The Big Picture: The death of Joyce Echaquan last month forced many Canadians to acknowledge that anti-Indigenous medical racism can be murderous. Few realize, however, that medical racism in Canada is not only murderous, but genocidal.
Anti-Indigenous racism in healthcare is a form of state violence, invisible to many of us who are privileged enough to be shielded from the daily trauma that many Indigenous peoples regularly experience in clinic rooms and hospitals across the country.
The medical system in Canada is two-tiered, and no health minister has taken the necessary steps to dissolve it.
When Kennedy* was selected to participate in a week-long student program for Indigenous students at her local hospital, she thought that she might be inspired to pursue medicine as a career.
Instead, the medical racism she witnessed deterred her from the profession forever.
“At the hospital, I saw hearts and skulls being opened, legs being amputated with the flesh still burning …” Kennedy recalls. “After my experiences, however, I realized that it was not the blood that I was scared of, but the overt racism I witnessed in the hospital against Indigenous patients.”
“That is what scared me the most, not the blood. I’ve continued to have nightmares about the way they treated one Indigenous woman.”
What did Kennedy see, and why is medical racism in Canada invisible to so many?
* Kennedy is an adult working professional from a city in a Canadian prairie (Alberta, Saskatchewan or Manitoba) province. They are First Nations. They have experience volunteering & shadowing in the medical field at a local hospital in a predominantly Indigenous neighbourhood. Themselves, their relatives and their friends have witnessed and/or experienced various incidents of racism while accessing healthcare services across the prairie provinces.
Health Inequality between Indigenous and Non-Indigenous People in Canada
According to a 2016 study sponsored by the University of Toronto, health inequality between Indigenous and non-Indigenous Canadians is greater than in the United States. It follows that the Canadian healthcare system may inhabit some of the highest levels of medical racism worldwide.
- A closer look at the numbers, recently published in a report conducted under the supervision of Dr. Theresa Tam, support this claim.
Life expectancy for Indigenous peoples in Canada is 10 years lower than the national average. Furthermore, First Nations, Inuit and Métis people are 2-3 times more likely to die from unintentional injuries, pointing to their severe lack of healthcare access in combination with remote and unsafe living conditions.
- These physical barriers to health translate to psychologically violent conditions, as suicide rates for all Indigenous peoples were found to be 2-6 times the national average.
- Rates of Type 1 and Type 2 diabetes, tuberculosis, obesity and other chronic and acute conditions are also significantly more common amongst First Nations, Métis and Inuit communities as well.
To Canadian citizens, it is important to recognize that these statistics are more than just numbers. They translate to the family members, friends and acquaintances of Indigenous peoples who are dying and experiencing suffering at alarmingly high rates compared to non-Indigenous populations.
These numbers signal an ongoing tragedy and the incessant loss of innocent life.
Systemic Barriers to Basic Healthcare
Many Indigenous peoples and non-Indigenous Canadians, who do not live in remote regions nor on reservation, are unaware of the numerous barriers Indigenous communities face when attempting to access basic healthcare services.
- According to Cathy Naveau, an Indigenous woman from Timmins, Ontario, her community’s local hospital is often referred to as a “place to go and die.”
- An anonymous Cree individual living in Saskatoon made similar associations between death and St. Paul’s Hospital. St. Paul’s Hospital services a dominantly Indigenous population and has the highest rate of inpatient mortality in Canada.
These stories are not isolated cases, but reflective of a more disturbing and decades-long trend involving Indigenous healthcare’s defunding and First Nations, Inuit and Métis health’s disregard.
- To begin, there is no national healthcare policy which provides comprehensive care for all status Indians, otherwise known as Indigenous peoples in Canada with government-recognized ancestry.
- Unlike the Canada Health Act, which guarantees universal, portable and accessible healthcare for all Canadians, irrespective of socioeconomic status or ethnic background, provincial healthcare policies for Indigenous peoples are scattered and non-uniform.
