples and ensuring I engage in critical and ongoing reflection
throughout the research process.
As I am not Indigenous, I undertake this review with an acknowledgement of the
limitations my social location confers and strive to offer a strengths-based summary of
Indigenous-led decolonization efforts and avenues to better inform social work allyship and
advocacy within the public health sector. It is because of these limitations that I chose this field
of inquiry. As a social worker, social justice, allyship, and anti-oppressive practice (AOP) are
central tenants that inform my practice. However, this was not always true for the social work
profession as social workers were part of the colonial structures and systems that left irreparable
scars among Indigenous peoples and communities. In order to engage in true reconciliation, one
must acknowledge the part that social workers played, and continue to play, in the ongoing
colonization of Indigenous peoples. This entails developing a critical understanding of the
colonial history in Canada and its ties to Indigenous health and wellbeing. Research can be an
important source of resistance, and by undertaking this review in a strengths-based manner, by
highlighting the voices, strengths, resiliencies, and innovations of Indigenous peoples, it offers a
discourse that challenges the dominant narrative of pathology, deficits, inferiority, and
victimhood. This kind of resistance is integral to meeting personal and professional
responsibilities of allyship and social justice.
Introduction
The universal healthcare system in Canada has become a key part of national pride and
identity. However, those on the margins of dominant society would claim that universal access to
healthcare is largely a myth. This is particularly true for Indigenous peoples as public healthcare

3
systems and policies continue to act as colonial tools of white, patriarchal power and oppression.
This is evident in the significantly wide gap between the health of Indigenous and nonIndigenous peoples (Adelson, 2005; Czyzewski, 2011; Manitowabi & Maar, 2018; Matthews,
2016; Wilk et al., 2017). Not only are Indigenous peoples more likely to die younger and
experience more chronic illnesses, but they are also more likely to contract infections (Power et
al., 2020). While these infections are often easily treated, many individuals seeking treatment are
dismissed due to pervasive discrimination and bias (Matthews, 2016; Wilk et al., 2017). The
media is rife with stories depicting the fatal outcomes of many Indigenous peoples within
hospitals after being dismissed as “just another drunk” (Matthews, 2016, p.1). Many do not
access healthcare services due to the fear and frustration of being misdiagnosed, misunderstood,
or simply dismissed. For others, in more remote regions, health care is simply inaccessible due to
distance and the cost of transportation (Matthews, 2016; Mitchell, et al., 2019). Clearly, access to
adequate health care is not a universal privilege shared by all Canadians. However, for
Indigenous peoples, it is not merely the lack of access that accounts for these health disparities
but the lack of access to safe, culturally appropriate health care (Czyzewski, 2011).
The literature is extant with depictions of the fear, adversity, and discrimination faced by
Indigenous peoples within the healthcare system (Matthews, 2016; Wilk et al., 2017). These
experiences continue to grow due to the entrenchment of pathologizing stereotypes and
inadequate public health polices that do little to acknowledge a colonial past and protect the
cultural identities, self-determination, autonomy, and traditional ways of knowing, being, and
doing of Indigenous peoples (Adelson, 2005; Bourassa et al., 2004; Czyzewski, 2011;
Manitowabi & Maar, 2018; Matthews, 2016; Wilk et al., 2017). The ties between the
disproportionate level of negative health outcomes and past and ongoing colonialism have

4
become so firmly entrenched in the literature that it is impossible to ignore its existence. Despite
this, the myth of universality persists, and health disparities continue. There appears to be a
nationwide case of wearing rose-coloured glasses that allows our pride and status to grow, while
human rights continue to deteriorate (Bishop, 2016).
While there have been several movements toward reform within the healthcare system,
Indigenous scholars and allies have critiqued these reforms as being tokenistic and ineffectual
(O’Neil et al., 2016; Regan, 2010; Tuck & Yang, 2012;). This is largely due to the way in which
these reforms are carried out (Lavallée, 2009). Decolonization movements often take place
within colonial frameworks in which western, individualistic ideals and norms, and white
fragility and guilt, place restrictions on the time and space needed for true reconciliation and
decolonization to occur (Jacklin & Warry, 2012; Kovach, 2005; Lavallée, 2009). Rather, the
process of decolonization involves stepping outside of the bounds of a paternalistic society,
where reforms are installed in an authoritarian manner. Instead, reforms should be created
through a holistic and inclusive process of relationship building, allyship, empowering
partnerships, and a respect and acknowledgement for the connection that all beings share with
their communities, the land, and spirit (Bishop, 2016; Spencer, 2008). This is important as
Indigenous peoples had thriving, healthy communities long before settlers arrived, and continue
to show great resiliency despite immense adversity and oppression (Browne et al., 2016). Thus,
to effectively decolonise healthcare systems and institutions, research efforts should be aimed at
understanding and not “discovering” (Bourassa et al., 2004). In other words, research efforts
should uncover the ways in which Indigenous peoples are already responding to community
health care needs, traditional understandings of health and wellness, and the social determinants
of health most relevant to Indigenous communities (Adelson, 2005; Bourassa et al., 2004;

5
Czyzewski, 2011; Manitowabi & Maar, 2018; Matthews, 2016; Spencer, 2008; Wilk et al.,
2017). When research is conducted in this way, more pertinent information can be gathered to
form more effective reforms to public health. Importantly, it also becomes a form of resistance
by providing a narrative that contradicts the dominant discourses that pervade society (Eni et al.,
2021). The narrative surrounding Indigenous peoples begins to change from a deficit-ridden,
victimising, “problem-based” narrative, to one that highlights Indigenous cultural strengths and
resiliencies, autonomy, and self-determination (Blackstock et al., 2007). This is an imperative
step towards reconciliation and decolonization within the healthcare system (Gray et al., 2013;
Moniz, 2010; Wilk et al., 2017).
These themes of reconciliation, decolonization, allyship, and social justice are key values
underlying the profession of social work (Moniz, 2010). Moreover, due to the variety of
positions social workers may take – frontline, research, and policy development - there are
numerous avenues for social workers to intervene, resist, and advocate at multiple levels within
public health (Browne et al., 2016). However, the profession of social work still resides within a
larger system of white, neoliberal ideals and values and one cannot discount the influence this
has on a social worker’s worldviews, thoughts, and actions (Miller et al., 2017). No matter how
well intentioned, social workers may fall prey to the same tokenistic and paternalistic ways of
advocating for reform and supporting Indigenous peoples within public health spheres
(Blackstock et al., 2007; Gray et al., 2013; Moniz, 2010). Considering this, this literature review
is guided by the following research question: What avenues are there for social workers to aide
in the decolonization of public health practice, research, policy, and education?

