The health and well-being of Indigenous people in Canada has always been threatened by colonization, but social movements in the last decade, and especially the last two years, have helped settler Canadians recognize inequities and work toward reconciliation.
Indigenous people in Canada have poorer health outcomes than the settler population. Things like employment, poverty, housing and food security factor into someone’s well-being, and health-care providers and institutions also play a role in determining Indigenous health outcomes. In primary and emergency health-care settings, discrimination against Indigenous patients acts as a barrier to adequate care.
But in an interview for doctorsNS magazine, Dr. Brent Young, the academic director for Indigenous health at Dalhousie Medical School, says focusing only on these aspects misses the root cause of the disparity Indigenous people face – colonialism.
“It’s colonialism and racism that perpetuate these disparities. It’s the fact we’re situated in a colonial system and have been oppressed by this system for many years,” he said.
Overcoming that reality means confronting the racist stereotypes that persist about Indigenous people, and which affect the quality of health care they receive. “A common assumption about Indigenous people is that they are genetically prone to disease and poor health,” says Dr. Young. “The way medical education perpetuates this thinking can be dangerous.”
Consequently, Indigenous people often face unsafe environments when they access health care, Dr. Young says. “When Indigenous people visit your clinic, they might think it’s going to be a dangerous situation. In my own practice, when I need to refer an Indigenous patient to the emergency department, they often refuse to go because they’ve had such terrible experiences there.”
Improving health care for Indigenous people in Canada, then, means reimagining our health and social systems. The Truth and Reconciliation Commission provides 94 Calls to Action that outline specific goals. They include addressing Indigenous social determinants of health, improving cultural safety for Indigenous people in health-care settings, improving Indigenous representation in health care and medical education and changing how health-care providers are educated.
It’s no small task, but work in Mi’kma’ki has begun.
Doctors Nova Scotia has created a Section of Indigenous Health for physicians caring for Indigenous patients. A course on care for Indigenous patients is now required of all first year Dalhousie University health professions students. Dalhousie Medical School is revamping the way Indigenous applicants are vetted to make the process more equitable.
In addition, a new Mi’kmaw health authority, Tajikeimɨk, has been formed to ensure high-quality, safe, accessible, holistic care for members of the 13 Mi’kmaw communities in Nova Scotia. The new health authority will be guided by Mi’kmaw culture and values, rooted in two-eyed seeing and informed by community engagement.
Dr. Young says that this holistic, inclusive approach to medicine – one that sees Indigenous individuals with a strength-based lens, focusing on their resiliency and all that their communities bring to health and well-being – will go a long way to improving Indigenous health outcomes.
“This can help empower Indigenous people and communities to better their health through things like self-determination and more control over how health care is delivered in their communities. We have the learning and expertise to solve these challenges.”
To that end, there is now a clinic that provides community-based primary care for Indigenous people living in Halifax. An initiative of the Mi’kmaw Native Friendship Centre, the Wije’winen clinic opened in July 2022 and is the first health-care centre of its kind in Nova Scotia to host medical learners formally. Located in the Friendship Centre, the clinic will serve about 1,000 patients in its first year.
Dr. Young is clinical lead at the new centre. “Being able to provide care that is culturally appropriate and culturally safe in a primary care setting will hopefully keep patients from trying to access care or needing to access care in more acute settings, whether that’s the emergency department or other hospital settings, which [are] more expensive and costly for the health-care system,” he said in an interview with CBC Information Morning.
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