Question Period Note: Addressing Anti-Indigenous Racism in Canada’s Health Systems

• Canada needs long-term, sustained, multi-leveled actions in order to eliminate racism in Canada’s health systems.

• In response to priorities identified by partners, resources were identified for Indigenous Services Canada and Health Canada to pursue actions with Indigenous and health partners to foster health systems free from racism and discrimination.

• Action is required from all levels of health systems, including provincial and territorial governments. The Government of Canada will continue to engage with all partners and explore every option available to ensure we work together to end racism in Canada’s health systems.

If pressed on Budget 2021
• Budget 2021 invested $126.7M to address anti-Indigenous racism in Canada’s health systems, with an emphasis on increasing access to culturally safe health services, prioritizing those targeted to Indigenous women, 2SLGBTQQIA+ peoples, people with disabilities, and other marginalized groups.

• Proposed investments will build on the progress being made, including increasing capacity and responsiveness to community needs, thereby promoting expanded and more diverse services and, ultimately, better outcomes.

If pressed on Opioids Crisis in BC
• The ongoing opioids crisis in this country has been exacerbated by the COVID-19 pandemic, and Indigenous populations continue to be disproportionately impacted.

• The Government of Canada is a governance partner in the British Columbia Tripartite process, and remains ready to support the First Nations Health Authority in responding to this crisis.

• In an effort to end anti-Indigenous racism in health care, including mental health care, the Government of Canada is collaboratively engaging with Indigenous organizations and leaders, provincial and territorial governments, and health system partners to identify concrete actions.

If pressed on National Dialogues
• Three National Dialogues have been convened by Indigenous Services Canada, with support of Health Canada and Crown-Indigenous Relations. These dialogues included National Indigenous Organization representatives, Indigenous health professionals, health systems partners, and provincial/territorial representatives to discuss racism in health systems and commit to strategies to eliminate it.

• In August 2021, the Government of Canada posted its federal response for addressing anti-Indigenous racism in health systems which includes support to patient advocates, health system navigators, and cultural safety training for medical professionals.

• These roundtables will help inform the next National Dialogue in 2022.

If pressed on Joyce’s Principle
• Joyce's Principle aims to guarantee to all Indigenous Peoples the right of equitable access to social and health services, as well as the right to enjoy the best possible physical, mental, emotional and spiritual health.

• Indigenous Services Canada provided $2 million to the Atikamekw Nation and Manawan First Nation to advance their advocacy for the implementation of the federal aspects of Joyce's Principle across Canada.

• The Department is taking additional concrete actions to address racism in the health systems, andis also a proud signatory to the Declaration of Commitment on Cultural Safety and Humility along with FNHA, Health Canada and the PHAC colleagues.

National Dialogues
On October 16 2020, the Ministers of Indigenous Services, Crown Indigenous Relation and Northern Affairs, and Health convened an urgent meeting, bringing together Indigenous, provincial and territorial governments and partners, and health practitioners and regulators to honour the life of Joyce Echaquan and to hear about the lived experiences of Indigenous patients and providers. The Rapporteur’s Final Report was shared with meeting attendees.

On January 27 and 28, 2021, federal, provincial and territorial governments and Indigenous and health system partners met virtually to share both short and long-term concrete actions to eliminate anti-Indigenous racism in health systems

At this National Dialogue, the Minister of Indigenous Services Canada launched the engagement process for the co-development of distinctions-based Indigenous Health Legislation to deliver high quality healthcare for First Nations, Inuit and Métis.

In addition to Health Legislation, the Government of Canada committed to and has since:
o Provided $2 million to the Atikamekw Nation and Manawan First Nation to advance their advocacy for the implementation of the federal aspects of Joyce's Principle across Canada;
 Joyce's Principle aims to guarantee to all Indigenous Peoples the right of equitable access to social and health services, as well as the right to enjoy the best possible physical, mental, emotional and spiritual health.
o Provided $4 million to the National Consortium of Indigenous Medical Education; and;
o Supported the National Collaborating Centre for Indigenous Health to create a one-stop shop for cultural safety and anti-racism tools and resources.

A 3rd National Dialogue was held on June 28 and 29, 2021 to pursue collective actions related to four themes: increasing Indigenous representation in post-secondary health education, cultural safety and humility, traditional approaches to health and safe patient navigation.
• Key outcomes of this meeting included:
o The Government of Canada affirmed its commitment that the distinctions based health legislation will be informed by the spirit and elements of Joyce's Principle;
o Continued leadership role of the federal government to address anti-Indigenous racism in health systems, including as a convenor to support organizations in their capacity to address systemic racism issues and advocacy/engagement;
o Need for focused regional distinctions-based approaches to address racism in health system;
o Sharing of best practices and lessons learned in order for organizations and governments to collaborate in advancing their actions.

In August 2022, Indigenous Services Canada and Health Canada released the federal response to addressing anti-Indigenous racism in Canada’s health systems: https://www.sac-isc.gc.ca/eng/1628264764888/1628264790978.

Joyce’s Principle
A female patient in her mid-thirties, from the community of Manawan was admitted to Joliette Hospital in September 2020 in order to receive urgent care for an acute health issue.

The patient recorded a video of herself during her hospital stay that shows her distress, but most of all, mistreatment as well as degrading and racist comments from the staff.

