Question Period Note: Addressing Anti-Indigenous racism in Canada’s health systems

• Canada is committed to working in partnership with provinces
and territories who are responsible for health service delivery
but continues to improve the quality of the services it delivers
directly to Indigenous peoples.
• Ministers of Health Canada and ISC have initiated trilateral
discussions to discuss Indigenous Health priorities and
investments in more culturally relevant and safe health services.
• ISC provides cultural competency training to federal nurses in
communities as well as to front line employees serving clients
directly in Non-Insured Health Benefits, in Jordan’s Principle
and in the Inuit Child First Initiative.

National Dialogues
Joyce Echaquan, 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.
Ms. Echaquan recorded a video of herself during her hospital stay that showed her distress, but most of
all, mistreatment as well as degrading and racist comments from the staff.
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 at the following link: http://www.radio-canada.ca/util/postier/suggerer-go.asp?nID=4562889
The Ministers of Indigenous Services, Crown-Indigenous Relations, and Health convened an urgent
meeting on October 16, 2020 that included Ms. Echaquan’s family, representatives from Indigenous
communities and organizations, officials from the federal, provincial, and territorial governments and other
institutions 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.
The second National Dialogue convened on January 27 and 28, 2021, where federal, provincial and
territorial governments and Indigenous and health system partners, which included over 170 participants
and 500 observers, 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 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;
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 third National Dialogue held on June 28 and 29, 2021 was designed as a working meeting to pursue
concrete collective actions related to 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 2021, Indigenous Services Canada and Health Canada released the federal response to
addressing anti-Indigenous racism in Canada’s health systems: https://www.sacisc.
gc.ca/eng/1628264764888/1628264790978.
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. In the spirit of Joyce’s Principle, the Government is treating anti-Indigenous racism in health care
as an urgent priority and has taken action and continues to take action to address this issue.
Joyce’s Principle was developed in pursuit of justice and honour for Joyce Echaquan. In March 2021, the
Atikamekw announced they were turning to the United Nations to obtain justice on behalf of Joyce
Echaquan. Complaints were brought before five special rapporteurs in advance of the United Nations
Annual Forum for Indigenous Peoples. The intention was 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 was already in charge of
a committee on mortality in Indigenous and Inuit communities. The coroner’s mandate was 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, 2021 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 final report following the Coroner’s inquest regarding Joyce Echaquan’s death was released on
October 1, 2021. It concluded that the racism and prejudice Joyce Echaquan was subjected to
contributed to her death and made several recommendations. While none were 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.
Background on the reinstatement of the hospital orderly involved in Joyce Echaquan’s care Global News
Article on August 23, 2023 (https://globalnews.ca/news/9914959/quebec-hospital-worker-job-arbitrationindigenous-
womans-death/)
• The orderly who was fired from Joliette Hospital following Ms. Echaquan’s death challenged the
dismissal at an arbitration tribunal.
• On August 16, 2023, the tribunal ordered her reinstatement noting that as an orderly, she was not
the main person responsible, and pointed that she was just a part of "a long chain of
responsibility." The tribunal ordered that the health board also give her the back pay she is owed,
minus a six-month unpaid suspension as penalty for her actions the day Ms. Echaquan died, and
suggested she be given additional training.
Family’s reaction Article La Nouvelliste August 24, 2023
(https://www.lenouvelliste.ca/actualites/actualites-locales/2023/08/24/la-famille-de-joyce-echaquan-seprononce-
sur-la-reintegration-de-la-preposee18
H3YKYOVQ2FEOTNHRZKCYKRYKIE/#:~:text=Sans%20commenter%20directement%20la%20sanction,
d%C3%A9cision%20constituent%20du%20racisme%20syst%C3%A9mique)
• Following that tribunal’s decision, members of Ms. Echaquan’s family reiterated that there is
systemic racism in the health care system, and noted that their priority in the wake of these
events is to create systemic change to prevent such situations from happening again.
• In a press release dated August 25, 2023
(https://www.facebook.com/photo?fbid=607004348289562&set=pcb.606970058292991), the
Assembly of First Nations Quebec and Labrador stated that the “purely administrative decision to
reinstate the patient attendant in her same workplace deeply undermines the confidence of First
Nations in the entire Quebec health and social services network”.
• Derek Montour, president of the First Nations of Quebec and Labrador Health and Social
Services Commission added that “the policies and laws of the current health care system must be
decolonized to enshrine genuine principles of cultural safety co-developed with First Nations. The
injustice experienced by Joyce Echaquan or any other First Nations person are unacceptable and
deserve to be addressed with all necessary means to put an end to it.”
Background on Birth Alerts CBC Article on May 15, 2023 (https://www.cbc.ca/news/canada/ottawa/birthalert-
the-ottawa-hospital-continue-after-october-2020-1.6835776):
• Birth alerts are notifications given to hospitals regarding unborn children who are deemed “high
risk” by child welfare agencies. Health-care providers are then required to alert welfare authorities
when the pregnant person comes to seek medical care or deliver their baby. In turn, the newborn
children are at risk of directions being taken, including medical testing, preventing the child from
leaving the hospital with their parent(s), or being removed from their parent(s) at birth.
• This alert system was stopped by Ontario government in October 2020, but Quebec child welfare
agencies continued to send alerts to Ottawa hospitals. CBC reported that the Ottawa Hospital
received 298 birth alerts from October 2020 onwards, although they were not acted upon,
according to the hospital. Victims who received birth alerts report not knowing the reasons why
the child welfare agencies issued alerts on them. An Indigenous Ottawa doula reported having
clients in Ottawa that had experienced birth alerts recently in 2023 and felt targeted and unsafe.
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, communitydriven
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.
Indigenous Health Legislation
The 2022 mandate letter for the Minister of Indigenous Services commits to "fully implement Joyce's
Principle and ensure it guides work to co-develop distinctions-based Indigenous health legislation to
foster health systems that will respect and ensure the safety and well-being of Indigenous Peoples."
The 2020 Fall Economic Statement announced an initial investment of $15.6 million over 2 years, starting
in 2021 to 2022 to support the co-development of distinctions-based+ health legislation with First Nations,
Inuit and the Métis Peoples.
From Winter 2021 to Fall 2022, regional and national First Nations, Inuit, Métis, and Intersectional
Partners led numerous engagements within their communities on the vision for distinctions-based
Indigenous health legislation. A national summary report, What we heard: Visions for Distinctions-based
Indigenous Health Legislation, was published in January 2023.
The report summarizes the input the Government of Canada has received to date from Indigenous
Peoples about their vision for what to include in distinctions-based Indigenous health legislation to
improve access to high-quality, culturally-relevant, and safe health services. This report will serve as one
tool to help pave the way for the co-development of legislative options.
Indigenous Services Canada is now working with First Nations, Inuit, Métis, and Intersectional partners to
co-develop legislative options through distinctions-based+ tables. Once fully-costed legislative options are
co-developed, drafting of the bill would take place from Spring 2023 to Fall 2023. Introduction of the bill
would follow in Winter 2024.

