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The Push to Make Anti-Racism a Key Medicare Principle

Only an amendment to the Canada Health Act can bring systemic change to racist health-care practices, says group.

Moira Wyton 30 Oct 2020 | TheTyee.ca

Moira Wyton is The Tyee’s health reporter. Follow her @moirawyton or reach her here. This reporting beat is made possible by the Local Journalism Initiative.

It’s time to add anti-racism as a fundamental principle of the Canada Health Act and launch anti-racist efforts at every level of the system, according to a group of health-care providers, academics and lawyers calling on Ottawa for action.

The act now sets out five principles governing the delivery of health care, saying it must be publicly run, accessible, cover all medically-necessary care, not require payments and provide care outside a person’s home province.

Those are not enough to ensure proper care for patients who are Indigenous, Black or people of colour, the group maintains.

“We call on the federal government to adopt anti-racism as a sixth pillar of the Canada Health Act,” their open letter says.

The act, the group says, is widely considered emblematic of values that are core to the country’s character.

“It has been identity-defining for Canada for many, many years,” said Josée Lavoie, a professor and expert in Indigenous health policy at the University of Manitoba and one of the creators of the open letter.

Adding anti-racism to its existing pillars would send a strong message to health-care providers, educators and leaders at all levels that combating systemic racism is work they are professionally obligated to carry out.

“Entrenching this as a principle would trigger the development of policies and programs and a national conversation about the way in which systemic and interpersonal racism plays out in health care,” said Annette Browne, a professor at the University of British Columbia school of nursing who studies Indigenous health equity.

The B.C. government currently has an independent investigation of reports of widespread anti-Indigenous racism in the province’s health-care system.

By Thursday morning, almost 900 people had signed the open letter launched by Browne, Lavoie and two other members of the Brian Sinclair Working Group, formed to study and expose the effects of systemic racism in health care after the 2008 death of Sinclair, an Indigenous man who had waited 34 hours for care in a Winnipeg emergency room.

The act governs Canada’s 15 health-care systems — one for each of the 13 provinces and territories and two federally run systems for veterans and for First Nations, Métis and Inuit. But there was no meaningful input from Indigenous communities or experts before being passed in 1984.

But long before the legislation’s inception, racism has been a defining characteristic of Canada’s health-care system.

“Racism [has organized] health-care practices, and really how our health-care system is structured, for more than two centuries,” said Browne, noting the forced sterilization of Indigenous women across Canada and the legacy of medical neglect and abuse in the residential school system.

“Stereotypes about Indigenous peoples that characterize them as using alcohol more continue to fuel resentment in the health-care sector as Indigenous people [are seen] as more undeserving of care.”

Instead of individuals having to prove over and over again that these stereotypes are not true, Browne said health-care providers and systems need to focus on recognizing and dismantling these assumptions.

“It kind of turns the spotlight away from looking at the culture of other people and looking at the culture of health care,” she said.

Health-care providers may not even realize they are influenced by these unconscious biases in their work, which is why Browne and Lavoie say it’s important to carve out time not just to learn, but to reflect and discuss how you can be anti-racist in your work.

“Racism is prevalent in health care, in hospitals across the country. It’s normalized sometimes as a joke, as tough love, and it’s not seen as systemic,” said Lavoie. “But the fact that it’s been normalized is what makes it systemic.”

Emily Hill, a senior staff lawyer with Aboriginal Legal Services in Toronto and a co-signer of the open letter, thinks of Sinclair and Joyce Echaquan, two Indigenous people who died in hospital 12 years and more than 2,000 kilometres apart after facing racism.

“It’s such a tragedy that we need to learn the names of people like Brian Sinclair and Joyce Echaquan only through their deaths,” said Hill, who worked on the inquest into Sinclair’s death. “We should be talking about people through their lives and their contributions in the community rather than in the death.”

The current lack of recognition of systemic racism by the health-care community places the burden of proof on individuals who have been mistreated, Hill said. 

Even in the reviews of Sinclair’s death, one judge denied any discussion of systemic racism as a contributing factor, a practice that is all too common and makes harder to identify needed change on a large scale.

“We can’t use individual remedies and ask people who have suffered racism, and likely had their own health conditions worsened, to try to use an individual tool to correct that racism,” said Hill, noting how expensive and time-consuming it is to get a lawyer’s help in these cases.

“It’s a really uphill battle, because of the system’s inability to even address systemic racism as a factor that could even be engaged.”

Barring a Supreme Court of Canada decision in an individual case, changing the act is the clearest way to embed addressing the reality of systemic racism into the thoughts and practices of health leaders.

And that’s where change is most needed, the group says.

“The real work starts after the act is changed,” said Lavoie.  [Tyee]

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