How does systemic racism undermine Indigenous health?

First, let’s start with the following facts:

• $8,400 vs $18,178. That’s the per capita gap between First Nations and other Canadians in federal, provincial and municipal spending for programs and services¹
• First Nations fall between 63rd and 78th vs Canada between 6th and 12th on the UN Human Development Index. The federal government’s Community Well-Being Index shows that the gap has not changed since 1981 – 39 years¹
• The Canada Health Act specifies the conditions and criteria of provincial health insurance programs. It excludes First Nations and Inuit peoples, Métis and non-status or off-reserve Indigenous peoples²

The death of Joyce Echaquan, a 37-year-old Indigenous mother of seven in Quebec on Sept. 28, 2020 is the latest example of the discrimination and entrenched systemic racism experienced by Indigenous people that is so prevalent not only in Quebec but across Canada. This truth has greater legitimacy when viewed through the immediacy of a local lens that sharpens the focus to make what is specific and tangible – highly visible and transparently real. Actions – political, institutional, personal – instigate real-life consequences of systemic racism on people who have been living with that reality for hundreds of years. What follows is a brief glimpse at 42 examples of how systemic racism impacts Indigenous people through the policies, actions and failures of federal, provincial and territory governments, health delivery organizations and business.  

Full details – dates, sources, links – on all of the following are available on the Health Home page of Indigenous Watchdog.

Health Delivery

• Centre intégré de santé et de services sociaux de Lanaudière: The death of Joyce Echaquan, a 37-year-old Atikamekw woman in a Joliette hospital while enduring racist abuse from hospital staff has led the government of Quebec to launch an investigation into her death
• Timmins and District Hospital: Ontario Human Rights Commission has filed an application with the Human Rights Tribunal of Ontario alleging discrimination based on Indigenous ancestry over the deaths of two Indigenous people citing systemic racism in northern Ontario
• Thunder Bay Regional Hospital: Death of a 19-year-old Indigenous man is under investigation by the Ontario coroner who will be looking for any “potential systemic issues that may have played a role in contributing to the death — policies, procedures, steps taken.”
• Winnipeg Health Sciences Center: Government of Manitoba refused to hold a public inquiry into the death of an Indigenous man who was ignored for 34 hours in the emergency department on the assumption he was drunk and/or homeless. Coroner’s inquest sidelined issues of race and social marginalization
• Saskatoon Health Region: Ongoing lawsuit of 60+ Indigenous women who underwent forced sterilizations in Saskatoon hospitals. 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
• BC Hospital Emergency Departments³: First Nations, Métis and Inuit patients seeking emergency medical services are often assumed to be intoxicated and denied medical assessments, contributing to worsening health conditions resulting in unnecessary harm or death. The BC Government launched an independent investigation to explore Indigenous specific racism in BC’s health care system on July 9, 2020
• Ontario Ministry of Health: Nishnawbe Aski Nation (49 First Nations in northern Ontario) declares a Public Health emergency after “decades of perpetual crisis and persistent health care inequities at the NAN community level”

Government Policies and Actions

Government of Ontario

• Grassy Narrows First Nation and Wabaseemoong First Nation⁴ have been fighting the Ontario and federal governments for over 50 years to clean up mercury pollution from the dumping of 9000 kg of mercury into the Wabegoon river in 1962. A study by Japanese scientists in 2002 and 2004 found that 74% of the sample population had symptoms of Minamata disease. The 2016 Canadian census reported that only 4% of individuals from the Grassy Narrows First Nation were 65 years or older vs 16.9% for the rest of Canada
• Chemical Valley, Sarnia: A government whistleblower claims the provinces’ environment ministry has for years failed to protect the Aamjiwaang First Nation  – whose ancestral land near Sarnia is surrounded by petroleum refineries and chemical plants – from potentially dangerous levels of sulphur dioxide emissions due to “systemic discrimination” that includes yielding to “secretive” industry lobbying to relax compliance standards. Similar concerns were raised in previous claims in 2009 and 2014. The Toronto Star Editorial Board stated that Sarnia and its environs are home to 57 polluters. Yet the government has never done a baseline study to see how residents are affected and its reporting system on chemical leaks appears lax
• Ontario’s People’s Health Care Act, 2019: Does not recognize First Nations jurisdiction over health. Indigenous leaders were not consulted on the transformation of 14 Local Health Integration Networks and 6 other health agencies into a new “Ontario Health”. (Note the declaration of a Public Health emergency in NAN territory in northern Ontario above to see why Indigenous people need to be consulted on any issues impacting their health)
• Bill 132 “Better for People, Smarter for Business Act, 2019” – An omnibus bill that buries issues that have a direct impact on First Nations treaty rights, environment, health and the government’s Duty to Consult and seriously undermines the mining industry obligation to consult with First Nation communities

Government of Alberta

• Repeated failure of government since 2009 to conduct a comprehensive baseline health study as recommended by Alberta Cancer Board with the support of Alberta Health Services. Cancer rates among Athabasca Chipewyan First Nation were 31% higher than expected with the primary blame resting on oil sand pollution of the environment. Athabasca Chipewyan First Nation, Mikisew Cree First Nation and the hamlet of Fort Chipewyan funded their own study that concluded water in the Peace-Athabaska Delta and animals that are part of the traditional food supply contained high concentrations of pollutants and carcinogens

Government of Manitoba

• The inequities between First Nations people and other Manitobans health status and heath care access are worse now than they were 18 years ago⁵ based on a joint study that compared health data from 2002 with 2015-17
• Refusal to participate in the first ever national Métis Nation Health Forum on Feb. 26, 2018 in Ottawa. Part of the discussion included a review of the “Profile of Métis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study“, created in 2010 to identify the key health issues facing Manitoba’s Métis Citizens
• The largest percentage of people seeking help in all identified services in mental health and addition services were Indigenous⁶. The report acknowledges the “history of colonization and historical trauma, and ongoing challenges with respect to social determinants of health
• Indigenous infants account for 57% of sleep-related infant deaths between Jan, 2009 and Dec. 2018, despite only representing 20-30% of live births⁷. 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

Government of Quebec

• Volume 2 of “The Final Report of The National Inquiry into Missing and Murdered Indigenous Women and Girls states⁸: “We have demonstrated that the prejudices, racism and indifference displayed by agents of the State are the direct result of that colonial legacy and are an inherent part of the daily reality of Indigenous women, girls and 2SLGBTQQIA people in Quebec
• Viens Commission released its Final Report with 142 Calls to Action⁹. “The Commission’s work has clearly demonstrated the systemic nature of the discrimination in relations between Indigenous peoples and institutions that provide public services…structural reforms that will effect lasting change are preferable to temporary measures

Government of Nunavut

Refusal of government to prescribe Palivizumab, the only prophylactic drug to combat respiratory viruses (RSV), to Inuit babies who are disproportionately hospitalized. On Baffin Island between 50-66% of all births require hospitalization. The expensive drug is routinely given to high risk babies every place else across Canada except Nunavut where the need is the greatest.

Government of Newfoundland and Labrador (GNL)

The Independent Environmental Advisory Committee’s mandate was to seek an independent, evidence-based approach to determine and recommend options for mitigating human-health concerns related to methylmercury throughout the reservoir as well as in the Lake Melville ecosystem. The government ignored 5 of 7 recommendations. The report on the Muskrat Falls Inquiry Key Finding # 13 stated: GNL failed to ensure that it and Nalcor acted fairly in its consultations related to Indigenous Peoples and environmental matters¹⁰.

Governments taking advantage of COVID-19

During the last H1N1 epidemic in 2009, the Indigenous population accounted for 27.8% of ALL hospitalizations in Canada in the first wave even though they only represented 4.3% of the population at the time (Macleans, July 16, 2009). Given the above reality, Indigenous leaders were shocked that the government of Canada limited their initial COVID-19 emergency funding for First Nations, Métis and Inuit organizations to .4% of 82B including $46M for urban Indigenous populations where 44% of 1.6M+ Indigenous people live (2016 StatsCan census) – an incredible shortfall given experience from 2009. Hence the urgency behind Indigenous nations implementing measures to protect their people from any potential negative impacts on their communities of COVID-19.

After the pandemic had been declared the governments of BC, Alberta, Manitoba, Ontario and Quebec have all used COVID-19 as a pretext to fast-track resource extraction projects and deny the “Duty to Consult” to Indigenous nations and/or suspend environmental protections on lands that negatively impact Indigenous people and health – all in the name of economic development and profit at the direct expense of Indigenous people.

British Columbia

• Expediting large construction projects through Indigenous territory despite their expressed concerns about the high risk of COVID-19 infections: Site C Dam, Trans Mountain Pipeline expansion, Coastal GasLink
• Refusal to share proximate case information with First Nations so they can implement preventative measures to combat spread of COVID-19 in their communities
• Release low risk Indigenous inmates who are a high-risk population from prisons. 40% of inmates in Mission Institute are Indigenous

Alberta

Alberta Energy Regulator suspends all environmental reporting requirements for industry under emergency powers enacted due to the COVID-19 pandemic with no clear oversight into the impacts on health and the environment. Result of lobbying by Association of Canadian Petroleum Producers.

Manitoba

Manitoba Métis Federation (MMF) filed a complaint with the Manitoba Human Rights Commission against the government of Manitoba and the Minister of Health, Seniors and Active Living and Manitoba’s Chief Provincial Public Health Officer alleging systemic discrimination throughout the COVID-19 pandemic by refusing to enter into a data sharing agreement with the Métis based on MMF membership list. Government relies only on self-identification which is not acceptable to MMF who are concerned about the integrity of their membership data.

Ontario

• Bill 197 (COVID-19 Economic Recovery Act, 2019: An omnibus bill passed in just 13 days that the Auditor General states violates the Environmental Bill of Rights. Fort Albany First Nation is under pressure and constraints due to COVID-19 and does not have the resources or capacity to meaningfully engage
• The Ontario government has used the cover of COVID-19 to make legislative, regulatory and policy changes that attempt to diminish the obligations of Ontario to honour the constitutionally-protected Inherent Aboriginal and Treaty Rights of First Nations across Ontario¹¹. Announcement of regional assessment or potential mining operations for the Ring of Fire only posted on the agency website severely impacts the ability of First Nations to meaningfully engage in the consulting process
• Water distribution system in Oneida territory with regulatory oversight from Indigenous Services Canada has failed to meet provincial standards since 2006. Upstream, the nearby City of London dumps millions of litres of raw sewage into the Thames river that serves as the community’s water source. Yet, Oneida has received none of the federal government’s high-profile funding for safe, clean drinking water to Indigenous communities

Quebec

• Bill 61 “An Act to Stimulate the economy of Quebec & mitigate the consequences…of the COVID-19 pandemic”: without any consultation with Indigenous groups. “It cannot take advantage of the current context to put the health of our populations on the back burner, nor can it more openly infringe First Nations’ Aboriginal and treaty rights,” said Assembly of First Nations Quebec – Labrador Chief Ghislain Picard.
• Resumption of mining activities in the Nunavik region of northern Quebec without any consultation with the local Inuit population. Quebec government refused to respond to repeated requests for meetings from Makivik Corporation, who represent the Inuit of Nunavik on COVID-19 issues including the mines re-opening.

Indigenous lawsuits against the federal government

• Tataskweyak Cree Nation, a Manitoba First Nation filed a statement of claim against the federal government for impact of long-term boil water advisories making people ill and moving away
• Ermineskin Cree Nation, Sucker Creek First Nation and two other Alberta First Nations have joined forces with Okanagan First Nation (OKIB) to coordinate legal actions to confirm First Nations’ – and other Canadians – human right to safe drinking water. After 9 years of determined and good faith efforts on the part of the OKIB, the federal government has made upgrades to only 1 of 7 systems
• Attawapiskat declares a state of emergency over state of drinking water. Pro-longed exposure to THMs and HAAs can cause skin irritation and could increase the risk of cancer, according to a consultant report prepared for the community. THMs and HAAs cannot be cleared through boiling water. Issue has been ongoing since the 1970s
• A class-action lawsuit in the works will seek damages on behalf of Inuit, First Nations and Métis who have suffered racial discrimination while in Canada’s health-care system. The civil suit would represent Inuit discriminated against while in care in southern facilities outside Nunavut, and in some cases the Northwest Territories

Suicide

A 2017 national report’s central finding— that First Nations people die by suicide at three times the rate of non-Indigenous Canadians, Inuit at nine times the rate, and Métis at two times — illustrates a crisis but is not likely to surprise those familiar with previous statistics. For those unfamiliar, it puts Inuit among the people with the highest rates of suicide anywhere in the world¹². Since then…

• Canadian Council of Child and Youth Advocates: Released a “National Paper on Youth Suicide” on Sept. 17, 2019 that acknowledges higher rates among Indigenous youth. Of the three recommendations # 3 addresses Indigenous youth specifically
• Manitoba: The report¹³ focuses on the suicide of 22 girls aged 11-17 from mostly rural and norther communities between 2013 -2019. 20 of the victims were either First Nations or Métis. Suicide is the leading cause of death among youth in Manitoba and lack of access to mental health services and addiction services for remote communities is an issue
• Saskatchewan: Lack of long-term help from the province and Canada to address systemic issues contributing to a suicide crisis. The NDP leader says the Saskatchewan Party government has failed to act on reducing poverty and developing economic opportunities in the north.
• Newfoundland and Labrador: Chief Eugene Hart declared a suicide crisis in the Labrador Innu community of Sheshatshiu after 10 people between ages 12 and 18 attempted suicide. He pointed to the failure to approve funding requests over 20 years ago to build infrastructure and capacity in mental health counselling, social work, education etc. in the community
• Inuit Nunangat: A recent study¹² found the following: While the national average is 11.3 suicides per 100,000 inhabitants, Inuvialuit is 60.4, Nunavik is 113.5, Nunavut is 116.7 and Nunatsiavut is a shocking 275.3. The report also identified the key reasons behind suicidal behavior among the Inuit as depression and substance use…traced these pathologies to the colonization era – a time which Kral calls “the most hurried and extreme event in Inuit History.” 

