Key Canadian health policy challenges include sustained poor health outcomes for Indigenous populations: analysis

An analysis of Canada’s health-care system has highlighted three key health policy challenges, including sustained poor health outcomes for Indigenous populations.

Published today [February 23] in the Lancet Series on Canada, the analysis highlights long waits for some elective health-care services, inequitable access to services outside the core public basket, and sustained poor health outcomes for Indigenous populations as key health policy challenges in Canada.

“How successfully Canadians address social cohesion at home will form the foundation for an expanded role internationally. Canada’s capacity and credibility, as a global health leader, derive directly from how well diversity is championed at home,” said co-author of the paper and Centre for Excellence in Indigenous Health co-director Nadine Caron.

The paper highlighted that life expectancy for Indigenous peoples is up to nine years lower for men, and four years lower for women, than the Canadian averages. First Nations, Inuit, and Métis peoples, which make up about 4.9% of the Canadian population, experience persistent health disparities relative to the non-Indigenous population, including higher rates of communicable and non-communicable disease, trauma, interpersonal and domestic violence, suicide, and higher infant mortality, the analysis found.

The paper highlighted that other inequities exist in the social determinants of health, including that Indigenous Canadians face wage gaps of up to 50% compared with non-Indigenous groups, and that persistent racism and social exclusion exist in health-care, education and justice systems.

The authors argue that steps to address Indigenous health disparities could include improving the social determinants of health, addressing intergenerational trauma, supporting new models of self-governance, and ensuring that Indigenous peoples are among the ranks of health providers and leaders in Canada.

Governments, professional organizations, and citizens, could take on as tasks the calls to action from the Truth and Reconciliation Commission, with such tasks including measurement and evaluation of health-care systems and programs; creation of cultural safety and humility within the health-care system; and representation of Indigenous Canadians within the ranks of providers and leaders of the health-care system, the authors argue.

Dr. Caron said the tasks were documented within the Truth and Reconciliation Commission calls to action in terms of the responsibilities of governments, post-secondary institutions, trainees, and citizens of Canada. “These are vital steps to addressing the health disparities that we continue to hear about.”

The Series on Canada consists of two papers, authored by scholars from across Canada, and is accompanied by commentaries from Prime Minister Justin Trudeau and Dr Jane Philpott, Minister for Indigenous Services.

Dr Philpott writes: “The historical denial of the rights of Indigenous peoples is directly linked to socioeconomic disparities, including poor health outcomes… Correcting for these inequities requires more than better health care. Health-care workers who respect Indigenous knowledge and practices are vitally needed and health-care systems must be improved. But real change requires the recognition of the inherent and treaty rights of Indigenous peoples, along with investments in the social determinants of health.”

The Series is led by authors from Dalhousie University, Hospital for Sick Children, McGill University, Ottawa Hospital Research Institute, Simon Fraser University, University of British Columbia, Université Laval, University of Manitoba, Université de Montréal, University of Ottawa, University of Toronto, University of Regina and York University.

Also part of the series is Picturing health: health advocates for Indigenous communities in British Columbia, Canada, a photo series taken by photographer Philomena Hughes, working with Dr. Caron and Indigenous communities in northern British Columbia, Canada. The series of photographs of people involved in supporting the health and wellbeing of Indigenous communities in this region were taken around Prince George, BC.

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