A call to end racism in Canada’s health care systems

The Hon. Dr. Jane Philpott is a former federal minister of health and minister of Indigenous services. She is dean of the Faculty of Health Sciences, Queen’s University.

I wish I could say with certainty that the death of 37-year-old Joyce Echaquan will be a wake-up call for health systems in Canada. It should be. But history gives us no confidence to make such a claim. Joyce Echaquan is not the first person to die as a direct or indirect result of racism in Canadian health care systems. Tragically she won’t be the last. But her death comes at a point in our history where Canadians may be more attuned to the dangers of systemic racism than we were, for example, when 45-year-old Brian Sinclair died in a Winnipeg hospital in 2008.

We must seize this moment in history and act to prevent more senseless deaths. There is no better place to start than with changing the way we train health professionals. A 2019 international consensus statement on Indigenous health equity notes that “Medical education institutions must acknowledge their historical and contemporary role in the colonial project and engage in an institutional decolonization process.”

Here at Queen’s University, our principal, Patrick Deane, has not shied away from declaring that racism and other forms of oppression, including colonialism, “deeply affect our institution, as they do the systems and formations of our society at large.” Such a categorical admission of institutional racism from the leader of a prominent post-secondary institution is not something we heard a decade ago. The open admission that an organization like ours is plagued with structural injustices, which permit some to be privileged and others to be harmed, is an essential step on our journey to changing those deep-rooted patterns of injustice. That kind of openness leads me to think that we are at a point in time when we can more effectively take on racism and colonialism in health care; in hopes that Joyce Echaquan’s death will not be in vain.

There is no single intervention that leads to the reduction or the elimination of racism and colonialism in health systems or in the training of health professionals. We need comprehensive and collaborative cultural transformation. We don’t need more studies; we need action on a suite of reforms. Steps have been laid out in multiple reports including the Calls to Action of the Truth and Reconciliation Commission and the Calls for Justice from the Inquiry on Missing and Murdered Indigenous Women and Girls. The Association of Medical Faculties of Canada tabled its own commitment last year entitled a Joint Commitment to Action on Indigenous Health.

As dean of the Faculty of Health Sciences at Queen’s, I’m determined to work with my colleagues to breathe life into those reports. We have hired new staff including an elder-in-residence to provide ceremonial and cultural supports. Last week we opened an Office of Equity, Diversity, and Inclusion and we now have over 150 volunteers from students, staff, and faculty participating in a Dean’s Action Table on Equity, Diversity, and Inclusion.

We have an obligation to expand the Indigenous health workforce by increasing the number of First Nations, Inuit and Métis students in medicine, nursing and rehabilitation therapy. Indigenous Peoples must see themselves reflected in the health professionals who treat them. We must continue to identify structural biases in our admissions processes and make amendments, accordingly, including diversifying the membership of admissions committees and introducing cultural safety training for their members.

We’ve already changed the focus of the Queen’s Accelerated Route to Medical School to enable 10 students who identify as Indigenous or Black to begin a pathway to medical education that addresses some of the well-known systemic barriers to access. We know this means we’ll need a broad community of support for growing numbers of Indigenous and Black students on campus and in our health professions programs, but we’ve already taken steps to enable that, by hiring mentors such as Wendy Phillips, elder-in-residence and former MP Celina Caesar-Chavannes, senior advisor on equity, diversity and inclusion.

Just as important as the diversity of our student body is what we teach our students. Our curricula must include Indigenous perspectives of history and culture. It should include concepts of power, privilege and conflict resolution. This work is underway. We have professional development courses in cultural safety, anti-racism and anti-oppression. We have started to diversify our workforce, recognizing the importance of having staff and faculty from under-represented groups in leadership positions and on decision-making bodies.

We also need tools to help us identify personal, institutional and systemic forms of racism. As we use these tools, there will be an obligation to act on what we learn, with cycles of self-reflection and informed action. Increasingly, we must learn safe and effective ways to speak up when we recognize bias, harassment, and micro-aggressions.

Speaking up is the minimum response. Our collective goal is to change the entrenched patterns of injustice in our health systems. In some cases, it’s a matter of life or death.