When Health Care Harms: Addressing Indigenous-Specific Racism in Canada
Sierra Scollard
Sierra Scollard is completing her Master of Public Health at the University of British Columbia. She is a member of the Kitigan Zibi Anishinabeg First Nation.
In September 2020, Joyce Echaquan, an Atikamekw woman and mother of seven, recorded herself in a Quebec hospital as staff insulted her with racist and degrading comments while she cried out in pain.1 She died shortly afterwards. Years earlier, Brian Sinclair, a First Nations man, sat in a Winnipeg emergency room for 34 hours without receiving care.2 Despite arriving with a referral note, hospital staff assumed he was intoxicated and ignored him until after his death.
Indigenous-specific racism is not a new issue in Canadian health care. It is a systemic issue rooted in colonialism and sustained through policy failures, institutional neglect, and widespread stereotyping. Indigenous-specific racism contributes directly to preventable illnesses, poorer health outcomes, and avoidable deaths,1,3,4,5 and remains an urgent public health challenge in our country today.
Racism as a Determinant of Health
It is racism, not race itself, that drives many of the health inequities experienced by Indigenous peoples. As a social determinant of health, racism influences who receives care, how they are treated, and what outcomes they experience, and it operates through both conscious and unconscious bias.1 It reinforces power imbalances by distributing resources and opportunities unequally based on perceived racial identity which results in the marginalization and exclusion of racialized groups.
For Indigenous peoples in Canada, racism has contributed to long-standing and well-documented health disparities including higher rates of chronic illness, delayed or denied care, inadequate pain management, and lower life expectancy.1,4,5 Indigenous patients are also less likely than non-Indigenous patients to receive timely medication, to feel safe filing complaints, or to have their symptoms taken seriously.5 In 2024, one in five Indigenous peoples reported facing discriminatory or racist behaviour from someone in the health care system.6
How Racism Shows Up in Health Care
In health care settings, racism operates at multiple levels. At the interpersonal level, Indigenous patients are often stereotyped as drug-seeking, non-compliant, or intoxicated, especially in emergency departments.5,7,8 These stereotypes lead to misdiagnosis, neglect, and harmful treatment. At the organizational level, hospital policies and clinical environments often reflect Eurocentric norms and exclude Indigenous practices, contributing to a lack of culturally safe care.4,9 Structurally, racism is embedded in governance, funding decisions, and jurisdictional fragmentation between federal and provincial systems which delays access to services.3,10
Racism is present in everyday clinical decisions, intake processes, and staff attitudes. Emergency departments are especially problematic and are often described as “hotbeds” for racism, where Indigenous patients face heightened scrutiny and disrespect during moments of vulnerability.7 Under stress and time pressures, providers may rely more heavily on stereotypes to determine who is deserving of care and these assumptions result in differences in how patients are triaged, treated, and spoken to.8
Many Indigenous patients avoid care altogether due to this fear of mistreatment, which then contributes to worse health outcomes and higher rates of emergency visits or untreated conditions.4,9 Avoidance of care is not irrational. It is a survival strategy shaped by a long history of medical trauma including Indian hospitals, forced sterilizations, and past and ongoing experiences of neglect and stereotyping.5
Indigenous Knowledge and Practices
These harms are compounded when Indigenous worldviews and healing practices are not recognized within the health system. Indigenous healing practices and ceremonies are often dismissed or restricted in clinical settings despite being essential to many patients’ well-being.4,5,9 Practices such as smudging, visits from Elders or traditional healers, or access to traditional medicine are frequently denied or treated as non-essential. In many hospitals, these practices require patients to request permission which can lead to discomfort, delays, or refusal.
This dynamic reinforces colonial assumptions about which forms of care are legitimate. Western biomedical care is prioritized, while Indigenous ways of knowing and healing are seen as inferior and undervalued.9,10 Denying Indigenous peoples access to traditional healing practices and medicine not only disrespects Indigenous knowledge systems but also violates rights affirmed in the United Nations Declaration on the Rights of Indigenous Peoples.11
Failures of Complaint and Accountability Systems
When Indigenous patients experience racism in care, the path to speaking up and getting help is rarely safe or straightforward. Indigenous patients often report that they do not trust complaint systems, find them overly complicated, or fear retaliation if they speak up. Data from British Columbia shows that 31% of Indigenous respondents believed their complaint would not be taken seriously, 25% feared worse treatment if they filled a complaint, and 27% anticipated poor treatment throughout the process, all significantly higher than responses from non-Indigenous patients.5 When complaints are submitted, the response often individualizes the problem rather than acknowledging systemic issues, leaving the broader patterns of racism intact.8
Path Forward: Recommendations
Tackling Indigenous-specific racism in health care demands structural change. The following actions offer steps toward building a more equitable and culturally safe system:
1. Expand cultural safety training to all hospital staff
Efforts to address racism tend to focus heavily on cultural safety training mainly for physicians, but this approach is too narrow. Racism is not limited to clinical staff. It occurs throughout the entire system, including at intake desks and with administrative and security personnel, and must be addressed at every level.3 To ensure a system-wide approach, mandatory and ongoing training across Canada should be funded and include all roles such as clerks, aides, triage staff, administrators, and security personnel.3 This ensures that bias is addressed at every point of contact.
