Ongoing problems and issues in fixing Indigenous health

What is the reality behind the statistics? We’ve all seen the numbers over the years that tell the unrelenting truth around the significant gaps in Indigenous health outcomes compared to the rest of Canada. Beyond the numbers, what are some of the current and ongoing problems and issues that sustain those negative results? The following infographic highlights some of the “numbers”. The examples that follow highlight some of the systemic issues behind the numbers: legislative and jurisdictional barriers, lack of funding, negative stereotypes, institutional racism , discrimination, inadequate and overcrowded housing, food insecurity, lack of clean drinking water, remote communities etc. etc. etc.

What follows are snapshots of current health-related problems and issues across Canada impacting Indigenous people identifying where, what, when, who is ultimately accountable, and where possible, identifies potential solutions

Manitoba Government for First Nations infant deaths by sudden infant death syndrome (SIDS) that were 4.5 times higher than non-First Nations infants (Luo et al., 2010).

Mar. 13, 2020 – Release of Manitoba Advocate for Children and Youth (2020): Safe and Sound: A Special Report on the Unexpected Sleep-Related Deaths of 145 Manitoba Infants” According to population projections, Indigenous infants account for between 20-30% of live births in Manitoba during the study period (Jan. 2009 – Dec. 2018), but represent 57% of sleep-related infant deaths. That translates to 83 First Nations and Métis infants.

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Policies articulated in the Indian Act have excluded Indigenous Peoples from participation in economic life for generations, leading to intergenerational poverty. In evidence of ongoing systemic racism, many Indigenous families have unequal access to health services, they lack suitable stable housing, and access to clean drinking water. The health gap between Indigenous and non-Indigenous Manitobans is widening (Katz et al. 2019). Of the 13 recommendations, 7 are directed towards First Nations and Métis governments and various federal and provincial ministries.

https://manitobaadvocate.ca/wp- content/uploads/SafeSleep-Report.pdf

Federal, Provincial and Territory Governments for failure to protect Indigenous people from H1N1 pandemic (27.8% of all infections in Canada were Indigenous)

Mar. 17, 2020: Globe and Mail – Despite accounting for just under 5 per cent of the Canadian population, Indigenous people  were 25 per cent of those admitted to ICUs during the first wave of H1N1. First Nations children were 21 per cent of the paediatric patients admitted to ICUs during both waves. This led to sad and tragic outcomes. Indigenous peoples represented 17.6 per cent of the reported deaths in the first wave and 8.9 per cent of reported deaths in the second.

These figures likely reflect the lack of timely interventions and diagnoses that plague communities who depend on understaffed nursing stations for their health-care needs, as well as jurisdictional squabbling about roles and responsibilities.

John Borrows is Canada Research Chair in Indigenous Law at the University of Victoria Law School writing with Constance MacIntosh, Viscount Bennett Professor of Law at Schulich School of Law at Dalhousie University

Timmins Police Service, Timmins and District Hospital, Cochrane District Social Services Administration Board for discrimination against Indigenous people

Feb. 5, 2020 – Timmins The Daily Press – On the second anniversary of the deaths of Joey Knapaysweet and Agnes Sutherland, the Ontario Human Rights Commission (OHRC) announced it has filed an application with the Human Rights Tribunal of Ontario (HRTO) alleging discrimination based on Indigenous ancestry by public service providers in Timmins, Ontario.

The February 2018 deaths of Joey Knapaysweet and Agnes Sutherland highlight the serious and sometimes tragic result of systemic discrimination against First Nations peoples in Northern Ontario. Both Joey Knapaysweet and Agnes Sutherland traveled to Timmins from Fort Albany First Nation, more than 400 km away, to access health services that were not available in their community. These circumstances left them particularly vulnerable to discrimination.

