The legacy of residential schools and segregated 'Indian hospitals', as well as the attitudes of some health care professionals, continue to be barriers to quality health care for Indigenous people in Canada, according to new research published in the Canadian Medical Association Journal.
Researchers held focus groups and conducted interviews with Indigenous people in five communities across the country for their paper, titled, 'Health care experiences of Indigenous people living with type 2 diabetes in Canada.' The locations of the communities are not identified in the research.
The research team used diabetes care as a way to look at the social determinants of health and the "ongoing impacts of colonization" on the increased rates of chronic disease in Indigenous communities, said Dr. Lindsay Crowshoe, a family doctor and associate professor at the University of Calgary's department of family medicine.
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"I've seen the disparities and I've seen patients' struggles with the circumstances they live in and their ability to follow directions of dieticians, physicians or other health care providers," said Kristen Jacklin, an associate professor at the Northern Ontario School of Medicine.
"On the other side of it, I've spent a lot of time talking to rural physicians, nurse practitioners and dieticians about the struggles, from their perspective, in having patients that don't have the means to follow the instructions that they're giving them," she said. "And I could really see there was this place in between where something had to change."
Indigenous people from across the country consistently told researchers similar things about the root causes of their mistrust in the health care system, according to the study.
Researchers divided their comments into the following four themes:
- 1. The colonial legacy of health care
"The reality is that historically, we've experienced, as Indigenous people, a host of bad outcomes from the initial engagement," Crowshoe said in an interview with CBC News.
"All that historical stuff that tends to be outside of what we learn as health practitioners is deeply embedded in the nature of how health care is organized," he added.
"The institutions of health care services arise from a dominant society and those can be experienced in a very negative way [by Indigenous people]."
- 2. The perpetuation of inequalities
"There are a lot of health care providers who are providing services to Indigenous patients who haven't been properly trained and so they bring a lot of their biases into the health care relationship," Jacklin said in an interview.
Indigenous patients talked about "being stereotyped, being mistreated because they're Indigenous, overhearing conversations in waiting rooms and clinics that were discriminatory," she said.
- 3. Structural barriers to care
The federal government is responsible for funding health services to First Nations people on reserve.
Provinces are responsible for health care everywhere else, but confusion reigns in policy and practice when it comes to living up to those responsibilities, Crowshoe said.
"We see disparities in accessing all types of [health care] resources and it's all because of the miscommunication and misinterpretation of how health services to First Nations communities on reserve should be organized and who should be providing them," he added.
- 4. The role of the relationship with health care providers in mitigating harm
Indigenous patients described empathy and humility as the signature traits among health care providers they developed comfortable relationships with, Jacklin said.
"This idea of working together also really came through," she said, "where the provider wasn't just coming across and saying 'this is what you have to do'. They had a relationship, saying, 'what can we do right now, what's manageable in your circumstances in life?'"
Crowshoe said the research helps flesh out the idea of cultural safety in health care and will inform training for health care providers.
Beyond that, he said he hopes it points to ways that health systems need to be reorganized to overcome their colonial roots and stop putting Indigenous patients at risk.