Canada’s National Failure: Indigenous Health
Indigenous youth are often still vulnerable to systemic racism in the Canadian health care system. From Jeff Thomas (2015), https://www.cmaj.ca/content/189/2/E78
Canada is one of the most developed nations in the world, known for its universal healthcare system, world-class education, and multiculturalism. Yet, the construct of Canadian society has severely disadvantaged Indigenous Peoples, with decades of discrimination and inequities. Colonialism has left the Indigenous community suffering from severe cultural, psychological, and sociological erosion. According to the United Nations Human Development Index, which measures health and lifespan, knowledge and education, and standard of living, Canada ranks 3rd out of 177, but if the Indigenous population is accounted the ranking drops to 63rd out of 177 [4]. Healthcare has presented to be one of the major grievances within the community due to present day jurisdictional disputes, and systemic and epistemic racism within the current system.
In Canada, the organization of the healthcare system is determined by the constitution. The federal government is accountable for administering the responsibilities underlined under the Canada Health Act (CHA). The CHA establishes certain criteria and conditions that have to be met by provinces and territories for them to receive federal cash transfers to fund the provincial/territorial health departments [3]. The five main criteria underlined in the Act are public administration, comprehensiveness, universality, accessibility and portability [3]. The provincial governments are responsible for administering health care services such as physicians and hospital care [3]. Following the 1982 Charter, Indigenous healthcare is provided through two governance models; community-controlled health services responsible for First Nations Governance, and government-funded clinics provided through the First Nations and Inuit Health Branch (FNIHB), while more acute and complex care is provided by the provincial governments [5].
Through the FNIHB, the Federal Government delivers a limited amount of services focused on prevention and home care, as well as establishes a system of primary care clinics delivered by nurses[8]. Due to underfunding and improper infrastructure, there are vast amounts of problems within this system. A review conducted by the Federal Government in 2016, showcased that the Indigenous have “limited access to health professionals and lack diagnostic equipment in many communities. They must cope with poor infrastructure in nursing stations and health centres, and there are inadequate health records” [6]. The Federal Government is responsible for the implementation of CHA principles, and as such, they are responsible for the sufficient allocation of funding to the FNIHB, which is under their jurisdiction.
The jurisdictional dispute to receive health care prompted the creation of Jordan’s Principle; named in memory of Jordan River Anderson, a young boy from the Norway Cree Nation, who spent more than 2 years in hospital waiting for funding for at-home care for a rare genetic disorder [1]. Jordan’s Principle was created to ensure equal and equitable access to all government-funded resources for Indigenous children living both on and off reserves. During Jordan’s case, Canada and Manitoba fought over who had a jurisdictional right, and who ought to fund his care [1]. The Federal Government agreed to accept the Principle in 2007, but failed to properly implement all of the recommendations [1]. According to Cindy Blackstock, professor, social activist, and executive director of the First Nations Child and Family Caring Society of Canada, “The federal approach to Jordan’s Principle restricted it to health services and then only to services provided to children with multiple disabilities and multiple service providers” [2]. Due to jurisdictional disputes between federal and provincial governments, the health of Indigenous children across Canada is still widely overlooked.
In 2013, Jeremy Meawasiage and his mother were victorious in challenging the narrow definition of Jordan’s Principle [1]. Jeremy was severely disabled, and his mother, who was his primary caretaker, experienced a stroke which prevented her from looking after his needs [1]. The Government of Canada refused to pay fully for his care, only providing a third of the total cost saying the rest would be subsidized through the provincial government [1]. Jeremy and his mother went to court and won the case to receive the full amount, with a judicial ruling encouraging its full implementation across all government services [1]. But the federal government has failed to amend its definition [1]. Cases such as these present the difficulties that Indigenous families have to go through to get basic access to medical care. Within a nation that prides itself on its healthcare system, the lack of empathy towards Indigenous Peoples proves otherwise.
