Systemic racism and a lack of quality care for Native Americans and Indigenous peoples in Canada are significant issues in medicine. Aside from being taught a history that focuses mainly on colonizers being portrayed as heroic and revolutionary, many healthcare providers are also unaware of the transgenerational trauma that this diverse patient population faces. Many healthcare providers are not aware of the Trail of Tears, relocations, and treaties violated by the US government, residential schools in Canada, and other atrocities that were clear violations of the Charter of Rights and Freedoms.
You might be wondering how this affects healthcare and the present day. I think a lot of the past has profound and powerful implications for the future – mostly if lessons were not learned. The type of trauma experienced by Indigenous peoples still has wide-reaching effects today. For instance, suicide rates among First Nations people, Métis and Inuit are significantly higher than those among non-Indigenous people. The rate among First Nations people (24.3 deaths per 100,000 person) is three times higher than the rate among non-Indigenous people (8.0 deaths per 100,000 person). This is still an on-going trend and a big crisis in healthcare today.
Indigenous peoples are among the highest-risk populations for type two diabetes and other complications. Due to a lack of screening at earlier stages of diseases, many face complications later on. These complications are rooted in colonization and the strain that it continues to take on their health. It is also essential to account for the social determinants of health. These determinants involve status, social support networks, physical environment, housing, food security, early childhood development, and several other factors. Healthcare and medicine only affect 20% of your health and wellness; however, the other large percentage involves these social determinants of health. It is known that racism and marginalization directly affect the quality of healthcare that Indigenous patients receive.
So, what can healthcare professionals do better? The American Medical Association Journal of Ethics recently did an entire issue focused on caring for Indigenous peoples, which involved case studies and commentaries to investigate this disparity further. One of the most significant takeaways involved collaboration. To make collaboration possible between Indigenous leaders and healthcare professionals, healthcare professionals need to investigate traditional medicine practices and know how those could affect these communities. Physicians are trained to follow evidence-based approaches in medicine, and many are usually not open to discussing traditional medicine/healing practices. This results in mistrust and a lack of willingness to open up to providers due to embarrassment or a fear of being judged.
Solutions such as an integrated approach focused on understanding traditional medicine/healing, and informing patients about allopathic treatment options, are the way to go. This respects patient autonomy but also ensures that doctors can look out for patients’ best interests. Cultivating this sort of mindset and practice can hopefully allow medicine to help this doctor-patient dynamic better and deal with some of the complexities affecting the quality of care of Indigenous peoples.