The OHRC acts in the public interest and is committed to ensuring that Indigenous peoples receive equal access to essential services consistent with their unique cultural and language needs, pursuant to the Ontario Human Rights Code and consistent with the UN Declaration on the Rights of Indigenous Peoples. The OHRC is seeking a variety of public interest remedies, including requiring the respondents to:

  • Engage with Indigenous communities to understand their concerns and needs
  • Develop policies and provide training to ensure that their services are delivered in a culturally competent and safe manner, free of discrimination
  • Develop a human resources plan to promote and expand the hiring and promotion of Indigenous staff
  • Collect human rights-based data to identify problems and monitor solutions.

Health Canada, Government of Canada and Government of Alberta for failure to conduct a baseline health survey as recommended by provincial health organizations

Dec. 17, 2019: Canada’s National Observer – Repeated failure by government authorities to conduct a comprehensive baseline health study as recommended by the Alberta Cancer Board (supported by the province’s governing health authority, Alberta Health Services) in 2009. In Fort Chipewyan a community of roughly 1,200 people, the study found, you would expect to see 39 cases of cancer. Instead, it found 51 cases, a difference of 30.7 per cent. The Athabaska River flows through Canada’s oil patch, giving rise to the theory that the oil-and-gas industry is responsible for the illnesses, having poisoned people for years by contaminating the environment. Government bodies and researchers have challenged that theory, leading to a call for a new more conclusive health study that could provide real answers.

Athabasca Chipewyan First Nation and Mikisew Cree First Nation pooled their resources to fund research. With some additional funding from Health Canada, a three-year, $1-million study was led by Stephane McLachlan, a professor at the University of Manitoba. His findings released in 2014 measured contaminants not only in water but also in beavers, ducks, fish, moose and muskrats — animals consumed as part of a traditional diet for those who continue to live off the land in the Peace-Athabasca Delta. He concluded that the animals contained high concentrations of pollutants such as carcinogenic polycyclic aromatic hydrocarbons and heavy metals such as arsenic, mercury, cadmium and selenium. All of these are by-products of extracting and upgrading bitumen. Arsenic in particular has been linked to increased risk of biliary tract cancer.

Thunder Bay Regional Hospital for accepted practice of escorting Indigenous patients in need of medical care off of hospital property

Nov. 9, 2019: Toronto Star – A 19-year old First Nations man taken to the hospital by ambulance in obvious distress was escorted off the hospital property three hours later by security staff. Apparently, escorting Indigenous people who are seeking medical care off of hospital property is common practice. The would be patient ultimately committed suicide at a remote part of nearby Lakehead University. 

An internal review of the case by the hospital “concluded that appropriate actions were taken and that the right decisions were made by clinical staff based on the information provided to them and the patient’s presentation.” 
Tanya Talaga, Toronto Star

An investigation is currently underway by Ontario’s chief coroner, Dirk Huyer. He told me it will look for any “potential systemic issues that may have played a role in contributing to the death — policies, procedures, steps taken.” It will also examine whether this death is part of a pattern — and make any recommendations necessary to break that pattern.

Federal Government and Government of Ontario for ongoing failure to address access to health issues in Nishnawbe Aski Nation who have declared a Public Health Emergency across NAN territory

Oct. 23, 2019 – Nishnawbe Aski Nation (NAN) Resolution 16/04 Call for Declaration of Public Health Emergency. The Sioux Lookout Chiefs Committee on Health and the NAN Executive declared a Health and Public Health Emergency for First Nations across NAN territory.  This Declaration was not made lightly.  It was forced into existence by decades of perpetual crisis and persistent health care inequities at the NAN community level.  The Declaration is an assertion of the inherent Treaty rights of NAN members to equal opportunities for health, including access to appropriate, timely, high-quality health care, regardless of where they live, what they have or who they are.

In order to exercise our self-determination over health we need to bring back accountability, responsibility and resource allocation to our communities.  This involves changing the current colonial system to a new system that is based on the needs and priorities of our communities. This led to the execution of a trilateral commitment document: The Charter of Relationship Principles Governing Health System Transformation in NAN Territory (the Charter) which was mandated by NAN Resolution 17/21. The Charter was signed by the Parties (Grand Chief Alvin Fiddler, Minister Jane Philpott and Minister Eric Hoskins) on July 24, 2017.

