In 2015, we published an article outlining the eight key issues of primary concern for Indigenous Peoples in Canada. Since then, the article has been viewed over 620,000 times, making it the most-viewed article of the hundreds on our Working Effectively with Indigenous Peoples® blog. Due to the continuing high interest, we decided to take a deeper look at each of the eight issues.
Destabilizing Indigenous health
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
World Health Organization (WHO)
This article looks at the historical and ongoing physical and mental health disparities between Indigenous people and other Canadians. Understanding the root of the disparities requires familiarity with the history of Indigenous Peoples in Canada.
Before contact, Indigenous Peoples led sustainable lifestyles developed over millennia. They generally had good health supported by traditional foods, healing practices, and cultural and ceremonial protocols.
In 1492, when Christopher Columbus arrived in the Americas, there were “approximately 100 million Native Americans - a fifth, more or less, of the human race.”  The ensuing influx of first European explorers and then settlers introduced viruses and bacteria (smallpox, measles, typhus, syphilis, cholera) to which Indigenous Peoples had never been exposed and therefore had neither immunity nor traditional medicines to heal the infected. By the 1600s, between disease and warfare, Indigenous Peoples' dieoff was so extreme it caused a cooling of the Earth’s climate.
- Earth system impacts of the European arrival and Great Dying in the Americas after 1492
- The Impact of Smallpox on First Nations on the West Coast
In 1876 the Indian Act was introduced in Canada with its ultimate goal “to get rid of the Indian problem”  through assimilation into the dominant European culture.
The Indian Act impacted health in the following ways:
- Dispossessed Indigenous Peoples of their lands, traditional economies, and traditional foods that had sustained them since time immemorial, which compromised their immune systems
- Destroyed their self-sufficiency and created a dependency on government agencies
- Outlawed their culture and traditions
- Moved them into poorly constructed housing that was often inappropriate for the environment
- Removed over 150,000 children and interned them in damp, cold "schools" that became breeding grounds for tuberculosis
- Performed medical experiments on children and adults at Indian hospitals
- Devalued women and denied them their legal rights and access to services for themselves and their children.
The physical, sexual, and psychological trauma experienced by survivors of the residential schools continues to impact the physical and mental health of survivors and generations of Indigenous families. Research is underway on how the trauma experienced is carried in the DNA of the survivors and passed down to their children.
Eugenics and Indigenous women
“Eugenics is the scientifically erroneous and immoral theory of “racial improvement” and “planned breeding,” which gained popularity during the early 20th century.” 
In Canada, the popularization of eugenics coincided with the Indian Act exerting tighter control over the Indigenous population. Eugenetistists believed the high rates of ill health and poverty in Indigenous communities were due to a lower racial evolution, not colonialism and Indian Act policies.
Both Alberta (1928) and BC (1933) passed sexual sterilization legislation; the Sexual Sterilization Acts were repealed in 1972 and 1973, respectively. In Alberta, “Aboriginals were the most prominent victims of the Board’s attention. They were overrepresented among presented cases and among those diagnosed as ‘mentally defective.’ Thus they seldom had a chance to say ‘no’ to being sterilized.”  The characterization of Indigenous women as “unfit” mothers is the root of the high number of Indigenous children in foster care in Canada. According to Census 2021, 53.8% of children in foster care are Indigenous but account for only 7.7% of the child population.
Forced and coerced sterilization of Indigenous women is ongoing (BILL S-250) and contributes significantly to the degree of distrust Indigenous women have with the healthcare system and healthcare workers.
Underlying determinants of health and the Indian Act
On the surface, determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health. The underlying determinants of health, according to WHO, are:
- “Safe drinking water and adequate sanitation;
- Safe food;
- Adequate nutrition and housing;
- Healthy working and environmental conditions;
- Health-related education and information;
- Gender equality.” 
If you look at the assimilation tactics and the ongoing impacts of the Indian Act in view of the underlying determinants of health, it becomes clear that colonialism is responsible for destabilizing Indigenous health.
Friction points in care
Access to healthcare in Canada has become increasingly challenging due to the pandemic. For Indigenous Peoples, access to healthcare has always been a challenging miasma of healthcare systems, jurisdictions, and eligibilities.
While Indigenous people living in urban centres have more readily available access to a range of services, they often experience racial stereotyping, discrimination, and culturally unsafe care. For remotely located communities, the high cost of travel to the nearest medical centre and separation from family and community, on top of the above concerns, makes access financially and emotionally daunting.
- Investigations launched after Atikamekw woman records Quebec hospital staff uttering slurs before her death
Additionally, the Western healthcare model focuses on the patients as individuals, whereas, generally speaking, the Indigenous healthcare model takes a more holistic approach that includes spiritual health and cultural wellness.
Incorporating an Indigenous model of healthcare
Transforming the Canadian healthcare system to include an Indigenous healthcare model is increasingly recognized as key to improving the health of Indigenous people.
In BC, the First Nations Health Authority, formed in 2013, is responsible for the over 200 First Nations in the province. Its goal is to “transform the healthcare system to include traditional healing and cultural practices and to improve the health of First Nations and Indigenous peoples.”
In 2015, The Truth and Reconciliation Commission of Canada's (TRC) calls to action included a call for Indigenous healing practices to be incorporated into healthcare for Indigenous Peoples.
“We call upon those who can effect change within the Canadian health care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients"
In 2022, the National Collaborating Centre for Indigenous Health and the Health Arts Research Centre jointly launched a two-year project, Hearts-based Education and Anticolonial Learning (HEAL). HEAL will promote cultural safety and recognize Indigenous knowledge and anti-colonial approaches in health service provision.
Understanding why there are disparities in health and resolving those disparities is vital for the current and future generations of Indigenous Peoples. Here are some hints and tips for healthcare practitioners who want to create a welcoming, culturally respectful space for their Indigenous patients:
- Read the TRC Report and the calls to action
- Read the United Nations Declaration on the Rights of Indigenous People in terms of health and healthcare
- Understand and own biases you may have
- Encourage your colleagues to take Indigenous awareness training
- Commit to our Personal and/or Professional Pledge of Reconciliation
- Research the Indigenous cultures in your catchment area; post signage in the local languages
- Ask Indigenous patients if they use traditional medicine or consult with healers and Elders, and be open to discussion
- Engage the services of Elders/Knowledge Keepers to be present when Indigenous patients have appointments
If you’re looking for resources related to Indigenous health, check out this site: Indigenous Health & Professional Organizations.
- This post is the first in a series. Read the second post:
- Lower Education - #2 of 8 Key Issues for Indigenous Peoples in Canada
 Wright, Ronald, Stolen Continents: The “New World” Through Indian Eyes (Toronto: Penguin Books, 1993) 4.
 Joseph, Bob, 10 Quotes John A. MacDonald Made About First Nations, Working Effectively With Indigenous Peoples blog
 World Health Organization, The Right To Health, Factsheet No. 31