Monday, September 28th was a sorrowful day when Joyce Echaquan, a 37-year-old Atikamekw woman, passed away in Joliette, Quebec. The circumstances surrounding her death were out of the ordinary, seen through Joyce’s Facebook Live that showed her being restrained to a hospital bed, ignored and insulted by healthcare workers. Insults thrown at her by the workers charged with saving her life included “ you are only good for sex” and that Echaquan was “stupid as hell.”.  Echaquan’s death highlights the systemic racism that endures in the Canadian healthcare system, specifically toward Indigenous peoples. Many Indigenous communities lack accessible healthcare due to discriminatory practices by federal and provincial governments that do not provide necessary medical facilities to minority groups in rural and remote areas. However, those Indigenous communities that are fortunate enough to live closer to medical facilities, such as in urban centers, may experience racism, as the very people they trust to save them can be culturally insensitive and unaware of the perpetuated racism that endures in the system they work for.

Provincial v. Federal Role in Indigenous Access to Healthcare

Under the 1867 British North America Act, healthcare in Canada is outlined as  provincial jurisdiction, meaning that each province is responsible for the healthcare of its residents. However, this same act sees Indian Affairs as under federal jurisdiction. This has created a dilemma over who has the responsibility for providing healthcare to Indigenous people. There is not a clear distinction between what responsibilities the federal government has in making healthcare accessible to Indigenous groups, and the healthcare that provincial governments provide to Indigenous groups. The federal government’s control over Indian Affairs means that they should theoretically be responsible for providing alternatives to provincial healthcare if those options are too far away for easy access by rural or remote Indigenous groups. This failure to define responsibility can have tragic consequences, as seen in the death of Jordan River Anderson. In 2005, the 6-year-old Cree child died after the provincial government of Manitoba and the federal government could not resolve the issue on who would pay for the necessary specialized care that Jordan required due to a complex health issue. This resulted in a public outcry, leading the federal government to invest $385.5 million into addressing inequalities and to propose the 2016 Canadian Human Rights Tribunal, whose goal was to address concerns of racial discrimination and propose laws to punish and prevent instances of racism toward First Nations children. However, disputes still exist over the role that the federal and provincial governments have in ensuring the health and safety of Indigenous communities. 

What Access to Healthcare do Indigenous People Lack?

Starting in the late 15th century with French and British expeditions, European settlers displaced Indigenous nations  in Canada, imposing  European governmental systems on the land’s original  inhabitants.. From legalizing Indigenous slavery in 1709 to establishing and continuing the assimilation of Indigenous tribes through the Residential School System up until 1996, a persistent culture of racism and displacement has existed. The reservations that tribes were forced onto were in remote areas, with little infrastructure or job opportunities. The reservations were not, and still aren’t, equipped for hospitals as the provincial governments did not see this as a necessity. However, Canada is 3.8 million square miles and has only three cities with more than one million people, prompting rural areas to be populated yet underserved. Even if provinces provide healthcare to all within provincial borders, it is not helpful if a certain group cannot access or rely on the system, such as Indigenous tribes living on remote tribal land.

Other issues have created problems for Indigenous tribes in gaining access to healthcare. Indigenous people are hospitalized at rates five times higher than the general population. Indigneous groups suffer from a lack of preventative medical resources, such as resources to address high obesity rates in Indigenous communities and remote locations that do not cater to extensive therapy or mental health resources—they are only available to Indigenous groups in urban locations. For instance, only 23% of Inuit have a regular medical doctor. Alongside these high hospitalization rates and lack of preventative measures are the problems of poor insurance coverage and mental health issues. The Non-Insured Health Benefits (NIHB) is a fund available to Canadian citizens that covers health care costs. However, Indigenous tribes, with remote access to technology, do not see the benefits of it as “the NIHB deny the insurance to First Nations Groups”. With a lack of infrastructure and the high price of insurance, there exists a system in Canada where insurance groups can deny Indigenous people their basic health needs These problems bring to light the present in governmental systems on a legislative level. In addition, historical experiences with healthcare systems, such as being refused treatment in racially-segregated hospitals for certain issues such as tuberculosis, may discourage Indigenous peoples from seeking and receiving treatment. This can be solved by increasing the number of Indigenous doctors and mental health professionals, to address the systemic distrust that Indigenous tribes may have of the healthcare system. However, this can be achieved alongside the federal government overseeing all decisions to make sure there exists no discrimination in decision-making, as well as the implementation of systems, such as health care.

Possible Canadian Policy Changes

The jurisdiction issue is a challenge that prevents Canada from providing adequate health care to Indigenous people and perpetuates a history of oppression and neglect. A slow but hopeful policy turnaround is in place, which may increase the access to healthcare systems for Indigenous tribes in Canada. One example of efforts to address this problem is the Canadian government’s recent fly-in programs for Metis populations during the Covid-19 pandemic. However, after public outrage following Joyce Echaquan’s death, the federal government has called meetings with provincial ministers, healthcare workers, and Indigenous leaders to address the inadequacies and systemic racism within Canadian healthcare. This can be seen as a step in the right direction, as the government could start to outline possible policies that would address how remote access and fear of racism affects Indigenous access to healthcare. However, a principal issue to be addressed in these meetings is the ongoing problem of jurisdiction.  Unaddressed, this will remain a loophole that both federal and provincial governments can use to excuse themselves from lawsuits and accountability. While a constitutional amendment is unlikely, federal and provincial governments can improve Indigenous peoples’ experiences with healthcare by acknowledging systemic racism and implementing policies designed to target the inadequacies that disproportionately impact Indigenous groups.  Employing an anti-racist and decolonial framework would be the first step in dismantling systemic racism in Canada’s healthcare system, opening the door for transformative policies that can build a better healthcare system from the ground up.