Environmental Scan: Otitis Media and Hearing Loss in Indigenous Children

Otitis media and related hearing loss among Indigenous children in Canada remains a significant and persistent public health concern. Rates of infection and hearing impairment in some northern communities are dramatically higher than those in southern urban populations. Addressing this issue requires understanding not only clinical factors, but also the broader social, structural, and cultural determinants that influence ear health outcomes. Conducting an environmental scan allows multiple forms of evidence to be examined to inform appropriate health promotion strategies.

Environmental Scan

1.    Population Health Status Evidence

Population health data highlight the magnitude of the problem. Additional population health data sources include Statistics Canada, the First Nations Regional Health Survey, and Public Health Agency of Canada surveillance reports, which provide data on infection rates, hearing loss prevalence, and access to care.

2.    Determinants of Health and Root Causes

Research consistently identifies structural determinants contributing to higher rates of otitis media among Indigenous children. These include overcrowded housing, limited access to primary care and ENT specialists in remote communities, and delays in diagnosis and treatment. Broader structural factors such as poverty, inadequate housing infrastructure, and colonial health governance systems also contribute to persistent inequities in ear health outcomes (Indigenous Primary Care Advisory Panel, 2023; Nguyen et al., 2020).

3.    Evidence on Effective Strategies (Peer-Reviewed + Grey Literature)

Several interventions have been identified to address ear health inequities. These include community-based screening programs, digital otolaryngology services connecting remote communities to specialists, and culturally safe care models that involve Indigenous leadership in program design (Crowshoe et al., 2021).

4.    Community Perspectives and Assets

Community knowledge and lived experience are essential forms of evidence in health promotion. Indigenous-led health organizations emphasize culturally safe care, local leadership, and trust-building as essential components of effective ear health initiatives (Jervis-Bardy et al., 2014; Khanal et al., 2025).

Challenges of Evidence in Health Promotion

Challenge 1 — Biomedical bias

A key challenge in environmental scans for health promotion is that different forms of evidence carry different levels of influence in decision-making. Quantitative epidemiological data often dominate policy discussions, while community knowledge and lived experience may be undervalued despite providing essential insight into local context and culturally appropriate solutions.

Challenge 2 – Data gaps

Indigenous health data is often incomplete due to jurisdictional fragmentation between federal, provincial, and Indigenous health systems.

Challenge 3 – Urban research bias

The majority of clinical research is conducted in urban settings and may not translate well to remote communities. There is less research done in remote settings, although this is starting to shift with more recent studies being published.

Critique of an Environmental Scan

I chose a document written by the National Collaborating Centre for Indigenous Health called Access to Health Services as a Social Determinant of First Nations, Inuit, and Métis Health. Although not labelled as a environmental scan it functions in a similar way by looking at existing literature and examining the system-level factors influencing access to healthcare for Indigenous populations in Canada. The report provides an overview of structural barriers including geographic isolation, jurisdictional fragmentation, and the ongoing impacts of colonial policies on the healthcare system.

A key strength of this resource is its strong grounding in Indigenous perspectives and the focus on access as a social determinant of health. It moves beyond a clinical or epidemiological framing and highlights how different levels of systemic inequities shape health outcomes. This is applicable to my topic as access to specialist services is strongly influenced by the challenges faced from a systems level.

A limitation is that the report is quite broad and not specific to any particular health conditions, interventions, or technologies which may be beneficial for improving health promotion strategies.

Overall, I felt that this resource is valuable in providing context on gaps in care and the structural factors that influence culturally safe healthcare which are crucial considerations when addressing Indigenous health issues.

References

Crowshoe, L., Sehgal, A., Montesanti, S., Barnabe, C., Kennedy, A., Murry, A., Roach, P., Green, M., Bablitz, C., Tailfeathers, E., & Henderson, R. (2021). The Indigenous primary health care and policy research network: Guiding innovation within primary health care with Indigenous peoples in Alberta. Health Policy, 125(6), 725–731. https://doi.org/10.1016/j.healthpol.2021.02.007

Indigenous Primary Health Care Advisory Panel. (2023, February 9). Modernizing Alberta's primary health care system – Indigenous stream: Indigenous Advisory Panel recommendations regarding opportunities for early investment. Government of Alberta.

Jervis-Bardy, J., Sanchez, L., & Carney, A. S. (2014). Otitis media in Indigenous Australian children: Review of epidemiology and risk factors. The Journal of Laryngology & Otology, 128(Suppl. S1), S16–S27. https://doi.org/10.1017/S0022215113003083

Khanal, V., Saurman, E., Russell, D. J., Newton, N., Coombes, K., Puruntatameri, A., Norris, S., von Huben, A., Cockyane, T., Burgess, P., Wakerman, J., & Shaw, T. (2025). Optimizing digital solutions to improve access to comprehensive primary health care services in remote Indigenous communities: Protocol for a participatory action research project. JMIR Research Protocols, 14, Article e68892. https://doi.org/10.2196/68892

National Collaborating Centre for Indigenous Health. (2019). Access to health services as a social determinant of First Nations, Inuit and Métis health. https://www.nccih.ca/docs/determinants/FS-AccessHealthServicesSDOH-2019-EN.pdf

Nguyen, N. H., Subhan, F. B., Williams, K., & Chan, C. B. (2020). Barriers and mitigating strategies to healthcare access in Indigenous communities of Canada: A narrative review. Healthcare, 8(2), Article 112. https://doi.org/10.3390/healthcare8020112