In order to support the NAN Health Transformation process, the governments agreed to several actions, including:

  • Developing new approaches to improve the health and health access, including access at the community level.
  • Supporting the ability of First Nations communities and organizations to deliver their own services.
  • Proposing policy reform and exploring legislative changes to design a new health system for NAN territory, including sustainable funding models and decision-making structures.
  • Removing barriers caused by jurisdiction, funding, policy, culture and structures so that First Nations can deliver better plan, design and manage their own services

NAN is a political territorial organization representing 49 First Nation communities within northern Ontario with the total population of membership (on and off reserve) around 45,000 people. http://www.nan.on.ca/upload/documents/mushkikiw-wiichihiitiiwin-gathering-fina.pdf

Government of Nunavut for repeated failure to implement recommendations from the Canadian Paediatric Society to administer Palivizumab to all Inuit babies with respiratory issues

Oct. 20, 2019 : Globe and Mail – A group of doctors is urging officials in Nunavut to offer an effective but costly drug to all Inuit babies living in remote communities in the territory to protect them against a respiratory virus that disproportionately leads to their hospitalization. But Nunavut’s chief medical officer disagrees, saying there isn’t enough evidence to support such an approach. Palivizumab, the only available prophylactic treatment for RSV, is currently given to infants in Canada who are considered at high risk of complications, such as those born prematurely or who have underlying heart or lung conditions. But it is not routinely administered in Nunavut to healthy Inuit infants who are born at full term.

For most people, symptoms of RSV infection are indistinguishable from the common cold, although an estimated 1 to 3 per cent of infants in developing countries experience complications requiring hospitalization. Inuit babies in Canada, however, have an exceptionally high rate of RSV complications. Among some Inuit communities on Baffin Island, as many as half to two-thirds of babies are hospitalized with lower respiratory lung infections, mostly owing to RSV, according to Anna Banerji, an expert on Indigenous and refugee health and associate professor of pediatrics at the University of Toronto who helped start the petition. Although it is not entirely understood why, experts believe Inuit infants are disproportionately affected because of a combination of genetic and environmental factors, including food insecurity and a lack of adequate housing arising from a history of forced settlement.

Government of Manitoba for failure to improve health outcomes of First Nations people comparing data from 2015-17 vs 2002. Outcomes have actually gotten worse

Sept. 17, 2019University of Manitoba Today – Joint study by the First Nations Health and Social Secretariat of Manitoba (FNHSSM) and the Manitoba Centre for Health Policy (MCHP) in the Rady Faculty of Health Sciences at the University of Manitoba, “The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba” compares health data collected in 2015-2017 with the results of a study the MCHP published in 2002.
“When we look at health status and health-care access, the inequities between First Nation people and all other Manitobans have gotten worse, according to many indicators,” said Leona Star, a Cree woman who is director of research at FNHSSM and co-led the study. For example, the First Nations life expectancy from birth in 2002 was 7 years lower than for the non-Indigenous population; in 2019 First Nations life expectancy from birth is now 11 years lower.

Other disturbing trends:

  • First Nation people’s rate of premature mortality (death before age 75): 2002 = 2x other Manitobans; 2019 =now 3x
  • Suicide rates for First Nations people = 5 x higher
  • Suicide attempts by First Nations people = 6x higher

As we have now documented that health inequities have increased since 2002, we propose the following specific actions: 

  1. Annual reporting on progress in addressing gaps in health and access to healthcare; 
  2. Development of strategic initiatives for equitable access to intervention and prevention measures (including addressing racism in the health system through mandatory cultural safety training for all staff, hiring of First Nation providers, new human resource policies for safe reporting of racist incidents); 
  3. Development of short- and long-term plans for the training and hiring of First Nation healthcare professionals; 
  4. Further development of research partnerships among MCHP, MHSAL, FNHSSM and Manitoba First Nations; 
  5. Setting First Nations on the path to borderless healthcare delivery by improving access to primary care healthcare that is designed and delivered through First Nations-led partnerships. 