6
Methods
The term Indigenous will be used throughout this paper to refer to the First Nations,
Metis, and Inuit cultural groups. The theoretical framework guiding this literature review follows
key elements of Indigenous research frameworks. Unlike more traditional western theories, that
often view humans as distinct from the world around them, Indigenous research frameworks
consider the inextricable ties all people have as sociocultural beings to each other, the land,
environment, communities, and ideas and worldviews across time. This framework also involves
a process of decolonization by incorporating Indigenous knowledge and voices to guide
interpretations rather than relying on Western theories (Bombay et al., 2013; Mitchell et al.,
2019; Wilson, 2008). It also takes an intersectional lens to highlight the multifaceted and layered
nature of social identities that are connected to a larger system of power and oppression. Lastly,
it requires that the researcher critically reflect on their own positionality, privileges, and power
(Wilk et al., 2017).
For this literature review, due to the limited research concerning public health as it
pertains to Indigenous peoples, all quantitative, qualitative, and mixed-methods studies from the
last two decades were reviewed. While more recent articles would have been preferred, time
frames were extended to include a greater variety of articles. To gather articles, internet and
academic database searches were employed using the terms Indigenous, First Nations, Metis,
Inuit, Aboriginal, Indian Act, public health, healthcare, decolonization, social determinants of
health, and reconciliation. Internet sources included Google Scholar, PubMed, and EBSCO.
Articles by Indigenous scholars and journals were prioritised as well as those that utilised
Indigenous research frameworks and participatory action research methodologies. Overall, 46
articles were included in this review. Although the methodologies employed by these studies

7
varied, most employed qualitative and participatory action research methodologies, while two of
the reviewed studies employed quantitative methodologies. Each article was primarily concerned
with uncovering, or calling attention to, the sociocultural, distal, and systemic aspects related to
the health disparities among Indigenous peoples. The authors of these articles also called
attention to several avenues of resistance, advocacy, and allyship for practitioners and future
research. Importantly, each article offered a strengths-based lens, highlighting protective factors,
resiliencies, the need to foster and support self-determination and self-governance as well as the
way Indigenous peoples have effectively responded to the growing health disparities.
Social Work and its Colonial Roots
Before the arrival of settlers in North America, Indigenous peoples possessed rich,
diverse, and prospering health, social, and political systems (Gray et al., 2013). Their way of life
was based on community, equity, reciprocity, and a sacred connection to the environment. In
turn, providing the necessary factors for fostering and maintaining health and wellbeing (Gray et
al., 2013; Lavoie, 2013). European settlers, however, would replace these prosperous systems
with their own individualistic, patriarchal systems based on competition and power imbalances
(Lavoie, 2013). While the first contact with settlers in Canada was relatively peaceful, when
compared with the violent colonization south of the border, this would be temporary. Once the
fur trade industry slowed down, colonialists settled their sights elsewhere: the land of the
Indigenous peoples (Gray et al., 2013; Manitowabi & Maar, 2018). With many new settlers
arriving each day, land theft, forced removals, and the depletion of natural resources, occurred on
a grand scale. Traditional migratory lifestyles were replaced, and Indigenous peoples were forced
into designated areas known as reserves (Manitowabi & Maar, 2018). These areas were often not
as fertile and had limited access to resources for hunting, trapping, and fishing. Together with the

8
new diseases that settlers brought, Indigenous populations were devastated (Blackstock et al.,
2007; Lavoie, 2013; Gray et al., 2013; Moniz, 2010).
In response to the epidemics of the time, the Canadian government began developing a
public health system (Datta, 2018; Eni et al., 2021). While public health may not have been
specifically intended to act as a colonial tool, it was a product of a paternalistic system that
privileged the white settler (Eni et al., 2021). During its conception, it was neither informed by
nor created for Indigenous peoples (Manitowabi & Maar, 2018). Instead, it echoed
individualistic models of pathology, disease, and illness that focused on inner causes of ill-health
(Eni et al., 2021; Kamran, 2020). Here, the beginnings of control measures like quarantine
outlined the “clean” perimeters of cities and communities, specifying what was normative or
pathological and what must be excluded (Power et al., 2020). Naturally, Indigenous people were
deemed “unclean” and segregated into inferior care to assuage the fears of the settler populace
(Datta, 2018; Kamran, 2020). With the increased resistance of Indigenous peoples, colonialists
sought to solve “the Indian problem” through a series of legislative actions (Bombay et al., 2013;
Bourassa et al., 2004).
This began with the passing of the Indian Act (1985), which designated health care
funding and delivery for status First Nations as the responsibility of the federal government (Eni
et al., 2021). The act defines a “status” Indian as any individual with at least one parent who is
registered or entitled to register under the Indian Act. Further, it is based on the degree of descent
from ancestors and refers to those who identify themselves as First Nations, and more recently,
Inuit. Status Indians have access to programs and services offered by federal and provincial or
territorial government agencies (Indian Act, 1985). First Nations who do not qualify may
identify as Indigenous but not as a “status” Indian. As for other cultural groups, Metis peoples

9
are recognised as Indigenous under the Constitution Act (1982) but are not eligible for federal
services or programs (Indian Act, 1985; Power et al., 2020). Defining identities, however, was
not the main purpose of this act. Assimilation of Indigenous peoples and the eradication of
Indigenous culture was the underlying goal (Datta, 2018; Eni et al., 2021). This act allowed for
the creation of many assimilation policies and each impacted Indigenous peoples over centuries,
its effects continuing into the present day. In this review, I will cover the four policies in which
social workers had a direct role to play. These include the Indian Act, residential schools, the 60s
Scoop, and Indian Hospitals.
Indian Act
The Indian Act was legislated in 1867 with the purpose of civilizing the Indigenous
populations. It furthered a discourse that Indigenous peoples and their way of life was primitive,
inferior, and a threat to moral, civil society (Bombay et al., 2013). The measures legislated by the
Indian Act were part of a larger set of structures set in place to forcefully remove many
Indigenous cultures from Canadian society (Browne et al., 2016; Lavoie, 2013). Further,
provisions controlled many aspects of Indigenous peoples’ lives – spiritual, social, cultural,
economic, and political (Power et al., 2020). Importantly, the act claims the right to define legal
identities through status designations (Indian Act, 1985; Power et al., 2020). To erase the Indian
culture, assimilation policies had the primary aim of incorporating Indigenous peoples into the
body politic. This was an organized form of cultural genocide and impacted the health of many
Indigenous peoples in enduring ways (Eni et al., 2021). It began with the dispossession of land,
the displacement of communities, and the forced removal of Indigenous peoples into reserves
(Bombay et al., 2013). This increased food insecurity, overcrowded and poor living conditions,
and limited access to traditional sources of health such as plant medicines, nutrient dense whole

10
foods, and cultural healing practices and ceremonies tied to the land (Power et al., 2020). It also
disrupted the dissemination of oral histories and healing knowledge became lost or forgotten in
time (Datta, 2018; Davy et al., 2016; Eni et al., 2021) These issues were only exacerbated by the
criminalisation of Indigenous cultural practices in the early 20th century (Lavoie, 2013).
However, the assimilation of Indigenous peoples did not end with the dispossession of land and
the outlawing of healing practices. Assimilation policies that allowed for the creation of
residential schools and the forced removal of Indigenous children into care, would leave lasting
scars on the health and well-being of Indigenous peoples (Lavoie, 2013). This is where the
profession of social work had the most significant role to play.
Forced Removal of Indigenous Children
Residential Schools. Residential schools were arguably one of the most egregious
mechanisms of assimilation (Blackstock et al., 2007; Crampton, 2015; Moniz, 2010). These
schools, mostly run by different Christian denominations, relocated Indigenous children without
consent and forced them to conform to western ways of living. Children were routinely, and
severely, punished for practicing their cultural traditions and speaking their language. They also
incurred physical, mental, and sexual abuse, malnutrition and neglect, and illnesses like
tuberculosis at rampant rates. Many children did not survive, while those that did, suffered the
impacts of trauma (Allan & Smylie, 2015; Klingspohn, 2018). At the individual level, many
residential school survivors experience significant mental health challenges such as anxiety,
depression, low self-worth and self-esteem, suicide, and substance misuse (Eni et al., 2021).
Further, having spent so much time away from their communities, many struggle with identity
issues and familial and cultural disconnection (Datta, 2018; Davy et al., 2016; Eni et al., 2021).
At the level of families and community, individuals struggling with residual trauma echoed the

