Policy Report POLS3340

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Oct 30, 2023

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POLS*3340 Maggie (Margaret) Reddon- 1192899 Prof. Marder August 6th, 2023 Decolonizing Indigenous Healthcare in Canada: A Report for the Federal Government Hearing that Métis people were reluctant or afraid to seek out care when they needed it most shows deep-rooted problems in the system.” – Paulette Flamond, Métis Nation BC Minister of Health, Northeast Regional Director, In Plain Sight Report, 2020, p.42

Although major changes have occurred in recent years, Indigenous healthcare remains a current and pressing issue facing Canadian politics. There are major disparities in health between Indigenous people and other Canadians; including the stigma around mental health and addiction, Indigenous women having overall poorer health, and logistical factors that affect physical access. Indigenous populations experience higher rates of diabetes, hypertension, substance abuse, and have an overall lower life expectancy (PJ, K. 2019) This report calls the Canadian federal government to further act upon this problem, because although management of healthcare is a provincial responsibility, the federal government provides the standards for the system, which has failed many, under the Canada Health Act (Government of Canada, 2021.) Whether the government would like to admit it or not, colonialism still impacts Indigenous Canadians today. The eurocentrism forced upon their culture and medicine, along with systemic racism, geographical exclusion, and the continued negative bias placed upon First Nations communities all perpetuate a lower standard of care for those who need it most. While financially driven solutions are always helpful, the most effective solution is to change the way all Canadian healthcare workers are educated, and to allow Indigenous Canadians autonomy and input into their healthcare systems. A trauma informed, culturally appropriate agenda is necessary to begin to reverse the harmful changes colonialism has brought upon Indigenous communities across the country. This report will exemplify the disparities found between Indigenous and non-Indigenous communities throughout Canada. This will be done through the use of statistics, studies, and news articles that highlight Indigenous struggles as well as mitigation strategies found from research inquiries. This report is informed by a narrative review on barriers to healthcare for Indigenous people. Case studies will also be provided to examine the tragic deaths of two 1

Indigenous people who were failed by the Canadian healthcare system. A report on the types of solutions proven to work in Indigenous communities around the world with similar problems will be included. The narrative review explaining the types of barriers is helpful because it allows the parsimonious backtracking of issues to a pragmatic solution. For example, if systemic racism is a barrier to healthcare, a solution for systemic racism needs to be looked into, to provide direct and effective change. Disparities between Indigenous and non-Indigenous communities have always existed, especially when looking at general health and disease. The impacts of settler-colonialism still affect Indigenous populations today, as the settlers’ goal at the time was to erase the Indigenous population, through displacement and sterilization (Marder, 2023.) Colonialism also shapes a culture of inequalities within healthcare due to a eurocentric idea of medicine. (COTBC, 2019.) Indigenous communities have had their own systems in place long before settlers came to Canada. (Marder, 2023.) They established government and healthcare systems of their own, and to colonize their land and population then tell them the western way of healing is superior to their traditional ways is racist, and perpetuates a pre-existing problem. Reasons for the disparities between Indigenous and non-Indigenous Canadians are explained through barriers to access, which date back to colonialism. These barriers include racism, geographical barriers, income inequalities, a lack of resources, and culturally ignorant structures. While physical health is reported on most, mental health issues are just as divided- if not more. Indigenous people face geographical barriers, due to many of their health centres being run by nurses or community health workers with limited training. This causes the need for people to travel long distances for decent care, and is especially a problem in Inuit communities who do not have access to roads all year long (MDPI, 2020.) Negative bias also creates a huge barrier, as 2

