Special Feature by Dr. David Tu, MD, CCFP, FCFP
In this article, Dr. David Tu shares his personal reflections and views on ways to create a more equitable healthcare system, which are informed by his experiences working with Indigenous peoples for most of his career.
As a non-Indigenous Family Physician who has spent most of his career working with Indigenous people, and as a member of the First Nations Indigenous Primary Care Network (FNIPCN), I was asked to share a reflection on the state of Indigenous health in honour of the upcoming National Day for Truth and Reconciliation on September 30. Similarly, I was recently invited to provide a 10-minute briefing to our then new provincial Minister of Health, the Honorable Ravi Kahlon, as he did a walk-about in the Downtown Eastside (DTES) and visited our Indigenous inner-city health and cultural centre, Kílala Lelum. I began my pitch to Minister Kahlon by acknowledging the health disparities he had witnessed on his tour of the DTES, exemplified by the number of people he saw on the sidewalks incapacitated from illicit opioids and at obvious risk of fatal overdose. A disproportionate number of these individuals identify as Indigenous, most of whom are disconnected from their families, traditional lands and practices. I invited the Minister to view the Indigenous community in the DTES not as a blemish within our province, but rather as a beacon exposing the most crucial deficiencies in our healthcare system. I encouraged Minister Kahlon to view this community as a treasure, for the health solutions found for the Indigenous people in the DTES can serve as a guide to improving the system for all people in the province.
I directed the Minister to consider the findings of the 2009 Senate Subcommittee Report, which indicated that 25% of the health disparities for Indigenous People in Canada are attributable to deficiencies in the health-care system which manifest as problems of poor “attachment” (driven by distrust) and inadequate resources; and that 60% are attributable to socio-economic and environmental determinants (all consequences of colonization) (1). The health system is deficient (not the Indigenous patients) for not promoting trust and attachment, which creates missed opportunities for timely cost-effective primary care interventions, and result in an increase of crisis oriented, expensive, emergent care management of otherwise preventable problems. This story repeats itself every day in our province as ambulances and emergency departments are overrun by the tragedy of unintentional synthetic opioid poisonings.
Kílala Lelum, and the seven other clinics who form the FNIPCN(2), are transforming the health care system to promote greater health equity for Indigenous people. The two common transformative innovations across our network are: 1. a “two-eye seeing”(3) partnership approach between Indigenous Elders/ Medicine providers and Primary care teams, and 2. Indigenous Leadership. These interventions have generated novel approaches within primary case, such as seeing the clinical relationship and environment as medicine; using food as medicine, and incorporating ceremony into medical practice. These approaches have been incorporated into a diversity of programs across the network, addressing issues ranging from substance use, to chronic pain, to employment. These innovations, approaches and programs are transformative, and the results are manifested in the very high rates of meaningful attachment (and trust) of Indigenous people within our network clinics. We are delivering on the promise of promoting health equity and are creating “islands” of effective care, linked within our network, that exist within a larger sea of the dominant colonial healthcare system.
The bottom-line message to the Ministry of Health is that it does indeed cost more, and requires different investments, for the health care system to work effectively for Indigenous people. Success, as demonstrated by our network, looks like trusted attachment and high levels of engagement in cost-effective primary care interventions and programs. Failure to invest will result in the continued status quo of Indigenous health disparities which are ultimately much more costly to the healthcare system. I was heartened when Minister Kahlon shared that his motivation for entering political life was the promotion of equity. I hope the Ministry of Health take up the opportunity to partner with the FNIPCN and other likeminded institutions to create a more equitable healthcare system for Indigenous people in British Columbians, which will have collateral benefits for all British Columbians.
- The Standing Senate Committee on Social Affairs, Science and Technology. (2009). A healthy, productive Canada: A determinant of health approach. Final Report of Senate Subcommittee on Population Health
- Member clinics of the FNAPCN: Musqueam Indian Band Health Department: Primary Care Clinic, Squamish Nation Yúustway Health: Kal’númet Primary Care Clinic, Tsleil-Waututh Nation Health: Helping House Primary Care Clinic, Tla’amin Nation Health: Primary Care Clinic, Lu’ma Medical Centre, Urban Native Youth Association, Vancouver Aboriginal Health Society, and Kílala Lelum Health and Wellness Cooperative.
- Bartlett, C., Marshall, M., Marshall, A. (2012). Two-eyed seeing and other lessons learned within a co-learning journey of bringing together indigenous and mainstream knowledges and ways of knowing. Journal of Environmental Studies and Sciences, 2, 331–340.