(Artwork: 'Land out of Sight' by Lisa Boivin)
Tansi Nîtôtemtik,
Yesterday we discussed the informational gap in data collection that leaves us with an incomplete picture of health outcomes among Indigenous people.[1] However, even the incomplete data clearly shows worse outcomes in health indicators for Indigenous people when compared with non-Indigenous people. The Truth and Reconciliation Commission compiled the following data regarding this gap as published in the Summary of the final report:
- Infant mortality rates for First Nations and Inuit children range from 1.7 to over 4 times the non-Aboriginal rate.
- Between 2004 and 2008, the “age-specific mortality rate” at ages one to nineteen in the Inuit homelands was 5.3 times the rate in the rest of Canada.
- First Nations people aged forty-five and older have nearly twice the rate of diabetes as the non-Aboriginal population.
- First Nations people are six times more likely than the general population to suffer alcohol-related deaths, and more than three times more likely to suffer drug-induced deaths.
- The overall suicide rate among First Nation communities is about twice that of the total Canadian population.
- For Inuit, the suicide rate is six to eleven times the rate for the general population.
- Indigenous youth between the ages of ten and twenty-nine who are living on reserves are five to six times more likely to die by suicide than non-Aboriginal youth.[2]
Today we will show how these worsened outcomes are a direct result of colonization and government policy in Canada. We will then evaluate progress on TRC Call to Action #18 which calls for acknowledgment of this causation and recognition and implementation of Indigenous healthcare rights as identified under international law, constitutional law, and Treaty.[3]
Colonial Roots
(Image Credit: Stephanie McConkey, The Indigenous Determinants of Health as Predictors for Diabetes and Unmet Health Needs Among Urban Indigenous People: A Respondent-Driven Sampling Study in Toronto, Ontario The University of Western Ontario, 2018) [unpublished], fig 1.)
Well over 100 years ago Indigenous people faced a period of starvation. During that time, rations were withheld as a tactic to force Indigenous people to give up the lands originally selected as reserve lands. Often, these actions forced the relocation of Indigenous people to agriculturally unproductive lands.[4] The driving of Indigenous communities from fertile land meant that, as the TRC states, “reserve housing was poor and crowded, sanitation was inadequate, and access to clean water was limited.”[5] During the same period, children were being whisked away to poorly constructed residential schools that were understaffed and undersupplied with food, clothing, sanitation, and medical supplies, and other necessities.[6]
The result was the en masse death of Indigenous people from tuberculosis. Those not killed by this lung disease were often severely weakened and likely to succumb to measles, smallpox, and other infectious diseases.[7] Despite the high death rates in the schools and Indigenous communities, health resources and hospital care was restricted in 1937 “to those required for the safety of limb, life or essential function.”[8] Policies that ignored the health of Indigenous people through multiple generations have had a lasting impact on the health of Indigenous people. Some survivors still suffer from untreated physical ailments from residential schools or an inability to access medical care. The impact of intergenerational trauma on health is also apparent in the high rates of substance-related death and suicide.
Contemporary Indigenous Health
(Image Credit: THE CANADIAN PRESS/Paul Chiasson)
Let us fast forward to today. First Nations and Inuit households are three and four times as likely to live in an overcrowded dwelling and/or one in need of major repairs.[9] There are also several communities living under long-term boil water advisories or who do not have access to running water and indoor toilets, including the Neskantaga First Nation who recently had to evacuate due to water access being cut off.[10] The current conditions sound pretty similar to 100 years ago when “reserve housing was poor and crowded, sanitation was inadequate, and access to clean water was limited”, doesn’t it?[11] In the words of Spirit Bear, Bearister with First Nations Child & Family Caring Society, Canada has not yet “fixed the unfairness” that created and continues to perpetuate these health indicators.[12]
While Canada has formally acknowledged the health care gap to be a result of colonial policy and has allocated additional funding for healthcare improvements, we are not seeing the change.[13] Indigenous patients, not the system, continue to bear the brunt of the blame for having poorer health outcomes. We have seen horrifying instances of healthcare failures in the deaths of Joyce Echaquan, Elder Hugh Papik, Brian Sinclair & Katie Ross; where people in need of healthcare for treatable illness or injury died after being accused or suspected of substance use on the basis of their Indigeneity.[14] We have seen provincial leaders flatly deny any problem of systemic racism that would impact healthcare for Indigenous people.[15] Healthcare is a right protected by the constitution and by treaty. However, Indigenous people are still being denied this basic right, and Canada continues to fail these people with a lack of formally implemented Indigenous healthcare rights.
