Josée Lavoie

Josée Lavoie
University of Manitoba, Faculty of Medicine · Community Health Sciences

PhD

About

122
Publications
28,820
Reads
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1,766
Citations
Additional affiliations
January 2014 - present
University of Manitoba
Position
  • Managing Director
September 2000 - March 2005
London School of Hygiene and Tropical Medicine
Position
  • PhD Student
Education
September 2000 - March 2005
London School of Hygiene and Tropical Medicine
Field of study
  • Health policy and financing
September 1990 - April 1993
McGill University
Field of study
  • Medical Anthropology
September 1982 - December 1985
McGill University
Field of study
  • Dietetics and Nutrition

Publications

Publications (122)
Article
In this paper, we review existing ethical guidelines that support Circumpolar Indigenous Peoples’ engagement in health research. For this study, we collated national and regional ethical guidelines addressing health research engaging with Indigenous communities. Our study found that ethical guidelines addressing Indigenous engagement in health rese...
Article
Inequitable access to oncology care is a significant issue among Indigenous Peoples in Canada; however, the perspectives of oncology nurses have not been explored. Guided by an interpretive descriptive methodology, we explored nurses' perspectives on access to oncology care among Indigenous Peoples in Canada. Nurses described the health care system...
Article
Manitoba is home to approximately 1,500 Inuit, and sees 16,000 consults yearly from the Kivalliq region of Nunavut to access services. The purpose of our study was to develop detailed profiles of Inuit accessing services in Manitoba, by using administrative data routinely collected by Manitoban agencies, to support the development of Inuit-centric...
Article
Interpersonal and structural racism is a significant contributor to pronounced and widespread health inequities affecting Indigenous peoples in Canada. Recent events surrounding the tragic death of Ms. Joyce Echaquan in Quebec have renewed attention to the devastating harms of Indigenous-specific racism. A recent series of meetings convened at the...
Article
Full-text available
Originally established as an expression of self‐determination, Indigenous‐governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous. To better understand these diff...
Article
Background: The Truth and Reconciliation Commission of Canada has called for better reporting of health disparities between First Nations people and other Canadians to close gaps in health outcomes. We sought to evaluate changes in these disparities using indicators of health and health care use over the last 2 decades. Methods: We used linked,...
Article
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In this study, we focused on readmissions for Ambulatory Care Sensitive Conditions (ACSC) ending in death, to capture those admissions and readmissions that might have been prevented if responsive primary healthcare was accessible. We propose this as a sentinel indicator of equity. We conducted analyses of Manitoba-based 30-day hospital readmission...
Article
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Introduction & Background Global persistence of health inequities for Indigenous peoples is evident in ongoing discrepancies in health and standards of living. International literature suggests the key to transformation lies in Indigenous efforts to control Indigenous health and healthcare. Previous authors have focused upon participation, structur...
Article
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Introduction Decades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by...
Article
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Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to...
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In the field of Arctic health, “resilience” is a concept used to describe the capacity to recover from adversities. The term is widely used in Arctic policy contexts; however, Arctic peoples and communities question whether “resilience” is an appropriate term to describe the human dimensions of health and well-being in the Arctic as it is currently...
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Although numerous comparative Indigenous health policy analyses exist in the literature, to date, little attention has been paid to comparative analyses of Circumpolar health policy and the impact these policies may have on Indigenous peoples’ rights to health. In this article, we ground our discussion of Indigenous peoples’ right to access cultura...
Article
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Health care delivery in the Circumpolar North is challenged by a scarcity of culturally relevant health care services, few medical providers trained in cross-cultural care, and high costs of transportation. Community health workers (CHWs) are primarily Indigenous individuals who provide on-the-ground health care and health promotion services in the...
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Indigenous populations in Canada are disproportionately affected by early childhood caries. The Healthy Smile, Happy Child initiative utilizes a community development approach to encourage community uptake of evidence-based early childhood oral health promotion strategies. Sharing circles and focus groups elicited First Nations and Metis (Indigenou...