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the stigmatization of issues like mental illness and alcoholism in the healthcare community can deter Indigenous people from seeking help. It also causes issues because healthcare workers may assume (due to stereotypes) that someone is only in the hospital because they are in search of pain medication, or that they are not being truthful (MDPI, 2020.) These are just a few examples of how culturally inappropriate and out of date the current healthcare system is. This is a dire and pressing problem, and although policy developments have incurred, issues remain and will continue until the root of the problem is resolved. Indigenous peoples' health indicators consistently lag behind the Canadian average in virtually every measure. By 2017, it was estimated that the life expectancy of Indigenous men would be 70.3 years compared to 79 years for all Canadian men, and for Indigenous women, it would be 77 years compared to 83 years for all Canadian women. (Statistics Canada.) Infant mortality among Indigenous populations are also seen at alarmingly higher rates than those of other Canadians (PubHealth, 2005.) Research highlights the higher rates of HIV infection and violence against Indigenous women and girls, rooted in the legacy of colonization, racism, and discrimination (The Wellesley Institute, 2015.) Although the problem persists, the government has enacted multiple policy developments in an attempt to rectify the clear disparities within the Canadian healthcare system. This includes the Canada Health Transfer policy, implemented in 1997 which allowed for certain Indigenous communities to handle their own healthcare services and resource management. The federal and provincial governments transfer authority to Indigenous communities regarding the allocation of funds, type of care, and healthcare programs (Government of Canada.) Each community handles their own healthcare system, but the government provides funding to them based on the amounts spent each year. This policy allows for Indigenous people to have autonomy over the 3

management of their community health, supporting self-determination and empowering Indigenous individuals, and allowing for a rebirth of traditional medicines as well as modern ones (MDPI, 2020.) This policy was an important step in reducing inequalities within the Canadian healthcare system, but due to persisting issues in First Nations communities such as lack of education and low incomes, there are still problems with employing Indigenous doctors, and paying for treatments (ex. Diabetes medications) the government does not fully cover. There was also the First Nations and Inuit Home and Community Care Program from 2016, a federal initiative that offers healthcare services to Indigenous people who live on reserves as well as Inuit people in the “North of 60” communities (Government of Canada, 2016.) This project provides Indigenous and Inuit people with help such as palliative care, nursing, and personal health support. The program intends to take cultural considerations into account, and allow for independence despite support. The Pathways to Health Equity for Aboriginal Peoples initiative was a huge step in the right direction more recently, as the Canadian government admits in their report that Indigenous health issues are not an anomaly, nor a coincidence, but directly affected by issues like “poverty, lack of education, culture loss, inadequate living conditions, exposure to trauma and violence, and lack of social support and resources.” (Government of Canada.) The pathways program works to design and implement programs that further health equity for Indigenous populations, specifically looking at categories of mental wellness, tuberculosis, diabetes/obesity and oral health. (Government of Canada.) The Canadian government fulfilled their promises to invoke policies that aimed to improve Indigenous health under the Truth and Reconciliation Commissions' plea. As with most political issues, policy takes time to be perfected and mistakes can be made. However, the cases below suggest immediate intervention 4

is necessary, even if not perfect at the offset, to make sure the country begins moving in a better direction concerning the First Peoples. The case of Joyce Echaquan, an indigenous woman in Canada, was determined to be preventable and a clear case of racism by the coroner, Géhane Kamel. Joyce Echaquan was a mother of seven who passed away in a Quebec hospital, later found to have had excess fluid in her lungs. Joyce had a history of heart problems, yet the hospital staff assumed she was experiencing withdrawal symptoms from narcotics use. It was later found that Joyce died due to excess fluid in her lungs. The staff insulted Ms.Echaquan, and infantilized her throughout her time at the hospital. They went so far as to say Joyce was stupid, and asked what her children would think if they could see her (BBC, 2021.) During the press conference following Joyce’s death, the coroner held back tears and suggested that Ms. Echaquan might be alive today if she were white. This case presents a clear example of the aforementioned ‘negative bias.’ Due to the fact that Joyce was an Indigenous woman, the hospital staff assumed she was a drug user, going through withdrawal. Quebec Premier François Legault called the incident ‘totally unacceptable,’ but still denies the existence of racism in Quebec. Even in the face of clear, systemic racism that goes so far as to cause an innocent woman’s death, policy makers still cannot admit that racism exists in Canada. Until it is acknowledged by all levels of government that racism indeed occurs in Canada- and that colonialism still impacts Indigenous people- they will continue to suffer under Canadian institutions, with healthcare being a huge one. Another case, different but similar, is that of Brian Sinclair in 2008. Brian Sinclair was an Indigenous man from Manitoba, Canada, and he died in the emergency department of Winnipeg's Health Sciences Centre (Gunn, 2008.) He came to the hospital for care related to a treatable bladder infection but was ignored and neglected for 34 hours, eventually succumbing to the 5

