Policy Brief by Charlotte Mackenzie.
Since the early 1960s, Canadians have taken pride in our universal health care system. It is ingrained in our society and a fundamental part of our national identity. (1) However, the care many of us take for granted is not experienced equally by all, as healthcare is another of the areas where Indigenous peoples in Canadian society experience systemic racism.
The inequity in our healthcare system was tragically exhibited by the death of Grace Echaquan. On September 28, 2020, two days before her death, Echaquan, a member of the Atikamekw First Nations, live streamed two nurses belittling her and uttering racist slurs at her in a Quebec hospital. (2) This incident is only one example of a widespread issue in Canadian healthcare, but the nation-wide public outcry over Echaquan’s death triggered a response from the federal government, who now say that they are committed to addressing systemic, anti-Indigenous racism in the health care system.
"The Constitution gives provinces and territories the right and responsibility to maintain and manage “hospitals, asylums, charities and charitable institutions,” including control of the medical centers and their funding. (7) But the bulk of this funding comes from the federal government, who have the power to set national principles for the system and deliver primary health care and emergency services to Indigenous and Inuit people on remote/isolated reserves where provincial support is unavailable. (8)"
Marc Miller, the Minister of Indigenous Services, responded to this tragedy by calling an emergency set of meetings for federal ministers, provincial representatives, and Indigenous leaders in October 2020 to give Indigenous people an opportunity to share their personal experiences of racism in the health care system. (3) While these meetings did not result in any substantive policy proposals, they were the beginning of a larger discussion that is currently playing out between Indigenous, federal, and provincial/territorial leaders about what should be done to address the anti-Indigenous racism in the health care system.
These emergency meetings in October were followed up in late January of 2021. Minister Miller hosted a two-day summit which focused on policy proposals to address the issue. In a statement after the event, Minister Miller said:
"The Government of Canada invited provinces and territories as well as First Nations, Inuit and Métis partners and healthcare organizations and representatives to renew their commitment to eliminating racism. At the core of this commitment is the development of response strategies to anti-Indigenous racism led by each level of government and key organizations who play an important role in healthcare delivery. (4)"
Leaders pledged to engage in another round of talks in Spring 2021 and to continue regional dialogues; however it is unclear whether or not the proposed solutions will be effective due to the plethora of jurisdictional conflicts. (5) Although many leaders emerged from these meetings saying they were part of a crucial first step in addressing systemic racism, the issues surrounding health care jurisdiction could impede any proposed changes.
"The United Nations Declaration on the Rights of Indigenous Peoples, which Canada as well as other colonial nations (i.e. Australia) was very reluctant to sign as it would mean fully acknowledging the harms colonial and Canadian governments perpetrated against Indigenous peoples, contains numerous articles relating to Indigenous people’s right to mental and physical health. (15)"
The Constitution Act of 1867 and the Canada Health Act, passed in 1984, govern the rules and regulations surrounding Canada’s health care system, but these documents create conflicting and overlapping jurisdictions. (6) The Constitution gives provinces and territories the right and responsibility to maintain and manage “hospitals, asylums, charities and charitable institutions,” including control of the medical centers and their funding. (7) But the bulk of this funding comes from the federal government, who have the power to set national principles for the system and deliver primary health care and emergency services to Indigenous and Inuit people on remote/isolated reserves where provincial support is unavailable. (8) The Canada Health Act also allows the federal government to restrict funding provided to provinces/territories if they do not uphold the federal government’s national principles for the system (9).
These contradictions pose a problem when the federal government wants to institute nation-wide changes to the healthcare system. For example, while Quebec attended the federal meetings held in October and January, it was largely a symbolic gesture as they do not plan on supporting any national strategy. Instead, they plan on taking a provincial approach by “continue to develop [their] own action plan and follow up on [systemic racism], in consultation with its Indigenous partners.” (10) Their commitment to addressing systemic racism was harshly undermined when Quebec’s provincial legislature failed to pass the Joyce Principles in October 2020. (11) These principles were proposed to the legislature by the Atikamekw Nation and the Atikamekw Council of Manawan after Joyce Echaquan’s death, proposing a “legal framework to guide the decisions of governments when it comes to health and social services.” (12) The federal government, on the other hand, has provided two million dollars to the Atikamekw Nation and the Atikamekw Council of Manawan to “advance their work and advocacy for the implementation of the Joyce Principles.” (13) This bickering between the federal and provincial governments could very well hinder any meaningful progress to end systemic racism.