Tragically, the patient passed during her hospital stay..

The video was shared on social media (Facebook) and the story was eventually published on the CBC website (see link below)

http://www.radio-canada.ca/util/postier/suggerer-go.asp?nID=4562889
The Government convened an urgent meeting on October 16, 2020, bringing together Indigenous, provincial and territorial governments and partners, and health practitioners and regulators to hear about the lived experience of Indigenous patients and providers.

On January 27-28, 2021, over 170 participants and 500 observers from National Indigenous Organizations, Indigenous Health Professional organizations, Provincial and Territorial Governments, Pan-Canadian Health Organizations, health experts, and other stakeholders attended a second National Dialogue to address Anti-Indigenous Racism in Canada’s Health Care Systems. Building from the Emergency Meeting held on October 16, 2020, this meeting provided an opportunity for the participants to renew their commitment to eliminating racism by identifying concrete actions and developing response strategies towards that shared objective.

In March 2021, the Atikamekw announced they are turning to the United Nations to obtain justice on behalf of Joyce Echaquan. Complaints will be brought before five special rapporteurs in advance of the United Nations Annual Forum for Indigenous Peoples. The intention is to encourage Ottawa and Quebec to implement Joyce’s Principle and urge immediate action to end systemic discrimination against Indigenous Peoples.

The Coroner’s public hearing into the death of Joyce Echaquan began on May 14, 2021 at the Trois-Rivières courthouse. The hearing was chaired by Coroner Géhane Kamel, who is already in charge of a committee on mortality in Indigenous and Inuit communities. The coroner’s mandate is not to decide criminal liability but rather to determine the causes and circumstances of death and to make recommendations on how to avoid similar deaths in the future.

The hearings lasted for thirteen days over four weeks to shed light on the causes and circumstances of Joyce Echaquan's death. About fifty witnesses were heard, including Joyce’s family and relatives, hospital employees, pharmacists and an emergency physician.

The inquiry came to an end on June 2, where Manawan Chief Paul-Émile Ottawa offered his thoughts and suggestions to the coroner in the “recommendations” section of the public inquiry, as did Ghislain Picard, chief of the Assembly of First Nations Quebec-Labrador.

The Government of Canada convened a third national dialogue in June 2021 to continue pursuing collective actions related to increasing Indigenous representation in postsecondary health education, cultural competency training, traditional approaches to health and safe patient navigation.

The final report following the Coroner’s inquest regarding Joyce Echaquan’s death was released on Friday, October 1, 2021. It concluded that the racism and prejudice Joyce Echaquan was subjected to contributed to her death and makes several recommendations. While none are directed towards the Government of Canada, some specific recommendations include:
• Recognize the existence of systemic racism within our institutions and make a commitment to contribute to its elimination.
• Ensure the effective integration of the Atikamekw liaison officer into the hospital, in particular by involving them with care teams.
• Include in the school curriculum training on the care of Indigenous patients that takes into consideration the realities of Indigenous communities.
• Establish with Indigenous communities a greater offer of internships for both nurses and medical residents.
Mary-Ellen Turpel-Lafond’s report
On June 19, 2020, Mary-Ellen Turpel-Lafond was appointed by British Columbia’s Minister of Health to conduct a review of Indigenous-specific racism in the provincial health care system. The purpose of the investigation focused on alleged incidents of Indigenous-specific racism in emergency departments in B.C. Her report, entitled “In Plain Sight” was released on November 30, 2020.
The report contained twenty-four recommendations to address anti-Indigenous racism in health care in British Columbia. While the recommendations were not directed to the federal government, the report did identify a number of areas where federal actions could be helpful to eliminate all forms of discrimination against Indigenous peoples, including:
• Federal legislation to specifically implement the UN Declaration to bring the federal laws, policies and practices in conformity with the Indigenous human rights, principles and standards in the UN Declaration;
• Federal Indigenous-specific health legislation and other legislative amendments which explicitly make cultural safety a desired outcome or requirement of quality within Canada’s health care system;
• Federal health regulatory standards that address anti-racism, cultural humility and trauma informed practices; and,
• Direct support by national health organizations to identify measures and tools to address antiracism, encourage cultural humility, and promote trauma-informed practices throughout all spheres of authority and work.

In follow up to the recent urgent meeting held in October to address racism experienced by Indigenous Peoples in Canada’s Health Care system, a second gathering has been scheduled for January 2021. This meeting will provide an opportunity for meeting participants (including the Government of Canada, Indigenous leaders and organizations, and provincial and territorial governments) to identify short term, concrete actions that can be taken to address this systemic issue. Mary Ellen Turpel-Lafond’s report will be a valuable guide and resource for identifying concrete next steps and actions to be taken by all levels of government.

Indigenous Services Canada is committed to equitable and culturally-safe, community-led, community-driven and distinctions-based approaches to health care. BC’s First Nations Health Authority is the first province-wide health authority of its kind in Canada. In 2013, the First Nations Health Authority assumed the programs, services, and responsibilities formerly handled by the Government of Canada’s First Nations and Inuit Health Branch. Indigenous Services Canada is in regular contact with the First Nations Health Authority, which is the lead on health protection measures and health preparedness measures for First Nations communities in BC.

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