Government of Canada actions to address anti-Indigenous racism in health systems

National dialogues

Four national dialogues, held between October 2020 and January 2023, offered new opportunities to bring together governments, health systems partners and Indigenous health organizations to discuss measures to address anti-Indigenous racism in Canada's health systems. These discussions have helped identify many of the root causes and critical gaps that need to be addressed to ensure access to high quality, culturally-informed health services and health care systems are free of racism and systemic discrimination against Indigenous people.

First national dialogue (October 16, 2020)

On October 16, 2020, after the death of Joyce Echaquan on September 28, 2020, the Government of Canada convened an urgent meeting with:

• Ms. Echaquan's family and her First Nation's leadership
• Indigenous health practitioners and students
• First Nations, Inuit and Métis Nation leaders
• federal, provincial and territorial government representatives
• health system partners
• Indigenous leaders

The objectives of the meeting were:

• to listen to lived experiences of Indigenous people and health care professionals regarding systemic racism in federal, provincial and territorial health systems
• to reflect upon the information shared to inform concrete measures that governments, educational institutions, health professional associations, regulatory colleges and accreditation organizations can take
• to commit to a second gathering in January 2021 where these proposed or implemented measures would be presented by governments and health care organizations

While the federal government can directly influence the provision of services on reserves for First Nations, Canada must work in partnership with provinces and territories, health system partners and educational institutions to advance anti-racism and cultural safety for all Indigenous people accessing services through those systems as well. Real and effective change requires all of our collective actions in a spirit of trust, commitment, cultural humility and reconciliation.

Second national dialogue (January 27 to 28, 2021)

On January 27 and 28, 2021, a second national dialogue was held, focusing on engaging federal, provincial and territorial governments, health systems and Indigenous partners.

While continuing to honour the legacy of Joyce Echaquan and many other Indigenous individuals who have faced traumatic experiences of racism in health systems, the objective of this meeting was to discuss concrete measures to eliminate anti-Indigenous racism in Canadian healthcare.

On February 10, 2021, the Government of Canada highlighted funding of $2 million to the Conseil de la Nation Atikamekw and the Conseil des Atikamekw de Manawan, Joyce's Nation, to advance their work and advocacy for the implementation of Joyce's Principle. With this funding, the Atikamekw, including the community members of Manawan, will be able to develop tools and training, promote Joyce's Principle to healthcare professionals and educate First Nations on their rights when accessing the healthcare systems.

Third national dialogue (June 28 to 29, 2021)

The first 2 national dialogues with National Indigenous Organizations, Indigenous health professionals, health system partners and provincial and territorial representatives, were initial steps in addressing anti-Indigenous racism in health systems.

The national dialogues, together with extensive work already undertaken on this issue, including through the Ignored to Death report, the In Plain Sight report and the findings of the Val-d'Or inquiry on relations between Indigenous Peoples and certain public services, identified many root causes, exacerbating factors and gaps that need to be addressed.

The third national dialogue on Anti-Indigenous racism was an opportunity to pursue collective actions related to:

• increasing Indigenous representation in postsecondary health education
• cultural safety and humility
• traditional approaches to health and safe patient navigation

Fourth national dialogue (January 24 to 26, 2023)

In partnership with First Nations, Inuit and Métis Peoples, the fourth national dialogue focused on data, with the goal of initiating work towards the co-creation of a data strategy (that is, frameworks for capturing progress) that will enable action against Indigenous racism and racist outcomes in health systems. The meeting convened people and groups working on anti-Indigenous racism data and cultural safety measurements across distinctions in Canada’s health systems. The dialogue helped establish common understandings of existing data sources, challenges and gaps, data governance structures and processes, as well as guiding principles and shared priorities.