11
poor parenting models of residential schools that were based on neglect, abuse, punishment, and
control. Few had any nurturing or protective familial examples from which to draw on to
effectively support their children’s psychological well-being. The effects of this can be seen in
the high rates of intimate partner and family violence and abuse among survivors and their
families (Datta, 2018; Eni et al., 2021). When children experience abuse, stress, or chaotic home
environments, they are less likely to develop healthy and positive coping skills to help manage
life stressors (Bombay et al., 2013; Bourassa et al., 2004). It also increases the likelihood that
these harmful parenting behaviours will be replicated by the next generation, renewing the cycle
of trauma (Klingspohn, 2018).
Despite the deleterious conditions that children incurred at residential schools, social
workers strongly supported their continued use (Eni et al., 2021). This stemmed from the belief
that children were better served at these schools due to the significant number of social issues
present on reserves such as overcrowded housing, food insecurity, and illness (Crampton, 2015).
The profession of social work was embedded in a system that infantilised Indigenous peoples
and categorised them as wards of the state (Crampton, 2015; Klingspohn, 2018). Social workers
applied these paternalistic values and beliefs without critical awareness, believing that residential
schools were an immediate and practical solution to the child welfare problem. They continued
to believe that they were aiding children by removing them from what they perceived as harmful
environments (Blackstock et al., 2007; Crampton, 2015; Klingspohn, 2018; Moniz, 2010). Many
social workers were unfamiliar with Indigenous cultures and their unique histories. Their
perceptions of “proper care” were clouded by middle-class Eurocentric values. Many Indigenous
households, for example, relied on natural sources of food from hunting, fishing, and gathering.

12
Social workers mistook empty fridges and pantries as a sign of food insecurity, assuming that
Indigenous peoples could not provide for their children (Datta, 2018).
The 60’s Scoop. When residential schools began to be phased out of Canadian society,
child welfare took its place. With growing attention to child welfare needs, an amendment to the
Indian Act in 1951 allowed provinces to provide child welfare services where none existed
federally (Crampton, 2015). In turn, this led to a massive removal or “scoop” of children, by
social workers, from their communities and families to residential schools, foster families, and
group homes (Crampton, 2015; Datta 2018). Children in foster and group homes incurred many
of the same traumas of children in residential schools (Blackstock et al., 2007). Trauma, paired
with the loss of cultural connection, increased rates of negative behavioural, psychological, and
developmental outcomes. These outcomes continue today as Indigenous children within care are
still overrepresented (Eni et al., 2021). Thus, assimilation policies, with the aid of social workers,
operated under the guise of good intentions. Children were placed into environments that would
affect, not only their own health and wellbeing, but generations to come. It is integral that social
workers understand this history, their part within it, and the underlying beliefs and value systems
that legitimised the removal of Indigenous children (Blackstock et al., 2007; Crampton, 2015;
Eni et al., 2021; Gray et al., 2013; Miller et al., 2017; Moniz, 2010). This understanding allows
social workers to contextualize the current overrepresentation of Indigenous children in care as
well as the high rates of ill-health among Indigenous peoples. In doing so, a social worker’s
interventions or supportive actions may be better aimed at key systemic causes underlying these
issues. Also, this knowledge is critical in transforming a social worker’s role from helper to ally
(Crampton, 2015).

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Indian Hospitals
Much like residential schools, Indian hospitals operated under the guise of good
intentions and were initially purposed to reduce the spread and prevalence of tuberculosis (TB).
However, they were largely created to segregate Indigenous peoples and assuage the fears and
anxieties of the non-Indigenous population (Eni et al., 2021). The first of these hospitals
originated out of the missionary hospital movement of the late 19th and early 20th centuries and
at first acted as sanatoriums and later as quarantine facilities to house children with TB from
residential schools. Often children would be stuck in a loop, moving from a residential school to
an Indian hospital and then back again, each time experiencing racial discrimination, neglectful
and abusive treatment, and medical care that was isolating and restrictive. These hospitals were
routinely understaffed and often employed undertrained or unlicensed personal (Eni et al., 2021
Kamran, 2020).
Over time, many atrocities occurred at these Indian Hospitals. For example, invasive
surgical treatments were frequently used to treat TB when general hospitals were moving to less
invasive treatments (Kamran, 2020). Moreover, while enforced hospitalization and physical
restraining of patients were not permitted in non-Indigenous hospitals, this was considered
common place at Indian hospitals. Greater risks were also routinely taken and there were many
cases noted of ill patients who were unnecessarily transported from one hospital to another (de
Leeuw et al., 2015). There was little, if any, focus on patient autonomy and fair and equitable
treatment that matched the level of services and interventions given to non-Indigenous people
(Eni et al., 2021; de Leeuw et al., 2015; Kamran, 2020). This trend of inequity, lack of
autonomy, and limited access to high standards of care, within the public health sector, continues
into the present day (Eni et al., 2021).

14
Literature Review: Thematic Findings
Social Work and Public Health
While public health may have been created to respond to epidemics and diseases like TB,
modern public health goes beyond that. It is concerned with the prevention of ill health,
morbidity, the spread of diseases, and premature death (Canadian Population Health Initiative,
2004). It is not solely focused on treating the unwell (Kamran, 2020). Unfortunately, as
mentioned, public health was created within a colonial system that fosters inequity. Healthcare
access and provision, for many Indigenous peoples, is connected to the Indian act; the only
active national-level policy based on race. This act, and any social policy or provision attached to
it, like public health, is part of Canada’s oppressive infrastructure of legislature, discourses, and
practices that devalue the identities of Indigenous peoples (Blackstock et al., 2007; de Leeuw et
al., 2015; Eni et al., 2021; Kamran, 2020; Moniz, 2010). Federal health polices, related to
Indigenous peoples, is plagued with complexity, a lack of transparency and federal
accountability, and jurisdictional ambiguity (Kamran, 2020). Its reliance on status designations
places limits on self-determination and access to services. Together with the racialization and
segregation the act fosters, it is a form of modern-day colonization (Blackstock et al., 2007; de
Leeuw et al., 2015; Eni et al., 2021; Kamran, 2020).
This act, together with the oppressive assimilation policies it created, allowed inequities
to grow over time due to the impact it had on the social determinants of health (SDOH) among
Indigenous peoples (Eni et al., 2021; Moniz, 2010). The SDOH can be described as the
environmental, sociocultural, political, and economic factors, conditions, and inequalities that
influence health and wellbeing (Marmot & Wilkinson, 2003). These factors operate along a
social gradient that mirrors hierarchies within a given society. The lower one’s socioeconomic

15
status or the more marginalised one is, the greater number of SDOH are negatively impacted
(Moniz, 2010). Accordingly, inequalities stem from the way that resources, power, and privilege
are unevenly distributed, not from biological causes or individual choices alone (Marmot &
Wilkinson, 2003). It is well established that many physical and mental health issues can be
traced back to preventable inequities such as poverty, precarious housing, harmful work
conditions, unemployment, food insecurity, racism and discrimination, and social exclusion (Eni
et al., 2021; Moniz, 2010)
Indigenous peoples in Canada endure these negative social conditions at
disproportionately higher rates, in turn, impacting their determinants of health (Eni et al., 2021).
For example, not only is it more difficult for racialized individuals to find employment, when
they do, they earn relatively lower incomes (Eni et al., 2021; Moniz, 2010). This makes it
difficult to sustain a nutrient dense diet or find and keep safe housing. Precarious employment,
housing, and food insecurity place additional psychological burdens of stress on an individual, in
turn, affecting physical and mental health (Eni et al., 2021). When Indigenous people become ill,
accessing services that are culturally safe and relevant is a challenge. While in some regions, due
to weather and terrain, healthcare is simply inaccessible (Eni et al., 2021; Kamran, 2020; Moniz,
2010). In response to this growing inequity that is globally present, the World Health
Organisation (WHO) has called on nations to improve the conditions of daily life, address the
unequal distribution of power and resources, and develop a workforce that is trained in the
SDOH framework (Kamran, 2020; Moniz, 2010). Social workers may be the most readily
equipped as these three calls to action already fall into the purview of social work (Crampton,
2015; Rine, 2016).

