Chapter 12: Advancing Indigenous Health Partnerships: Ethical Approaches to Qualitative Research and Health Systems Improvements

Indigenous people and communities all over the world face significant barriers to healthcare and experience exacerbated health inequities. In this chapter, we reflect on the challenges that Indigenous health partnerships face including in the context of institutional research ethics processes, drawing on examples from a health services research project undertaken in Ontario. We focus on ways to improve Indigenous health partnerships, make suggestions as to how researchers and service providers can engage in meaningful partnerships that honour the role of Indigenous peoples, and suggest strategies for undertaking ethical qualitative research in such a way that it can contribute to transformative change that supports Indigenous peoples’ health and well-being. We advocate that research should be conducted in partnership with communities to identify priorities. Such partnerships, we argue, are more successful when based on formalized guiding principles that are agreed upon between parties prior to the start of the research and oriented to actionable recommendations for change. Finally, these partnerships should be tailored to each Indigenous community and based on collaborative co-decision-making. We conclude by proposing that university research ethics committees and boards should improve their own capacity to work in partnership with communities, and this should include working toward an understanding of Indigenous ethics. Ultimately, while successful partnerships are possible, they require re-evaluating the current systems in which we work: it follows that systems of ethical approvals based on colonial norms of control should be redesigned.