“The Next 150”: A Focus on Indigenous Health Care at The Dalla Lana School of Public Health’s 10th Annual Student-led Conference
The necessity of truth in the Truth and Reconciliation process was discussed head-on at “The Next 150: Resisting colonialism and (re)claiming health on Turtle Island,” the Dalla Lana School of Public Health’s 10th student-led conference. Hosted at the Dalla Lana School of Public Health, the conference drew a number of academics, community partners, and student researchers, all of whom focused on contextualizing the state of the health of Indigenous peoples within Canada’s colonial history.
Held on November 10th and 11th 2017, the event was a response to recent Canada 150 celebrations which largely overlooked the impacts that colonization has had on Indigenous people, whose history on Turtle Island, the original name for North America, far exceeds Canada’s own.
The conference was jointly sponsored by a number of bodies, which included Access Alliance, the Association of Local Public Health Agencies, Diabetes Canada, the University of Toronto’s Institute of Health Policy Management and Evaluation, Public Health Ontario, Sinai Health System, Toronto Public Health, the Dalla Lana School of Public Health, the Public Health Students’ Association, End Poverty Now, Nihang Law, St. Michael’s Hospital, and the University of Toronto’s Arts and Science Students Union.
As was discussed throughout the conference, knowledge and a critical understanding of the true impact of colonialism on Indigenous people is inextricably connected to the development of a more inclusive health care system in the future. Throughout, it was emphasized time and again that over the next 150 years, our health care system must actively and critically reflect on the continued effects of this colonial history on the lives of Indigenous people, as this is the only lens through which their disproportionately poor health outcomes can truly be understood, and in time, healed.
Truth precedes reconciliation
Acknowledging the racism and colonialism which historically and currently influence the provision of health care is a key step in the process of working towards reconciliation. Dr. Nanky Rai, a family physician at St. Michael’s Hospital, advocates for the examination of power and privilege in health care. In her presentation on integrating anti-oppression frameworks into health care delivery, Rai discussed a thesis published by Tommy Douglas, shortly after his graduation from McMaster University in 1933. Titled “The Problems of the Subnormal Family,” Douglas’ thesis made arguments in support of the eugenics ideology. It focused on the relationship between poverty and what were deemed to be biological determinants of poverty such as ‘incurable disease’ and mental defects (Shevell, 2012). Douglas also argued that state intervention into the reproduction of ‘the subnormal family’ could benefit society (Shevell, 2012). Douglas’ thesis is publicly available to read online.
This publication contradicts the values which this renowned social democrat would later espouse throughout his political career, and the ideas discussed within it were not enacted under his own government (Shevell, 2012).
However, as Rai emphatically stated, the ideologies discussed in Douglas’ thesis were the same ideologies that were realized in the Sexual Sterilization Acts enacted in Alberta and British Columbia in 1928 and 1933 respectively (Shevell, 2012). These ideologies were also prevalent in Nazi Germany. For example, the 1933 passage of the “Law for the Prevention of Genetically Diseased Offspring,” a law which saw to the sterilization of over 400,000 individuals (Shevell, 2012).
Douglas’ position changed later in life, his government never enacted policies that applied these views in practice, and this does not negate his contributions to the inception and success of Medicare in Canada.
Medicare is a cornerstone of the Canadian identity and national pride, and Douglas’ contributions to its inception, and to the Canadian health care system overall earned him the title of “The Greatest Canadian” in a 2004 CBC poll.
However, alarmingly, whenever Douglas is discussed, this part of his history is often omitted, in favour of a story in which only the positive aspects of Douglas’ contributions are told. Thus, an informed and honest discussion of this part of perhaps the most prominent founder of Medicare is largely underdeveloped.
This same kind of national ignorance continues to influence Canada’s failures in the realm of the health care of Indigenous peoples. The health of Indigenous peoples is inextricably tied to and affected by the lasting impacts of colonialism, systemic racism, and the intergenerational traumas which the results of these ideologies have created. However, this context is oftentimes not considered by medical practitioners, and thus, prejudicial ideas and approaches to health care for Indigenous peoples persists.
After the closing ceremonies at the conference, I spoke with Clayton Shirt, a Traditional Teacher from the Wolf Clan of Saddle Lake Alberta, Treaty 6. Shirt has been working as a Traditional Teacher for over 15 years in the Native and multi-cultural community in Canada.
When asked about the place of post-secondary institutions in reconciliation efforts, Shirt explained that “without truth, you cannot [have reconciliation], so you have to see that truth, you have to talk about it amongst yourselves, you have to reconcile with it, friendly relations again, all this, ‘cause where is it going? Where’s all this going? Is it being led to the void, is it just rhetoric again, just words?”
For non-Indigenous individuals, it is still far too easy to go through a health-focused academic and professional career without ever needing to seek out such historical truths, which are largely absent from the mandatory coursework in most health science and public health curricula.
Moving towards reconciliation
The conference itself happened to fall on the final two days of the Ontario’s Treaties Recognition Week, which occurred between November 5th and 11th, 2017. Treaties Recognition Week is the result of legislation passed in 2016, which designates the first week of November to increase public knowledge and understanding of and on the 46 treaties and other agreements that Ontario is covered by.
