{'fraction_non_alphanumeric': 0.032234251968503935, 'fraction_numerical': 0.014025590551181102, 'mean_word_length': 5.004431314623338, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 2, 'lorem ipsum': 0, 'www.': 1, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The importance of engagement with Indigenous peoples in health research

I write this commentary not as a scientist who is particularly knowledgeable about cerebral palsy, but as an Indigenous-community-engaged health researcher. I am Anishinaabe (Ojibway), a member of the Mississaugas of the Credit First Nation in Ontario. I situate myself as having Indigenous lived experience, having grown up on an Indian Reserve and maintaining continuous connections with my home community. Overall, this study by Chen et al. addresses an important issue in Canadian Indigenous health, through an analysis of the Canadian Cerebral Palsy Registry. Ethnicity data were available for 94 Indigenous children compared with 1555 non-Indigenous children. Indigenous children were identified on the basis of having at least one parent identifying as Indigenous, which is standard. The limitations of self-identification were discussed, in particular the possibility that some parents might choose not to identify given concerns about stigma. There could be other reasons for non-identification as Indigenous, such as not knowing in the case of adoption, although this is perhaps less common. The overall percentage of Indigenous children in this registry population did not seem particularly high (94/ 1649, 5.7%), given that 4.9% of people in Canada selfidentify as Indigenous, and the percentage of children (7.0%) and young people (5.9%) even higher (https:// www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011x2011001-eng.cfm). However, it appears that parts of Canada with higher Indigenous populations were not part of the registry, in particular Saskatchewan and Manitoba, provinces where the Indigenous child populations are at least 20%. Also, the northern territories were not included and there the overall Indigenous population is over 50%. The registry has only one socioeconomic indicator, namely parental education, and so this was used as a surrogate for socioeconomic status. This is probably adequate as a general marker of socioeconomic status. In future studies, however, it would be good to also include a more specific indicator of Indigenous health such as exposure to multigenerational trauma, for example residential school experience or the foster care system. The fact that there were no Indigenous contributors to this report was also discussed. This is an important limitation. My suggestion would be to establish an Indigenous advisory or reference group. It was a suggestion I made in regard to another Indigenous population-based study in the past. In general, it would be good to establish a patient/parent advisory group to bring the voices of cerebral palsy lived experience to the research. This would be consistent with the principles of patient-oriented research (https://cihr-irsc.gc.ca/e/41204.html). Finally, it is mentioned in the article that improving the living conditions of Indigenous populations is essential to reduce these health inequities. This is entirely in line with the conclusions of Canada’s Truth and Reconciliation Commission (TRC): if a root cause of the poor health of Indigenous people relates to poor living conditions, then it makes sense that this root cause should be addressed in finding a solution. The fact that it is beyond the scope of the health system by itself to effect such change does not negate that all Canadians, in particular those who have influence, should support efforts to redress the situation. The report of the TRC of Canada, released in 2015, is worthwhile reading for the broader health research community. The TRC report firmly and definitively established that residential schools and other aspects of Canadian policy led to the current precarious state of Indigenous health in Canada. This led the TRC to issue a series of Calls to Action (http://trc.ca/assets/pdf/Calls_to_ Action_English2.pdf). In particular, it called on everyone in Canada to recognize these facts and called on governments, in consultation with Indigenous peoples, to take action to address current inequities.