Issues in Healthcare: Indigenous Health in A “Nation of Equity”
Shining a light on the inequities within the Canadian healthcare system
Resilience is a remarkable thing of nature, a core of steel inherited by humanity. Ironically, those who honour this memory in Canada are those who need it now more than ever.
The Indigenous peoples, still reeling from over three centuries of oppression, continue to struggle for equity in accessing even the most basic of human needs. Within the bounds of our world-renowned healthcare system, the idea of such a desperate struggle appears ridiculous in a society so infused in its social modernity as ours.
The recent devastation wrought by COVID-19 has given us a new perspective to see just how desperate the situation is. Through the lens of healthcare, a vital social fabric woven by the threads of socioeconomic and cultural factors stretched taut with the pandemic, the essence of disaster is laid bare.
Though it is said that Canada’s healthcare program, of high international standing, is founded on the basis of need, the reality is much more complex than simply “free and universal healthcare”. Despite the fact that the public income tax manages to pay for 70% of health insurance costs in hospitals, 30% must still be covered by the patient. Such a portion, though minimized to make sure the less fortunate can access the critical tenets of a healthy life, is still not very affordable with 1 in 5 Canadians living near the poverty line today.
In addition, many of one’s routine services, such as dental, home and mental health care are not provided at a hospital, and thus does not fall under the universal coverage plan. Instead, services must be paid in full, with 94% of dental services and 60% of medication costs covered by private insurance plans across Canada.
If access to healthcare is critically affected by affordability, health becomes more of an analysis of factors that create the conditions for poverty rather than physical health. Many cannot reliably provide for many of the prerequisites of health, such as food security, and proper housing, much less the associated transit or insurance costs. This line of logic is summarized in the idea of a social gradient of health, in which the poor are not as healthy as those who can access all of the above.
As such, it is then no surprise that the gradient predicts that children who live in poverty will be more vulnerable to chronic conditions such as asthma and malnutrition. This translates into a greater chance of developing cardiovascular disease, cancer, diabetes, mental health issues and addictions as an adult.
However, it is difficult enough for Indigenous peoples to access healthcare so far away from the urban centres that are the nexus of Medicare in the first place, with the majority living on rural reserves or in remote territories. With an already low physician count of 2.42/1000 people, most health professionals are concentrated at such population centres that require immense travel expenses to reach by oneself and their families.
There is little incentive for physicians to set up shop in rural areas to begin with, for isolation from the main system marginalizes a doctor’s voice in the larger medical community, with limited support from other specialists. As a result, 58% of patients in Nunavut needing hospital care had to be transported out of the territory.
In remote locations and reserves that require fly-in physicians, caregivers are not able to truly immerse themselves in a community and see to their needs as they move from place to place, leaving many voices lost amongst the larger interconnected system.
In being overlooked by the poor stewardship of the federal government, reserves have little of the funding needed to build the necessary infrastructure for a modern society based on public services, from concrete roads to sanitation. In limiting their autonomy to govern their health in the way deemed right by their culture, whilst not providing the financial resources to help build from the ground up, the efficient delivery of primary care is but a pipedream. Though many physicians have moved to virtual care to keep them and their patients safe, many do not have the technological infrastructure to access this care. Even in the context of a pandemic such as COVID, vital medical supplies such as test kits, personal protective equipment (PPE) and vaccines are difficult to access.
The lack of proper infrastructure also cripples a community’s ability to be a part of the larger regional economy, whether it be importing or exporting the necessary goods, or establishing businesses to create jobs and allowing access to employment outside. Not having this independence and having to rely on inadequate federal subsidies robs people of their chance to build a healthy life for themselves, as well as defacing their quest for autonomy. With a resultant wage gap of up to 50% between Indigenous peoples and the rest of society, such is the reality of the Indigenous struggle. Many First Nations reserves have to subside on muddy roads or even have bottled water flown in, not to mention healthcare!
Another particular point, in the context of limited economic resources during the time of COVID-19 is the inability to provide adequate housing, resulting in multigenerational housing and overcrowding throughout their communities. With perhaps not even enough space to self-isolate, the perfect conditions for the rapid transmission of COVID and other diseases are born.
Cultural barriers between the biomedical model of the wider Canadian society, which emphasizes a formal healer/patient relationship, and the traditional Indigenous model of wellness are also a critical thorn in accessing culturally safe healthcare. One draws on precise and efficient treatments, whilst the other draws on aspects of mentality and spirit within family and community relationships to truly heal.
In terms of cultural safety, understanding between the two models is often hard to come by without taking away from Indigenous traditions already in place or understanding their economic situation. For example, issues such as diet control might not be feasible for low income mothers whilst traditional herbal medicine, smudging or pipe ceremonies may be put off, making soothing care difficult without one who understands the cultural context of their environment.
With the addition of the unresolved trauma and distrust wrought by residential schools, cross-cultural care is extremely difficult when it comes to cultural safety. The lack of any real autonomy and the limits of poverty restricts the Indigenous peoples from creating a meaningful system that suits their own cultural and economic needs.
Poverty further limits access to stable education, the key to even rising out of it in the first place, since families need every hand on board to survive. Those who even get an education often do not have a culturally appropriate one, but if they do have one, such a skill set may not be very high in demand amongst the capitalist hierarchy of jobs. The absence of an adequate healthcare system is a result of the constant struggle to even obtain the prerequisites of food security, income, housing, and a tangible line of action for a united community.
Against such an onslaught, a community’s outlook on life is naturally decimated alongside each individual’s collective potential for physical and mental health. Reserves suffer from extremely high rates of mental health issues and substance addiction, but with the necessary services having to be paid in full and impossible to access, not to mention the stigma associated with seeking help, devastating results become frequent. High rates of violence, suicide and chronic illnesses bear among the consequences.
If only the once proud peoples could protect themselves, stand for themselves, and live for themselves. If only children did not have to starve nor watch their parents suffer, and feel the certainty of their future unfolding before their eyes, the certainty that there is no hope. So many ifs, so many things we could have done to give them a decent answer. But few of us did, so is it too late?
No.
We MUST say no to the complacency that has anesthetized us from the plight unfolding before us. Such a change starts with us, our community, our caregivers, and our government.
We must recognize the need to integrate both Indigenous and biomedical models to create the conditions for culturally safe care. We must recognize the necessity for people to govern themselves, for who knows oneself better than themselves?
Communication, trust and partnership between us all are essential to coordinate efforts to meet the needs of an entire society, whether it be providing the financial resources where needed, negotiating treaties and laws concerning the land and Indigenous rights, or simply taking a step back to understand the people one is supposed to help. What better time to do so than now, when the field is bare after the storm and new crops are to be sown?
From such a bleak picture, with the slimmest glimmer of hope that must be seized, one can conclude that healthcare is about one’s ability to choose the life one chooses to live. It is their ability to act to protect themselves, their families, and their communities. It is about the solidarity that ties us all together in working towards a better world, for unity is the missing piece that binds us all. The only way forward is together.
About the Author
Jim Xu is an incoming grade 12 high school student, a jack-of-all-trades who strives to play his role in helping to make the community a better place. An ardent writer, one can always find Jim with his nose in a fantasy novel with just the right sprinkle of romance.
Sources
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Canada, P. H. A. of. (2021, March 16). Government of Canada. Canada.ca. Retrieved August 22, 2022, from https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19/indigenous-peoples-covid-19-report.html#a4.8
Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018, April 28). Canada’s Universal Health-care system: Achieving its potential. Lancet (London, England). Retrieved August 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138369/
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