Article
Aims: Historically, health research in the Arctic has focused on documenting ill-health using a narrow set of deficit-oriented epidemiologic indicators (i.e., prevalence of disease and mortality rates). While useful, this type of research does not adequately capture the breadth and complexities of community health and well-being, and fails to high...
Article
Worldwide, Indigenous peoples focus on being well rather than merely managing diseases and illnesses. We have elaborated on a mental wellness framework earlier developed with Manitoba First Nations (FN). This article further explores wider community perspectives in relation to the themes previously shared by FN Elders. Surveys were administered to...
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In this call to action, a coalition of Indigenous and non-Indigenous researchers from Australia, Aotearoa New Zealand, United States and Canada argue for the urgent need for adequately funded Indigenous-led solutions to perinatal health inequities for Indigenous families in well-resourced settler-colonial countries. Authors describe examples of suc...
Preprint
Full-text available
Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous in nature. In order to better un...
Preprint
Full-text available
Background This paper focuses on a longitudinal research program in Manitoba, Canada, by the Innovation Supporting Transformation in Community-Based Research Project (iPHIT) to learn from First Nations across the province that have developed effective community-based primary healthcare models. The research is relevant and timely as First Nations ac...
Article
Recognizing the right of self-determination of Indigenous Peoples is essential to improving the state of community-based primary healthcare of First Nations in Canada. Understanding communities’ priorities and local health agendas is critical for primary healthcare transformation. We used a community-based participatory research approach to engage...
Article
This study tested the assumption that geographical isolation is associated with poorer population health outcomes among First Nations in Manitoba. Our results show higher premature mortality rates (PMR) in northern communities, declining slower than for any other Manitoba communities. Our results also show lower ambulatory care sensitive conditions...
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The First Nations in Manitoba, Canada, are calling for active recognition and incorporation of holistic traditional healing and medicine ways and approaches by the mainstream healthcare system that has hitherto tended to ignore all but biomedical approaches. This request for recognition requires elaboration on areas of opportunity for collaboration...
Article
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Despite advancements in research and medicine, health inequities and disparities among First Nations peoples (FN) in Canada are well documented and continue to grow. Once virtually unheard of, cancer now is a leading cause of death among FN. Many factors contribute to cancer disparities, but FN face unique challenges in accessing healthcare. In thi...
Article
Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma‐ and violence‐informed care have been...
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The study is on racism against First Nation peoples in the Canadian healthcare system. The study design incorporates principles of grounded theory, participant and Indigenous (decolonizing) research. Four questions are addressed: (1) What is the root cause of racism against First Nation peoples in the healthcare system? (2) What factors perpetuate...
Article
Objectives The objective of this study was to assess the performance of models of primary healthcare (PHC) delivered in First Nation and adjacent communities in Manitoba, using hospitalization rates for ambulatory care sensitive conditions (ACSC) as the primary outcome.Methods We used generalized estimating equation logistic regression on administr...
Article
Objectives: This article articulates the complexity of modeling in First Nations, Metis, and Inuit contexts by providing the results of a modeling exercise completed at the request of the First Nations Health and Social Secretariat of Manitoba. Methods: We developed a model using the impact of a previous pandemic (the 2009 H1N1) to generate estimat...
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Introduction: Indigenous peoples in Canada have endured and continue to experience the impact of colonization by European settlers. The deleterious manifestations of intergenerational historic trauma (HT) are evidenced in the high HIV/AIDS epidemic-related premature mortality rates among Indigenous men, despite the availability of novel highly acti...
Article
Objectives The objective of this article is to document patterns and trends of in-hospital mental health service use by First Nations (FN) living in rural and remote communities in the province of Manitoba.Methods Our sample included all Manitoba residents eligible under the Manitoba Health Services Insurance Plan living on FN reserves and those li...
Article
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Background: Critical stakeholder-identified gaps in current health research engagement strategies include the exclusion of voices traditionally less heard and a lack of consideration for the role of trauma in lived experience. Previous work has advocated for a trauma-informed, intersectional, and critical reflexive approach to patient and public i...
