Joyce Echaquan, Brian Sinclair, Jordan River Anderson – our healthcare system failed these Canadians in the worst possible way. All three suffered unduly and died within a health care system that did not give them the care they deserved simply because of their Indigenous identity. Their powerful stories are not isolated anecdotes but part of a systematic problem.
A recently published study examined more than 11 million emergency department visits in Alberta and found that First Nations’ patients were assigned lower priority for treatment than non-First Nations patients. This was true for conditions such as upper respiratory infections and anxiety, but also for obvious and painful diagnoses such as long bone fractures.
It has been well-documented that Indigenous people have worse health outcomes in Canada – from lower life expectancy to increased rates of chronic disease. Most of these differences can be explained by poverty, lack of access to clean water, substandard housing and other social determinants of health. But they are also in part related to how Indigenous people in Canada are treated by the health care system.
Take the case of Brian Sinclair, an Indigenous man referred to a Winnipeg hospital emergency room for urgent treatment. He sat in the emergency waiting room for 36 hours before dying of a treatable urinary tract infection. At the inquest into his death, nurses testified that they noticed him in the waiting room but did not check on him because they assumed that he was drunk or homeless or waiting for a ride to pick him up.
Stereotyping of Indigenous people as alcoholics or homeless or not deserving of urgent care is unfair and dangerous. It can lead to fatal outcomes as it did for Sinclair. Health care professionals, either unconsciously or overtly, often blame Indigenous people for their medical problems.
We are all guilty to some extent or another of assuming that the world works for other people in the same way that it works for us. If we are lucky enough to be born into social privilege, we may blame Indigenous people for their misfortunes and be blind to the racism and injustices faced by them.
Joyce Echaquan posted a video recording of health care professionals insulting her in her dying moments at the hospital in Joliette, Quebec. As painful as it was to witness the interpersonal racism she experienced, it was only one source of her unnecessary suffering.
Systemic racism and discrimination embedded in the policies and practices of the Canadian health care system can have an even greater negative effect on the health outcomes of Indigenous people. These systemic effects can be invisible to other Canadians, even to those who work within the health care system.
The federal-provincial jurisdictional debate over health care provision for Indigenous peoples contributes to Indigenous people receiving substandard health care in Canada. Provinces are responsible for health care provision. But the federal government has control of “Indians” and “Indian lands”, and has a duty to provide health services for Indigenous people. Interpretation of which level of government provides what health care service to Indigenous people varies from province to province. It is often arbitrary and results in both federal and provincial jurisdictions denying responsibility for key services.
Jordan River Anderson was born into and died within the confines of this debate. He was born with multiple medical conditions and disabilities, and died five years later having spent his entire life in hospital. Why? The province of Manitoba and the government of Canada could not agree on who would pay for home-based medical care for Jordan, thus denying him the right to live at home in the community like every other child in Canada.
We have a lot of work to do in improving healthcare for Indigenous children and adults. We must start with acknowledging that systemic racism exists within our health care system. We need policy makers, healthcare leaders, and healthcare workers to use multiple strategies to counteract the harms created by racism. We need to examine existing policies and practices to make sure that they are not oppressive nor perpetuate negative health outcomes for Indigenous people.
Anti-Indigenous racism and cultural safety training for all working in health care is essential. Education on the colonial history of Canada, and the consequences of policies to eliminate or assimilate Indigenous people, will provide context for understanding why Indigenous people experience the health and social problems they do.
Access for Indigenous people to traditional healing practices and acknowledgement of Indigenous worldviews will help Indigenous people heal on all levels – spiritual, emotional, physical and social. Furthermore, reviving culture, language and connection to the land will be crucial to promoting the health of Indigenous people.
Policies to provide clean water, adequate housing, and other social determinants of health have to be put into place if we are to eliminate inequalities between Indigenous and non-Indigenous Canadians. And finally, ensuring that Indigenous communities and people have adequate funding and decision-making power over their health care services will ensure anti-racist and culturally-safe health services.
Racism kills and it has no place in a health care system tasked with saving lives.
Vamini Selvanandan is a family physician and public health practitioner in Alberta. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles like this, visit www.engagedcitizen.ca.
