Hospital room. Image credit: Daan Stevens/Unsplash

Imagine living in a country where hospitals refused to treat you for a stroke, because the doctors and nurses assumed you were drunk. Imagine further that the emergency room doctor refused to treat your young child for epilepsy, because they assumed she was on drugs. Well folks, that country is Canada.

It doesn’t sound like the Canada you know. It doesn’t seem to reflect Canada’s world-renowned medical experts and hospitals. Nor does it seem to jibe with Canada’s impressive array of human rights protections. Yet, if you are Indigenous in Canada, you can expect this kind of treatment, and worse — even in Canada’s best hospitals in British Columbia.

Just before the holidays, a report was released which confirmed what most Indigenous peoples already knew — that racism against Indigenous peoples, especially First Nations peoples — is widespread in B.C.’s health-care system.

In plain sight

The report entitled “In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care“ was written by Dr. Mary Ellen Turpel-Lafond who was the first First Nations judge appointed to the provincial court of Saskatchewan, former child and youth advocate in B.C., and now the independent investigator for this report.

She had been appointed by B.C.’s minister of health to conduct a review of racism against Indigenous peoples in B.C.’s health-care system. Dr. Turpel-Lafond and her Indigenous-led team engaged in four months of investigations, which included:

  • talking to 9,000 people from B.C.;
  • reviewing 185,000 data sets, including more than 900 studies; and
  • logging 600 cases via their 1-800 number and website.

The report — which includes both its core findings and recommendations — contains numerous examples of Indigenous peoples given substandard medical treatment or no treatment at all in hospitals and health-care facilities of all kinds. In some cases, individuals were treated so poorly that they refused to go back for treatment and this was especially true for Indigenous women.

Findings

There were 11 main findings divided into: the problem of Indigenous-specific racism and the problem with current solutions — both of which provide significant insight into the lack of accountability for racism and the harm it causes Indigenous peoples in B.C.’s health-care systems.

Her main findings in relation to anti-Indigenous racism were as follows:

1. Widespread Indigenous-specific stereotyping, racism and discrimination exist in the B.C. health-care system;

2. Racism limits access to medical treatment and negatively affects the health and wellness of Indigenous peoples in B.C.;

3. Indigenous women and girls are disproportionately impacted by Indigenous-specific racism in the health-care system;

4. Current public health emergencies magnify racism and vulnerabilities, and disproportionately impact Indigenous peoples and

5. Indigenous health-care workers face racism and discrimination in their work environments.

She also noted that talking about anti-Indigenous racism in health care can be very triggering for Indigenous peoples who have experienced the physical and mental harms associated with racist comments, substandard treatment or the denial of treatment. At the same time, she also stressed that the issue must be named, so that institutions can be held to account and the problems addressed.

Stereotypes

Dr. Turpel-Lafond shared the eight most common racist stereotypes held by B.C. health-care workers about Indigenous peoples (primarily First Nations), and include that belief that they are:

1. Less worthy of care;

2. Drinkers/alchoholics;

3. Drug seekers;

4. Bad parents;

5. Frequent flyers — misuse health system;

6. Irresponsible and won’t do aftercare;

7. Less capable; and

8. Unfairly advantaged.

Racism causes real harm

She also stressed that these racist stereotypes lead to real physical harm, mental harm and even death for Indigenous peoples, in the following ways:

1. Unacceptable personal interactions — like racist comments;

2. Long wait times/denial of service — more so than non-Indigenous patients;

3. Lack of communication/shunning Indigenous patients;

4. Not believing or minimizing health concerns — Indigenous peoples accused of faking;

5. Inappropriate or no pain management — assuming patients are drug seeking;

6. Rough treatment — like man-handling or physical harm;

7. Medical mistakes and misdiagnosis — assuming patients drunk and not addressing underlying health issues; and

8. Lack of respect for cultural protocols — intolerance of families or ceremonies.

The significant harms experienced by Indigenous peoples on a regular basis are why the report’s recommendations on how to move forward to address anti-Indigenous racism in B.C.’s health-care system are so important. At their core, the recommendations all work to confronting the legacy of colonialism in health care head on:

“A basic awareness has grown that the current inequities and injustices faced by Indigenous peoples in Canada — such as those examined in this Review — are deeply rooted in an enduring legacy of colonialism, and that confronting that legacy requires substantive, transformative change.”

Moving forward

It is important that Canadians read this report and then push governments, hospitals, universities and all those working in the health-care system in any capacity to embrace their role in reconciliation and ensuring that the human rights of Indigenous peoples to health care are respected, protected and fully implemented. To do this, Dr. Turpel-Lafond believes that our collective path forward must be based on acknowledging and accepting three foundational principles:

1. Racism in health care reflects a lack of respect for Indigenous rights to health;

2. Racism in the health-care system is integrated with racism in society; and

3. While Indigenous voices must be centred in developing solutions, the responsibility to do this work rests with non-Indigenous people, communities, organizations and governments.

Before anyone breathes a sigh of relief that this is only a B.C. issue — it isn’t. Anti-Indigenous racism in health care is rampant in other provinces as well. It was only weeks ago that Quebec came under fire when a video showed nurses making racist and hateful comments to Joyce Echaquan before she died in the hospital. This was not an isolated incident but reflects a long-standing pattern of racism experience by Indigenous peoples in Quebec hospitals.

Don’t forget the Brian Sinclair inquiry in Manitoba, which documented how the hospital staff ignored Brian — a double amputee confined to a wheel chair — for 34 hours until he subsequently died of a treatable urinary tract infection. And sadly, these are not exceptional cases. From the Royal Commission on Aboriginal Peoples in 1996 to the Truth and Reconciliation Commission’s report in 2015 and the National Inquiry into Missing and Murdered Indigenous Women and Girls report in 2019 — racism in health care is a national crisis and has been for decades. 

Health care is a human right

Racism in health care is a matter of life and death for Indigenous peoples and forms part of the ongoing genocide that the national inquiry talked about in their report.

It was important for the B.C. government to undertake this investigation and accept the findings. Every other province and territory should follow suit and conduct a similar investigation. While it is important that B.C. Minister of Health Adrian Dix apologized and committed to take action — it is yet to be seen whether they will take the action needed to hold themselves accountable, make the required changes and make reparations to Indigenous peoples. Given the many reports sitting on government shelves gathering dust, it is incumbent on Canadians to do their part to ensure governments are held to account.

Health care is a basic human right and we are all served when we take steps to make sure that all peoples — including Indigenous peoples — can enjoy that right.

Pamela D. Palmater is a Mi’kmaw lawyer and member of the Eel River Bar First Nation in New Brunswick. She teaches Indigenous law, politics and governance at Ryerson University and heads Ryerson’s Centre for Indigenous Governance. This article was originally published in Indigenous Nationhood.

Image credit: Daan Stevens/Unsplash