Cardiovascular Care Disparities for Indigenous Communities in Canada

By K. Coco Zhang

Cardiovascular diseases (CVD) are the leading cause of mortality worldwide, causing approximately 18 million deaths each year. In Canada, over 80,000 people die from CVD annually. CVD prevalence and mortality rates are higher in Indigenous communities compared to those in non-Indigenous populations in Canada. For example, the prevalence rates of several types of CVD, including congestive heart failure and stroke, were 25% to 77% higher in Métis communities compared to those in the general Canadian population. Moreover, the CVD prevalence in Indigenous communities is around 2.5 times as high as that in non-Indigenous populations in Canada. 

Despite Canada’s universal health coverage system, which has largely reduced disparities related to the financial affordability of medications, barriers to accessing healthcare services persist. Geographic distances limit timely access to specialty care for remote Indigenous communities. Indigenous patients with CVD often need to travel far to receive necessary care. The difficulties of care access are compounded by poor road infrastructure and potentially difficult geographic conditions. These barriers are especially problematic for cardiovascular emergencies. As a result, Indigenous populations in Canada are considerably more likely to experience a delay longer than four days between symptom onset and hospital presentation compared to those in the general population. Notwithstanding the higher CVD burdens among Indigenous communities, their use of cardiology services was remarkably lower compared to that in non-Indigenous populations, such as a lower likelihood of receiving important diagnostic tests such as coronary angiography. This lack of healthcare could be due to many factors such as geographical barriers, systemic racism, and a lack of trust in the healthcare system. These care disparities are reflected in healthcare outcomes. Indigenous patients were reported to have significantly higher rates of complications and deaths after cardiac surgery compared to non-Indigenous patients.

Inequities in access to and outcomes after cardiovascular care for Indigenous communities in Canada can be reduced through various means. One possible approach is to bridge the gap between Western and Indigenous medicine by integrating Indigenous knowledge and practices as part of healthcare delivery. For example, healthcare facilities can involve Indigenous social workers, Elders, traditional healers, and cultural programming to support Indigenous patients’ physical, mental, emotional, and spiritual health. Another suggested approach is to increase health literacy surrounding cardiovascular health and care in Indigenous populations via local media. Evidence suggests that such interventions could help increase medication adherence for Indigenous patients with CVD. 

In recent years, a range of strategies have been implemented to support heart health among Indigenous communities in Canada. In a digital storytelling study, Indigenous women with lived experiences of heart conditions created publicly available stories that addressed themes such as changes to diet and lifestyle, experiences with the healthcare system, and residential schools. These stories facilitated the application of Indigenous knowledge as well as public awareness of the historical and social roots underlying heart health issues Indigenous women faced. Furthermore, in a heart health pilot initiative, nurse practitioners co-led a group of Indigenous women with Indigenous representatives to integrate Indigenous cultural practices, such as storytelling, sharing circles, and the blanket exercise, into the pilot program. This project promoted positive changes regarding the participants’ diet, physical activity level, and emotional health, confirming the need for employing culturally relevant approaches to heart health promotion.

Overall, despite clear evidence of disparities in access to and outcomes after cardiovascular care between the Indigenous populations and the general population in Canada, there remains ambiguity in this topic, suggesting an immediate need for a greater understanding of existing disparities.