2. Implement independent Indigenous patient advocacy hubs
To ensure safety, accountability, and culturally grounded support, health systems should provide sustained funding for independent, Indigenous patient advocacy hubs that are designed and led by Indigenous peoples. They should operate outside of hospitals and health authorities, with the authority to liaise directly with health care institutions. These hubs would support Indigenous patients who have experienced harm or discrimination by offering complaint navigation, advocacy, and trauma-informed care, removing the burden from individuals to navigate complex and often hostile complaint systems on their own. By placing this under Indigenous leadership, these hubs can create safer spaces to speak out without fear or re-exposure to the same institutions that caused harm.
3. Protect traditional healing practices as health rights
Indigenous patients frequently encounter barriers when seeking cultural support in care settings. This devalues Indigenous worldviews and reinforces colonial power dynamics.4,9 A shift to a presumed-consent model would respect the right of Indigenous peoples to access traditional practices and medicines as part of their care. Unless there are clearly explained and documented safety risks, traditional healing practices should be supported without requiring special permission. Health systems must also invest in creating spaces where traditional practices and ceremonies can take place safely and without disruption. This approach affirms Indigenous peoples’ rights to self-determination and culturally grounded care.
4. Increase access to Indigenous practitioners
Many Indigenous patients feel safer when cared for by providers who share their cultural background or recognize the value of Indigenous knowledge. Health systems should fund more roles for Indigenous practitioners, including physicians, midwives, nurses, and traditional healers, and ensure that patients can access their care without unnecessary delay or redirection. At the same time, sustained investment to increase education and training for Indigenous practitioners is essential to increase the number of Indigenous professionals working in health care.12
References
1. Ramsoondar N, Anawati A, Cameron E. Racism as a determinant of health and health care: Rapid evidence narrative from the SAFE for Health Institutions project. Canadian Family Physician. 2023 Sep 1;69(9):594-8. doi:https://doi.org/10.46747/cfp.6909594
2. Lett D. Emergency department problems raised at Sinclair inquest. CMJA. 2013 Nov 19;185(17):1483. doi:10.1503/cmaj.109-4633
3. Browne AJ, Lavoie JG, McCallum MJ, Big Canoe C. Addressing anti-Indigenous racism in Canadian health systems: multi-tiered approaches are required. Canadian Journal of Public Health. 2022 Apr;113(2):222-6. doi:10.17269/s41997-021-00598-1
4. Cooke M, Shields T. Anti-Indigenous racism in Canadian healthcare: A scoping review of the literature. International Journal for Quality in Health Care. 2024 Jul;36(3):mzae089. doi:10.1093/intqhc/mzae089
5. Turpel-Lafond ME. In plain sight: Addressing Indigenous-specific racism and discrimination in B.C. health care [Internet]. Government of British Columbia; 2020 [cited 2025 Jul 2]. Available from: https://engage.gov.bc.ca/app/uploads/sites/613/2020/11/In-Plain-Sight-Summary-Report.pdf
6. Statistics Canada. Health care access and experiences among Indigenous people, 2024 [Internet]. Ottawa: Statistics Canada; 2024 Nov 4 [cited 2025 Jul 3]. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/241104/dq241104a-eng.htm#
7. McLane P, Mackey L, Holroyd BR, Fitzpatrick K, Healy C, Rittenbach K, Big Plume T, Bill L, Bird A, Healy B, Janvier K, Louis E, Barnabe C. Impacts of racism on First Nations patients' emergency care: results of a thematic analysis of healthcare provider interviews in Alberta, Canada. BMC Health Services Research. 2022 Jun 21;22(1):804. doi:10.1186/s12913-022-08129-5
8. Muller da Silva M. A moral economy of care: How clinical discourses perpetuate Indigenous‐specific discrimination and racism in western Canadian emergency departments. Medical Anthropology Quarterly. 2024 Sep;38(3):328-41. doi:10.1111/maq.12867
9. Pilarinos A, Field S, Vasarhelyi K, Hall D, Fox ED, Price ER, Bonshor L, Bingham B. A qualitative exploration of Indigenous patients’ experiences of racism and perspectives on improving cultural safety within health care. Canadian Medical Association Open Access Journal. 2023 May 1;11(3):E404-10. doi:10.9778/cmajo.20220135
10. Phillips-Beck W, Eni R, Lavoie JG, Kinew AK, Achan KG, Katz A. Confronting racism within the Canadian healthcare system: systemic exclusion of First Nations from quality and consistent care. International Journal of Environmental Research and Public Health. 2020 Nov;17(22):8343. doi:10.3390/ijerph17228343
11. United Nations. United Nations declaration on the rights of Indigenous Peoples [Internet]. United Nations; 2007 [cited 2025 Jul 3]. Available from: https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf
12. Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada: Calls to action [Internet]. Truth and Reconciliation Commission of Canada; 2015 [cited 2025 Jul 3]. Available from: https://ehprnh2mwo3.exactdn.com/wp-content/uploads/2021/01/Calls_to_Action_English2.pdf
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