Aboriginal Canadians face racism, stereotyping in urban health care: report

The cover image from the report 'Empathy, dignity, and respect: Creating cultural safety for Aboriginal people in urban health care' released by the Health Council of Canada on Dec. 11, 2012. (Health Council of Canada)

TORONTO -- A new report suggests aboriginal Canadians frequently face racism and stereotyping when using health care services in urban centres, a situation which can breed a degree of mistrust deep enough for some to avoid seeking professional help when sick.

The 74-page document, titled "Empathy, dignity, and respect: Creating cultural safety for Aboriginal people in urban health care," was released by the Health Council of Canada on Tuesday.

The independent national agency is now calling for "culturally competent" care and environments in which aboriginal patients can be treated with understanding and respect.

"When aboriginal patients present themselves -- whether it's in an emergency room or in any health centre -- they're not necessarily seen for who they are and consequently they're not respected, they're not engaged as fellow human beings and as a result the care they get suffers," John G. Abbott, CEO of the Health Council of Canada told The Canadian Press.

"I think this is one area which has been under reported, understated in the Canadian health care system."

According to the report, while factors like poverty and the impact of colonization are known to have an impact on aboriginal health, a "Western approach to health care" often reinforces stereotypes which alienate and intimidate some patients.

As some aboriginal patients avoid seeking care or drop out of treatment programs, the report says ailments are diagnosed later, when they are harder to treat, and the benefits of preventative care measures, like immunizations and screening tests, may be missed.

"If they're not feeling safe or respected, they're not going to communicate as effectively as they should, and they're not going to follow up on their treatment plan and they're not going to come back," said Abbott.

The report was based on meetings with health care providers across the country, many of whom were aboriginal.

In one example shared with researchers, the report said some aboriginal patients were refused painkillers even when in severe pain because of a belief they were at a higher risk of becoming addicted or were already abusing prescription drugs.

In another, the report said an aboriginal man who was beaten and bloodied was brought to an emergency room where he was not allowed to lie on a bed. When a doctor asked why, the report said a nurse explained that the man was dirty and would return to the street to engage in the same risky behaviour that had landed him in hospital. In fact, the report said, the patient was employed, owned a home, and had been attacked on his way home from work.

"Part of it is ignorance...some of it racism...part of it is just general stereotyping," said Abbott in detailing the possible reasons for the way many aboriginal patients say they are treated.

"There is inefficient attention paid to training people on the front lines in particular to really be receptive to a different culture and a different way of life, particularly when they're dealing with healthcare."

The situation is all the more concerning because aboriginal people often have poorer health and shorter life expectancies than other Canadians, he said.

The report -- which points out that aboriginal patients often felt most safe when they had some sort of interaction with aboriginal staff -- suggests having aboriginal patient navigators and cultural interpreters in place to support patients and healthcare providers, measures which have been a success in some Canadian facilities.

It also suggests an increased emphasis on aboriginal history and cultural sensitivity during post-secondary and on-the-job training of those in the health sector.

"This is a fairly complicated issue, but there are solutions. But they need to happen at the front line and they need to be supported continuously. It's not so much an issue of money as it is an issue of leadership," Abbott said.

"Many Canadians come up through the mainstream western European model of health care and then when an aboriginal person comes in ... they're just not exposed to their way of life, their thinking, their approach to health care."

The report does point out that cultural competency and cultural safety are becoming a priority for many governments and health care providers, and said many people interviewed while research was being conducted expressed a sense of "hope and anticipation."

The report will be presented to health officials at provincial and federal levels, and will be shared with health-care providers as well.

"Individual initiatives are certainly good in themselves but I think each provincial government as well as the federal government...they really need to put in the policies and programs that make sure this issue is addressed," Abbott said.

"(We must) get to a zero tolerance on this particular aspect of health care."