Addressing anti-Indigenous racism in health systems: Federal response
The Government of Canada's response to the National Dialogues held in October 2020, January 2021 and June 2021.
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Canada is committed to ending anti-Indigenous racism in our health systems in a way that is informed by the lived experiences of Indigenous Peoples and based on the recognition of rights of Indigenous Peoples, respect and co-operation.
Following the October 2020 and January 2021 National Dialogues to address anti-Indigenous racism in Canada's health systems, participants, including the federal government, were asked to provide input on their past, ongoing, and planned/proposed anti-racism actions. At the Third National Dialogue in June 2021, Canada announced the initial Federal Response, co-led by Indigenous Services Canada (ISC) and Health Canada. It is comprised of immediate and targeted initiatives (described below) that aim to help address anti-Indigenous racism in Canada's health systems. The Federal Response is informed by:
- discussions with partners at the National Dialogues and roundtable meetings
- analysis of existing reports and written submissions
- Budget 2021 announcements
Canada is also committed to working with all partners, including Indigenous organizations, provincial/territorial governments, health systems partners, and educational institutions, to develop a longer-term national approach. The longer-term approach will be informed by the ongoing national dialogue, the renewal of Canada's Anti-Racism Strategy and the co-development of distinctions-based health legislation.
Making meaningful progress towards eliminating anti-Indigenous racism in Canada's health systems will require action at all levels. We recognize that the federal government has a number of important roles to play, including:
- helping to bring together all partners for meaningful engagement and discussion
- providing funding to support Indigenous-led initiatives
- leading by example with concrete actions that will improve the Government of Canada's policies, programs and service delivery
These federal roles are the focus of the initiatives described below.
Listening to what we have heard
The National Dialogues offered new opportunities to bring together governments, health systems partners and Indigenous health professional organizations to discuss measures to address anti-Indigenous racism in Canada's health systems.
These discussions have helped identify many of the root causes and critical gaps that need to be addressed. Some general themes that have emerged include:
- Training and learning: The need to develop tools for health institutions and organizations to further integrate learning on cultural safety in training for health professions, to integrate cultural and patient safety within the health system, and improve Indigenous representation in health professions and throughout the system.
- Access: The need for funding, legislative and policy changes which eliminate discrimination and improve access to high-quality, culturally safe health care that is adaptable to the needs of communities.
- Accountability: The need to establish mechanisms that enable people to report incidents of racism safely and effectively, and hold systems and actors accountable.
- Data: The need to improve the approach to data collection and monitoring progress on reducing anti-Indigenous racism in health systems.
- Health transformation: The importance of:
- transforming and expanding health systems to include practices that meet the unique needs of First Nations, Inuit and Métis Nation, including traditional approaches to health
- increasing Indigenous control and responsibility over the design, delivery and management of federally-funded health services
The themes and recommendations brought forward in the National Dialogues echo those provided through other important initiatives and reports:
- Canada's Anti-Racism Strategy 2019-2022
- The Truth and Reconciliation Commission's Calls to Action
- Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls
- The National Action Plan to End Gender-Based Violence
- The United Nations Declaration on the Rights of Indigenous Peoples
- In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in British Columbia Health Care
- The Public Inquiry Commission on relations between Indigenous Peoples and certain public services in Québec: listening, reconciliation and progress: Final Report
- Joyce's Principle
Federal response to the national dialogues
The Government of Canada has committed to address anti-Indigenous racism in Canada's health systems. We will work with partners to take immediate action on the issues and recommendations that have been raised, while recognizing and respecting that many jurisdictions and organizations already have their own plans in place.
To support the implementation of this commitment, Budget 2021 provided $126.7 million over 3 years, beginning in 2021-22, to take action to foster health systems free from racism and discrimination where Indigenous Peoples are respected and safe. In addition, this investment aligns with the federal response to the National Inquiry into Missing and Murdered Indigenous Women and Girls Calls for Justice, in recognition of the fact that Indigenous women and other marginalized groups, such as 2SLGBTQQIA+ people, are disproportionately impacted by anti-Indigenous racism in Canada's health systems.
The federal response to the national dialogues, funded through the Budget 2021 investment, consists of initiatives and activities that will improve access to high quality and culturally safe health services, including those for Indigenous women, 2SLGBTQQIA+ peoples, people with disabilities and other marginalized groups who are disproportionately impacted by anti-Indigenous racism. The federal response also aims to address anti-Indigenous racism in Canada's health systems more broadly through:
- support for the integration of cultural safety throughout health systems
- increased Indigenous representation in health professions
- improved supports for Indigenous patients
- increased accountability
- demonstrated federal leadership
Specifically, the Federal Response consists of a suite of initiatives under 4 key themes:
Improve access to culturally safe services
$33.3 million over 3 years, with a focus on services for Indigenous women, 2SLGBTQQIA+ people, people with disabilities and other marginalized groups who may experience intersecting discrimination:
- Expanding support for Indigenous midwives and doulas: Distinctions-based funding to improve access to pre-natal, post-natal and birth supports to First Nations, Inuit and Métis.