Additionally, there is the possibility that these meetings will become no more than a symbolic response to a tragedy Indigenous people face on a daily basis. The federal government has acknowledged systemic racism in the health care system and pledged to implement reforms before on national as well as international levels. The Truth and Reconciliation Commission’s 94 Calls to Action contains a whole section on the health needs of Indigenous Canadians as well required changes to Canada’s healthcare system as a whole. (14) The United Nations Declaration on the Rights of Indigenous Peoples, which Canada as well as other colonial nations (i.e. Australia) was very reluctant to sign as it would mean fully acknowledging the harms colonial and Canadian governments perpetrated against Indigenous peoples, contains numerous articles relating to Indigenous people’s right to mental and physical health. (15)
It is unclear how systemic racism in Canada’s healthcare system will be addressed, and whether or not any proposed solutions will be effective. However, the federal government’s acknowledgement of the problem and their commitment to openly discussing the issue on a national stage is a promising start.
Health Canada. “Government of Canada.” Canada.ca. / Gouvernement du Canada, September 17, 2019. https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html.
Shingler , Benjamin. “Investigations Launched after Atikamekw Woman Records Quebec Hospital Staff Uttering Slurs before Her Death | CBC News.” CBCnews. CBC/Radio Canada, September 30, 2020. https://www.cbc.ca/news/canada/montreal/quebec-atikamekw-joliette-1.5743449.
Zimonjic , Peter. “Health Care System Was Designed to Subject Indigenous People to Systemic Racism: Hajdu | CBC News.” CBCnews. CBC/Radio Canada, October 17, 2020. https://www.cbc.ca/news/politics/health-indigenous-racism-miller-1.5764659.
Indigenous Services Canada. “Statement by the Minister of Indigenous Services, the Minister of Crown-Indigenous Relations, the Minister ...” Canada.ca. Government of Canada, January 29, 2021. https://www.canada.ca/en/indigenous-services-canada/news/2021/01/statement-by-the -minister-of-indigenous-services-the-minister-of-crown-indigenous-relations-the-mini ster-of-health-and-the-minister-of-northern-aff0.html.
Indigenous Services Canada, 2021
Health Canada, 2019
Health Canada, 2019
Health Canada, 2019
Health Canada, 2019
Indigenous Services Canada. “Statement in Response to Calls for Action by Indigenous Leaders, Federal, Provincial and Territorial Partne...” Canada.ca. Government of Canada, February 1, 2021. https://www.canada.ca/en/indigenous-services-canada/news/2021/01/statement-in-res ponse-to-calls-for-action-by-indigenous-leaders-federal-provincial-and-territorial-part ners-collaborate-to-prevent-and-address-anti.html.
QNAC. “Joyce's Principle.” QCNA EN. Quebec Community Newspapers Association, December 4, 2020. https://qcna.qc.ca/news/joyces-principle#:~:text=Joyce's%20Principle%20similarly% 20intends%20to,are%20respected%2C%E2%80%9D%20explained%20Awashish.
Page, Julia. “Atikamekw Leaders Hope Joyce's Principle Will Help Quebec, Ottawa Tackle Systemic Racism | CBC News.” CBCnews. CBC/Radio Canada, November 16, 2020. https://www.cbc.ca/news/canada/montreal/joyces-principle-quebec-indigenous-health -care-1.5803416.
Indigenous Services Canada. “Government of Canada Provides $2 Million to the Conseil Des Atikamekw De Manawan and the Conseil De La Nati...” Canada.ca. Government of Canada, February 10, 2021. https://www.canada.ca/en/indigenous-services-canada/news/2021/02/government-of-c anada-provides-2-million-to-the-conseil-des-atikamekw-de-manawan-and-the-conseil -de-la-nation-atikamekw-for-the-development-of-joyce.html.
Truth and Reconciliation Commission of Canada. “Truth and Reconciliation Commission of Canada: Calls to Action.” Truth and Reconcilliation Commission of Canada, 2015. http://nctr.ca/assets/reports/Calls_to_Action_English2.pdf.
United Nations. “United Nations Declaration on the Rights of Indigenous Peoples.” United Nations. United Nations, 2007. https://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf.