Now is the time to eliminate the health inequities of Indigenous peoples

March 7, 2018

Cara A. Bablitz, MD

Contributed by: Cara A. Bablitz, MD

The Indigenous Health policy paper demonstrates the Alberta Medical Association’s commitment to improving health outcomes of First Nations, Metis and Inuit patients. It is not acceptable that Indigenous peoples have poorer health outcomes than other Canadians. We hope the steps outlined in this paper will bring meaningful change. During the writing of this policy paper, we were guided by the Truth and Reconciliation Commission Report, as well as the United Nations Declaration on the Rights of Indigenous Peoples.

The history of colonization, including residential schools, targeted the culture of Indigenous peoples and changed the course of our health. Residential schools were created to eliminate all that was Indigenous, and the effects are multi-generational. It is important for physicians in Alberta to realize that the history of residential schools still directly impacts all Indigenous patients.

Alberta had 25 residential schools, the most of any Canadian province, and the last of these closed recently – in 1996. The atrocities that happened in residential schools can be read about in detail in the Truth and Reconciliation Report. Those who did not attend residential schools were also affected as they were taught to be ashamed of their culture and faced systemic racism. Most health care providers have had minimal education on the history of Indigenous peoples and residential schools. This knowledge is critical for all medical students, residents and physicians to better understand Indigenous community perspectives and experiences.

Past experiences cause Indigenous peoples to be distrustful of the health care system. Relationships with patients and communities should be valued and fostered over time. The AMA must continue outreach to prove it is committed to improving the inequities faced by our people.

The following story demonstrates the challenges Indigenous peoples face in the health care system. An elderly female Indigenous patient was admitted for symptom control related to advanced metastatic breast cancer. She left the hospital many times against medical advice and was deemed to be a “difficult patient.” When the physician sat down with her for a consult, they took a robust social history and learned that being in an institutional setting reminded her of her days in residential school. This brought up memories of the abuse she suffered. For example, every morning memories were brought up because of the porridge that was served. This was the same food she got daily at residential school and was forced to eat even if she vomited. With an understanding of this, the team was able to better understand her perspective and offered wrap-around support including regular visits from a cultural helper. With these changes, the patient agreed to stay in hospital and received much-needed treatment. This is just one story of many demonstrating the struggle I have seen our people face in a health care setting.

Past experiences cause Indigenous peoples to be distrustful of the health care system. Relationships with patients and communities should be valued and fostered over time. The AMA must continue outreach to prove it is committed to improving the inequities faced by our people.

Most Indigenous peoples do not have adequate access to primary care. When there is a small town in Alberta that doesn’t have a physician, it is a crisis. However, when a reserve or settlement doesn’t, it is accepted as normal. Many Indigenous patients seek care in the emergency department because equitable access to primary care is not provided and this creates bias. There are also complex jurisdictional challenges that Indigenous peoples face, and I encourage you to review Jordan’s Principle as an example.

The AMA has recognized that you cannot have true reconciliation unless you have an Indigenous voice at every table where health decisions are being made for Indigenous peoples. That is why it was so important to have Indigenous community members and Indigenous physicians as part of our Indigenous Health Working Group and now the Indigenous Health Committee.

Our committee will continue to advocate for equitable Indigenous Health and use the AMA policy paper as our guiding principles. The ultimate hope for the future is that we can remove barriers and health inequities to improve the health of Indigenous peoples.

The Alberta Medical Association stands as an advocate for its physician members, providing leadership & support for their role in the provision of quality health care.