A Resource Guide:

HEALTHCARE ACCESS AND QUALITY AMONG FIRST

NATIONS IN CANADA

INTRODUCTION
First Nations experience health inequities due to inadequate access and quality of
healthcare services across Canada. We chose to emphasize the Canada-wide setting
because the federal government is instrumental in funding and delivering certain First
Nations health services (Government of Canada, 2023). In 2017, Brian Sinclair died in a
Winnipeg hospital after waiting in the emergency room for more than thirty-four hours;
the healthcare workers assumed he was “drunk and sleeping it off” (CBC News, 2017).
The death of Joyce Echaquan in a Quebec hospital for similar reasons in 2020
(Gouldhawke, 2021) and the In Plain Sight (2020) report of BC also show that racism
against First Nations people in healthcare is prevalent across Canada.

First Nations people experience the consequences of Colonialism propagated by the

Canada Government, such as through the Indian Act and residential schools, whose
legacies can still be felt today. Colonialism stratifies people such that settlers are in closer
proximity to power than First Nations peoples (Davies et al., 2023) and produces negative
health outcomes on structural and individual levels (Kim, 2019). Colonial biases and
barriers result in unearned disadvantages for First Nations via insufficient care,
impacting wellness through increased risk of negative physical and mental health
outcomes, increased mortality, mistrust of the healthcare system, and reduced capacity
to work and afford housing. First Nations health advocacy persists despite these
inequalities. The Assembly of First Nations was founded in BC in 1982 and continues to
advocate for First Nations all across Canada; the First Nations Health Authority (FNHA)
was founded in BC in 2013 to improve First Nations health delivery, services, and
outcomes in BC (FNHA, 2023).

1
 By learning about First Nations health inequities and solutions, people can advocate
for change. The following resource list provides more context regarding healthcare
inequities among First Nations in Canada.

RESOURCES

HISTORICAL, POLITICAL, AND SOCIAL CONTEXT: COLONIZING TO

DECOLONIZING

Colonial Trauma: Complex, continuous, collective, cumulative, and compounding

effects on the health of Indigenous peoples in Canada and beyond

Medium: Peer-Reviewed Article (21 pages)

This article by Mitchell et al. (2019) anchors Indigenous health inequities as products of
historic and present colonialism. The authors explain that, although there is lots of
research documenting health inequities, there is still a need for research that investigates
the historical, political, and cultural contexts that have given rise to the health inequities
faced by Indigenous peoples in Canada today. The authors describe how colonial trauma
has cumulative and compounding impacts on Indigenous peoples, resulting in myriad
physical and mental health challenges.

Decolonization and Indigenous Issues

Medium: Webpage and Downloadable PDFs

This webpage from the Public Service Alliance of Canada provides numerous resources
that educate about decolonization. These can help people to learn about individual-level
and structural-level methods of decolonization. This page also provides further resources
for BC, Alberta, and Montreal specifically, as well as resources about decolonizing
research, policy analysis, and labour.

2
ACCESS TO HEALTHCARE AS A SOCIAL DETERMINANT

Access to Health Services as a Social Determinant of First Nations, Inuit, and Métis
Health

Medium: Fact Sheet (16 pages)

This resource explores how accessibility, availability and acceptability of health services
have impacts on First Nations health. It addresses how access is not equally or universally
available to all Canadians. Indigenous peoples continue to experience barriers to health
care, which creates significant health disparities. Historic examples such as forced
relocation and use of Indian hospitals, alongside negative interactions experienced with
health care providers have resulted in many Indigenous people having pronounced
mistrust and apprehension in accessing health services. These concepts must be explored
to understand how health inequities arise and what actions can be taken to mitigate them.

COMMUNITY MEMBERS’ PERSPECTIVES, ENCOUNTERS AND

SOLUTIONS; IMPLICATIONS OF STRUCTURAL ISSUES

Indigenous Perspectives on Health

Medium: Podcast (55:56 minutes)

This episode of the Raw Talk podcast discusses Indigenous ideas and methodologies of
health and compares them with Western ideas and methodologies. Numerous Indigenous
and non-Indigenous guests talk about how the integration of these two perspectives has
caused problems for First Nations health in the past and present, such as by imposing
Western standards of medicine to the detriment of First Nations people. Solutions are
posited on individual and institutional levels to improve First Nations health research
and outcomes, combining both Indigenous and Western aspects of health to provide the
best outcomes.

First Nations Women's Encounters with Mainstream Health Care Services

Medium: Peer-Reviewed Article (42 pages)

3
 The researchers conducted a study to examine health care encounters of several First
Nations women. The findings depicted that these encounters were shaped by racism,
discrimination, and structural inequities. Two main research questions guided the study:
How do First Nation women describe their encounters with local, mainstream health
services? And how do these encounters influence the health and well-being of First Nation
women? This article enhances the discussion of health inequities because it focuses on
the firsthand experiences of First Nation women when attempting to access quality health

Indigenous Knowledge to Close Gaps in Indigenous Health

Medium: YouTube Video (18:35 minutes)

This TED talk by Marcia Anderson-DeCoteau, a Cree-Saulteaux physician, discusses gaps

created in Indigenous health because of government policies. She mentions Canada’s
reports on health and healthcare impacts of systemic racism. It refers to the specific case
of Brian Sinclair who was denied medical treatment for several hours, which led to his
death. This was a result of racism in the Canadian healthcare system and medical
negligence that contributed to a poor health outcome. She further discusses how in order
to close Indigenous health gaps and promote health equity, it’s important to re-examine
the assumptions of Western healthcare medicine.

