Anti-racism policies in health care should be led by Indigenous staff: report

More Indigenous practitioners are needed to address systemic racism, but that can't happen without a supportive education system that also envisions them in leadership roles, says a report commissioned by Health Canada and touted as the first comprehensive review of the health-care workforce.

The report, released Tuesday by the Canadian Academy of Health Sciences (CAHS), includes an assessment of 5,000 studies done over the last decade on various issues, such as the retention of nurses and doctors and the impact of technology. Some of the research was from countries with similar care models, including Australia, the United Kingdom and Germany.

It outlines multiple hurdles in health care, including inadequate staffing, burnout, moral distress and dissatisfied patients. It also says the system should prioritize culturally safe workplaces, with a focus on team-based care and gender equity so women, who have been the main caregivers at home as well during the pandemic can stay in leadership roles.

The report, which includes surveys of 400 health leaders and professionals, also calls on governments and organizations to develop strategies to support Indigenous practitioners and trainees.

It says racism is a major barrier for many workers as recruitment and retention are among the biggest challenges to planning a health-care system for the future, including in rural and remote areas.

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What systemic racism in Canada looks like

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Duration 9:56

The police killing of George Floyd and the protests that followed have brought renewed attention to systemic racism. In Canada, some have been quick to deny its existence. But these experts say racism has been normalized within Canadian institutions.

"There are substantial disparities between rates of Indigenous and non-Indigenous Peoples in every health profession, including nursing, medicine, midwifery, dentistry," said the report, which calls for data collection on racialized trainees and workers.

Indigenous participants highlighted the legal and ethical need to advance the Indigenous health workforce, linking the labour gap to persistent social inequities among First Nations, Inuit and Mtispeoples.

"They also noted the legal obligations of our governments to the United Nations Declaration on the Rights of Indigenous Peoples, along with the ethical responsibility to fully implement the calls to action of the Truth and Reconciliation Commission of Canada," the report says.

'Really high levels of racism'

Dr. Marcia Anderson, an internist at Grace Hospital in Winnipeg, was among the 15 people who assessed the scientific literature. She said that as part of Canada's systemically disadvantaged populations, Indigenous peoples face "really high levels of racism in the workplace or in the learning environment."

"In some reports that could be 80 or 90 per cent of people who report experiencing racism," she said, adding one of the key "pathways" forward is through Indigenous-led development of policies, safe reporting and investigation processes, as well as mandatory education and training for all employees.

"Even within Indigenous populations there is significant diversity. As a First Nations person, I need to know more about cultural safety and cultural humility so I can provide culturally safe care to Inuit people, for example," said Anderson, who is Cree and Anishinaabe.

Anderson said the gap also compromises care for Indigenous patients, who have endured racism in the health-care system.

She cited the case of 37-year-old Indigenous patient Joyce Echaquan, who died in a Quebec hospital of pulmonary edema in 2020, shortly after filming herself being insulted by hospital staff, as an example of the need for Indigenous peoples to be part of the health-care workforce and provide leadership in ensuring culturally safe care.

However, Indigenous peoples face the additional burden of driving change, often on their own and without compensation, Anderson said.

That may involve using connections to their community to help build relationships, sometimes referred to as "cultural load" or a "minority tax," she said.

"That's not something my non-Indigenous colleagues are getting asked to do," said Anderson, also vice-dean of Indigenous health, social justice and anti-racism at the University of Manitoba.

"There can be significant expertise, community connections and relationships and experience and those are really valuable to institutions but institutions haven't always valued them. So, when we're asking Indigenous members of our teams to do this extra work, the point is, it should be fairly compensated because it's part of the value-add to the institution."

Indigenous peoples in remote areas are more likely to be employed in community care settings and in jobs that don't involve advanced education, compared to their counterparts in urban locations, Anderson said.

"I think that has to do with educational inequities that make it harder for Indigenous peoples to enter programs like nursing or medicine or pharmacy and then be in those positions."

Health Canada said health-care workers from family doctors to personal support workers, massage therapists, dental hygienists and dietitians are "the backbone of our health-care system and they are currently experiencing unprecedented challenges."

"The government of Canada is committed to protecting and strengthening Canada's publicly funded health-care system, including by addressing the health workforce crisis," it said in an emailed response.

"This evidence-based assessment report will inform ongoing collaboration between the government of Canada, the provinces and territories and key stakeholders to identify both immediate and longer-term solutions to address significant health workforce challenges."

Serge Buy, CEO of the CAHS, said many Canadians, including himself, are regularly affected by health-care issues, including the lack of a family doctor.

"I don't have a doctor. My father, who's 85, doesn't have a doctor, for two years," said Buy."My doctor quit in the middle of the pandemic. He sobbed on my shoulder saying, 'I can't do this.'"

Buy said that while much of the report highlights issues unveiled during the pandemic, they have not previously been backed up by scientific evidence now available to governments, non-government organizations and other stakeholders.

For example, during the pandemic, women health-care practitioners have found it difficult to remain involved in leadership, administration or research due to increased caregiving responsibilities, the report says.

"These factors are rarely considered in workforce planning," it said regarding gender equity.