16
The SDOH model fits well with social work's person-in-environment and
biopsychosocial model of understanding and responding to individual issues (Crampton, 2015;
Moniz, 2010; Rine, 2016). In their frontline work, social workers consider the client in their
specific context to meet their unique needs. Needs may span multiple areas such as income and
employment, housing, mental health, or physical health needs (Moniz, 2010). The SDOH
framework is often apparent in the models that social workers naturally use in order to meet the
needs of clients and address the underlying social causes of issues faced (Rine, 2016). This
framework also directly correlates with the Canadian Association of Social Workers Code of
Ethics as outlined in the following values: “social workers respect the unique worth and dignity
of all people and uphold human rights”; “social workers uphold the right of people to have
access to resources to meet basic needs”; “social workers advocate for fair and equitable access
to public services and benefits” (BCCSW Code of Ethics and Standards of Practice, 2009, p.1).
The SDOH consist of the basic rights and needs that all people in Canada should have fair and
equitable access to (Marmot & Wilkinson, 2003). Unfortunately, the frontline experiences of
social workers speak to the challenge of addressing these SDOH. Barriers encountered include:
limited policy that is specific to Indigenous SDOH, insufficient funding, pervasive
discrimination and bias at all levels, and cultural misunderstandings that lead to tokenistic or
harmful reforms to programs and services (Eni et al., 2021; Kamran, 2020; Moniz, 2010; Rine,
2016). Indeed, the federal government has been called upon by local and international human
rights counsels for failing to address inequities in access to basic human rights among Indigenous
peoples (Moniz, 2010; Rine, 2016). Thus, addressing the health disparities in Canada requires
more than simply providing equal access to healthcare as it is social justice matter (Kamran,

17
2020). With social work’s focus on structural change, allyship, and anti-oppressive practice, this
profession may be particularly suited to work within the public health sector (Rine, 2016).
Social workers have always had a role to play in the health sector, whether it be directly
supporting others with individual health concerns or indirectly addressing SDOH through
advocacy for greater access, cross-sector cooperation, and policy reform (Moniz, 2010). Due to
the increased attention on health disparities and the use of the SDOH framework, public health
social workers are gaining traction as a specialisation within this field (Rine, 2016). Rather than
the more narrow focus on individuals, they shift their focus outwards and take a socioepidemiological approach. Also, they are not necessarily engaged in a typical hospital or clinic
setting. Their work takes on a comprehensive, integrated approach building working
relationships with individuals, communities, organisations, and government parties to address the
underlying factors of ill-health (Moniz, 2010; Pecukonis et al., 2003; Rine, 2016). The nature of
their work may also include counselling, policy creation, advocacy, or frontline outreach work
(Pecukonis et al., 2003).
Public health social workers bring with them their ability to communicate and listen
actively and empathetically at an individual level, their understanding of the wider systems of
power and oppression, and a strengths-based, person-centered approach to addressing social and
health issues (Pecukonis et al., 2003). This is the kind of work that the WHO has called for. In
order to effectively address the SDOH that underly Indigenous health and well-being,
multisystemic action is required that meets the specific needs of individuals and communities,
not a blanket approach that is superficial and tokenistic (Crampton, 2015; Moniz, 2010;
Pecukonis et al., 2003; Rine, 2016). Despite this new field of social work, Indigenous scholars
have noted that more is required for decolonization efforts to be truly effective. They point to

18
Indigenous-led efforts already being undertaken as points of learning (Blackstock et al., 2007;
Crampton, 2015; Gray et al., 2013; Miller et al., 2017; Moniz, 2010).
Opportunities for Decolonizing Social Work and Public Health
In keeping with the recommendations of Indigenous scholars, this review will examine
Indigenous-led programs, reforms, recommendations, and movements to better inform social
work within the realm of public health. Rather than looking at deficits and “solutions”, this
review echoes a strengths-based perspective. All too often the social work profession has
assumed the role of “helper” or “savior” without proper regard for the autonomy and resiliency
of the people whom they purport to serve (Blackstock et al., 2007; Crampton, 2015; Gray et al.,
2013; McGibbon, 2019; Moniz, 2010; Pecukonis et al., 2003; Rine, 2016). Indigenous people are
already responding effectively to their health needs. Listening to their voices and understanding
their strengths and unique needs is where true reconciliation begins (Eni et al., 2021; Kamran,
2020). After all, decolonization occurs by “acknowledging and harnessing the strengths of
Indigenous communities” (Gray et al., 2013, p. 33). While the literature examining Indigenousled movements is limited, several themes appear that may be used to inform decolonization
efforts in social work practice, education, policy, and research within public health.
Social Work Practice and Public Health
Learning and Critical Reflexivity. While the profession of social work has made
progress in recognising the oppressive role social workers have played, social work practice may
fall prey to the same misguided and ill-informed “good intentions” of its predecessors. A central
theme throughout the literature was the need for decolonization before any genuine
reconciliation can be achieved (Blackstock et al., 2007; Crampton, 2015; Gray et al., 2013;
McGibbon, 2019; Moniz, 2010; Pecukonis et al., 2003; Rine, 2016). While reconciliation was

19
used and defined in slightly different ways by each scholar, there were central tenants. The first
was the idea of a mutual relationship that sought to foster trust and a balance of power. This
relationship is intentional and active, where one makes an ongoing attempt to acknowledge,
honour, and understand differing ways of knowing, being, and doing (Blackstock et al., 2007;
Crampton, 2015; Pecukonis et al., 2003). However, it is not the responsibility of the one who has
been oppressed by dominant society to impart their cultural knowledge (Crampton, 2015).
Further, this process of relationship building is not a singular event. It is an ongoing process that
begins with listening. Listening in a way that entails humility, respect, and a willingness to learn
and unlearn (McGibbon, 2019; Moniz, 2010; Pecukonis et al., 2003; Rine, 2016).
These skills are not necessarily taught to social workers and are unlike the active listening
skills they may be highly trained in. Studies capturing the experiences of Indigenous peoples,
within healthcare settings, show that helping professionals are too accustomed to listen in a way
that entails identifying deficits, pathologies, and potential solutions (Klingspohn, 2018). The
kind of listening Indigenous scholars point to requires that one listen without attempting to make
inferences. It involves looking inward and maintaining ongoing critical reflexivity. This involves
being aware of one’s social location, unearned privileges, and power, and how this affects
perceptions of, and interactions with, those who are marginalised (Crampton, 2015; Eni et al.,
2021; Kamran, 2020). For many social workers, who occupy positions of privilege, this may be
an unfamiliar and uncomfortable way of listening. One that runs contrary to socialisation within
an individualistic and paternalistic society that values “power-over” relationships (Crampton,
2015). However, when helpers listen in this way, not only does learning naturally follow, the role
of expert, as well as any unearned power, is relinquished. In turn, providing a safe foundation for

20
trusting and authentic relationships to be built and for mutual understanding to grow (Crampton,
2015; McGibbon, 2019).
Building this kind of relationship, however, entails a particular responsibility. Listening
to, and learning from, Indigenous stories and knowledge is a scared practice and privilege. Social
workers have a responsibility to learn how to incorporate or employ traditional Indigenous
perspectives in a way that honours their diversity while being mindful of misappropriation
(Blackstock et al., 2007; Crampton, 2015; Gray et al., 2013; Moniz, 2010). Practices like
smudging or the use of circles in gatherings, should only be employed with permission and an
acknowledgement of its origins (Crampton, 2015; Gray et al., 2013). Also, it should not be
assumed that all clients may want culturally based services or are connected with their culture
(Crampton, 2015). Again, self-determination and autonomy are central to the reconciliation
relationship. Lastly, practices should also not be used in a generalised, pan-Indigenous way
(Crampton, 2015; Klingspohn, 2018; McGibbon, 2019). While Indigenous peoples may share
worldviews or values, each Indigenous culture is specific and distinct. This not only refers to
their histories and ways of knowing, being, and doing but also their relationship with colonialism
and the systems of power and oppression (Blackstock et al., 2007; Crampton, 2015; Gray et al.,
2013; Moniz, 2010).
Models of Practice. As mentioned, despite this diversity, there are commonalities among
Indigenous perspectives that provide avenues for social workers to decolonise their own practice
within public health. This is important as the institution of social work is not value free and was
created within a westernised paradigm. This may mean that many social work models,
perspectives, or training methods may not be relevant to or supportive of traditional Indigenous
ways of knowing, being and doing (Blackstock et al., 2007; Crampton, 2015; Pecukonis et al.,

21
2003; Rine, 2016). For example, western paradigms like the medical model are emphasised
within public health, particularly with regards to clinical social work. However, this model
pathologizes a client’s thoughts and experiences and does little to acknowledge that clients are
multidimensional, inextricably connected to a sociocultural context (Adelson, 2005; Bourassa et
al., 2004; Czyzewski, 2011; Manitowabi & Maar, 2018; Matthews, 2016; Tagalik, 2015).
Individual, physical symptoms may be due to unhealthy social conditions and burdens rather
than internal causes alone. In contrast, Indigenous worldviews do take this into account and are
more conducive to developing a holistic and complete understanding of the client, honouring all
parts of identity and being (Blackstock et al., 2007; Crampton, 2015; Pecukonis et al., 2003;
Rine, 2016). Among the Anishnaabe, for instance, health is depicted by utilising the medicine
wheel which consists of four quadrants: physical, mental, emotional, and spiritual. These
elements are considered essential to health and wellbeing, and optimal health is reached when all
elements are in balance and harmony (Tagalik, 2015). When ill health appears, it is “treated”
through healing the imbalance among these four quadrants by utilising traditional healing
practices. These practices, unlike more singular focused biomedical approaches, promote
psychological, spiritual, cultural, and emotional well-being. This may include rituals and
ceremonies, herbal treatments, and natural healing practices that utilise resources from animals
or the land (Richmond & Ross, 2009; Tagalik, 2015).
While it may be more effective, particularly for decolonization efforts, to employ more
traditional models of practice, it is not always possible. For social workers within clinical and
hospital settings, they may find themselves mandated to stay within biomedical models.
However, it has been suggested that these two seemingly opposing models can be joined together
to allow for a more culturally relevant clinical model of practice for helpers (Miller et al., 2017).

22
This broadly captures the paradigm of Two-Eyed Seeing, which refers to the notion that one eye
is used to understand the traditional knowledge of Indigenous cultures, while the other is used to
understand conventional western knowledge. Both are used harmoniously to ensure a balance
between these two separated worlds. (Richmond & Ross, 2009; Tagalik, 2015). This view has
become popular as it encourages health care professionals to draw upon new techniques and
practices as well as traditional Indigenous ways, ensuring more culturally sensitive and safe
medical care that is holistic, addressing the sociocultural as well as the biological aspects of an
individual. When applied in practice, these perspectives allow social workers and other clinicians
to go beyond the biological and address the key social determinants of health (Gray et al., 2013).
However, in the literature, a common warning is given when utilising this approach. Indigenous
worldviews and ways of knowing, being, and doing should not be seen as a novel adjunct to the
“superior” biomedical approaches nor should it be appropriated, generalised, or used in a
tokenistic way (Eni et al., 2021; Powers et al., 2020). Further, not all Indigenous peoples may
want traditional healing methods or practices as they may be disconnected from their culture or
prefer mainstream services (Richmond & Ross, 2009; Tagalik, 2015). Practitioners should
always seek permission when utilising traditional interventions and knowledge (Tagalik, 2015).
Social Work and Community Public Health: Indigenous-led Partnerships
Self-determination is the most cited barrier to effective decolonization of public health
and is understood as disregarding the knowledge, voices, and input of Indigenous peoples
(Browne et al., 2009; Eni et al., 2021; Powers et al., 2020; Reading & Wien, 2009; Smith, 1999).
However, when this barrier is addressed by providing easily accessible services that are led and
informed by Indigenous peoples, positive health outcomes are consistently found (Eni et al.,
2021; Powers et al., 2020; Smith, 1999). Moreover, many negative health outcomes are avoided

23
as they address both the spiritual, sociocultural, psychological, and physical aspects of health as
well as the SDOH that are impacted by histories of colonialism and intergenerational trauma
(Greenwood et al., 2018). Accordingly, the theme of “culture as a cure” is recurrent throughout
the literature. In keeping with a Two-Eyed Seeing approach, there are several examples of
Indigenous-led partnerships that work in collaboration with other helping professionals,
successfully merging western and traditional paradigms of health (Allen et al., 2020).
It is important to note, however, that while these partnerships may merge differing
models, they are based on traditional Indigenous knowledge and led and supported by Elders,
traditional community healers, and Knowledge Keepers. Only if needed, do these partnerships
utilise specialist biomedical knowledge (Allen et al., 2020). The first of these partnerships
appeared in the 1990’s, and utilised traditional ways of knowing, being, and doing while
fostering reconciliation within broader public health structures. Accordingly, in the Yukon, at
Whitehorse General Hospital, programs were developed and installed by Indigenous peoples that
utilised traditional foods, plant medicines, healing rooms, Elder suites, cultural specific
programs, and liaison workers. Among those who have accessed this hospital, significant
improvements in cultural safety ratings were noted (Allen et al., 2020). Similarly, in Haida
Gwaii, BC, a diabetes clinic was developed that employed traditional community diets, plantbased medicines, and increased physical activity. With the increased access to nutritious whole
foods and aerobic exercise, significant decreases in risk factors associated with diabetes and
cholesterol were found (Heffernan et al., 1999). Particularly noteworthy are the drug
rehabilitation centres among the First Nations communities in Northwestern, Ontario. The
programs included traditional modalities of counselling, land-based healing practices such as
fishing, hunting, memorial walks, and community gardening, and Elder-led healing sessions. The

24
central focus of these programs was to rebalance the spirit, mind, body, and connection to the
land, culture, and community. After program completion, significant reductions in suicide rates
in all six communities were noted. At one year after onset, criminal involvement decreased by
61.1%, child protection cases decreased by 58.3%, and school attendance rates increased by
33.3% (Mamakwa et al., 2017).
Other programs attempted to address health concerns and the SDOH that were specific to
a particular community through traditional healing practices. For example, Vang et al. (2007),
found that among the birth centres in Nunavut, access to prenatal care was a barrier many
Indigenous women faced. Not only were some physically unable to access clinics due to
logistical reasons, but cultural safety issues were also raised. To address this, prenatal, birth, and
postpartum services were given by Inuit midwives with medical and traditional training both
onsite and remotely. Midwives were available by phone and would provide home visits. Not only
were medical professionals more representative of the community they served, which increased
levels of cultural safety, many more women were able to access essential care. Consequently,
complex deliveries were drastically reduced, and perinatal mortality rates lowered to the
Canadian average (0.9%). In some cases, rates were better than comparable populations. While
all Indigenous-led programs in the literature vary according to the kinds of services provided and
health issues addressed, all programs noted positive outcomes (Allen et al., 2020). Selfdetermination and autonomy were respected and individuals attending the clinics were able to
access culturally safe and relevant programs that were specific to their distinct Indigenous
culture. Moreover, these programs did not simply treat the presenting problem, efforts were also
aimed at “treating” the underlying SDOH that contribute to ill health, thus providing key
preventative measures (Allen et al., 2020; Eni et al., 2021).

25
Partnerships help to bridge a gap within public health and healthcare. This is particularly
important due to the minimal training that healthcare professionals, including social workers,
receive within the areas of preventative medicine, cultural safety, Indigenous history, and the
sociocultural, spiritual, historical, and community-specific aspects of Indigenous peoples’ health
(Allen et al., 2020; Pecukonis et al.,2003). By fostering these partnerships, social workers work
collaboratively with community members and Elders, who have greater expertise in
understanding Indigenous cultural worldviews and determinants of health. In turn, they may be
better able to address the underlying social causes of a client’s ill health (Pecukonis et al., 2003).
Importantly, these kinds of partnerships are central to any advocacy efforts to decolonise clinical
protocols, patient care, and preventative healthcare (Allen et al., 2020; Eni et al., 2021). While
the research is limited, it does show markedly improved outcomes across a range of aspects
related to health and wellness, as well as access to care and adherence to care plans, among some
Indigenous communities (Allen et al., 2020).
Social Work and Public Health Research
The Applicability of Public Health Research. A relatively small number of studies
within this area is a limitation frequently cited among the reviewed literature. However, the need
for these studies is also questioned. Indigenous scholars, statisticians, and Elders have queried
the use of western models of scientific inquiry, as they tend to overly value and emphasize
quantifiable evidence to justify efficacy of health interventions and programs (Bourke et al,
2018; Eni et al., 2021; Greenwood et al., 2018; Lavallée, 2009). These methods do not capture
the voices of Indigenous peoples, leaving any “objective” data gathered to be interpreted in ways
that echo biased dominant discourses (Greenwood et al., 2018; Lavallée, 2009). Despite this
well-known limitation, there continues to be a strong belief in the rigour of statistical evidence

26
that is seldom extended to qualitative research and Indigenous studies (Lavallée,
2009). Indigenous scholars maintain that “proving” traditional Indigenous knowledge and
healing practices, either quantitatively or qualitatively, according to dominant western research
paradigms and methods, is problematic (Datta, 2018; Lavallée, 2009). Using colonial tools and
frameworks to examine and validate traditional Indigenous ways of knowing, being, and doing
assumes superiority of one cultural worldview or perspective over another. It is often purported
in the literature that if traditional Indigenous knowledge and cultural practices are only viewed
through the lens of western science, that relies on empirical evidence, one’s ability to fully
understand and conceptualise the potential benefits are limited. Often, these practices contain
intangible aspects, like spirituality, that are neither easily observable or quantifiable (Allen et al.,
2020; Datta, 2018; Eni et al., 2021; Lavallée, 2009; Wilson, 2008).
The need for more public health research is debated among Indigenous scholars. Some
posit that it echoes western values and does little to value experiential oral knowledge passed
down from one generation to the next (Crampton, 2015; Datta, 2018; Eni et al., 2021; Lavallée,
2009; Matthews, 2016). Conversely, others purport that there are ways to honour Indigenous
experiences and voices and for research to become a form of resistance (Datta, 2018; Kovach,
2005). However, for the latter to occur, both the process of research and the researcher must be
decolonised. Indigenous scholar Linda Tuhiwai Smith (1999) suggests that the process of
decolonising health research must begin by placing Indigenous voices and ways of knowing as
central to the research process while recognizing Indigenous land, autonomy, diversity, and
sovereignty. This process is ongoing and demands unlearning and relearning, taking
responsibility for participants and their wellbeing. Indeed, when research is not conducted in this
way, which is the case for a large proportion of western research, it becomes a source of

27
oppression (Kovach, 2010; Lavallée, 2009; Wilson, 2008). Further, Indigenous scholars assert
that the decolonization process must be honoured and considered as significant and scientific. In
doing so, research becomes a form of resistance that can be used for social justice (Datta, 2018;
Eni et al., 2021; Matthews, 2016; Tuck & Yang, 2014).
It is important to note that Indigenous researchers do not reject all western, scientific
methodologies. Rather, an attempt is made to link Western and Indigenous research methods,
according to what is suitable and valuable for the local community under study (Wilson &
Young, 2008). Indigenous scholar, Wilson (2008), advises that research methodologies may be
“borrowed from other paradigms, as long as they fit the ontology, epistemology, and axiology of
the Indigenous paradigm” (p.39). The goal of this research should not be to “discover”, rather
research efforts should aim to readjust power imbalances and employ traditional Indigenous
ways of knowing, being, and doing to address health inequities that have arisen from complex
social dynamics and histories (Adelson, 2005; Kovach, 2010; Lavallée, 2009). Further,
Indigenous peoples should be involved in meaningful and intentional ways in every aspect of the
research process (Datta, 2018).
Social Work and Public Health Policy
Another central theme throughout the literature concerns Indigenous peoples as
knowledge holders, and the need for their involvement at all levels of decolonization (Allen et
al., 2020; Crampton, 2015; Datta, 2018; Eni et al., 2021; Lavallée, 2009; Matthews, 2016;
Wilson, 2008). This is particularly relevant in policy reformation, given the paternalistic fashion
in which colonial acts and policies were created (Crampton, 2015). Taking a social work
approach, public health policies should focus on “what matters”, shifting the focus away from
reductionist policies that overly emphasize individual factors of health. Instead, utilising a

