Working together to do better: Addressing inequities facing Indigenous people in the health system

Results from a survey of HealthCareCAN members


In October 2020 and January 2021, HealthCareCAN participated in meetings held by the federal government to address the inequities Indigenous people experience in the health system. To better inform this consultative process, HealthCareCAN surveyed members in early January to better understand the actions our member organizations have taken to incorporate Indigenous health services and address discrimination against Indigenous people in their organizations. The survey also identified areas where additional supports could be developed to support health organizations with this work.

HealthCareCAN received twenty-three responses to the survey from members in six provinces and one territory. This policy brief provides a summary of those efforts from member organizations across the country to engage and incorporate Indigenous voices and personnel.

  • Health organizations are taking concrete actions to improve the health system for Indigenous people and work toward creating safe and inclusive environments within their institutions for Indigenous practitioners, patients and families.
  • Most respondents have implemented cultural safety and anti-racism HR training programs.
  • The top three areas where members want more guidance are: traditional health practices, food services and incident reporting policies.
  • Advocacy, developing resources and tools, and championing Indigenous medical education were focus areas raised as ideas for HealthCareCAN’s future policy and advocacy work to enhance Indigenous people’s experiences with the health system.

The survey responses demonstrate that HealthCareCAN members have taken multiple actions at the organizational level to incorporate Indigenous practices alongside the services they provide and to create safer environments for Indigenous practitioners and patients. The most common actions respondents indicated their organizations have carried out include:

  • Implemented cultural safety training for staff.
  • Implemented training on Indigenous racism in the workplace.
  • Incorporated traditional Indigenous health practices.
  • Offer patient navigation services.

Specific examples of these actions include:

  • Policy on smudging ceremonies in hospital.
  • Blanket exercises.
  • Equity, diversity and inclusion (EDI) and accessibility task force.
  • Indigenous leadership at the Senior Executive table.
  • Indigenous Board Members.
  • Memorandums of Understanding with Indigenous organizations, self-governing Nations (including to co-design Indigenous culture safety training).
  • Indigenous youth wellness website.
  • Panel discussions with Indigenous leaders.
  • Indigenous Community Partnership tables and committees.

Similarly, many respondents indicated their organizations are planning to take further action to ensure their healthcare and work environments are inclusive, respectful and safe spaces for Indigenous people. The leading actions respondents said their organizations were planning to take include:

  • Implementing cultural safety training for staff.
  • Implementing training on Indigenous racism in the workplace.
  • Offering patient navigation services.
  • Implementing incident reporting mechanisms and policies.
  • Setting up Indigenous patient and family committees.

Specific examples of planned actions include:

  • Establishing dedicated delivery rooms for Indigenous birthing mothers.
  • Creating First Nations, Inuit, Metis and urban Indigenous Community of Practice.
  • Forming an Indigenous employee resource group.
  • Creating Indigenous land acknowledgement signage and messaging.
  • Establishing an EDI task force with Indigenous representation.
  • Striking a diversity committee to identify what actions can be taken to improve Indigenous relations.
  • Co-developing Indigenous-led policies to address discrimination against Indigenous people and Indigenous health strategies.

Survey respondents indicated they were eager to expand the services offered and approaches taken by their organizations to ensure that the health services being provided are inclusive and culturally appropriate and that all Indigenous people seeking care in their institutions are treated with respect and dignity. The most-cited areas where respondents indicated they would benefit from additional support are:

  • Implementing traditional Indigenous health practices.
  • Implementing incident reporting mechanisms and policies.
  • Offering a traditional food services menu.

HealthCareCAN members continue to make improving the experience of Indigenous practitioners working within the health system and Indigenous patients seeking care a priority. However, much more work remains to be done as evidenced by recent examples across Canada of racist treatment of Indigenous patients seeking care. Examples of such treatment and experiences were shared by Indigenous leaders, practitioners and patients in the two federal government meetings on Indigenous health and they were reported in the In Plain Sight report released late last year, the latest in a line of reports outlining systemic racism in provincial and territorial healthcare systems.

Survey responses show that gaps remain at both the organizational and system levels, and that HealthCareCAN members are prepared to address these gaps and improve the experience of Indigenous people with the health system. However, the survey responses also make clear that additional support is needed.

Survey respondents indicated that guidance documents, policies and frameworks related to Indigenous racism in the workplace and Indigenous health practices targeted to healthcare staff would be useful in realizing improvements within their organizations. Respondents also expressed their eagerness to champion and implement medical education reforms so that the profession is more inclusive of Indigenous individuals and practices. They also noted a desire to better share best practices and programs from across the country so that successful solutions can be scaled and spread within Canada.

In considering the above information and the way forward, it is vital that any initiatives be co-designed with Indigenous people and communities. It is also crucial that a distinctions-based approach is taken, meaning that initiatives acknowledge the distinct histories, interests and priorities of First Nations, Inuit and Métis. There is no one size fits all approach and health institutions will need to work in partnership with the communities they serve and Indigenous staff within their organization to ensure actions reflect the unique needs of these groups.

HealthCareCAN is leveraging previous work including the HealthCareCAN report Bringing Reconciliation to Healthcare in Canada: Wise Practices for Healthcare Leaders, in this space to avoid duplication and determining how best to partner with Indigenous leaders, communities, government and members on next steps to address the identified gaps and ensure the health system meets the needs of all Indigenous people.

As an immediate next step, HealthCareCAN will interview member institutions to discuss in more detail the programs and best practices members have implemented, and how these approaches can be shared with the entire membership for broader adoption. For members who indicated through the survey an interest to be contacted to discuss their work, we will be in touch to schedule a meeting. If you did not indicate such a preference in the survey but have an initiative you would like to speak to us about, please contact Emily Follwell, Policy and Research Analyst at efollwell@healthcarecan.ca.


March 3, 2021


Emily Follwell
Policy and Research Analyst

Bianca Carlone
Government Relations and Policy Analyst

Jonathan Mitchell
Vice President – Research and Policy