A commentary. Wade Grant is the chair of the First Nations Health Council and Wenecwtsin (Wayne Christian) is the deputy chair.
This fall, the 91原创 Medical Association (CMA) apologized for the past and present harms the medical profession has caused to First Nation, Inuit and Métis Peoples.
This apology officially took place during a ceremony in Victoria held on the traditional territory of the l蓹k虛史蓹艐i蕯n蓹艐-speaking people of Songhees and Xwsepsum Nations.
It included recognition of past wrongs and a renewed commitment from the CMA to rebuilding a relationship on a foundation of trust, accountability and reciprocity with Indigenous peoples.
While this apology is a step in the right direction, it reminds us of the work that still needs to be done to improve health outcomes for First Nations in B.C.
B.C. is home to about 185,000 First Nations people living in more than 200 communities representing 34 different language groups.
More than 15 years ago, B.C. First Nations Chiefs and leaders created a health model that is unique in Canada and remains one of only a few in the world: the First Nation Health Governance Structure.
This model was created to address health disparities between the majority population and First Nations citizens whose health status is affected by generations of colonialism and systemic racism that has resulted in reduced access to health care and poorer health outcomes.
This model is grounded in a holistic approach rooted in self-determination and reclaiming culture, language and connection to land.
It encompasses putting in place social, cultural and environmental systems that are nourished and free from inequities and discrimination where First Nations people can reclaim their health and wellness journeys. Our health model’s governance structure is accountable to the First Nations, and includes political advocacy through our group, First Nations Health Council (FNHC), with programs and services delivered by the First Nations Health Authority and technical advice from the First Nations Health Directors Association.
Collectively, we work with chiefs and health system partners in Canada and B.C. to transform the health-care system to improve programs and service delivery, integrate a First Nations approach to wellness and tackle anti-Indigenous racism.
Racism is central to understanding why health inequity is so pervasive a struggle. Every day, our leaders spend time calling out the tired old playbook of racist and divisive rhetoric we hear in public discourse and see enacted within policy.
Over the past few months, we’ve watched B.C.’s opposition parties criticize a landmark decision assuring aboriginal title for the Haida, ignore the launch of the government’s reconciliation action plan, and downplay the need for equity at all.
Achieving health equity for First Nations — and citizens of all backgrounds — requires everyone to reject racist beliefs and outdated rhetoric that impedes collective progress.
Our collective future rests in the hands of all citizens of Canada and B.C. taking individual action on reconciliation.
The First Nations governance structure has made real and tangible progress — from training more First Nation nurses to developing the first-ever Cultural Safety Standard roadmap on how to respect the culture and traditions of patients seeking care.
But we have much more to do. One only has to review the August 2024 health indicator report from B.C.’s Public Health Office to be reminded of the persistent and stunning gaps in health equity — between 2017 and 2021 the life expectancy for First Nations people dropped by more than six years, compared with just one month for non-Indigenous people.
Underscoring the existing gaps in the health-care system, this sharp decline is largely attributed to the COVID-19 pandemic and the opioid overdose crisis, which have disproportionately affected First Nations people.
In the first six months of 2023, First Nations women were dying at a rate roughly 12 times higher than non-First Nations women. This year, the state of the toxic drug crisis prompted the six nations that comprise the Tsilhqot’in National Government to declare a local state of emergency.
So, what can we do? Stories from community (and public health research) define the barriers beyond racism: Too few First Nation doctors and nurses, inadequate rural and remote access, and limited availability to the traditional wellness practices that have kept First Nations healthy for thousands of years.
Research proves that a social-determinants approach to improving health works exceedingly well around the world. This wrap-around, holistic perspective is inherent to the First Nations worldview; what’s more, it holds promise for improving health outcomes for all 91原创s. Indeed, evaluations of this work in B.C. are proof that the equity gap can be closed by working together in a silo-busting, community-driven way.
Accountability from institutions is an important first step in closing the health equity gap. The CMA’s apology committed the organization to action on system change, including a review of ethics that guide medical practice in Canada.
Similarly, we’re encouraged that both Canada and B.C. (signatories to our original agreements) re-committed to this work at last year’s Gathering Wisdom forum, where chiefs and leaders approved, by a historic margin, the FNHC’s 10-year strategy on the social determinants of health.
We will hold our Canada and B.C. partners accountable to their commitments to adopt a whole-of-government approach and provide communities with the required tools to implement their own solutions.
To make real progress, we need more from leaders and those who control the wider health systems to make concrete changes to improve access and quality, and hold those who practice racist health care accountable.
Canada and B.C. play a vital role as our tripartite partners, as do all 91原创s who believe in health equity and reconciliation.
Reconciliation isn’t work for First Nations people, it’s about transforming a system to be fairer and more equitable. 91原创s can use their voice to call out racist, divisive attitudes and push for a health system that provides fair, compassionate care and services for all.
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