Shirt explained that the public largely misunderstands treaties as “declarations of surrender” but emphasized that “they’re not.” He explained treaties as negotiations of nation-to-nation talking, as agreements wherein Indigenous leaders carefully considered the needs and wants of their people, and the needs of settlers, all within their holistic ways of understanding the limits of the ecosystem of Turtle Island. Their treaties were created to protect the resources that would be required looking seven generations into the future.
Shirt asked “If Canada lived up to those treaties, what do you think the country would look like now?” and quickly answered his own question by stating “It would look really different, completely different, ‘cause you could go down, and I’m pretty sure, you could go to any river and drink out of it. You can’t do that now. We’re not at that now, you can’t stick your hand in there and drink that water, you can’t.”
Beyond truth, another barrier can be found in the imbalanced power dynamics between the individuals responsible for the solutions to the current state of Indigenous health care, and the people that are affected by their relative lack of power – as stated by Shirt, “[i]f we’re going to have true reconciliation, that means the other side is going to have to give up some of their power.” Ideally, the development of policy and changes in practice that target Indigenous peoples would be Indigenous-led initiatives – reaching this goal will require the provision of support to Indigenous peoples.
Conference attendees engaging in the land based knowledge session at the Mashkikii;aki’ing (Medicine Earth) Medicine Wheel Garden. Photo credit: Dalla Lana School of Public Health Student-led Conference’s Communications Committee
Youth-driven change
The Dalla Lana School of Public Health’s student-led conference is an example of the kind of youth-driven action which may serve as a fast-track for positive action in the fight for more equitable health care for Indigenous people.
After the conference, I had the opportunity to speak with one of the conference’s content committee’s co-leaders, Marlena Nguyen-Dang, who is in her second year in the Masters of Public Health in Social and Behavioural Health Sciences program at the Dalla Lana School of Public Health.
Nguyen-Dang found that the greatest challenge for the planning committee in organizing an Indigenous-led conference was that many of the planners were non-Indigenous. This is not surprising, as due to a host of systemic barriers that Indigenous youth face, only 9.8% of Indigenous people aged 25 to 64 have a university degree, as opposed to 26.5% of non-Indigenous people aged 25 to 64 (Statistics Canada, 2015).
These numbers should stand as proof for the need for better support for Indigenous students, as having access to a university education will provide Indigenous students with a better opportunity to engage in and lead academic research and events much like this very conference, and to become change-makers in the community.
To address this lack of representation, conference planners reached out to form an advisory circle, composed of eight health care researchers and professionals, who were either Indigenous, or who focused explicitly on Indigenous health.
Nguyen-Dang noted as well that the conference explicitly sought to partner with a number of community groups and Indigenous groups on campus, as well as the University of Toronto’s First Nations House and the Well Living House research centre affiliated with St. Michael’s Hospital, and showcased research conducted by Indigenous students from across the Greater Toronto Area.
Efforts like this, wherein Indigenous voices are sought out during the conception, planning, and running of such conferences, requires a self-awareness at the institutional level which is not often incentivized.
In the planning of this conference, for example, Nguyen-Dang noted that oftentimes, individuals involved in the planning process were “hesitant to really critique the institution, […] almost like they [had] this sort of like, idea that you don’t want to bite the hand that feeds you, but maybe the hand that is feeding you is just feeding you scraps.”
She described how much of the institutional support for the conference came from the Waakebiness-Bryce Institute for Indigenous Health, which is affiliated with the Dalla Lana School of Public Health, and was attended by directors who were part of the advisory committee, but that support from the institution as a whole was less direct.
Nguyen-Dang emphasized the complexity of creating a conference on Indigenous health care in an academic setting, wherein the dominant voice is typically that of settler Canadians. It is a process which requires one to “confront a lot of [one’s own] identities.”
Looking forward, the conference planners have made plans to contribute to ongoing conversations and actions towards improving Indigenous health care.
One such action includes creating reading circles focused on the Truth and Reconciliation Report on campus. This initiative is being spearheaded by the conference’s advisory circle and the Public Health Students’ Association. The goal of the reading circles is to contribute to the creation of a more informed discussion on where reconciliation efforts currently stand.
In terms of more systemic change, Nguyen-Dang noted the importance of self-reflection. As was discussed during the conference, academic research is often funded by sources that benefit from the very endeavors which oppress the groups that one’s research is geared towards liberating. For example, student and community activists have been calling for U of T’s divestment from fossil fuel companies, the goal being to remove our financial support of and interest in companies which are directly benefiting from environmental degradation.
As noted by Nguyen-Dang, it is important to reflect on “how critical [research can] really be, and how much can we really push the envelope if our funding sources are the very people who won’t really benefit from real critical research.”
Moving forward, Canada’s Truth and Reconciliation efforts will require ongoing, active involvement and work, and this kind of systemic rewiring will require an energy and self-reflective critical capacity which youth are perhaps best able to offer.
References
Shevell, M. (2012). A Canadian Paradox: Tommy Douglas and Eugenics. Canadian Journal of Neurological Sciences / Journal Canadien Des Sciences Neurologiques,39(1), 35-39. doi:10.1017/S0317167100012658
Statistics Canada. (2015). Proportion of Aboriginal people by selected levels of educational attainment, sex and age groups, Canada, 2011. 2011 National Household Survey. Retrieved from http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-012-x/2011003/tbl/tbl1-eng.cfm