Making Canada’s health care system more culturally responsive to Aboriginal Peoples

Keith Neuman, Ph.D., Executive Director, the Environics Institute for Survey Research

The new report issued by the Health Council of Canada on cultural competency and cultural safety for Aboriginal People in urban health care is a welcome addition to what is hopefully a broader renaissance in how health care services are provided in this country.  This report presents the outcomes of regional roundtable sessions across the country focusing on an issue that lies at the nexus of two unfortunate trends in our country’s history:  i) the historic and still ongoing discrimination and stereotyping of Canada’s Aboriginal Peoples (which thankfully is diminishing); and ii) the increasing strain placed on the delivery of health care services due to rising costs and system demands.

The central premise addressed in these roundtables is clear. The current health care system is not designed to be sensitive to cultural differences that have a bearing on health outcomes, and has been especially inept in addressing the needs of the country’s Aboriginal Peoples because of systemic ignorance and discrimination. This problem is not limited to the health care system, but is arguably one area where the effects are most pronounced (along with education).

The report makes the telling point that establishing cultural competency is more than learning the facts but is developing a basis for empathy, to appreciate what it is like to be someone else. This was a major focus of the landmark Urban Aboriginal Peoples Study (UAPS), conducted by the Environics Institute for Survey Research in 2008-09 in 11 cities across the country (see www.uaps.ca).  That study points to what is perhaps the greatest challenge for health care providers seeking to be more culturally competent in the services they deliver to Aboriginal people:  On the one hand to recognize that Aboriginal People share much in common with all Canadians (including providers (?)), having similar life experiences, values and aspirations (e.g., an education, a decent quality of life, a future for their children), while on the other hand to appreciate the distinct history and identity (as First Nations, Métis or Inuit) as they may bear on individuals’ health care needs.

This report provides an excellent overview of an impressive number of promising initiatives taking place across the country that are working towards developing and incorporating cultural competency and cultural safety into health care services for Aboriginal communities. There is surely much learning taking place as a result of this effort, and it is hoped that this knowledge is being shared with a broader range of health care providers, and will result in systemic improvements.  And perhaps there are lessons here about how better to serve the distinct health care needs of other ethnically and culturally diverse communities across the country.