Evaluation of Canada’s Response to Call to Action #18
On this basis, Team ReconciliAction is assigning a grade of ‘D’ to Canada on Call to Action #18.
A formal acknowledgment and an increase to short term funding is the bare minimum for a passing grade. Truth is the first step in reconciliation. However, reconciliation here requires;
- a formal Indigenous health rights framework that works to counter pervasive systemic racism in healthcare;
- addressing the century-old housing and clean water crises that lead to poorer health; and
- a commitment to long term and sustainable funding to ensure substantive equality in access to healthcare.
Canada has a duty to actively correct the ‘unfairness’ against Indigenous people created by colonialism and government policy. Telling the truth about it is only the first step in meeting this Call to Action.
Thank you for reading today after a presumably long night of nail-biting over the US election non-results. Check back tomorrow for more on the TRC Calls pertaining to Indigenous health.
Until Next Time,
Team ReconciliAction YEG
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1 ReconciliAction YEG, “Improving Indigenous Health”, (3 November 2020), online: University of Alberta Faculty of Law Blog <https://ualbertalaw.typepad.com/faculty/2020/11/improving-indigenous-health.html>.
2 Truth and Reconciliation Commission of Canada, Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada. (Ottawa: Truth and Reconciliation Commission of Canada, 2015) at 160.
3 Ibid.
4 Ibid at 94.
5 Ibid.
6 Ibid at 99.
7 Ibid at 94.
8 Ibid at 98.
9 Chantelle A M Richmond & Catherine Cook, “Creating conditions for Canadian aboriginal health equity: the promise of healthy public policy” (2016) 37:1 Public Health Reviews 2; see also Heather Tait, Aboriginal Peoples Survey, 2006: Inuit Health and Social Conditions, Catalogue no. 89-637-X, No. 001 (Ottawa: Statistics Canada, Social and Aboriginal Statistics Division, 2008).
10 Helen Fallding, “Disease factory Consequences of living without tap water and flush toilets”, Winnipeg Free Press (3 November 2010), online: <https://www.winnipegfreepress.com/no-running-water/health/disease-factory--consequences-of-living-without-tap-water-and-flush-toilets.html>; Jody Porter, “Few left behind in Neskantaga First Nation prepare for winter without water”, CBC News (26 October 2020), online: https://www.cbc.ca/news/canada/thunder-bay/neskantaga-left-behind-1.5776993.
11 Truth and Reconciliation Commission of Canada, supra note 2 at 94.
12 Spirit Bear, Spirit Bear’s Guide to the Truth and Reconciliation Commission of Canada Calls to Action (Ottawa: First Nations Child & Family Caring Society of Canada) at 3.
13 Government of Canada; Indigenous and Northern Affairs Canada, “Health”, (23 April 2018), online: Delivering on Truth and Reconciliation Calls to Action <https://www.rcaanc-cirnac.gc.ca/eng/1524499024614/1557512659251>.
14 ReconciliAction YEG, “Joyce Echaquan: Death by Racism”, (5 October 2020), online: University of Alberta Faculty of Law Blog <https://ualbertalaw.typepad.com/faculty/2020/10/joyce-echaquan-death-by-racism.html>.
15 Kristy Kirkup & Tu Thanh Ha, “Indigenous woman records slurs, taunts of Quebec hospital staff before her death”, The Globe and Mail (29 September 2020), online: <https://www.theglobeandmail.com/canada/article-indigenous-woman-records-slurs-taunts-of-quebec-hospital-staff-before/>.
