Mainstream health care services – not meeting the needs of Aboriginal People

Mistrust and racism are cited in a new report as barriers to Aboriginal people using health care services in urban centres

Winnipeg, MB (December 11, 2012) – Today the Health Council of Canada releases Empathy, dignity, and respect: Creating cultural safety for Aboriginal people in urban health carea report that highlights some of the reasons why many Aboriginal people are not seeking care in mainstream health care settings and describes key practices that are working towards positive change.

The report is based on a series of meetings held across Canada with health care providers, many of whom were First Nations, Inuit, or Métis. Many Aboriginal people do not trust and therefore do not use mainstream health care services because they experience stereotyping and racism, and because the Western approach to health care can feel alienating and intimidating.

“Aboriginal people often feel uncomfortable, fearful, or powerless when they try to use the health care system, and some avoid going for care even when they are sick,” said Dr. Catherine Cook, a Councillor with the Health Council of Canada who is Métis. “While these issues would be a concern for any population, it is a particular concern for Aboriginal people, who have the poorest health and shortest life expectancies of all Canadians.”

The report includes examples of racism, which is not unique to health care but simply an extension of negative stereotypes that are deeply entrenched in Canadian society. Many participants shared personal or professional stories of being stereotyped and racialized. For example, people were refused painkillers, even when in severe pain, because of a belief that they were at high risk of becoming addicted or already abusing prescription drugs.

This must change,” said John G. Abbott, CEO of the Health Council of Canada. “Health care providers can and must create culturally competent and safe environments that are free of racism and stereotypes, where Aboriginal people are treated with empathy, dignity and respect.” He noted the experience and needs of Aboriginal people are very different due to “a long and painful history of racism in Canadian society and efforts to eradicate their culture.”

Across Canada, provinces and territories are at different stages of development in cultural competency efforts, which include changes to policies, governance, education, and training. The report describes a number of practices that are having positive effects, such as a new role for Aboriginal patient navigators and cultural interpreters who provide support to patients and providers. Participants in sessions stressed that Aboriginal people trust and feel most safe when they have some level of interaction with Aboriginal staff.

Professional education in universities and colleges and on-the-job training about Aboriginal history, issues, and cultural competency is another significant area of focus in developing cultural competency. Several examples, including a province-wide online cultural competency program, are profiled in the report.

“Until recently, many Canadians learned very little about Aboriginal people in school, and what they did learn was typically a European perspective on the founding of Canada, not the story of forced relocations of Aboriginal people, the Indian Act, and residential schools,” said Abbott.  “Health care providers may be unaware that their unconscious attitudes or behavior are the reasons an Aboriginal patient doesn’t follow a treatment protocol or doesn’t return for appointments.”

Finally, the report calls for a major shift in  the way health care is provided to Aboriginal people, calling for policy changes and structures and processes to be put in place to support and formalize culturally safe health care environments.

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