http://mchp-appserv.cpe.umanitoba.ca/reference//FN_Report_web.pdf

Government of Ontario for failure to consult First Nations on Bill C-74 “The People’s Health Care Act, 2019

Feb. 28, 2019 – Bill-74 “The People’s Health Care Act, 2019” does not contain recognition of First Nations jurisdiction in health area and specifically Articles 18 and 23, of the United Nations Declaration on the Rights of Indigenous Peoples, have not been recognized, as there has been no consultation with First Nations in developing this legislation. (Chiefs of Ontario)

This legislation is set to create a new Agency called Ontario Health, which will be formed by dissolving the province’s 14 Local Health Integration Networks (LHINs) and merging their duties with those of six other health agencies, including Cancer Care Ontario and eHealth Ontario. First Nations must be involved in the conversation if we are to improve the overall health of First Nations in Ontario,” said Ontario Regional Chief RoseAnne Archibald. “We hope for a continued collaboration between First Nations and the Government of Ontario, so First Nations can provide a recommended approach that will lead to overall healthcare improvement and address the gap within First Nations healthcare. “

Government of Manitoba for failure to address the overwhelming need for access to Mental Health and Addiction services by Indigenous people

March 31, 2018 – Release of the Virgo Final Report: “Improving Access and Coordination of Mental Health and Addiction Services: A Provincial Strategy for all Manitobans” specifically emphasizes the discovery made during the system review that for almost every service encountered, the largest percentage of people being served were of Indigenous background. 

The report acknowledges the “history of colonization and historical trauma, and ongoing challenges with respect to social determinants of health. More importantly, we believe the overall system of services will not improve significantly in terms of access or coordination without a concerted and sustained effort to better meet the needs of the province’s Indigenous people.

Of the many issues brought forward unique to Indigenous people, two were particularly salient:

  • the need for more culturally informed services, including land-based programs, and support for those community members whose customary language is their own native language and who have trouble understanding words and concepts expressed in English. Last,
  • the “jurisdictional issue”— a fundamental challenge to be addressed going forward as it underlies significant issues related to access and coordination. This was one of the top priorities identified in the validation events.

Other specific issues identified previously with respect to the preceding Strategic Priorities, including,

  • the need for more local, and more flexible, services, including longer term treatment and pre-and post-treatment supports; 
  • the need for better integration of SUA and MH (substance use/addiction and mental health problems and illnesses) services; 
  • the need to fill specific gaps for youth and women; and 
  • a critical need for Withdrawal Management Services (WMS), transitional stabilization to support access to treatment, housing, transportation and crisis services, including post-crisis healing opportunities.

https://www.gov.mb.ca/health/mha/docs/mha_strategic_plan.pdf

Federal, Provincial, Territory Governments for failure to include Indigenous health within the Canadian Health Act.

Sept. 21, 2017: Healthy Debates – “Indigenous health services often hampered by legislative confusion“. The federal and provincial governments negotiate health transfers based on the Canada Health Act, which specifies the conditions and criteria required of provincial health insurance programs. It doesn’t mention First Nations and Inuit peoples, Métis and non-status or off-reserve Indigenous peoples who are covered by the Indian Act.

This lack of clarity – and lack of policies for providing Indigenous health services – has historically been used by both the federal government and provinces to narrowly define their responsibilities toward Indigenous health. It’s created bureaucratic delays that leave Indigenous peoples waiting for care or medications readily available to non-Indigenous Canadians. And it’s created gaps in care between Indigenous and non-status and First Nations people living off-reserve.

“The move to a new fiscal relationship is significant,” Grand Chief Doug Kelly, chair of the First Nations Health Authority of BC says. Leaving Indigenous people out of health care discussions and program design hasn’t worked. Instead, he says, First Nations communities should be empowered to identify their priorities and develop a plan. Once costs are attached, communities would negotiate with the government for transfer payments. Groups like the First Nations Health Managers Association that Marion Crowe, Executive Director represents, have been working to prepare communities for the eventual transfer of responsibility, focusing on developing health human resource and health administrative capacity within First Nations communities.

