Places & Spaces: A Critical Analysis of Cancer Disparities and Access to Cancer Care Among First Nations Peoples in Canada


  • Tara Horrill University of Manitoba
  • Josee Lavoie University of Manitoba
  • Donna Martin University of Manitoba
  • Annette Schultz University of Manitoba



Health equity, health services accessibility, cancer, First Nations, Indigenous


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 this critical review and analysis, we explore potential links between cancer disparities and poor access to cancer care among FN. Research suggests FN experience difficulty accessing cancer services in several ‘places’ of care, including screening, diagnosis, treatment, survivorship and palliative care. Furthermore, there are notable ‘spaces’ or gaps both within and between these ‘places’ of care likely contributing to cancer disparities among First Nations. Gaps in care result from jurisdictional ambiguities, geographical location, unsafe social spaces, and marginalization of FN ways of knowing, and can be linked to colonial and neocolonial policies and ideologies. By drawing attention to these broader structural influences on health, we aim to challenge discourses that attribute growing cancer disparities among FN in Canada solely to increases in ‘risk factors’.


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Author Biographies

Tara Horrill, University of Manitoba

Tara Horrill, RN, PhD(c). Doctoral Student, College of Nursing, Rady Faculty of Health Sciences, UManitoba 

Ms. Horrill’s research focuses on health inequities and the role of structural determinants of health. Using mixed methods approaches, her research has specifically focused on mapping cancer-related disparities among First Nations peoples in Manitoba and exploring equitable access to cancer care for Indigenous Peoples in Canada.

Josee Lavoie, University of Manitoba

Josée G. Lavoie, PhD

Professor, Max Rady College of Medicine, Rady Faculty of Health Sciences. University of Manitoba


Dr. Lavoie’s program of research is located at the interface between policy and Indigenous health services, with a focus on contracting, accountability and responsiveness. She is particularly interested in how western and Indigenous knowledge systems interface in the provision of health services in Indigenous communities.

Donna Martin, University of Manitoba

Donna Martin, RN, PhD, Professor, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba


Dr. Martin works collaboratively with interdisciplinary teams and marginalzed groups to conduct community-driven research focusing on health equity and social justice. Primarily through the use of qualitative methods, her research explores health equity and social justice from the perspective and lived experience of marginalized groups.

Annette Schultz, University of Manitoba

Annette Schultz, RN, PhD, Professor. College of Nursing, Rady Faculty of Health Sciences, University of Manitoba


Dr. Schultz’s program of research is grounded in health services and policy contexts, and explores systemic and structural determinants of health, and how health is understood beyond biomedical perspectives. Examples of structural determinants of health explore in her research include how policies or programs are structured, systemic racism, effects of epistemological privileging and other forms of colonial relations.






How to Cite

Horrill, T., Lavoie, J., Martin, D., & Schultz, A. (2020). Places & Spaces: A Critical Analysis of Cancer Disparities and Access to Cancer Care Among First Nations Peoples in Canada. Witness: The Canadian Journal of Critical Nursing Discourse, 2(2), 104–123.