Creating cultural safety for Aboriginal people in urban health care

Dr. Catherine Cook is a Councillor with the Health Council of Canada and the Vice President of Population and Aboriginal Health for the Winnipeg Regional Health Authority in Manitoba. Dr. Cook is also Métis. 

**This is an editorial initially published in the Winnipeg Free Press.

Most Canadians are aware that many First Nations, Inuit, and Métis people have poorer health and more challenging living conditions than the larger Canadian population. In 2010, the Health Council of Canada started a multi-year project to learn about programs and strategies that have the potential to reduce these health disparities between Aboriginal and non-Aboriginal Canadians.

Last spring, the Health Council of Canada travelled across the country to learn more about health care for Aboriginal people in urban settings. Approximately half of Canada’s 1.3 million Aboriginal population live in cities, but they don’t use mainstream health care services at the same rate as other Canadians. Aboriginal people are less likely to seek help when they have symptoms and more likely to be diagnosed at a later stage of disease than non-Aboriginal people, a delay that can make treatment more difficult or no longer possible. Although this has been documented in the research literature, it’s not as well known by health care service providers, that many Aboriginal people don’t trust the system enough to use it.

The Health Council held meetings with health care providers and policy makers in Saskatoon, Winnipeg, Vancouver, Edmonton, Toronto, Montreal and St. John’s. Many participants were from First Nations, Inuit, and Métis communities, and they generously shared both their personal and professional insights and experiences.

Participants described Aboriginal people’s feelings of discomfort, powerlessness, and fear when trying to use the health care system. To quote one participant, “they have had experiences like being treated with contempt, judged, ignored, stereotyped, racialized, and minimized.” One story exemplified the type of racist assumptions that many Aboriginal people experience. An injured Aboriginal man was brought to an emergency department, where he was not allowed to lie on a bed. When a physician asked why the patient was not lying down, the nurse explained that the man was dirty, and would just return to the street after leaving the hospital. In fact, the patient was employed, owned a home, and had been attacked on his way home from work.

Most health care professionals are well intentioned and unaware that they are acting out deeply entrenched stereotypes of Aboriginal people that exist throughout Canadian society. Health care professionals may not realize that they are the reason a First Nation, Inuit or Métis patient does not follow a treatment protocol or doesn’t return for appointments.

Despite these challenges, there is good news – very good news. Across the country there are programs underway to create health care environments that are free of racism, where Aboriginal people can feel welcome and safe. For example, in recent years there has been an increase in cultural competency training for health professionals and an increase in the use of Aboriginal support workers who serve as cultural interpreters between Aboriginal patients and the mainstream health care system. These programs and others are described in the Health Council’s recent report, Empathy, dignity and respect: Creating cultural safety for Aboriginal people in urban health care.

Canadian health care systems have a responsibility to reach out to populations that are suffering from poor health or not using services, to find out why, and to adapt health care services to better meet their needs. Making specific efforts to ensure that the health care system is culturally safe for Aboriginal people is important not only to improving their health - it is also a concrete way to show respect and work towards reconciliation.