Health care Justice for Indigenous Communities in Canada: What Government Claims and the Truth
By Jonathan Giroux
This post is part of a series in diverse mediums focusing on the theme “How do we envision equity in global health?”. These submissions are by McGill students who were part of the course, Fundamentals of Global Health, in Fall 2023.
Not in the Books
Canada’s healthcare grapples with its colonial roots, harboring systemic racism against Indigenous people, undermining the traditional knowledge systems and perpetuating a legacy of poverty and forced sterilization which continues to devastate Indigenous communities. These enduring oppressions have left Indigenous health in the midst of a health crisis, particularly maternal health. This reality is not presented in our history books, but it is an ongoing reality that needs urgent and informed action. Thus, it is crucial we confront these deeply rooted inequities and work towards a more just healthcare system in Canada.
The ‘Truth and Reconciliation’ Governance and Its Reality
The systemic racism and the vestiges of colonialism permeate throughout Canada’s institution. The ramification of these impacts is that Indigenous people in Canada have denied the opportunities, infrastructures, and resources to economically prosper and have led to Indigenous peoples being among the poorest in Canada and experience disproportional health burdens (9). While most low-income Canadian experience poverty for short periods, Indigenous people are more likely to endure persistent poverty (8). Individuals experiencing poverty are exposed to more hazardous conditions while having reduce access to essential health services, proper nutrition, and exposed greater stress(9). The relationship between poverty and ill health is integral and thus, causing a vicious spiral/vicious cycle. The devastating effects of poverty result in lower life expectancy and mental health, greater rates of suicide, birth complications, and vulnerabilities to both communicable and non-communicable disease (9). The manifestations of all these affects are seen in various Indigenous communities in Canada. For example, the Inuit, recognized as one of the three Indigenous heterologous groups in Canada, have a suicide rate 11.6 times higher, live 13 years less than the Canadian average and in which around 70% young children lack food security (7). These heart-wrenching disparities are unacceptable in a country which claims to be attempting to be show “Truth and Reconciliation” with the Indigenous communities, which on their historical and unceded lands are treated as second-class citizens.
Maternal Health and the Systemic Racism in Healthcare
While bringing to face inequities in Canada, it is crucial to acknowledge the immense tribulations faced by Indigenous birthing people. The horrors of what happened to Joyce Echaquan, a mother of seven and member of the Atikamekw nation, which through a Facebook Live exposed the degrading systemic racism which caused her death, is still freshly entrenched in Canadian and Indigenous Society. This mother, at the prime of her life, faced repeated discrimination and coercive pressures to undergo multiple abortions and sterilization, not from her treatable case but from racist and criminal neglect (6). This form of settler-colonial violence within the healthcare systems stems from the absence of trauma-informed care, rushed stereotypical racist diagnosis, and wrongly assumptions that all Indigenous people are the same even though there exists a vastly diverse Indigenous community (4). Sadly, her case was not the exception; throughout Canada, forced sterilization and denigration of Indigenous bodies have been common and are still ongoing today (5). Over 25% of middle-aged Inuit women in Igloolik were coercively sterilized (6). These genocidal desecrations, compounded by the emotional traumas they inflict, have eroded credibility between healthcare workers and Indigenous and erected barriers to adequate and equitable access to treatment. Given the forced sterilization, the ongoing abuses and the deep mistrust of Canadian healthcare, Indigenous communities ‘s lack of trust placed in a government that claims to reconcile is understandable due to little action placed on preventing and redressing the harms inflicted on at least 12,000 Indigenous birthing people over half the century (6).
Grand Pacific March in Trois-Rivières, QC, Canada in memory Joyce Echaquan and to protest systemic racism that led to her death.