- Capacity funding for National Indigenous Women's Organizations: Distinctions-based funding to:
- support organizations in addressing Indigenous women's health and anti-Indigenous racism issues
- help ensure that women's voices and perspectives are included in policy development
- Funding for regional and grassroots organizations: Distinctions-based funding to organizations that serve women, 2SLGBTQQIA+ people, people with disabilities and other marginalized groups and work towards improving access to culturally-safe health services.
- Strengthening youth sexual health networks: Expanding current activities to increase awareness of sexual and reproductive health rights, particularly in relation to the consent to medical treatment of any kind, including sexual or reproductive treatment.
Adapting health systems
$46.9 million over 3 years for the integration of cultural and patient safety at the local and systems levels, as well as through increased Indigenous representation in health professions:
- Cultural and Patient Safety: Funding for activities and initiatives that help to integrate cultural and patient safety in health systems. This funding would be provided through 2 complementary federal initiatives that would support change at both the local and the systems levels:
- A new Cultural Safety Partnership Fund at ISC which would support Indigenous-led community and regional initiatives that aim to strengthen cultural safety and address anti-Indigenous racism and systemic barriers in health systems.
- New funding at Health Canada to support Indigenous organizations and health system partner initiatives that aim to address systemic anti-Indigenous racism and support capacity development to enable Indigenous partners to engage on their health priorities.
- Indigenous Representation: Increasing the number of Indigenous health professionals by funding community-based worker training and Indigenous-specific health education programs.
Improve supports and accountability
$37.8 million over 3 years to provide Indigenous patients with supports and recourse to safely navigate federal and provincial health systems, including:
- Patient Navigators: Distinctions-based funding for urban Indigenous service delivery organizations, Indigenous health centres or other Indigenous partners to hire new Indigenous health systems navigators, who would support Indigenous patients in navigating federal, provincial and territorial health services.
- Patient Advocates: Distinctions-based funding for Indigenous patient advocates or similar mechanisms that will help patients navigate the provincial, territorial and professional regulatory complaints processes and work to resolve issues within existing ombudsperson/complaint resolution frameworks.
- Tools and Resources: Support for the development of a repository of wise practices, cultural safety and anti‑racism tools and resources.
- Data Collection: Supporting targeted data collection to inform a longer-term approach to addressing anti-Indigenous racism.
Provide federal leadership
$8.7 million over 3 years for the Government of Canada to continue bringing together all partners to advance concrete actions to address anti-Indigenous racism in Canada's health systems and to lead by example through the evaluation and improvement our own programs and practices:
- Continued Dialogue: Continuing to convene Indigenous, provincial, territorial and health systems partners in the ongoing national dialogues and roundtables. Funding will be provided to support the capacity of Indigenous partners to participate in the discussions. This will allow for continued engagement and the development of transformative measures to help eliminate anti-Indigenous racism as part of a longer-term national approach.
- Evaluating Internal ISC programming: As part of the mandate to transform service delivery to First Nations, Inuit and Métis individuals, families and communities, ISC has laid out in its Strategic Plan a commitment to review its practices to ensure more culturally responsive and safe services. ISC is continuing to make progress on ensuring cultural safety within the federal workforce, including through:
- the introduction of a cultural competency baseline survey and cultural competency training for all ISC staff
- a commitment to increase the recruitment, retention and advancement of Indigenous staff, including through support for Indigenous employee networks, development programs and national and regional targets
- a review of human resource policies and processes through the lenses of diversity, inclusion and reconciliation, and work to eliminate biases that discriminate against Indigenous peoples
These federal investments in short-term initiatives respond to many of the key recommendations from the national dialogues and other key reports. They lay the groundwork for the development of a more comprehensive, longer-term national approach in the coming years. The way forward needs to be rooted in cultural safety and humility, informed by the ongoing impacts of colonialization, and guided by Indigenous Peoples and the contributions they bring to Canada's health systems.
Other federal commitments
- Distinctions-based Indigenous Health Legislation: The federal government will continue to support the co-development of distinctions-based Health Legislation with First Nations, Inuit and Métis Nation partners informed by the elements and spirit of Joyce's Principle. The 2020 Fall Economic Statement announced an initial investment of $15.6 million over 2 years, starting in 2021-22, to support this co-development process.
- Implement recommendations from key reports: The federal government will continue to support the implementation, across the all federal departments, of key reports, including the Final Report of the Truth and Reconciliation Commission and the Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls.
- Advance health transformation: The federal government will continue to support building capacity in First Nations and Inuit-led health organizations to develop new health governance models that increase First Nations/Inuit control and responsibility over the design, delivery and management of federally-funded health services. This will help ensure that First Nations and Inuit have access to high-quality services to address socio-economic conditions in their communities and that they are positioned to work with partners to address systemic racism in health systems.
- Support training and skills development: The Government of Canada recently announced an investment of $4 million to support the National Consortium of Indigenous Medical Education. Their work will focus on reforming Indigenous medical education and improving the experiences of Indigenous Peoples in medical school admissions, education and medical practice in 6 priority areas, including:
- Assessment of Indigenous studies, cultural safety and anti-racism
- Indigenous faculty recruitment and retention
- Improving cultural safety in Curriculum
- Indigenous physician wellness and joy in work
In parallel, we will continue discussion with partners towards a longer-term national approach. Together, we can transform Canada's health systems into spaces free from racism and discrimination, where Indigenous Peoples are respected and safe.