Improve access to culturally safe services

$33.3 million over 3 years, with a focus on services for Indigenous women, 2SLGBTQQIA+ people, people with disabilities and other marginalized groups, who may experience intersecting discrimination:

• Expanding support for Indigenous midwives and doulas: Distinctions-based funding to improve access to pre-natal, post-natal and birth supports to First Nations, Inuit and Métis.
• Capacity funding for National Indigenous women's organizations: Distinctions-based funding to:
  • support organizations in addressing Indigenous women’s health and anti-Indigenous racism issues
  • help ensure that women’s voices and perspectives are included in policy development
• Funding for regional and grassroots organizations: Distinctions-based funding to organizations that serve women, 2SLGBTQQIA+ people, people with disabilities and other marginalized groups, and work towards improving access to culturally-safe health services.
• Strengthening youth sexual health networks: Expanding current activities to increase awareness of sexual and reproductive health rights, particularly in relation to the consent to medical treatment of any kind, including sexual or reproductive treatment.

Adapting health systems

$46.9 million over 3 years for the integration of cultural and patient safety at the local and systems levels, as well as through increased Indigenous representation in health professions:

• Cultural and patient safety: Funding for activities and initiatives that help to integrate cultural and patient safety in health systems. This funding would be provided through 2 complementary federal initiatives that would support change at both the local and the systems levels:
  • A new Cultural Safety Partnership Fund at Indigenous Services Canada (ISC) which would support Indigenous-led community and regional initiatives that aim to strengthen cultural safety and address anti-Indigenous racism and systemic barriers in health systems.
  • New funding at Health Canada to support Indigenous organizations and health system partner initiatives that aim to address systemic anti-Indigenous racism and support capacity development to enable Indigenous partners to engage on their health priorities.
• Indigenous representation: Increasing the number of Indigenous health professionals by funding community-based worker training and Indigenous-specific health education programs.

Improve supports and accountability

$37.8 million over 3 years to provide Indigenous patients with supports and recourse to safely navigate federal and provincial health systems, including:

• Health systems navigators: Distinctions-based funding for urban Indigenous service delivery organizations, Indigenous health centres or other Indigenous partners to hire new Indigenous health systems navigators, who would support Indigenous patients in navigating federal, provincial and territorial health services.
• Patient advocates: Distinctions-based funding for Indigenous patient advocates or similar mechanisms that will help patients navigate the provincial, territorial and professional regulatory complaints processes and work to resolve issues within existing ombudsperson and complaint resolution frameworks.
• Tools and resources: Support for the development of a repository of wise practices, cultural safety and anti racism tools and resources.
• Data collection: Supporting targeted data collection to inform a longer-term approach to addressing anti-Indigenous racism.

Provide federal leadership

$8.7 million over 3 years for the Government of Canada to continue bringing together all partners to advance concrete actions to address anti-Indigenous racism in Canada's health systems and to lead by example through the evaluation and improvement our own programs and practices:

• Continued dialogue: Continuing to convene Indigenous, provincial, territorial and health systems partners in the ongoing national dialogues and roundtables. Funding will be provided to support the capacity of Indigenous partners to participate in the discussions. This will allow for continued engagement and the development of transformative measures to help eliminate anti-Indigenous racism as part of a longer-term national approach.
• Evaluating internal ISC programming: As part of the mandate to transform service delivery to First Nations, Inuit and Métis individuals, families and communities, ISC has laid out in its strategic plan—a commitment to review its practices to ensure more culturally responsive and safe services. ISC is continuing to make progress on ensuring cultural safety within the federal workforce, including through:
  • the introduction of a cultural competency baseline survey and cultural competency training for all ISC staff
  • a commitment to increase the recruitment, retention and advancement of Indigenous staff, including through support for Indigenous employee networks, development programs and national and regional targets
  • a review of human resource policies and processes through the lenses of diversity, inclusion and reconciliation, and work to eliminate biases that discriminate against Indigenous peoples

These federal investments in short-term initiatives respond to many of the key recommendations from the national dialogues and other key reports. They lay the groundwork for the development of a more comprehensive, longer-term national approach in the coming years. The way forward needs to be rooted in cultural safety and humility, informed by the ongoing impacts of colonialization and guided by Indigenous peoples and the contributions they bring to Canada's health systems.