28
person-in-environment approach, the focus of health policy should be on social factors that affect
health and well-being (Miller et al., 2017). As social workers are often responsible for
implementing social policies on the frontline, they are able to directly observe and form critical
insights into these social factors. In turn, helping to determine “what matters” to specific
populations. They are also able to see the interplay between different social policies, or lack
thereof, and health and well-being (Blackstock et al., 2007; Crampton, 2015; Gray et al., 2013;
Miller et al., 2017; Moniz, 2010; Rine, 2016). For example, the lack of policies surrounding
subsidized childcare for single caregivers affects income levels, in turn, affecting food and
housing security, which ultimately affects well-being for single caregiver families (Rine, 2016).
Being placed on the frontlines, allows social workers to act as allies, advocating for policy
reforms that are more relevant to the people whom they purport to serve (Crampton, 2015).
Social workers, however, do not solely work on the frontlines. They are uniquely placed
across multiple sectors, particularly in the area of policy development. Working within
provincial, federal, and institutional levels, allows social workers many opportunities to use their
frontline experience to inform policy development (Rine, 2016). Moreover, together with their
professional values of social justice and practice frameworks that are anti-oppressive, traumainformed, person-centered, and strengths-based, scholars assert that social workers may be best
placed to support the decolonization of health policy and its reform (McGibbon, 2016). That is
not to say that social workers should adopt the kind of “white saviour” helping mentality that
their predecessors did during the 60’s scoop. Rather, these values and practice frameworks
encourage social workers to engage in social issues and inequities with critical reflexivity,
acknowledging how they may benefit from the same system that oppresses others. It involves

29
using this unearned power to support the self-determination and autonomy of those who are
marginalised (Blackstock et al., 2007; Crampton, 2015; Miller et al., 2017; Rine, 2016).
While social workers may support the creation of more relevant policy, Indigenous
scholars also assert that simply resisting discriminatory policy is an avenue for decolonization
(Gray et al., 2013). Accordingly, they encourage helpers to use their power to resist faulty and
biased discourses that legitimise oppressive systems that cause and exacerbate inequities in
health status (Blackstock et al., 2007; Crampton, 2015; Miller et al., 2017; Rine, 2016). For
example, social workers may choose to combine pathology-based practice modalities, like the
medical model, with a psychosocial model of practice, that takes social and ecological factors
into account, while utilizing a strengths-based perspective (Blackstock et al., 2007; Crampton,
2015, Rine, 2016). In doing so, policy discourses that categorise Indigenous peoples as “other”
and “inferior”, can be replaced with ones that highlight their resilience and cultural strengths.
Instead of merely “treating” the problem, social workers may advocate for the inclusion of
assessments and treatment protocols that identify and foster existing strengths among their
clients (Rine, 2016). Together with AOP and allyship, the true source of health inequities among
Indigenous peoples– racial discrimination and intergenerational trauma – can be resisted and
actively addressed (Blackstock et al., 2007). Thus, social workers may be able to support the
creation of policy that is both culturally informed and anti-oppressive to better address the
SDOH unique to Indigenous peoples (Blackstock et al., 2007; Crampton, 2015; Miller et al.,
2017). At the heart of practice, however, is the understanding that for positive outcomes to occur,
any working relationship must share an equal balance of power. Social workers must walk beside
Indigenous peoples as allies, adopting the role of supporter and helper, not guide. This can be
achieved by, for example, attending public marches and talks, and engaging in conversation with

30
Indigenous peoples, Elders, and leaders. It may also involve simply listening to the needs and
wishes expressed by Indigenous peoples and using one’s professional power to bring those
forward (Choate, 2019). This must always entail following the direction and lead of Indigenous
peoples, offering support where appropriate and needed (McGibbon, 2016). If policy is created
in this way, it resists the paternalistic and oppressive nature of current neoliberal social norms.
This is an integral step in decolonising public health policy (Blackstock et al., 2007; Crampton;
McGibbon, 2016; Miller et al., 2017).
Decolonising Social Work Education
Opportunities for decolonization cannot be effectively taken if the foundational skills and
capacities for AOP and allyship are not properly developed (Blackstock et al., 2007; Crampton,
2015). However, Indigenous scholars question whether educational institutions adequately foster
these skills. There is concern regarding the glaring lack of Indigenous-focused curriculum that
allows social work students to learn about Indigenous cultures, worldviews, inherent diversity
and resiliencies, history, and the legacy and outcomes of colonialism (Crampton, 2015).
Moreover, the role of helping professions, like social work, in the past and ongoing colonization
of Indigenous peoples is given little attention or critical reflection (Choate, 2019; Gray et al.,
2013). This is important as social work is a western form of intervention that was created in
response to the deleterious effects of colonial policies. In its inception, however, social workers
directly contributed to the trauma experienced by Indigenous peoples and their children, that
would affect many generations to come (Blackstock et al., 2007; Crampton, 2015). The
overrepresentation of children in care is a clear example that history is repeating itself and that
social services, including social work as an institution, requires decolonization. Yet, several
studies show that the need for decolonisation is rarely taught at post-secondary institutions, and

31
when it is, it is superficially discussed (Blackstock et al., 2007; Crampton, 2015; Gray et al.,
2013; Moniz, 2010;).
Knowledge and recognition of the past lays the foundation for anti-oppressive practice as
it brings to light the invisible systems of power and privilege. According to Indigenous social
workers, the profession is largely made up of helpers who carry social privileges and protections.
They are blinded to the oppression and discrimination that define daily life for many Indigenous
peoples simply because they do not experience it. When this is combined with professional
privilege, Indigenous scholars found that helpers are more likely to employ interventions that
echo the systems in which they are embedded (Blackstock et al., 2007; Crampton, 2015; Datta,
2018; Eni et al., 2021;Tuck & Yang, 2014). This defined the paternalistic and forceful child
removal interventions of the past, and to a large degree, the child welfare systems of the present
(Eni et al., 2021). They also call attention to more clinical settings and the mental health system
that is still largely based on individualistic, pathologizing medical models. The use of these
models contradicts social work’s underlying social justice aims and code of ethics (Blackstock et
al., 2007). To address this and better equip potential social workers, social work curriculums and
pedagogies must be decolonised (Crampton, 2015).
For this to occur, the literature points to several actions that must be taken. First, postsecondary boards, professors, and support personnel must be representative of the Indigenous
student body. Together with Indigenous communities, Elders, and other key stakeholders,
curriculums that accurately depict their lived experiences, histories, and worldviews should be
created (Choate, 2019). Second, training in trauma-informed practice should be combined with
greater training and practice opportunities in cultural safety, critical reflexivity, and antioppressive models of practice (Blackstock et al., 2007; Choate, 2019; Crampton, 2015).

32
Moreover, traditional Indigenous perspectives that encourage students to critically reflect on, and
incorporate into their practice models, aspects such as the interconnectivity between individuals,
communities, and the land; intangible protective cultural factors like spirituality; environmental
responsibility; and assessment and treatment models that include physical, mental, social, and
spiritual aspects of health and wellbeing (Choate, 2019; Crampton, 2015). However, it is also
important that students be taught not to misappropriate traditional knowledge (Crampton, 2015).
Third, training and scholarly activities should be translated into action. Scholars point out that
knowledge and training must be paired with opportunities to practice allyship, advocacy, and
resistance. Given the pervasive discrimination and overreliance on western models of practice,
particularly in healthcare, being comfortable resisting and advocating are essential skills
(Blackstock et al., 2007; Choate, 2019; Crampton, 2015). Lastly, social work education should
shift away from overly focusing on individual interventions. Given the amount of structural risk
factors, such as poverty and unemployment that marginalised peoples are disproportionately
affected by, structural interventions are equally important (Blackstock et al., 2007; Crampton,
2015; Czyzewski, 2011). Focusing on these factors necessitates the use of models that go beyond
individual factors. For social workers within the public heath sector, utilizing a SDOH model is
recommended due to its focus on both proximate and distal structural factors like colonization
(Miller et al., 2017). For these calls to action to occur, educational institutions and systems
require reform, in turn, requiring, advocacy. A consistent theme throughout the literature is that
systems do not change easily, or willingly in some cases. However, with advocacy and allyship,
social workers may support Indigenous scholars and other allies to reform social work
curriculums and pedagogy to better align with the profession’s code of ethics, social justice, and