Photo by Thérèse May, Creative Common License
Rebuilding Trust: Looking With Both Eyes
A step forward to uproot these inequities, strive for a more just healthcare and rebuild trust is through implementing Two-Eyed Seeing and strength-based approaches. Two-eyed seeing is a concept first coined by Mi’kmak Elder Albert Marshall, which describes it as a way of “[Seeing] from one eye with the strengths of Indigenous knowledges and ways of knowing, and from the other eye with the strengths of Western knowledges and ways of knowing, and to use both these eyes together, for the benefit of all”(3), which means that both traditional knowledge systems and western knowledge are like pieces of the puzzle. Combined, they are not opposed but build a more comprehensive and clearer image. This integration enables a greater learning and understanding necessary to foster successful strength-based approaches to health. Strength-based approaches do not focus on what is missing but rather on supporting and capitalizing on strengths to empower the individual and the entire community (2). Indigenous communities often agree that health arises from a balance of the mind, spirit, body and emotions. Healing approaches should be focused on strengthening interpersonal bonds with the family and community to elevate one’s well-being. Significance evidence emphasizes the importance of Elders as pillars and menders of communities and conveyers of wisdom to the younger generations (2). Elders plays a pivotal role in the context of the strength-based approach as an educator to define essential concepts and establish priorities for both research and initiators. However, with the vastness, heterogeneity and depth of cultural practices present in Indigenous communities in Canada, one size does not fit to address the multiple
problems faced by these communities. Though Truth and Reconciliation Commission emphasized seven resolutions linked to health in their call to action to address these problems. Notably, the recognition of historical atrocities committed by governmental policies related to Indigenous health, upholding healthcare rights of Indigenous in line with the law, reducing health outcomes and financial gaps, funding healing centers, implementing Two-Eyed Seeing and training healthcare professionals in cultural competency and Indigenous health issue (1). These approaches must empower the individuals and communities by integrating Indigenous and Western knowledge systems, recognizing balance in well-being and respecting the wisdom and leadership of the Indigenous community in these projects to foster success in these initiatives and a more equitable future in health.
We Must Do Better
It is without a shadow of a doubt that Canada’s healthcare system with its still existing systemic racism, with forced sterilization is one of the manifestations have marred the quality of health an Indigenous person may receive. The government must properly address the issues brought up by the Truth and Reconciliation Commission by implementing Two-Eyed seeing and strength-based approaches to push forward a more equitable healthcare future. Individually, Canadians can help breach the gap by advocating for policy reform that addresses systemic racism and historical and ongoing injustice by putting pressure on their politicians, supporting Indigenous-led initiatives, including wellness programs, and elevating Indigenous voices and knowledge in leadership and solutions within healthcare.
References
1. Truth and Reconciliation Commission of Canada: Calls to Action.
2. First Nations Information Governance Centre. Strengths-Based Approaches to Indigenous Research and the Development of Well-Being Indicators. 2020 [cited 2023 Oct 29]; Available from: www.FNIGC.ca
3. Bartlett C, Marshall M, Marshall A. Two-Eyed Seeing and other lessons learned within a co-learning journey of bringing together indigenous and mainstream knowledges and ways of knowing. J Environ Stud Sci. 2012;2(4):331–40.
4. Native Women’s Association of Canada. Racism in Healthcare Toolkits [Internet]. [cited 2023 Dec 2]. Available from: https://nwac.ca/assets-documents/Racism-in-Healthcare- Toolkits-En.pdf
5. Gunn BL. ‘Ignored to Death: Systemic Racism in the Canadian Healthcare System’ Submission to EMRIP the Study on Health.
6. Shaheen-Hussain S, Lombard A, Basile S. Confronting medical colonialism and obstetric violence in Canada. The Lancet [Internet]. 2023 May 27 [cited 2023 Dec 1];401(10390):1763–5. Available from: http://www.thelancet.com/article/S0140673623010073/fulltext
7. Pulver LJ, Haswell MR, Ring I, Waldon J, Clark W, Whetung V, et al. Indigenous Health- Australia, Canada, Aotearoa New Zealand and the United States-Laying claim to a future that embraces health for us all. World Health Report. 2010;33.
8. Who is at higher risk of persistent poverty in Canada? | Fraser Institute [Internet]. [cited 2023 Dec 1]. Available from: https://www.fraserinstitute.org/blogs/who-is-at-higher-risk- of-persistent-poverty-in-canada
9. ᐱᕚᓪᓕᖅᑎᑦᑎᓂᖅᖃᐅᔨᒃᑲᐃᖃᑎᒌᓃᖅ ·. sharing knowledge · making a difference partager les connaissances · faire une différence.