Health is a basic human right.
But across Canada, First Nations, Inuit and Métis Peoples and communities face unacceptable health disparities.
Due to the legacy of colonialism and systemic racism, Indigenous Peoples are more likely than other Canadians to experience persistent poverty, contributing to food insecurity and barriers to housing and education — key contributors to chronic illnesses and other health challenges.
And seeking medical care is fraught. Indigenous Peoples face extreme and inequitable barriers to accessing care, including a dire lack of health services, particularly in remote communities. They also experience anti-Indigenous racism in health systems, and face a lack of cultural safety and acceptance of Indigenous health and healing models. These barriers have led to disproportionately poorer health outcomes for Indigenous Peoples in comparison to the non-Indigenous population in Canada.
Within Indigenous communities, health workers of any kind are in short supply. Despite making up more than 4.5% of Canada’s population, less than 1% of the country’s physicians identify as Indigenous.
We have a teaching called Seven Generations, meaning I’m the product of seven generations and my impact will be felt forward for seven generations. So we have a responsibility to the younger generations that they not only survive medical school, but thrive throughout their medical careers.— Dr. Nel Wieman, Indigenous Physicians Association of Canada president (IPAC)
These issues were highlighted in the 2015 Truth and Reconciliation Commission report on the devastating legacy of Canada’s residential schools. Eight of the 94 calls to action are aimed at wide-ranging transformations to health care, from requiring medical schools to facilitate training on Indigenous issues to recognizing the value of Indigenous healing practices.
As part of its long-term strategic work, the Canadian Medical Association Board unanimously called for action to address the ongoing structural inequities that marginalize Indigenous communities and to advance their inclusion in social systems — including health care.
Indigenous Peoples guiding the change
Improving health outcomes for Indigenous Peoples must start with Indigenous voices leading the way.
In June 2022, the CMA convened a Guiding Circle with 16 First Nations, Inuit and Métis leaders, experts and knowledge-keepers. Together, they will identify areas of focus for the CMA’s work on Indigenous health going forward.
The Guiding Circle is an opportunity to address the historic devaluation, and in many cases outright dismissal, of Indigenous Peoples’ voices regarding their own health care.— Dr. Alika Lafontaine, CMA president
An Indigenous lens is critical to our work on health and climate change. The CMA’s contribution to Canada’s first National Adaptation Strategy includes a call to fund, promote and learn from Indigenous-led, land-based mitigation efforts.
The CMA advocates for better health policies affecting Indigenous Peoples. In May 2022, CMA President Dr. Alika Lafontaine appeared before a House of Commons committee to discuss the Non-Insured Health Benefits program, explaining how improving its administration and accessibility is key to addressing health inequities between Indigenous and non-Indigenous people in Canada.
The CMA Foundation continues to support the work of Indigenous-led organizations, most recently with a $2-million contribution to the Indigenous Peoples Resilience Fund and a $1-million grant to the Indigenous Physicians Association of Canada to support the sustainability and longevity of the organization and to develop a national mentorship program.
The CMA also continues to build awareness of the impact of colonialization on Indigenous health through training for employees, and through public-facing projects such as the film The Unforgotten.
Building relationships with Indigenous partners
The CMA is in the process of building meaningful relationships with Indigenous Peoples and Indigenous-led organizations and initiatives, most notably with the Indigenous Physicians Association of Canada, the member-based organization that represents Indigenous physicians and medical learners.
In order to incorporate Indigenous perspectives in all of its work, the CMA continues to solicit expertise from Indigenous organizations such as NVision, an Indigenous-owned and led consultancy group.
I am pleased to hear that the CMA is looking deeply at their history and also the role that physicians have played in the history of Canada. Recognition of the truths of the traumas inflicted, as well as the ongoing harm and racism occurring today in healthcare, will be essential if we are to support healing through partnered action rooted in a common understanding.— Tammy White Quills-Knife, CMA Patient Voice
What physicians can do to help
Collaboration with physicians and learners of all ages, stages and specialties, from rural and remote communities as well as big cities, is essential for a better way forward.