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infection. The Manitoba government ordered an inquest to investigate the circumstances of his death, initially intending to address racism, poverty, and disability issues. During the inquest, witnesses testified that the hospital staff made assumptions about Brian Sinclair, assuming he was intoxicated and homeless. The nurses claimed to have not seen Mr. Sinclair, although video evidence showed them walking by him multiple times. (Gunn, 2008.) There is also an argument that even if they did not see him, it was their duty to have seen him. The presiding judge eventually ruled that issues of race, racism, poverty, disability, and substance abuse were beyond the inquest's scope, which led to criticism and disappointment from various groups. This shows that negative bias and racism are not only present in healthcare systems, but the legal institutions that impact healthcare systems as well. The neglect he experienced was a result of stereotypes and biases against Indigenous people deeply embedded in the healthcare system and Canadian society. Despite claims that wait times and visibility were the issues, it was ultimately racism that led to Brian Sinclair's death. He only needed a simple procedure and antibiotics for his condition, but the preconceived notions about Indigenous people prevented proper care and attention. This case serves as yet another example among many of the systemic issues faced by Indigenous communities in the healthcare system. A four year study conducted by BMC Health Services research looked into primary healthcare (PHC) services provided to marginalized populations, particularly Indigenous and non-Indigenous peoples facing systemic inequities. The study utilized a mixed-methods, ethnographic design and was conducted in partnership with two urban Aboriginal health centers in Canada. Their research set out to identify the key dimensions of equity-oriented PHC services and developed indicators to assess the quality, process, and outcomes of care (Browne et al. 2016.) when serving marginalized populations. The study was guided by an Indigenous 6

community advisory committee (CAC) and informed by critical theoretical perspectives and Indigenous epistemologies (BMC Health Services Research, 2016). Critical theories allowed for a deeper understanding of the political and moral concerns arising from the legacy of colonialism, while Indigenous epistemologies provided a broader perspective on “interconnectedness, relational values, and knowledge about relationships among people, land, and community.” (BMC Health Services Research, 2016).Data was collected through in-depth interviews and participant observation at the health centers. The participants included both patients and staff, and the study analyzed their interactions and experiences within the healthcare system. The analysis of the data showed that people who were treated equitably, that is, without racism and bias, received similar care, and thus recovered/were treated in similar ways. The study sheds light on the importance of equity-oriented PHC services for marginalized populations and provides insights into addressing systemic inequities and challenges in healthcare provision. The study found certain approaches were favourable when treating First Nations patients. The themes include Trauma and Violence informed care, Contextually tailored care, culturally safe care, and Inequity responsive care (BMC Health Services Research, 2016). These approaches in a day-to-day sense, would look like the following; for one, involving Indigenous people in their own systems. This would ameliorate issues concerning the current priority put on western medicine, and allow for Indigenous people to choose what is best for them. The report also suggests action at all levels for contextually tailored care. This means action at a) the interpersonal level within patients and providers, b) the intrapersonal level, within staff at all levels including training for special circumstances, and c) the contextual level, which, according to the study, will create change within large organizations and the wider community (BMC Health Services Research, 2016). Finally, the report suggests attention to ‘local and global 7

histories’ (BMC Health Services Research, 2016) due to the diversity and rich history within each Indigenous community. Looking into local histories (not panoramic) is essential in slowly shifting healthcare providers mindsets on Indigenous peoples’ care. Other, more expensive developments have occurred, but the ideas mentioned above are the most practical when looking at Indigenous communities’ needs, not just through a poverty lens but a cultural one. Indigenous communities have a history of being misunderstood, insulted, and forgotten through a healthcare lens. It has been shown through the above study that if healthcare workers put the effort in to provide equitable care, the impact can be similar or greater than that provided to non-Indigenous people. Funding is absolutely required in Indigenous health sectors, but less costly solutions exist that could better suit these communities. Poverty, food insecurity and barriers to housing and education” contribute to the poor overall health in Indigenous communities (Canadian Medical Association.) Compassionate care is just as important, if not more, than financially driven solutions. The Federal government has made strides towards better training and programs for First Nations communities across Canada, but in the end, only training through the healthcare sector can provide a broad systemic change. It is clear funding towards programs have ameliorated but not solved healthcare related problems so far. Education is truly the best way to ensure healthcare workers can provide necessary and equal treatment to all patients. An education based solution is not only effective because of human nature, but is also cheaper than any other solution. INAC invested $4.6 billion into Indigenous education to provide more education, which is great, but cases like those mentioned above have still occurred since, indicating the work is not done (MDPI, 2020.) If education became the priority for healthcare workers from non-Indigenous communities, accompanied by consultation with Indigenous people themselves, colonialism would begin to unravel as it exists and allow for change to occur 8

