“… I visited the emergency department to receive care because I was feeling ill, before I could even share my symptoms the physician tells me that [he] will not be prescribing me any drugs …” Anonymous, First Nations person.
Indigenous peoples are subject to social injustices, racism and discrimination across Canada, based on policies, acts and legislation imposed by provincial and federal governments. Reassurances from these governments create the illusion that systemic racism is being addressed despite the lack of tangible results.
The tendency to see First Nations patients as drug seekers is one of the many racial prejudices and stereotypes embedded in the healthcare system that result in poorer health outcomes. In a recent online survey of 1,002 respondents across Quebec conducted by the Assembly of First Nations Québec-Labrador (AFNQL), nine out of 10 non-Indigenous Quebecers think that First Nations are subject to racism or discrimination and 58 per cent admit that they have limited knowledge about those issues.
This ignorance of issues and realities faced by First Nations may be one explanation for the persistence of system-wide barriers despite the mountain of evidence that racism has impacted the safety and health of Indigenous peoples. For example, Jordan River Anderson, a five-year-old from Norway House Cree Nation, died in a Manitoba hospital following a two-year jurisdictional dispute over coverage of the toddler’s healthcare costs for home care; and Brian Sinclair, a 45-year-old Indigenous person presenting to the emergency department with a treatable bladder infection, died after waiting 34 hours without receiving any treatment. Hugh Papik, a 68-year-old Aklavid elder in the Northwest Territories, suffered a stroke and was denied treatment after being mistaken for a drunk. During the pandemic, Joyce Echaquan, a 37-year-old Atikamekw woman, was subject to vicious racial slurs at the Centre hospitalier de Lanaudière in Joliette, Que., before dying. These are but a few of the incidents highlighting the presence, persistence and under-recognition of systemic racism in the Canadian healthcare system.
Policies impacting Indigenous health have evolved since the Indian Health Policy in 1979 but have not yet resolved the ongoing issue of systemic racism. The need to reform the healthcare system due to systemic barriers faced by Indigenous people is not a novel idea. The Royal Commission of Health Services, established in 1961, issued a report three years later on finances, training for healthcare professionals and improving health services. In 2002, the Romanow Commission Report provided an overview of the quality of health services in Canada and covered access to health services; funding and jurisdictional conflicts; and Aboriginal health and the challenges faced in those communities. In 2015, the Truth & Reconciliation Commission (TRC) Report included 94 recommendations, including seven specific health-related calls to action covering an array of items relating to funding for Indigenous health centres, recognition of Indigenous healing practices, increase in the number of Indigenous professionals working in healthcare and cultural competency training for all healthcare professionals. In 2019, the Viens Commission Report included 33 calls to action addressing systemic racism, including a call to “make the development of culturally appropriate spaces for Indigenous nations a priority in public health institutions …”
Despite the goal of eliciting a national response and with the reports providing further evidence of systemic racism, it still took nine years for the government to implement Jordan’s Principle across the healthcare system following his death. Jordan’s Principle (2005) aimed to eliminate service inequities by ensuring that First Nations’ children can access and receive support from health, social and educational services when they need it. Despite the continuous provision of concrete solutions to bridge the health gap and provide a culturally safe environment for Indigenous peoples to receive healthcare, governments have resorted to talking points and systemic reassurances rather than taking concrete actions to address systemic racism.
Will to Change
After the horrendous incident in Joliette, the Manawan Atikamekw Council and the Council of the Atikamekw Nation (Atikamekw Sipi) presented Joyce’s Principle, a guarantee that all Indigenous people can access health and social services without discrimination, to the governments of Canada and Quebec. After the first round of deliberation, Quebec declined to adopt the proposed measures as it refused to recognize systemic racism in its healthcare system. To date, the federal government has not responded to the call and Quebec has not yet published its provincial plan to combat systemic racism. “The government’s response reminds us that the political will is not there (to address systemic racism),” said Manawan Chief Paul-Emile.
Despite this setback, the Quebec Chiefs of the AFNQL developed an Indigenous-led action plan to combat systemic racism and will move forward without the commitment of the provincial and federal governments.
“Rather than butting our head on the wall of governments that maybe are not as interested as we are – or not as interested as the people who elect them – well, we’re going to call on the people themselves of Quebec to tag along and support our work,” said AFNQL Regional Chief Ghislain Picard.
Canada and Quebec have continued misleading Canadians, including Indigenous peoples, with systemic reassurances, entertaining dialogue with Indigenous peoples about systemic racism and policy change.
But it’s now time for action. Canadian governments of all stripes need to acknowledge systemic racism within the healthcare system; stop using conversations to delay fixing the deeply rooted racist and discriminatory issues; and recognize that when we ALL do well, we prosper.
There needs to be more political will to address and solve systemic racism as well as recognition of Indigenous sovereignty and self-determination. Joyce’s death could have been prevented if only the governments would have been held accountable in having to implement changes and show results.
Let us not wait for another tragedy. Comfort may be a good place for Canadians to live but it is not a good place to grow, challenge the status quo and foster change to eliminate systemic racism and increase cultural safety for Indigenous peoples.