Government of Manitoba and Winnipeg Health Sciences Centre for refusing to conduct a public inquiry into the death of an Indigenous man, Brian Sinclair, who died as a direct result of institutional racism and stereotyping

Sept. 15, 2017: CBC – Brian Sinclair was killed by racism on Sept. 21, 2008.  He was ignored for 34 hours, despite his need for urgent medical care, because medical professionals made negative assumptions about him based solely on his appearance. Anti-Indigenous bias is an endemic problem in Canadian health care:

  • The hospital authority denied that stereotyping had anything to do with Mr. Sinclair’s death.
  • The government of Manitoba refused to hold a public inquiry.
  • The inquest into Mr. Sinclair’s death sidelined issues of race and social marginalization.
  • Regulatory bodies have been slow to implement any changes, if at all, and
  • no one has been held accountable for professional misconduct or criminal neglect.

The findings of the Manitoba Ombudsman rely on the government’s health and justice departments “appraising their own progress.” http://s3.documentcloud.org/documents/5782400/Brian-Sinclair-Final-Report-En.pdf.

The Brian Sinclair Working group was formed to examine the role of racism in the death of Brian Sinclair and in the inquest that followed, in order to highlight ongoing structural and systemic anti-Indigenous racism in our contemporary health and legal systems. The Sinclair family and the Sinclair Working Group have called for a public inquiry to explore the underlying systemic racism in the delivery of Health services to Indigenous populations. The Working Group aims to release a final report in 2018. The interim report “Ignored to Death” was issued Sept. 2017

Sept, 2017 – “Out of Sight: A summary of the events leading up to Brian Sinclair’s death and the inquest that examined it and the Interim Recommendations of the Brian Sinclair Working Group”. Over-all recommendation:
We recommend that all stakeholders in the healthcare system (including the federal government, the provincial government, Regional Health Authorities, unions, professional organizations, and post-secondary institutions involved in the delivery of professional programs) adopt anti-racist policies and implementation strategies that include committing resources to providing anti-racist training and supporting independent investigations when complaints are filed.
http://ignoredtodeathmanitoba.ca/index.php/2017/09/15/out-of-sight-interim-report-of-the-sinclair-working-group/

Saskatoon Health Region for forcing Indigenous women to undergo tubal ligations while in labour

July 22, 2017 -Indigenous women were coerced into having a tubal ligation in Saskatoon hospitals while still in labour. A class action lawsuit was initiated on October 5, 2017 by two affected women in the Saskatoon Health Region. (CBC). Now about 60 women are part of the lawsuit. Authorities should very carefully read Article 2 of the Convention on the Prevention and Punishment of the Crime of Genocide adopted by the UN in 1948”, Romeo Saganash, an NDP MP said. “It says that “genocide” includes any acts committed with the intent to destroy, in whole or in part, a national, ethnic, racial or religious group, such as by “imposing measures intended to prevent births within the group.”
Dec. 10, 2018 – 72 organizations endorse the joint statement from Amnesty International Canada, the Native Women’s Association of Canada, and Action Canada for Sexual Health and Rights, calling for government action to #DefendConsent and end #ForcedSterilization of Indigenous women in Canada 

All the women interviewed felt that the health system had not served their needs, and they had felt powerless to do anything about it. Aboriginal women who have had such an experience that prevents them from accessing health care are aware that they are higher risk for negative consequences of health problems that are preventable or treatable if diagnosed early; they still cannot get past their distrust. In its submission to the UN committee, the law firm said there has been no effort at a comprehensive review to understand the scale of the problem or the conditions that make forced sterilizations possible. (Canadian Press)
Nov. 22, 2018 – Senator Murray Sinclair, former Chair of the TRC, says Canada needs a national investigation to find out how common coerced sterilizations are among Indigenous women and how they’ve been allowed to continue for so long.
http://nationtalk.ca/story/usw-joint-statement-calling-on-canada-to-end-sterilization-without-consent

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