33
Indigenous values and worldviews (Blackstock et al., 2007; Choate, 2019; Crampton, 2015;
Czyzewski, 2011; Eni et al., 2021).
Implications for Social Work Practice, Policy, Research, and Education
This review highlights the many avenues that social workers may take to support the
decolonization of public health. Due to the diversity in roles that social work may take, these
avenues spanned across several areas: practice, research, policy, and education. The central
theme among these avenues was that reforms to public health cannot happen before a social
worker’s ways of knowing, being, and doing undergo reformation first. This entails decolonising
one’s worldviews, values, and ways of helping as professionals (Datta, 2018). This begins when
social workers take responsibility for their predecessor’s actions and history, however shameful
that may be (Blackstock et al., 2007; Choate, 2019). In turn, this paves the way for reconciliation
to occur which involves ongoing critical reflexivity (Crampton, 2015). Social workers must
remain ever reflexive of the social locations they occupy and how different parts of their social
identities may play a role in the larger system of power and oppression. Specifically, social
workers should be mindful of the parts that offer the most privilege and social protections at the
expense of others. It is in recognising the unearned privileges one has that casts the invisible
systems of power into relief. When they are observable, they can be addressed and resisted
(Blackstock et al., 2007; Choate, 2019; Crampton, 2015; Eni et al., 2021). Decolonising one’s
personal worldviews and perspectives allows social workers to more effectively identify the
ways in which their practice may lie in contrast with Indigenous ways of knowing, being, and
doing. It also makes it easier to adopt models that are holistic, trauma-informed, person-centered,
and strengths-based (Rine, 2016).

34
Decolonizing one's worldviews and practice allows social workers to act as allies in their
communities and organisations, and to form partnerships that are led by Indigenous peoples.
These partnerships, allow for the creation of health programs and services that are culturally
specific, safe, accessible, and relevant to community SDOH. In turn, honouring the selfdetermination and autonomy of Indigenous peoples (Eni et al., 2021). This theme of allyship in
social work, extends beyond individual practice. Indigenous scholars suggest that to achieve
effective decolonization, a multisystemic approach is needed. In terms of research, the
underlying goal should not be to “discover”. Instead, research efforts should be aimed at
readjusting power imbalances and employing traditional Indigenous ways of knowing, being,
and doing to address health inequities that have arisen from complex social dynamics and
histories (Adelson, 2005; Kovach, 2010; Lavallée, 2009). Indigenous peoples should be involved
in every aspect of the research process and not merely included as variables under examination
(Datta, 2018).
Echoing this, while there are multiple avenues for the decolonization of public health
policy, the involvement of Indigenous peoples must remain central. Moreover, any reforms made
must be multisystemic for public health to be effectively decolonised (Blackstock et al., 2007;
Choate, 2019; Crampton, 2015; Eni et al., 2021). As social workers are uniquely placed across
multiple realms in public health, they have a professional responsibility to act as allies to
Indigenous peoples, resisting the discriminatory discourses that legitimise problematic policies
and aiding in policy reform efforts (Rine, 2016). Importantly, they also have a duty to use their
unearned power and privileges, to support and highlight the voices of Indigenous peoples and
movements within public health (Choate, 2019; Crampton, 2015). However, to become allies,
educational institutions must equip social workers with the fundamental skills and knowledge to

35
do so (Crampton, 2015). With greater emphasis on learning about Indigenous worldviews,
histories, and diversity; cultural safety training; critically reflexive practice; the inclusion of
SDOH frameworks; and opportunities to practice advocacy and allyship, social workers may be
better able to support decolonization efforts (Blackstock et al., 2007; Choate, 2019; Crampton,
2015; Eni et al., 2021).
Despite the multiple avenues suggested by Indigenous scholars and allies, more research
concerning public health as it pertains to Indigenous peoples, is needed. Specifically, more
qualitative, and participatory action research, that is Indigenous led and informed, is required.
Moreover, much of the research reviewed takes a pan-Indigenous approach and did not control
for variation between different cultural groups and communities. Except for a few, studies tend
to group different cultures or populations together. Further, there is little intersectional analysis.
Almost all studies reviewed had a focus on culture alone. Lastly, further research that examines
specific Indigenous-led decolonization efforts that are already underway and showing positive
outcomes is required. These studies can be used to further inform and legitimise the need for
decolonization in a western society that values empirical outcomes.
Conclusion
From the reviewed literature, it is clear that public health continues to reinforce colonial
systems of power and oppression through inadequate policy reform, pervasive discrimination,
and tokenistic and ineffectual reforms that ignore the self-determination of Indigenous peoples
and traditional perspectives of health. It would be faulty to assume that colonialism is an aspect
of the past. Settler assimilation policies, and resultant intergenerational trauma, has had
cascading effects, creating persistent, and in some cases, worsening barriers to accessing
culturally safe and relevant healthcare services, programs, and policy. To address the gap

36
between the health of Indigenous and non-Indigenous peoples, the issues underlying Indigenous
health inequity must be critically addressed for effective decolonization to take place.
Decolonization begins with an understanding of Canada’s colonial history, and how this
history is intricately woven into the current state of Indigenous SDOH. Knowledge of the past
must be combined with ongoing critical reflexivity of unearned privileges and power that allow
disparities in health to grow. This necessarily entails a refracturing and restructuring of a social
worker’s worldviews to allow for the incorporation of perspectives based on holism, reciprocity,
balance, and the interconnection between all beings and the land. It is a lifelong process that
must be accompanied by a constant commitment to ongoing learning and unlearning. This
commitment to learning, social justice, and allyship are integral to ethical social work practice
(BCCSW Code of Ethics and Standards of Practice, 2009). Decolonising one’s mind and ways of
knowing, begins to change one’s ways of being and doing.
This kind of inner decolonization becomes an avenue of resistance in and of itself. By
thinking in a way that runs counter to the dominant white settler norms and values of
individualism, competition, and paternalism, social workers resist the status quo. This form of
resistance can be echoed across all levels of practice – micro, mezzo, and macro. At the
individual level, resistance takes the form of alternative practice models that do not simply focus
on inner “causes” of ill heath, deficits, or pathologies. Rather, models include tenants of social
justice, AOP, and cultural safety, are strengths-based and ecological in nature, addressing the
biopsychosocial factors of health. Social workers go beyond the individual body and address the
oppressive systems and structures that contribute to their client’s ill health.
Resistance also opens avenues for allyship and advocacy. Due to the varied roles and
positions social workers may take in public health, they can participate in multisystemic

37
decolonization efforts. This may occur in research by undertaking qualitative, participatory
action methodologies, in collaboration with Indigenous communities, or by supporting
Indigenous-led partnerships in community health settings. Social workers can also advocate for
policy reform within their organisations, educational institutions, or across provincial and federal
platforms. However, any advocacy or allyship must be informed and led by Indigenous peoples
and be specific to their unique needs, SDOH, worldviews, and culture. It must also honour their
self-determination and autonomy at every step, fostering their inherent strengths and resiliencies.

38
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