By Alika Lafontaine, Chair, Indigenous Health Alliance & President, Indigenous Physicians Association of Canada.
See original article published in the Ottawa Citizen here
June 20, 2016 – In a well-publicized answer to the reasons for his cabinet’s gender parity, Prime Minister Justin Trudeau famously stated last fall, “Because it’s 2015.” This summarized a self-evident truth: Full engagement of women in our country’s future enhances the value of being Canadian. Reflecting on the anniversary of the Truth and Reconciliation Commission’s “Calls to Action,” consider this a self-evident truth for Indigenous Peoples as well.
Indigenous Peoples suffer worse health disparities than almost any other demographic. These health disparities are widening, in some cases accelerating. Canadians’ awareness of this reality is high, but the plight of Indigenous Peoples still seems far away.
There are very real consequences to these disparities. The human cost of morbidity and death. Increased health-care costs for advanced disease and critical care intervention. Measurable opportunity costs of lost productivity and lost capacity-building, estimated in the billions.
Few argue the status quo is an option. Still, we justify our inaction through familiar excuses: jurisdictional ambiguity; a need for more research; a belief Indigenous patients don’t care about their health or are uneducated; disparities as a result of inherent genetic and cultural characteristics. We approach the challenge waiting for someone else to act, repeating yet another study or dismissing it outright. If indigenous patients don’t care, why should I?
These justifications are the most rigid barrier to transforming indigenous health. Excuses that the problems aren’t mine, so I’m not going to solve them. Not making data-driven decisions. Disenfranchised patients. Are these not the same challenges we are addressing in mainstream health? Could we not consider similar solutions?
Mainstream health transformation has four pillars: clear communication; strong engagement; targeted intervention; and cultural transformation. These pillars have enabled revolutions in patient safety, clinical quality and patient-centred care, making enormous impacts on health outcomes. Framing indigenous health as an impossible challenge is a mischaracterization; problems are community-specific but can still be generalized to the common issues in health care.
We have been asking ourselves, “How do we deal with the unique challenges in indigenous health?” A more actionable question is, “How are challenges in the mainstream health care system similar and how can we ensure a safe, high-quality, patient-centred approach in indigenous health?”
The facts are compelling when indigenous health is considered from a safe, high-quality, patient-centred point of view. Mainstream health care has strong legislative frameworks that necessitate thresholds of safety and quality; these safeguards do not exist on-reserve. There is no Health Professionals Act, Health Quality Act or Health Act on-reserve. These are provincial laws, not federal. Without these acts, there is no legally enforceable regulatory regime, no legislated mechanism for health quality and no minimum threshold of care. Everything is policy. Policy is fickle. It is not accountable. It is not equal.
To achieve equity in indigenous health – something seven in 10 Canadians desire in a recent HealthCareCAN-commissioned poll – we need to develop the same hope we have towards mainstream health transformation. Things can change. We can become more effective. We have no other option because health is a fundamental human right.
Indigenous Peoples are ready for health-system transformation. On June 7, regional chiefs representing 150 First Nations spoke directly to health leaders at the National Health Leaders Conference (co-sponsored by HealthCareCAN and the Canadian College of Health Leaders), the largest annual gathering of health leaders in Canada. The message First Nations brought was one of revolution: changing the way we think, feel and act towards Indigenous health.
Overwhelmingly, health leaders voted to make implementation of the Truth and Reconciliation’s seven Calls to Action on health their top priority for 2017. On the anniversary of those Calls to Action, let us join a growing indigenous health revolution.
Not because its easy. Not because its effortless. Because in 2016, this truth is self-evident.
Alika Lafontaine is Chair, Indigenous Health Alliance and President, Indigenous Physicians Association of Canada.