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on the most basic, and individual level. If a doctor believes that an Indigenous person is telling the truth, and deserves the same standard of care that any other Canadian does, then they will perform to the best of their abilities, reducing unnecessary judgements and instances of improper care due to external factors. Building new hospitals and providing subsidies are indeed necessary, but teaching future healthcare workers that there are alternatives to western medicine, and that every life is worth the same, is priceless, and exactly what Canada needs to begin reparations to Indigenous people. 9

Bibliography - 8 Key Issues for Indigenous Peoples in Canada. Indigenous Corporate Training Inc., 22 Nov. 2017, www.ictinc.ca/blog/8-key-issues-for-indigenous-peoples-in-canada. - First Nations and Inuit Health. Government of Canada, Indigenous Services Canada, 2021, www.sac-isc.gc.ca/eng/1611843547229/1611844047055. - The Failure of Federal Indigenous Healthcare Policy in Canada. Yellowhead Institute, 4 Feb. 2021, yellowheadinstitute.org/2021/02/04/the-failure-of-federal-indigenous-healthcare-policy-i n-canada/. Ostermann, Herwig, et al. - Implementing the European Primary Care Strategy in Canada: Challenges and Opportunities. International Journal of Environmental Research and Public Health, vol. 8, no. 2, 2011, pp. 112-126, MDPI, www.mdpi.com/2227-9032/8/2/112. - Table 13-10-0410-01 Health indicator profile, annual estimates. Statistics Canada, 2021, www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=4110004101. Sáez-Martí, Núria, et al. - Addressing the Health Needs of Indigenous People in Canada. Public Health Reviews, vol. 37, no. 1, 2016, article no. 16, BioMed Central, publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0016-5. - Gupte, Pranav, and Alika Lafontaine. A Call to End Racism in Canada's Health Care Systems. Maclean's, 11 June 2020, macleans.ca/opinion/a-call-to-end-racism-in-canadas-health-care-systems/. 10

- Canada Health Transfer. Government of Canada, Department of Finance, 23 June 2021, www.canada.ca/en/department-finance/programs/federal-transfers/canada-health-transfer. html. - Indigenous Health. Canadian Medical Association, www.cma.ca/our-focus/indigenous-health#:~:text=Due%20to%20the%20legacy%20of,ill nesses%20and%20other%20health%20challenges. - Fact Sheet – Indigenous Services Canada. Government of Canada, Indigenous Services Canada, 28 Feb. 2020, www.sac-isc.gc.ca/eng/1582550638699/1582550666787. - 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), 112. doi:10.3390/healthcare8020112 - Indigenous Services Canada. Report on Trends in First Nations Communities, 1981 to 2016. https://www.sac-isc.gc.ca/DAM/DAM-ISC-SAC/DAM-STSCRD/STAGING/texte-text/re port-trends-FN-Comm-1981–2016_1578933771435_eng.pdf - Allan, B. & Smylie, J., First peoples, second class treatment , Canadian Electronic Library. Ottawa, Ontario. https://policycommons.net/artifacts/1204263/first-peoples-second-class-treatment/175736 9/ on 06 Aug 2023. CID: 20.500.12592/dvhszp. - Kim PJ. Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System. Health Equity. doi: 10.1089/heq.2019.0041. - Marder, L. (2023, July). “ Unit 11 Contemporary Political Mobilization and Resistance: Indigenous Legal Orders and Governance” POLS*3340: Indigenous Politics in Canada. The University of Guelph. - Marder, L. (2023, June). “ Unit 3: Colonialism Through Dispossession” POLS*3340: Indigenous Politics in Canada. The University of Guelph. 11

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