BRANDON, MB – With respect to current discussions around racism experienced by Indigenous peoples accessing health care in Canada, Dr. Yvonne Boyer, who is Brandon University’s Canada Research Chair in Aboriginal Health and Wellness, offers the following commentary:
The recent report authored by Dr. Janet Smylie and Dr. Billie Allen, “First Peoples, Second Class Treatment: The role of racism in the health and well-being of Indigenous peoples in Canada” is an important reminder of the problems that many Indigenous people face when accessing health care in Canada. Ironically, not only do Aboriginal people hold equality and the right to life rights under the Charter of Rights and Freedoms, but they also hold constitutionally protected rights to Aboriginal and treaty rights through Section 35 of the Constitution Act, 1982. First Nations, Metis and Inuit are the only people in Canada to hold these remarkable rights. Section 35 recognizes the inherent or Aboriginal rights and Treaty rights (as legally binding agreements between two sovereign nations). These documents affirm the right to health and health care as an important part of Canada’s agreement with the First Peoples. But yet, we hear of Indigenous people in Canada dying in emergency rooms and being ignored by some health care professionals who assume the Aboriginal clients seeking help are homeless and looking for a “free ride” in their emergency room.
Such incidences, rather than reinforcing the role of care that grounds the health care system and its providers, perpetuate the injustices suffered by the most vulnerable of the vulnerable – the homeless and others who are sexually exploited or involved in sex work on the streets. Research has shown time and again that historical and complex socioeconomic issues for many Indigenous people in Canada have resulted from racism, including the legacy of physical and sexual abuse experienced in the residential school system, dispossession of identity and culture via the Indian Act, violence, and the marginalization of Indigenous women. These racial attacks on cultures and nations of Peoples undermine cultural knowledge, attack self-esteem, promote poverty, and create a heightened vulnerability to being trafficked as human beings. Experts, who have lived the experiences and were canvassed for the 2014 Public Safety Canada Report, “Trafficking of Aboriginal Women and Girls,” were clear that racist experiences were a strong element, if not the overarching theme, in the experiences of vulnerable women when accessing health care. Stories told and retold were experiences of racism, including routinely asked questions such as: “How much have you had to drink?” “What drugs have you done?” and “You are a prostitute, are you not?” These vulnerable women told of the horrors of being trafficked and raped and having to endure the smack of racism from cold responses, racial questioning and refusal of care. Some of the women learned to rely upon a trusted advocate to ensure the violence they endured would be taken seriously by the health care system. There was a perception that the nursing staff hoped the woman would just go away. Indeed, women do often get tired of waiting, go back to a shelter and do not return to the hospital and the rape goes unreported.
In Ottawa, Dr. Jeff Turnbull, an expert in inner city health, has designed an approach that will offer better health outcomes for the homeless by having hospital-based health care provided directly to Ottawa’s five shelters. Dr. Janet Smylie emphasizes that cultural competency is critical when delivering health care to the Aboriginal population and has proposed that a stand-alone Ambulatory Health Care clinic be developed in centres with a high Aboriginal population. The Public Safety Report heard that “street nurses, doctors or nurse practitioners” would help ease the health gap for the street sex workers.
Multigenerational racism experienced by Indigenous peoples in the health care system has been well documented in the stories of the vulnerable and captured by many in academic literature and numerous inquiries and studies. There are no easy answers, but the first step is recognizing that there are problems that have solutions. The solutions lie in recognizing that a process must be implemented to start addressing some of the inequities in the health care. Concentrated efforts at reform through a constitutional legal lens coupled with health policy changes and cultural awareness training for healthcare workers may be a logical start to begin to address these issues.
Dr. Yvonne Boyer has published extensively on the topics of First Nations, Métis and Inuit and the intersect between health and the law as well as Aboriginal and treaty rights and their constitutional protections. A former Canadian Human Rights Commissioner and an appointed Member of the Federation of Saskatchewan Indian Nations, First Nations Appeals Tribunal, Dr. Boyer is a member of the Law Society of Upper Canada and the Law Society of Saskatchewan. She has held the Canada Research Chair in Aboriginal Health and Wellness at Brandon University since January, 2014.
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