Article
To monitor the progress of the COVID-19 outbreak, ensure equitable access to testing and treatment, and provide up-to-date information to Indigenous decision-makers engaged in setting up measures to protect their communities, the Manitoba Inuit Association (MIA) mobilized to work with the First Nation Heath and Social Secretariat of Manitoba, Ongom...
Article
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Objectives Early childhood caries (ECC) continues to be the leading reason for pediatric dental surgery in Canada and is particularly prevalent among Indigenous children. Silver diamine fluoride (SDF) offers an alternative method to manage non‐restoratively caries. It is important to determine Indigenous communities' views on and receptivity toward...
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Persistent underperformance of public policy and program implementation in Aboriginal affairs is widely recognised. We analysed the results of two case studies of attempted reforms in public administration of Aboriginal primary health care in the Northern Territory, using a framework based on the institutionalist and systemic racism literatures, wi...
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Background: The development of rh immune globulin (RhIG) for the prevention of Rhesus D (RhD) alloimmunization has significantly decreased the incidence of RhD alloimmunization. Despite long-standing prevention, the experiences of RhD negative women with pregnancy is absent in the literature. Aim: The purpose of this study was to explore the exp...
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Background: First Nations (FN) have unique perspectives and experiences of health and healthcare services, which are critical to the provision of effective community-based primary healthcare (CBPHC). Objective: This paper shares FN perspectives on primary healthcare (PHC), taking geographical, cultural and historical realities into account, to e...
Article
This article shares experiences and lessons learned through a collaboration between the University of Manitoba, the First Nation Health and Social Secretariat of Manitoba (FNHSSM), and eight First Nation communities in Manitoba. We employed a participatory approach from planning the research project, to data collection, and to the analysis, interpr...
Article
The inequities in access to healthcare documented and experienced by Indigenous peoples in Canada are startling given Canada's publicly funded and 'equally accessible' healthcare system, however little is known about access to cancer care, and barriers to accessing cancer care in particular. We conducted a scoping review to identify what is known a...
Article
Background: End-stage kidney disease (ESKD) continues to fundamentally impact the lives of First Nations (FN) patients. Home peritoneal dialysis (PD) offers patients more mobility and flexibility, but few Manitoba FNs have availed themselves of this option. Objective: This paper discusses Manitoba FNs' experience of PD, to highlight enablers and...
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Little research has focused on how Indigenous girls and their familial female caregivers negotiate issues pertaining to wellbeing and decision-making practices. To address this gap, we employed a novel intergenerational Indigenous partnership methods using various decolonizing action and arts-based activities, to allow participants to guide and mod...
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It is important to recognize that experiences of racial and gendered violence are a sad legacy of colonialism. The experiences of historical trauma are on-going. These affect the mental and physical wellbeing of individuals, families and communities. Addressing historical trauma through community-informed practices is central to creating space for...
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A medevac involves the transport of a critically ill patient, usually by plane or helicopter, to access necessary and at times life-saving care, most often only accessible in urban centres. Medevacs are commonly used in resource-limited and geographically isolated areas in Canada. The objective of this study was to explore the determinants of medev...
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Background Since the 1960s, the federal government has been providing or funding a selection of community-based primary healthcare (PHC) programs on First Nations reserves. A key question is whether local access to PHC can help address health inequities in First Nations on-reserve communities in British Columbia (BC). Objectives This paper examine...
Article
In Canada, high rates of anxiety, depression and suicides have resulted in mental health crises in First Nation (FN) communities. To date, Indigenous worldviews and approaches have not been fully heeded in mainstream strategies to address the complexity of living in colonial oppression, despite ongoing crises for decades. We describe perspectives o...
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Within the context of a study about the lived experiences of Indigenous males living with HIV in Vancouver, Canada, we explored the utilization of an innovative method of collecting the narratives of study participants. This article describes and assesses the use of the Life Story Board (LSB) as a potentially rich interview tool for qualitative res...
