The hope is to see more Indigenous folks coming into medicine in the Maritimes. Being a physician is a position of privilege and power and we can leverage that to bring positive change.
Changing the system from within
He is just one year out of residency, but family physician Dr. Brent Young is already making waves in Nova Scotia when it comes to transforming medical education and promoting health equity for Indigenous people.
Since starting a new role last summer at Dalhousie Medical School as academic director of Indigenous health, he has been shining light on the systemic barriers Indigenous people face in medicine, as patients, learners and providers.
As an Anishinaabe physician, Dr. Young has lived experience and resiliency that shapes the approach he takes with this work.
“My grandmother was a residential school survivor,” he said. “My mom was born in Sandy Bay First Nation in Manitoba. When she was an infant, she was taken from her family and adopted into a white family as part of Sixties Scoop. All of her siblings were adopted or placed in foster care. It’s been a long journey researching what happened to my family.”
Knowing that many Indigenous people are grappling with similar traumatic histories is what drives him to change how they experience health care.
The work Dr. Young is doing extends beyond the university and into his practice as a family physician. He works at the Sipekne’katik Health Centre, and he is the clinical lead for a new urban health centre that will serve the 15,000 Indigenous people who live in Halifax. In addition, he serves as co-chair of Doctors Nova Scotia’s Section of Physicians for Indigenous Health.
Dr. Young grew up in Sydney Forks, Cape Breton. “In school, I loved learned learning how ecosystems worked, which planted a seed about doing family medicine,” he recalled. “I also had a great family doctor growing up, Dr. Estelle Cameron.”
He went on to study biochemistry and molecular biology, and then completed a master’s degree in pharmacology at Dalhousie University. He studied medicine at Dalhousie and completed his family medicine residency at the University of Calgary.
Through his role at Dalhousie Medical School, Dr. Young is helping revise medical curriculum to be more inclusive for Indigenous people and is exploring ways to support and mentor Indigenous learners.
“The hope is to see more Indigenous folks coming into medicine in the Maritimes,” he said. “Being a physician is a position of privilege and power and we can leverage that to bring positive change.”
Another goal is to help Indigenous people achieve health equity – meaning they can attain the highest standard of health possible.
Things like employment, poverty, housing and food security all factor into someone’s health and well-being. But Dr. Young 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.”
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,” said 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.”
One thing health-care providers can do to help Indigenous people feel safe is to ask permission before doing a test or physical exam. “I’ll ask them, “Is it OK if I listen to your heart and lungs?” These things go a long way in making a space feel more comfortable. It’s a basic thing that we forget about, especially in family medicine because our appointments are so short.”
For the past year, Dr. Young has been providing primary care at Sipekne’katik Health Centre. A hub of the rural First Nation community, the collaborative centre serves 2,600 band members, offering primary care and a range of other services and programs. Three family doctors, one nurse practitioner and a dentist all provide care at the centre. “Our interdisciplinary team helps patients navigate the health-care system,” Dr. Young said.
Ultimately, he’d like Indigenous communities to have greater control of their health care. Today, ambiguity about health-care services causes confusion and service delays for many Indigenous communities. “The way funding is delivered to First Nations communities is fragmented,” Dr. Young said. “It can be a fight among local, provincial and federal governments. We need an organized, overarching approach to address these issues.”
Having more Indigenous doctors and medical staff is key to improve the system. To that end, Dr. Young is working with Dalhousie admissions staff to revamp the way Indigenous medical applicants are vetted.
“Indigenous students face specific barriers on the journey to med school,” he said. “They might be one or two points from the cut-off on their MCAT score and are excluded from advancing. It’s usually because of family circumstances, like having to take care of a sick family member. We need to take that into account when assessing their applications.”
For him, medicine needs to have a more holistic, inclusive approach – one that sees Indigenous individuals with a strength-based lens, focusing on their resiliency and all they have overcome and achieved.
“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.”