The current healthcare system was developed in accordance with western principles. Systematic and epistemic racism is evidentiary within the current laws, policies and practice of health. Systematic racism can be regarded as the marginalization of the Indigenous due to underfunding, poor infrastructure, and denial of services. Though the cause may be related to finance, it is important to recognize that the Indigenous are in this situation due to colonialism. Likewise, epistemic racism within the healthcare system can be the imposition of western medical practices over Indigenous health practices. Within many government-funded clinics on reserves, Indigenous healing practices are not seen as legitimate, and as such, they are not allowed to be practiced within the clinics, regardless of their merit [9].
Refusal of the government to allocate funding towards Indigenous cultural healing processes showcases that health, law, and policy within Canada continues the process of cultural erosion. In the case of the Indigenous, it is important to preserve their healing methods and beliefs, as it can reshape the healthcare environment and allow the Indigenous to regain their trust within the healthcare system. In the case of mental health and healing, it has been showcased that Indigenous circles are extremely effective within the community. According to Research conducted by Lynn F. Lavallee & Jennifer M. Poole, the Indigenous healing methods helps in “self-esteem as well as recognizing and working against feelings of undeservingness. Healing must also begin with an Indigenous understanding of mental health” [7]. As such, the federal government should ensure a funding system, in which the Indigenous can have access to both western medical clinics but also Indigenous healing clinics.
Health care is one of the major grievances within the Indigenous community. Colonization has brought upon severe cultural, economic and physical victimization of the Indigenous, and many of their health problems are related to the impacts of colonization. To continue, jurisdictional disputes over funding has caused many problems for the Indigenous as they are unable to have proper access to the healthcare system. Finally, racism is still ingrained into the healthcare system and actions have to be taken to mitigate its effects. The Indigenous have the right to a health-care system which respects their cultural identity and provides them with equal and equitable access to resources. The Government of Canada, has the duty to comply with their requests.
References
[1] Blackstock C. (2012). Jordan’s Principle: Canada’s broken promise to First Nations children?. Paediatrics & child health, 17(7), 368–370.
[2] Blackstock C. (2016). Toward the full and proper implementation of Jordan’s Principle: An elusive goal to date. Paediatrics & child health, 21(5), 245–246. doi:10.1093/pch/21.5.245
[3] Canada, H. (2011, May 26). Canada’s Health Care System [Education and awareness]. Retrieved November 5, 2019, https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html#a6.
[4] Chambers, L., & Burnett, K. (2017). Jordan’s Principle: The Struggle to Access On-Reserve Health Care for High-Needs Indigenous Children in Canada. The American Indian Quarterly 41(2), 101-124. https://www.muse.jhu.edu/article/663047.
[5] Dwyer, J., Boulton, A., Lavoie, J. G., Tenbensel, T., & Cumming, J. (2014). Indigenous peoples’ health care: New approaches to contracting and accountability at the public administration frontier. Public Management Review, 16(8), 1091-1112. doi:10.1080/14719037.2013.868507.
[6] Galloway, G. (2017, April 14). Ottawa still failing to provide adequate health care on reserves: Report. (n.d.). Retrieved from https://www.theglobeandmail.com/news/politics/ottawa-still-failing-to-provide-adequate-health-care-on-reserves-report/article33746065.
[7] Lavallee, L. F., & Poole, J. M. (2010). Beyond recovery: Colonization, Health and Healing for Indigenous People in Canada. International Journal of Mental Health and Addiction, 8(2), 271–281. https://doi.org/10.1007/s11469-009-9239-8.
[8] Lavoie, J., Kornelsen, D., Wylie, L., Mignone, J., Dwyer, J., Boyer, Y., . . . O’Donnell, K. (2016). Responding to health inequities: Indigenous health system innovations. Global Health, Epidemiology and Genomics, 1, E14. doi:10.1017/gheg.2016.12.
[9] Matthews R. (2016). The cultural erosion of indigenous people in health care. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 189(2), E78–E79. Advance online publication. doi:10.1503/cmaj.160167.