What do Independent Institutions say about systemic racism?

• The Lancet¹⁴: highlighted the disparities in social determinants of health. The authors emphasize that “deep inequities persist in wellness indicators and access to health care for Indigenous populations in Canada….”
• UNICEF¹⁵: Canada placed # 30 out of 38 countries mainly due to poor health outcomes of Indigenous children. Of the “Top 5 Policies to Defend Childhood in 2020” released by Unicef on Dec. 30, 2019 one – # 3 was “Ensure Fairness for indigenous Children”
• YellowHead Institute¹⁶: identifies specific systemic barriers to the collection of relevant and valid Indigenous data that negatively impacts Indigenous health and lives

Is systemic racism a problem?

The Hawthorne Report concluded in 1963 – 57 years ago – that “Aboriginal peoples were Canada’s most disadvantaged and marginalized population. They were “citizens minus.“¹⁷ The main problem is the lack of political will to make any meaningful progress on implementing the recommendations from any of the previous commissions, reports and studies that have been documenting the same truths over and over again. In the last five years alone, we have had the following commissions and inquiries documenting how pervasive systemic racism against Indigenous people still is throughout Canadian society:

• Truth and Reconciliation Commission of Canada (TRC): 2015 – 46% of the 94 Calls to Action are either Not Started or Stalled
• National Inquiry into Missing and Murdered Indigenous Women and Girls: June 3, 2019 – 231 Calls to Justice. Still no Action Plan from the federal government
• Viens Commission Final Report⁹: Concluded that the province’s Indigenous communities suffered “systemic discrimination”. The most Calls for Justice (34) were within Health and Social Services. Despite the evidence, the premier denies that systemic racism exists within Quebec’s health system

The 42 specific examples above from 2017-2020 represent the reality of how systemic racism undermines Indigenous health through actions, policy decisions and failures of leadership. Indigenous Watchdog has also identified and documented 62 current problems and issues across Canada directly impacting Indigenous lives including 21 in Indigenous Health since April 21, 2020.

If there has ever been a wake-up call  this is it!

NOTES:

1. AFN National Chief Perry Bellegarde “Honouring the Promises: 2019 Federal Election Priorities for First Nations and Canada”
2. Health Debate. “Indigenous health services often hampered by legislative confusion”). Sept.21, 2017
3. San’yas Indigenous Cultural Safety Training Program documented thousands of cases of systemic racism in the delivery of health services to Indigenous people in British Columbia
4. See Grassy Narrow and Wabaseemoong (White Dog) in “How Much is an “Indian” Life Worth? Apparently, not very much” in Indigenous Watchdog
5. “The Health Status of and Access to Healthcare by Registered First Nations People in Manitoba”: First Nations Health & Social Secretariat of Manitoba and Manitoba Centre for Health Policy in the Rady Faculty of Health Sciences at University of Manitoba: Sept. 17, 2019
6. Virgo Final Report: Improving Access and Coordination of Mental Health and Addiction Services
7. Manitoba Advocate for Children and Youth (2020): “Safe and sound: A special report on the unexpected sleep-related deaths of 145 Manitoba infants” March 13, 2020
8. Volume 2 of “The Final Report of The National Inquiry into Missing and Murdered Indigenous Women and Girls. Reclaiming Power and Place: A Supplementary Report – Quebec”. Sept. 29, 2020. p.128
9. “Public Inquiry Commission on relations between Indigenous Peoples and certain public services in Quebec” listening, reconciliation and progress”. Viens Commission. Sept. 29, 2019
10. “Muskrat Falls a Misguided Project”. Muskrat Falls Inquiry. March 6, 2020
11. Pandemic shouldn’t impede meaningful Indigenous engagement on Ring of Fire” Policy Options May 22, 2020. See UN Declaration “Current Problems and Issues” in Indigenous Watchdog
12. “Breaking Point: The Suicide Crisis in Indigenous Communities: Report of the Standing Committee on Indigenous and Northern Affairs. House of Commons. June 2017
13. “Stop Giving Me a Number and Start Giving Me a Person: How 22 Girls illuminate the Cracks in the Youth Mental Health and Addictions System. Manitoba Advocate for Children and Youth. May 7, 2020
14. The Lancet – “Challenges in health equity for Indigenous peoples in Canada”. Feb. 23, 2018
15. Unicef “Innocenti Report Card 16: Worlds of Influence – Understanding What Shapes Child Well-being in Rich Countries.” Sept. 8, 2020
16. YellowHead Institute. Policy Brief: “Colonialism of the Curve: Indigenous Communities and Bad COVID Data“. May 12, 2020
17. “The Hawthorne Report: A Survey of the Contemporary Indians of Canada: Economic, Political, Educational Needs and Policies”. Volumes 1 and 2