THE IMPACT OF COVID-19 ON HEALTHCARE DELIVERY

Indigenous communities, systemic racism, and COVID-19

Medium: Podcast (20:00 minutes)

This podcast discusses health care inequities faced by many Indigenous communities
during the era of COVID-19. The main host talks to Dr. Janet Smylie, a Canadian Métis
doctor. Many Indigenous communities face major challenges in accessing equal health
treatment, such as fewer doctors, inadequate housing, and contaminated water supplies.
Collectively, these issues lead to bad health outcomes during a pandemic. The podcast
also discusses the influence of colonialism on First Nations by providing the example of
Sioux Lookout, a town where two separate hospitals were made accessible. Non-First
Nations received better access and quality of healthcare compared to First Nations.

4
DEVELOPING PATHS TO SUCCESS FOR FIRST NATIONS YOUTH

Systematic Review and Meta-Analysis: First Nations, Inuit, and Metis Youth Mental
Health

Medium: Peer-Reviewed Article (24 pages)

This systematic review by Owais et al. (2022) highlights that there is insufficient
disaggregated data about the prevalence of mental health among First Nations, Inuit, and
Metis youth. It is important to have good data about each group independently to
accurately measure prevalence, provide specificity of mental health conditions affecting
each group, and to plan and implement health programs directed at First Nations youth.
Each group will have different constructs of mental health, so the research needs to
account for the norms that each community has with appropriate constructs; with only
aggregated data, these nuances become hidden.

Creating environments for Indigenous Youth to live and succeed

Medium: YouTube Video (14:14 minutes)

This TEDx talk is made by T’áncháy Redvers, of Dene and Métis heritage, who explains
that Indigenous youth are disproportionately burdened with negative health outcomes.
T’áncháy explains how the context of Indigenous youth health today is shaped by the
history of colonialism, through such actions as residential schooling, the Indian Act, and
removal of Indigenous peoples from their lands. They highlight strategies to
decolonization that demonstrate the strength-based needs of Indigenous youth and the
importance of healthy environments for healthy people and development.

FIRST NATIONS GOALS AND SOLUTIONS TO EQUITABLE HEALTH

Implementing the Vision: BC First Nations Health Governance

Medium: Book (48 pages)

This book provides an overview of the collective goal of the Tripartite First Nations
Health Plan. The plan aims to ensure that First Nations are involved in the planning and
management of health services for their communities. By having First Nations as equal
partners, it provides a deeper incentive for change to remove existing barriers and health

5
inequities. It’s important to understand the work being done by BC First Nations to
ensure future generations have authority to enact policies, measure success, allocate
resources, and establish service standards that are of utmost quality and accessibility.

ACTIONS YOU CAN TAKE

To promote First Nations health equities, structural and individual action is
imperative, and First Nations must be given autonomy to promote holistic health. First
Nations advocates have recommended that the Canadian federal and provincial
governments must acknowledge and apologize for anti-Indigenous racism; colonial
governments must consult First Nations in order to develop laws and policies that
promote culturally safe healthcare; and governments and health institutions must be
willing to hold individual personnel accountable for instances of interpersonal racism by
taking seriously the concerns brought to light by First Nations patients (In Plain Sight,
2020). In 2013, the First Nations Health Authority of BC began work to improve access
and cultural competency in delivery and performance of health services for First Nations,
which is an important political initiative in striving for First Nations health self-
governance (Lavoie et al., 2016), and other Canadian provinces would do well to
collaborate with and organize Indigenous-led health organizations specific to the regions.
Healthcare professionals should be given training to improve cultural safety of
healthcare, which will help to move healthcare philosophy away from a deficit/sickness
model and towards a strengths-based model promoting holistic health of First Nations
people (Lavoie et al., 2016). Here are some actions that you can take to help promote
these goals:

• Continue to educate yourself about issues that contribute to First Nations inequities
in healthcare by consulting primary and other resources. This webpage from Cape
Breton University contains further resources about decolonization to help you on
your learning journey.

• Create an environment (e.g., school, work, home) that is accommodating to First

Nations. This can be done by using language inclusive to First Nations, such as found
here, here, and here. Challenge anti-First Nations language from others in your life if
you feel it is safe to do so.

• Write a journal entry about your learning journey. Potential prompts: how does your
relationship to colonialism effect your health, how you feel learning about these
6
topics, or how will you support inclusivity for First Nations in your life? You may feel
discomfort doing this; that is normal and okay!