Indigenous Health Inequity: Understand our Journey, to Understand our Health
Will Chukra
Lac Seul First Nation Band Member
MD Candidate: Schulich School of Medicine & Dentistry
In Manitoba, the life expectancy for an Indigenous man is predicted to be 70.3 years, almost 10 years less than non-Indigenous Canadian men, who are expected to live for 79 years (Gunn, 2017). A similar discrepancy can be said for women, with Indigenous women having an average life expectancy of 77 years, and non-Indigenous Canadian women averaging 83 years of life (Gunn, 2017). The differences in health and well-being between Indigenous and non-Indigenous Canadians, as there has been growing awareness, research, and even changes made in our country to help address these issues. Despite progress, health disparities remain, and there is much to be done to ensure health care is truly equitable towards our Indigenous peoples.
In particular, racism continues to course through our healthcare systems. On September 28 of 2020, a 37-year-old Atikamekw woman and mother of seven named Joyce Echaquan died due to healthcare workers harbouring racially-guided assumptions about her suffering and worthiness to be treated with respect and timely care. Echaquan’s unfortunate story begins with her being admitted into the Centre Hospitalier de Lanaudiére in Saint-Charles-Borromée, Quebec. She was restrained to her bed and given morphine, despite her verbalized concerns that she would have an adverse reaction to it. Ignored by staff, Echaquan then started recording live on Facebook, where hospital staff are heard calling Joyce Echaquan stupid, questioning her life choices, and saying she’s only good for sex, and that she would be better off dead (Feith, 2020). Joyce Echaquan later went into cardiac arrest and then died from pulmonary edema, that physicians stated could have been prevented had she received the adequate care that she drastically needed sooner (Page, 2021). The death of Joyce Echaquan is a tragic reminder that systemic discrimination is ongoing within Canada’s healthcare system and that several Indigenous people have and will continue to face the resultant violence until immense changes are made.
Several changes need to be made to the healthcare system if there is to one day be equitable healthcare in Canada. For one, to understand Indigenous peoples' current health statuses, healthcare workers need to understand the current and historical colonial policies that Indigenous people have endured which have resulted in lasting impacts on our health and well-being (Kitching et al., 2020). Colonial practices such as starvation, incarceration, community confinement to reserves, child removal to “schools”, and much more, all had enormous, unequal impacts on Indigenous peoples’ physical health and well-being (Gunn, 2017). These colonial practices disrupted indigenous social, educational, knowledge, spiritual, and medicinal systems, and have ultimately led to barriers to health that we as Indigenous people are still trying to overcome, including the ongoing norms of mistreatment towards Indigenous peoples within healthcare. Therefore, one of the foundations to improving Indigenous healthcare is to first understand these colonial policies and systems and their impact on Indigenous health, as this can then help determine strategies for deconstructing them, followed by building systems that are more equitable to all.
While there have been efforts to improve healthcare for Indigenous people through systemic changes following the Truth and Reconciliation Commission of Canada’s Calls to Action, there is still an undeniable shortage of culturally safe health care providers. Kitching and colleagues (2020) conducted a study that assessed the prevalence of discrimination and unmet health needs that Indigenous people encounter in an urban hospital setting (Toronto, Ontario). It was found that in a 12-month period, 28.5% of Indigenous patients experienced discrimination by a healthcare provider, and 27.5% also experienced unmet health needs. Furthermore, those who had been discriminated against by a healthcare provider had over five times higher odds of reporting unmet health needs. The point here is that Joyce Echaquan’s story is not of rare occurrence. Many Indigenous people continue to encounter discrimination and a lack of care from their healthcare providers, and unfortunately, few have the opportunity to have their voices heard, often once it is too late and they have passed from an otherwise preventable cause.
As stated by Gunn (2017), to prevent further deaths and mistreatment such as that faced by Joyce Echaquan and many others, we need our healthcare leaders and policymakers to acknowledge the discrimination currently in the system and develop strategies for providers to become more culturally safe, ultimately reducing the harm Indigenous people encounter in healthcare. There needs to be further development of anti-racism policies, strategies, and training for all who work in the healthcare system, as well as for the students in healthcare. More specifically, these programs need to educate healthcare workers about the colonial history we’ve had to overcome (and are still dealing with today), and our resulting social disparities and inequities. Healthcare workers at all levels also need to understand our diverse culture and ways of life, our ways of healing that can benefit the medical system, and that we are worthy of their respect and care. This understanding begins by acknowledging that the various stereotypes set through Eurocentric views are not representative of who we are as people. Lastly, there need to be tools set in place that aid with effective communication, listening, and relationship building towards Indigenous patients, ensuring our voices are heard. While there is much more change that needs to be done to effectively create an equitable healthcare system, such structural, educational changes will be a leap in the right direction.
As an Indigenous person myself, I was taught of the prayer “grant that I may not criticize my neighbour until I have walked a mile in his moccasins.”. To me, this prayer teaches the importance of not judging others until you understand their perspectives and journeys in life. Regarding the Canadian healthcare system and its workers, our system and those it employs cannot enact stated commitments to equitable care in the absence of meaningful awareness and understanding about the colonial barriers Indigenous people have faced and continue to encounter. Rather than having racial stereotypes and assumptions guide care encounters between Indigenous and non-Indigenous peoples in Canada, we need care fostered by a deeper understanding of what we as Indigenous peoples have gone through to be where we are in terms of our health and well-being. Dr. William Osler once said “The good physician treats the disease; the great physician treats the patient who has the disease.” (Centor, 2007). Working towards a better understanding of our full story as Indigenous people through systemic changes to the education of healthcare providers, and the creation of channels for indigenous peoples to speak and be heard on their experiences with healthcare, is a first and essential step towards equitably treating us as patients, rather than clouding the treatment we need with racist biases and assumptions.
References
Centor R. M. (2007). To be a great physician, you must understand the whole story. MedGenMed : Medscape general medicine, 9(1), 59.
Feith, J. (2020, September 30). Indigenous woman records slurs by hospital staff before her death. Montreal Gazette. https://montrealgazette.com/news/local-news/indigenous-woman-who-died-at-joliette-hospital-had-recorded-staffs-racist-comments
Gunn, B. L. (2017). Ignored to death: Systemic Racism in the Canadian healthcare system. Retrieved from https://www.ohchr.org/sites/default/files/Documents/Issues/IPeoples/EMRIP/Health/UniversityManitoba.pdf
Kitching, G. T., Firestone, M., Schei, B., Wolfe, S., Bourgeois, C., O'Campo, P., Rotondi, M., Nisenbaum, R., Maddox, R., & Smylie, J. (2020). Unmet health needs and discrimination by healthcare providers among an Indigenous population in Toronto, Canada. Canadian journal of public health, 111(1), 40–49. https://doi.org/10.17269/s41997-019-00242-z
Page, J. (2021, May 27). Joyce Echaquan died of pulmonary edema, could have been saved, inquiry hears. CBC News. https://www.cbc.ca/news/canada/montreal/joyce-echaquan-inquiry-toxicology-1.6042783
Image retrieved from: Interior Health. (2019, April 11). Aboriginal Cultural Safety: How to be an Ally [Video]. YouTube. https://youtu.be/cLDkA2RIeCM
