GRSJ224/Disparate Postcolonial Access to Healthcare among Canada’s Indigenous Peoples

Disparate Postcolonial Access to Healthcare among Canada’s Indigenous Peoples

Overview

In theory, every person in Canada is supposed to have fair and equal access to medical treatment without fear of financial barriers or any form of discrimination . However, there is ample evidence which indicate that Indigenous peoples, which include First Nations, Metis, and Inuit, do not have equal or equitable access to healthcare when compared to non-Indigenous Canadians . Such healthcare disparities experienced everyday by Indigenous peoples is a legacy of Canada’s racist, colonial past as this visible minority has been historically treated as second class citizens in their own land . Historically, European colonial authorities considered Indigenous peoples to be underdeveloped, uncivilized, and uneducated, and were determined to “civilize” these “barbarians” by imposing Euro-centric ideas on Canada’s natives . Many of the existing physical and mental health issues common among First Nations peoples can be traced to past racist policies, such as the Indian Act (1876), growing up in abusive residential schools or living in under-funded, isolated native reserves . Even urban Aboriginals experience racism and inequalities when trying to access medical care in Canadian cities and towns . To deal with post-colonialism and healthcare issues (PCH), Canadian healthcare training programs should incorporate PCH-specific content such as teaching medical students about the history of the colonization and systemic mistreatment of Canada’s Aboriginal peoples .  

Colonialism & Canada’s Indigenous Peoples

In the post-Confederation era, colonial authorities adopted supposedly ‘protective paternalistic policies’ because the European colonists held very low opinions of the native peoples . The racist European colonial authorities considered Indigenous peoples to be uncivilized and uneducated, and were determined to impose Euro-centric ideas and ideals in order to “civilize” these supposed “barbarians” . Many of the existing physical and mental health issues common among First Nations peoples can be traced to past racist policies, such as the Indian Act (1876), growing up in abusive residential schools or living in under-funded, isolated native reserves with poorly equipped or no local hospital .  Colonial authorities forced native bands to leave their traditional lands and most were moved to native reserves that were, at the time, considered undesirable for settlement by newly arrived European colonists and farmers . Along with the Indian Act (1876), the government’s assimilative policies included the establishment of residential schools, where all every Indigenous child was supposed to be taken in order to learn basic math, English, and other lessons . The children were forbidden from speaking native languages, performing native cultural traditions, or communicating with the families and native tribes back home . The intent of the ‘cultural, ethnic, linguistic and religious imperialism’ practiced by the churches which operated the government’s residential schools was to commit cultural genocide by cutting off native children from their own people and cultures .  

Postcolonialism & Health (PCH)    

In the postcolonial era, many Indigenous communities and individuals continue to suffer from widespread inequities, like healthcare disparities. One of the most cherished aspects of Canadian society is reasonable access to the country’s massive public healthcare system. In theory, every person in Canada is supposed to have fair and equal access to medical treatment without fear of financial barriers or any form of discrimination . The Canadian Health Act (2010) even states that ‘healthcare should be accessible to everyone without any discrimination’ . However, there is ample evidence which indicate that Indigenous peoples, which include First Nations, Metis, and Inuit, do not have equal or equitable access to healthcare when compared to non-Indigenous Canadians . Most notably, sick or injured Indigenous people face the challenges of an uneven distribution of healthcare services if they live in rural areas or on isolated reserves far from cities and city hospitals . For instance, in Manitoba, of the 63 native communities, 25 are considered to be isolated . While rural areas have traditionally had less healthcare resources, native reserves located in remote areas have even less access to qualified health practitioners and many only have small first aid clinics. Many reserves are dependent on a nurse or nurse practitioner who travels to several remote communities to provide some primary healthcare on a rotating schedule . Significantly, changes to the Indian Act has resulted in the ‘disintegration of a system of health care financing and delivery designed to serve the needs of First Nations’, leaving many native reserves with an even less stable, uncertain healthcare services situation . The low numbers of residents in many reserve communities result in ‘diseconomies of scale’ which makes it challenging to recruit and retain qualified healthcare professionals, especially if the reserve is in a remote location .

Racism & Sexism Impacts Indigenous Women

There is also ample evidence that even among Indigenous people, Indigenous women have suffered from the compounded impact of racism and pervasive sexism . Indigenous women, in general, are in poorer health and have less access to good healthcare situations than other groups of Canadian women . Just as Indigenous men often face barriers caused by racism in the healthcare system, Indigenous women face the same racism but with the added burden of facing sexism in the same system. Such healthcare disparities experienced everyday by Indigenous peoples is a legacy of Canada’s racist, colonial past as this visible minority has been historically treated as second class citizens in their own land, which would make Indigenous women third class citizens .

Urban Aboriginals Healthcare Inequities

Not only are residents of native reserves with poor healthcare facilities impacted, because even urban Aboriginals experience racism and inequalities when trying to access medical care in Canadian cities and towns . This last fact is significant because over 55 percent of registered Native peoples live off-reserve, mainly in bigger Canadian cities . Certainly by living in major cities there are more hospitals and better equipped hospitals to choose from when ill or injured. The greater healthcare issue faced by urban Aboriginals needing medical attention is the high likelihood of having to deal with racism by their healthcare providers . Many urban Aboriginals have suffered through a lifetime experience of racial discrimination from healthcare providers and, as a result, have many unmet health needs . There is a lot of proof that those who have ‘lower access to medical services’ will also suffer from ‘lower health status’ .

Recommendations:

Retraining & Restructuring of Medical Training Programs

To deal with post-colonialism and healthcare issues (PCH), Canadian healthcare training programs should incorporate PCH-specific content such as teaching medical students about the history of the colonization and systemic mistreatment of Canada’s Aboriginal peoples . Past researches that exposed the unmet health needs of Indigenous patients who faced discrimination in the healthcare system highlight the need to increase ‘Indigenous cultural safety training for healthcare providers’ . Therefore, by including education on Indigenous cultures and histories in their modified curriculums, future healthcare professionals will hopefully have the knowledge and training to be less racist and more understanding when dealing with Indigenous patients . Licensed healthcare professionals and medical workers should also receive some retraining on these same issues to lessen the discrimination faced by their Indigenous patients.

Increasing Healthcare Resources to Indigenous Communities (Reserves & Urban Natives)

With so many Indigenous communities poorly served by healthcare professionals and services, there is a major need to increase funding to both expand services and facilities, but to also increase recruitment of medical personnel to help patients in these communities. Among the native bands which have won land claims and gained greater control over their lands and resources, some of this increased funding should come from the native communities themselves. However, medical colleges should be encouraging more of their graduates to consider starting their careers treating under-served native communities rather than trying to enter saturated city ‘markets’ where there are already plenty of medical professionals.