- Available Indigenous healthcare policies differ from province to province regarding critical aspects of care, such as the use of traditional healing practices and the ability of the province to request financial assistance from the federal government to provide care. In many provinces, there isn’t a framework outlining Indigenous patient coverage at all.
This incomprehensible patchwork of provincial healthcare policies for status Indians means that First Nations and Métis people, and Inuit patients are often caught between provincial and federal financial disputes whilst waiting for life-saving medications or critical care.
The Non-Insured Health Benefits Program
When care is finally accessed, it furthermore exists at a quality that is sub-par to individuals who are not using federal healthcare.
Contrary to a popular misconception in Canadian culture, a status Indian card does not guarantee free access to all of the same healthcare services that non-status Indians or other Canadian citizens receive.
There is a limit to what is covered, and this limit encroaches on progressively more basic services each year. There are a number of necessary medical services that are not insured by provinces and territories or other private insurance plans.
- As a result, the Canadian government founded the Non-Insured Health Benefits program (NIHB) to provide eligible First Nations & Inuit clients with coverage for health benefits not covered with social programs, private insurance plans nor provincial or territorial health insurance.
- The NIHB is the primary body responsible for providing healthcare to Canada’s First Nations people.
While many recognize that the NIHB program covers dental and vision care, mental health counselling as well as rehabilitation services, it is less well-known that the NIHB also provides critical ambulance funding, medical supplies and equipment, as well as prescription and over the counter (OTC) medications.
- These essential items include transportation to the nearest hospital for remote or reserve communities, dressings and bandages, oxygen supplies and equipment and respiratory supplies and equipment.
Consequently, as a status Indian, encountering a physician who does not have a clear understanding of the NIHB and how they can be compensated for your care already presents a life-threatening scenario prior to the provision of medical treatment itself.
Structural and Attitudinal Racism in Healthcare
Beyond the structural barriers to equity in healthcare for Indigenous peoples in Canada, there is the overt, attitudinal racism from healthcare workers that people such as Kennedy witness on a regular basis.
A relative of Kennedy’s once had an aneurysm labelled as a hangover: As a result, they passed away prematurely.
“A very close relative of mine once had a series of terrible, excruciatingly painful headaches. They went to the doctor three to four times to ask for help with a diagnosis. Each time, their physician would say that it was likely from drinking and that they should go home and get some rest. But my family member was not even drinking alcohol at the time…regardless, further testing from her physician was not pursued at all. Tragically, one week after my close relative’s last doctor’s appointment, they had a brain aneurysm and died. They were supposed to have been at my wedding the following weekend.”
Why didn’t Kennedy file a wrongful death lawsuit? Unfortunately, for many Indigenous peoples across Canada, these lawsuits are far too expensive, inaccessible and fruitless.
“I could have filed a wrongful death lawsuit, but how could I provide the evidence?” Kennedy states. “Furthermore, I work full-time as a professional. Where would I find the time to pursue legal action? These hospitals and doctors often rely on the fact that lawsuits are so difficult to file and pursue. As a result, there are no repercussions for many medical malpractices.”
Kennedy’s story is not an isolated case. From the story of Joyce Echaquan, to Brian Sinclair, to Jordan River Anderson and the numerous lawsuits that have been filed against the Timmins Hospital , there is a disturbing pattern of racism amongst Canada’s healthcare system. The stories we hear as non-Indigenous Canadians are a sliver of medical racism’s traumatic reality.
The Final Word: Through its structural and attitudinal manifestations, medical racism continues to perpetuate state violence against hundreds of thousands of Indigenous peoples in Canada.
And so, I ask: How can we begin to decolonize our healthcare system, to find the political will to enact new policies which heal and protect Indigenous lives?
I believe that it begins with each and every Canadian’s deeply personal recognition that our state-operated medical system is anti-Indigenous by design. As we begin to reject willful ignorance of, and complicity with oppression, we can build a better world.