Improving the health of indigenous people and culture through decolonization of tobacco, says Dr. Cree
According to a Cree (nehiyô) doctor in Alberta, high smoking rates among indigenous peoples pose a serious risk not only to personal health but also to culture.
“The number one way to make sure people are healthy is to stop smoking,” said Dr. James Makokis, who is from the Saddle Lake Cree Nation and works in Kehewin Cree Nation and South Edmonton.
First Nations smokers are almost twice as likely to smoke outside the reserve than non-Indigenous people, according to Public Heath Canada. According to a 2016 report, half of First Nations men (50 percent) and women (49 percent) living in Reserves in Ontario reported smoking daily or occasionally.
Makokis said he has seen many patients who have smoked since they were young and are now struggling with a variety of health problems. He said communities need to speak respectfully with elders about smoking.
“The younger generation needs our elders to reach a healthy age so that they can pass on their knowledge of language, culture, spirituality and medicine [and] around songs and ceremonies so that as they grow older they have all the tools to ensure continuity of knowledge into the future,” he said.
Culturally Appropriate Services Required
Elder Doreen Spence of the Saddle Lake Cree Nation said tobacco has traditionally been used by the Cree people in ceremonies—in a sacred fire or as an offering to the earth.
“In the beginning of time we were gifted with tobacco. Tobacco is a sacred herb,” Spence said.
At 86, she still sometimes grows the plants in small containers, but she only uses the medicine for ceremonial purposes.
Spence said tobacco had been abused and it was important to understand how and why that happened.
According to a University of Saskatchewan study, traditional use of tobacco typically requires minimal inhalation.
“Generally speaking, if we look at the instrument we use to smoke tobacco, in our teachings, people are not supposed to inhale the drug, they just smoke it,” Makokis said.
But as commercial tobacco entered communities, it became confused with traditional tobacco uses, he added.
“There’s a misperception in our communities that if you smoke, you’re doing some form of prayer because it’s a medicine,” he said.
Spence agrees, saying a better understanding of the ceremony and Aboriginal people’s place in the life cycle is essential to reducing smoking rates.
Smoking reduction programs
Government programs have helped reduce smoking rates since the 1970s, but as Aboriginal smoking rates are still higher than non-Indigenous, Makokis said there is a need for culture-specific programs.
CBC News reached out to Alberta’s health services to find out what resources are available to reduce smoking among Indigenous Peoples, but has received no response as of publication.
Such programs should address tobacco use in a culturally respectful and trauma-informed way, Makokis said. This should include understanding how addiction is often linked to trauma, and Makokis highlighted specific sources of trauma, such as the ’60s scoop and dormitories.
“If we look at the tremendous trauma that indigenous peoples have experienced from colonial violence, we know that they are more inclined to regulate their emotions … through the abuse of substances, be it alcohol or drugs,” Makokis said.
Vaping is also a problem
Makokis said he’s also worried about young people and vaping. As with smoking, Indigenous youth are more likely to vape than non-Indigenous youth.
A 2022 Statistics Canada report estimated that in 2019, 31 percent of Indigenous youth ages 15 to 17 had vaped in the past 30 days, compared to 20 percent of non-Indigenous youth.
Makokis said more needs to be done to reduce smoking and vaping rates among young people, which includes better access to cultural services and activities.
“One of the most important protective factors for Indigenous youth to prevent harmful activities is connection with their culture, identity, language, ceremonies and spirituality,” Makokis said.