If pressed on Budget 2021

• Budget 2021 invested $126.7M over 3 years, to address anti-
Indigenous racism in Canada’s health systems, while prioritizing
the needs of Indigenous women, 2SLGBTQQIA+ peoples, people
with disabilities, and other marginalized groups.
• Budget allocations include, a total of:
o $33.3M to improve access to culturally safe health services
o $46.9M to adapt health systems
o $37.8M to improve supports and accountability
o $8.7M for federal leadership (i.e. National Dialogues)
• Through these investments, Canada is committed to developing
a comprehensive national approach that addresses anti-
Indigenous racism in health systems.
• Leadership and commitment to making sure health services are
safe for Indigenous peoples is needed from all jurisdictions.

If pressed on outcomes of Budget 2021 investments
• Through Budget 2021 funding, 152 Indigenous-led initiatives are
currently underway across all provinces and territories to
improve access to high quality and culturally safe health
services.
• As a direct result of the Budget 2021 funding, 65 health system
navigators and 20 patient advocates have been hired to date.
• In addition, two national Indigenous health professional
associations have been created- the Indigenous Dental
Association of Canada, and the Indigenous Pharmacy
Professional Association, who are working with Indigenous and
non-Indigenous professionals and regulatory bodies to promote
culturally safe practices in health service delivery.
• The department will seek an opportunity to renew funding in
addition to other sunsetting health programs including mental
health, and health systems transformation

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
• Four National Dialogues have been convened by Indigenous
Services Canada since October 2020, with support of Health
Canada and Crown-Indigenous Relations.
• The latest National Dialogue on Data initiated discussion on how
data can enable action against anti-Indigenous racism and racist
outcomes in health systems by identifying priorities for data
collection and upholding principles of Indigenous data
sovereignty.
• In August 2021, the Government of Canada posted its federal
response for addressing anti-Indigenous racism in health
systems which includes providing support to patient advocates,
health system navigators, data collection initiatives, and cultural
safety training for medical professionals.

If pressed on Joyce’s Principle
• Our Government is fully committed to implementing Joyce's
Principle and supporting initiatives aimed at combating anti-
Indigenous racism in health systems across the country.
• 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 $2M to the Atikamekw
Nation and Manawan First Nation to advance their advocacy for
the implementation of the federal aspects of Joyce's Principle.
• ISC provided funding to create and launch the Joyce’s Principle
Office, to support Joyce’s Principle implementation in the fields
of health, social services and education.

If pressed on reinstatement of Joliette Hospital employee
• We understand that the recent news regarding the reinstatement of
one of the employees involved in Joyce Echaquan’s treatment at
the Joliette Hospital may cause disappointment and dismay to the
Echaquan family, and Indigenous communities in Quebec and
across the country.
• The Government of Canada is fully committed to implementing
Joyce's Principle and supporting initiatives aimed at combating
anti-Indigenous racism in health systems across the country.
If pressed on Indigenous Health Legislation
• Our government is committed to co-developing new
distinctions-based+ Indigenous health legislation to improve
access to high-quality, culturally relevant, and safe health
services, with First Nations, Inuit, Métis, and Intersectional
partners.
• We are now working with First Nations, Inuit, Métis, and
Intersectional partners to co-develop legislative options through
distinctions-based+ tables, with the intention of tabling
legislation in winter 2024 that will contribute to improving health
equity.
• A key elements document has been released publicly on August
29, 2023 and partners have been given until September 22, 2023
to submit their views and comments.

If pressed on Birth Alerts
• The Government of Canada recognizes that the presence of birth
alerts disproportionately affected Indigenous mothers. We are
concerned to see a May 15th 2023 CBC report regarding a
significant number of birth alerts still happening in the Ottawa
area.
• Birth alerts are supposed to have ceased in all provinces as of
April 2023, however the May report indicates more work needs
to be done to implement Joyce’s Principle and address the
systemic racism that still exists in health systems as well as in
Child and Family Services.
• We are encouraged that all provinces and territories have now
formally abolished birth alerts and we support the provinces in
ensuring equitable services where Indigenous Peoples can be
respected and safe.