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Background: Indigenous peoples globally experience a disproportionate burden of mental illness due to forced policies and practices of colonization and cultural disruption. The objective of this study was to provide a baseline profile of hospitalization rates for mental health-related Ambulatory Care Sensitive Conditions among First-Nations living...
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Policy Points • A consensus regarding the need to orient health systems to address inequities is emerging, with much of this discussion targeting population health interventions and indicators. We know less about applying these approaches to primary health care. • This study empirically demonstrates that providing more equity‐oriented health care...
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Background: The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health car...
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Background: Non-government, not-for-profit community health centres (CHCs) play a crucial role within healthcare systems in fostering equity, acting both as direct providers of services and as sentinels of health and social inequity. In a study of an intervention to promote equity-oriented health care, we enlisted four diverse primary healthcare c...
Article
Community-based participatory research (CBPR) provides the opportunity to engage communities for sustainable change. We share a journey to transformation in our work with eight Manitoba First Nations seeking to improve the health of their communities and discuss lessons learned. The study used community-based participatory research approach for the...
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The Canada Health Act 1984 (CHA) is considered foundational to Canada’s publicly funded health care system (known as Medicare). The CHA provides for the federal transfer of funding to the provinces/territories, in exchange for provincial/territorial adherence to Medicare’s key principles of universality; comprehensiveness; portability; accessibilit...
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Circumpolar regions, and the nations within which they reside, have recently gained international attention because of shared and pressing public policy issues such as climate change, resource development, endangered wildlife and sovereignty disputes. In a call for national and circumpolar action on shared areas of concern, the Arctic states health...
Article
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Background The concept of patient engagement in health research has received growing international recognition over recent years. Yet despite some critical advancements, we argue that the concept remains problematic as it negates the very real complexities and context of people’s lives. Though patient engagement conceptually begins to disrupt the i...
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Indigenous peoples of Canada face an elevated risk of intimate partner violence (IPV) compared to non-Indigenous Canadians. Few empirical studies have been conducted to understand this elevated risk, and none have examined child maltreatment (CM) as a predictor. This study used data on a nationally representative sample of 20,446 Canadians to exami...
Article
Purpose The purpose of this paper is to present a study of the transformation of First Nations’ health governance, describing the development of partnerships between First Nations and provincial and federal governments for co-creating solutions to address First Nations’ health inequities in British Columbia (BC). The paper frames this transformatio...
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The settlement of the land now known as Canada meant the erasure – sometimes from ignorance, often purposeful – of Indigenous place-names, and understandings of territory and associated obligations. The Canadian map with its three territories and ten provinces, electoral boundaries and districts, reflects boundaries that continue to fragment Indige...
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Background Structural violence shapes the health of Indigenous peoples globally, and is deeply embedded in history, individual and institutional racism, and inequitable social policies and practices. Many Indigenous communities have flourished, however, the impact of colonialism continues to have profound health effects for Indigenous peoples in Ca...
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Background Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are f...
Conference Paper
An international conference titled “Transforming Health Care in Remote Communities” was held at the Chateau Lacombe Hotel in Edmonton, Canada, April 28–30, 2016. The event was organized by the University of Alberta’s School of Public Health, in partnership with the Institute for Circumpolar Health Research in Yellowknife, Northwest Territories, and...
Article
Full-text available
An international conference titled “Transforming Health Care in Remote Communities” was held at the Chateau Lacombe Hotel in Edmonton, Canada, April 28–30, 2016. The event was organized by the University of Alberta’s School of Public Health, in partnership with the Institute for Circumpolar Health Research in Yellowknife, Northwest Territories, and...
Article
Objective: Given the high prevalence of chronic disease, it is of concern that access to and sustained engagement with primary healthcare services by Aboriginal and Torres Strait Islander Australians is often far lower than would be expected. This study sought to explore ways in which relationships can support sustained engagement with healthcare...
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Access to geographically disaggregated data is essential for the pursuit of meaningful rural, remote and First Nation health services research. This paper explores the opportunities and challenges associated with undertaking administrative claims data research in the context of two different models of administrative data management: the Manitoba an...