GRSJ224/IndigenousDiscriminationInTheCanadianHealthCareSystem

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Overview

Indigenous Canadians, specifically Metis, Inuit, and First Nations people, continue to experience a significant decline in health and health care treatment in contrast to their non-Aboriginal counterparts. Specific health issues affecting Indigenous peoples include high infant and young child mortality, malnutrition and stunted growth, heavy infectious disease burdens, shortened life expectancy, social problems, and a wide range of other ailments [1]. The prevalence of chronic conditions and subsequent lower life expectancies of Indigenous Canadians can be contributed to the underlying social determinants of poor health that have historically plagued Indigenous peoples, and has resulted in the “significant health disparities (that) exist between Aboriginal and non-Aboriginal Canadians” [1]. Historical, as well as present discrimination against Indigenous peoples within the Canadian health care system has been linked to systemic racism, internalized biases, and lack of knowledge surrounding Indigenous way of life, and has thus contributed to the heavy burden of illness suffered by Indigenous peoples [2].

Health Issues

Indigenous Canadians experience a wider range of health issues than the rest of the population in Canada. This includes chronic diseases such as heart disease and diabetes, obesity, arthritis, hypertension, respiratory problems, and a higher rate of infectious diseases particularly among indigenous children.[3] Tuberculosis is a disease that is more than 40 times higher among Indigenous people.[4] As a result of the social inequities faced by this cohort including lower education levels, inadequate housing, lower income, and higher unemployment to name a few, suicide rates are much higher among Metis, First Nation, and Inuit people. For youth, the suicide rate is “11 times the national average”.[3] Additionally, physical and mental illness, depression, and worse self-rated health continues to plague this community. These overwhelming health problems contribute to an alarming fact; that Indigenous people experience earlier death and illness than non-Aboriginal people in Canada, and a lower life expectancy overall.[3]

Historical Origins

Discrimination against Indigenous peoples can be traced to the historical roots in colonialism; constructing the notion of the inferiority of indigenous peoples, and influencing deeply held stereotypes today [5]. The legacy of mandatory residential schools, discriminatory child welfare legislations, outlawing of Indigenous practices, and other aggressive assimilation schemes, are the systemic factors of colonization that has dramatized current health issues in Indigenous communities [6]. Sponsored by the government, Residential schools attempted to assimilate Indigenous children into Canadian society; in the process, disrupting lives, communities, and causing long term health problems [7]. The cultural deprivation and systemic isolation resulting from colonial practices such as segregation and residential schools has then created a vicious cycle of health injustice, and well-documented disparities in Aboriginal and non-Aboriginal health [8]. These policies have left behind a legacy where Indigenous Canadians are traumatized from enduring abuse, discriminated against, and unable to cope with the inequalities of health care treatment that exist [9]. Other factors contributing to the current health climate include the dispossession of Indigenous lands leading to limited healthy food choices, inadequate living conditions, and experienced interpersonal racism from health care providers [10].

Indigenous Discrimination in Health Care

The disparity in access to health care services and treatment between Aboriginal and non-Aboriginal Canadians persists. Receiving “second-class health care,” this is in part due to the stereotyping, abusive treatment, and lack of quality care received by Indigenous peoples, which then discourages their seeking of medical care and attention [11]. Power imbalances within the health care system as well as the social, political, and colonial history experienced by Indigenous peoples has resulted in systemic discrimination and racist practices by health workers [12]. The heavier burden of illness faced by this group also contributes to the lower life expectancy for Canada’s Indigenous population; 68.9 for men, and 76.6 for women [4]. One of the most harmful stereotypes that negatively impacts the treatment received by Indigenous peoples is the image of the ‘drunken Indian’. Biased assumptions are formed by these broad societal views, and consequently contributes to both procedural neglect, and caring neglect by health care providers [13]. Another issue that compromises the standards of care is the lack of understanding and knowledge towards Indigenous challenges, culture, and medicinal practices which prevents health care workers from adequately providing, and caring for their specific needs [5]. Poor communication, trust, and unwillingness to listen to the unique experiences of Indigenous peoples has led to the cycle of ineffective health treatment, and worsening health for this cohort. As a result of the western approach to healthcare in Canada, “only 64% of First Nations people provided a positive rating for the quality of healthcare received” in the previous year [14].

Reforms

In order to improve the care of Indigenous peoples within the Canadian health care system and address the prevalent issues of racism and discrimination, certain measures must, and have been taken. Informative courses in cultural competency have generated greater awareness among health care providers about Indigenous history and knowledge [4]. Additionally, the recognition of internalized biases that lead to discriminatory behaviour and inferior care has been achieved through Cultural Safety Training Programs [5]. The 2015 Truth and Reconciliation Commission has similarly sought to educate the public on the experiences of Indigenous peoples within residential schools, and encourage a shift in attitudes away from negative stereotyping, and attempt to eliminate discrimination within health services. Overall, equity for Indigenous peoples within the healthcare system is an ongoing struggle, and requires attention to internalized biases, further knowledge, improved skills of health care providers, accountability of healthcare organizations, and more inclusive health care access to improve the lives of all Indigenous peoples in Canada [5].

References

  1. ↑ 1.0 1.1 "Introduction to Aboriginal Health and Health Care in Canada". Historical Overview. 2013. doi:10.1891/9780826117991.0004.
  2. ↑ Cameron, B.L. (2014). "Understanding Inequalities in Access to Health Care Services for Aboriginal People". Advances in Nursing Science. 3: 37. doi:10.1097/ans.0000000000000039.
  3. ↑ 3.0 3.1 3.2 Lendsay, K. (n.d.). "Indigenous Health Issues in Canada".
  4. ↑ 4.0 4.1 4.2 Rammohan, I. (September 16, 2019). "Why do Canada's Indigenous People Face Worse Health Outcomes than Non-Indigenous People?".
  5. ↑ 5.0 5.1 5.2 5.3 Wylie, L. (2018). "Insiders' Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals". Journal of Racial and Ethnic Health Disparities. 1: 6. doi:10.1007/s40615-108-0495-9.
  6. ↑ Duran, J. (March 17, 2019). "A Glance at the State of Indigenous Health".
  7. ↑ Miller, J.R. (October 10, 2012). "Residential Schools in Canada".
  8. ↑ McCue, D. (February 4, 2015). "'Unconscious, pro-white bias' a major factor in poor aboriginal health care". CBC News.
  9. ↑ Malone, G. (August 21, 2018). "Indigenous patients still waiting for equity in health care: Canadian doctor".
  10. ↑ Leyland, A. (2016). "Health and Health Care Implications of Systemic Racism on Indigenous Peoples in Canada". Indigenous Health Working Group: 1–6.
  11. ↑ Marchildon, J. (July 6, 2018). "Canada's Indigenous People are Dying Because of Racism in Health Care".
  12. ↑ Boyer, Y. (November 20, 2017). "Healing Racism in Canadian Health Care".
  13. ↑ Gunn, B.L. (n.d.). "Ignored to Death: Systemic Racism in the Canadian Healthcare System". The Study on Health: 1–7.
  14. ↑ Goodman, A. (2017). ""They treated me like crap and I know it was because I was Native": The healthcare experiences of Aboriginal peoples living in Vancouvers inner city". Social Science & Medicine. 178: 87–94. doi:10.1016/j.socscimed/2017.01.053.

Candace Sykes

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