Just before Tina Campbell recently had a minor medical procedure, she recalled the discrimination she said she felt when trying to access health care nearly two decades ago.
“As I was getting ready, I thought I have to look good and be presentable because I don't want to be treated any differently,” Campbell said.
“I told my non-Indigenous friends that, and they were like, ‘Wow, I've never thought about that.'”
Campbell, who hails from the Mosakahiken Cree Nation of northern Manitoba, is a registered nurse with the Northern Inter-Tribal Health Authority in Prince Albert, Sask. and advocates a culturally secure supply for the indigenous population in the region.
Her role addresses an issue of health inequality that persists across Canada, according to researchers and indigenous peoples, quantified in a study published Monday in the Canadian Medical Association Journal.
Researchers from the Public Health Agency of Canada wanted to measure the disparities in access to health care for Indigenous women living off reservations compared to non-Indigenous women across Canada. They found evidence of a number of systemic barriers, particularly during pregnancy.
Using data from the Canadian Community Health Survey – an annual nationwide survey by Statistics Canada – from 2015 to 2020, the new study found that 18.6 percent more non-Indigenous women who were recently pregnant or currently pregnant had a regular healthcare provider compared to Indigenous women.
Compared to non-Indigenous women, 14.2 percent fewer Indigenous women said they had a point of contact for immediate, non-urgent care in both urban and rural areas.
“After socio-demographic adjustment, health care inequalities persisted, suggesting that systemic barriers such as racism, which leads to mistrust of health systems, may be primarily responsible,” the study states. “These results did not surprise our indigenous advisors.”
According to lead author Sebastian Srugo, it is the first study of its kind to quantify these inequalities at the national level and fills a gap in data on First Nations, Métis and Inuit women's access to health care.
“We found that these gaps still exist across the country, whether it's in a remote location or an urban location,” Srugo said.
“Indigenous women used hospital services more often for non-emergency purposes. They had less access to specialized care, were less likely to see an ophthalmologist or dentist, and were also less likely to receive the care they needed, particularly for mental health.”
Those gaps, now quantified, might have been larger if the study had included women living on reservations — Aboriginal people on reservations are excluded from the national health survey — and if the comparison had been made more specifically with white women, Srugo said.
“29 percent of the reference group belonged to racialized communities in Canada,” Srugo said. “It's very likely that these gaps are actually larger if we just compare them to whites. There is data showing that other racist communities are also struggling to access healthcare.”
Indigenous women have spoken out about systemic racism in healthcare for years, with birth warnings and forced sterilization still a reality in parts of the country.
As a result, a number of Indigenous healthcare providers and communities have taken matters into their own hands and found ways to fill the gaps, even as more people are left without healthcare due to the growing shortage of doctors.
Finding care in Indigenous-run spaces
According to Campbell, rural, remote Indigenous communities are hardest hit by health care staff shortages, forcing many to seek treatment in city-based clinics.
“It's really difficult when communities don't have ambulance assigned,” she said. “Again, human resources are required to make this work effectively.”
Once Indigenous women reach a city hospital or clinic, Campbell says some face the additional hurdle of not speaking English as their first language. A lack of Indigenous staff who speak languages like Cree or Dene sometimes means patients don't know exactly what they consented to, she said.
Additionally, Campbell said, Indigenous patients regularly face discrimination in these areas, making them reluctant to seek treatment. Campbell recalls her own experiences from nearly two decades ago.
“Unfortunately, when I was a young college student…in Saskatoon, I had a pair [of] Experiences [where] “I faced discrimination when I sought access to health care,” Campbell said. “Feeling like you're reluctant to access healthcare, wanting to access it more in the future.” That feeling stayed with me.
One of her goals as a public health nurse is to build a bridge between indigenous peoples and the health system, “to show them that there are people who are caring, compassionate and understanding of history,” she said.
A separate study published in the Canadian Medical Association Journal in May 2023 found that culturally safe care exists at Indigenous facilities that provide holistic, comprehensive services. This paper was based on responses from Vancouver residents in exchange circles led by Indigenous elders.
After citing reports of racism and the resulting distrust of healthcare, the 26 participants (most of whom were women) shared positive experiences at a Vancouver city Indigenous-run clinic.
“This clinic offered support and services not typically available at other clinics. For example, one participant who was affected by homelessness described how the staff not only took care of their health problems but also helped them find housing,” the report reads.
“In another example, a participant discussed his appreciation for how a healthcare provider intervened on his behalf after having a negative experience with a specialist he was referred to, which made him feel more secure when seeking medical care in entitlement, and confident that his health issues would too.”
Srugo said access to culturally safe health care is especially important during pregnancy and is one of the reasons his team tried to quantify the barriers that exist for Indigenous women.
“We thought about it – and there's a lot of research on that – [about] how important equitable health care really is at this stage of life because it may have the ability to break intergenerational disease cycles and also close the gaps in health outcomes that we are seeing in Canada,” he said.
“There are often judgments”
The lack of health care in Canada in 2023 isn't just limited to indigenous peoples, said Cheryl Whiskeyjack, executive director of the Bent Arrow Traditional Healing Society in Edmonton — but also to the level of discrimination that leads to inconsistent care.
“What we hear from our wives is that they often drop out of Medicentre [clinic] to the Medicentre…because there's often judgment,” Whiskeyjack said. “You will see this medicentre.” [doctor] and will feel that there is some stigma attached to the issue they are addressing [doctor]. They don't want to experience that, so the next time they need a doctor, they go to a different medical center.
In the absence of a regular doctor, indigenous women's health issues are overlooked. According to Whiskeyjack, for example, referrals for a mammogram or specialist consultations are missed.
She recalled a story of painkillers being withheld after surgery because the doctor assumed the Indigenous patient was addicted, and another story of a doctor asking a married woman if she knew who the Being the father of her baby made her feel like she was being reprimanded, which is not a happy occasion.
According to Whiskeyjack, the best way to make things better is for practitioners to learn more about indigenous communities and their history.
“The ability to connect those dots really helps,” Whiskeyjack said. “I think when we start talking to people in medical school or in nursing school, when we start providing these kinds of educational opportunities, then the picture looks different when you see the big picture and not just that person, sitting in front of you.” Day.”
Now that her article has been published, Srugo said the next step is to write a human-readable version of the text to make it more accessible to more people. After that, more research follows.
“We've already established a relationship with these indigenous women's organizations and two-spirit grassroots organizations, so we're definitely looking at other questions that the community may need answers to,” Srugo said.
This research is a step toward one of Canada's Truth and Reconciliation Commission calls for action: identify, monitor and address health inequalities affecting Indigenous Peoples, he said.