Systemic racism continues to impact Indigenous Peoples as they attempt to access what, for most Canadians, is a fundamental right: health care. This is even more true during a pandemic. Although systemic inequalities have perhaps become even more apparent in the context of the pandemic, there is much to be learnt from the management of this health crisis by Indigenous communities’ leaders. The relatively low rate of COVID-19 among on-reserve Indigenous Peoples, especially in Quebec and during the first wave, is evidence that self-determination can contribute to positive public health outcomes.

Since the beginning of the pandemic, just over 200 on-reserve First Nations people have died from COVID-19. The COVID-19 case fatality rate among First Nations living on reserve is about 46% of the case fatality rate of the general Canadian population. While Indigenous peoples have, in fact, been disproportionately affected by the pandemic in terms of rates of infection, there are key approaches to health care that have mitigated the fatality of the virus in comparison to the general Canadian population.

What might explain these numbers? During the COVID-19 pandemic, many Indigenous communities have shown self-determination by articulating and enforcing rules on who can enter their communities, often implementing far stricter measures than those enacted by municipalities, such as closures and checkpoints. Current strategies for Indigenous public health practice, grounded in self-determination, are an important reason for the relative resilience of Indigenous communities in Canada, especially in Quebec, during COVID-19. Mentioned in their piece COVID-19 and the decolonization of Indigenous public health, Dr. Lisa Richardson, Co-Lead Indigenous Medical Education and Assistant Professor in the Department of Medicine at the University of Toronto, and Dr. Allison Crawford, a psychiatrist at Centre for Addiction and Mental Health in Toronto, state that the reinforcement of Indigenous sovereignty, leadership, and knowledge might be an essential foundation for public health during moments of crisis.

Self-determination will not heal all the damage of Canada’s colonial past, but it might help resolve numerous issues in the healthcare system.

First Peoples, Second Class Treatment

This complex burden of systemic inequities, magnified during the pandemic, has many characteristics: it is colonial, highly discriminatory, and socially inequitable. Canada cannot continue to overlook the unique vulnerabilities and dangerous burdens the virus imposes on Indigenous communities. 

Indigenous Peoples are disproportionately represented in socio-economic indicators for poor health, having higher rates of arthritis, diabetes, obesity, and asthma. Many of the health disparities experienced by Indigenous Peoples correlate to social, economic and political factors. Boil water advisories, food insecurity, lack of access to consistent health care, lack of connectivity to the internet and cell phone towers, and inadequate housing are also factors exacerbating the situation in which communities have found themselves during the pandemic. Not to mention the dearth of personal protective equipment available to Indigenous communities during the first wave of COVID-19. Now, as vaccine distribution ramps up across Canada, Indigenous communities are again poised to get the short end of the stick.

Vaccination: One-Size-Fits-All

Sweeping, uniform federal preventative recommendations are incompatible with the circumstances of reserves, and this is why communities have adopted diverse measures fitted to their needs and situations. 

For the COVID-19 vaccination, Indigenous people have good reason to distrust the Federal government: historical trauma and vaccine hesitancy is well-documented. Just as with preventive measures, the COVID-19 vaccination campaign must be adapted to the needs of specific nations, embracing local Indigenous languages, cultures, and ways of knowing. It also needs to be developed, implemented and led by Indigenous communities. “Buy-in from the local population is important,” according to Marjolaine Sioui, the executive director of the First Nations of Quebec and Labrador Health and Social Services Commission.

The National Advisory Committee on Immunization (NACI), an external advisory body to the Public Health Agency of Canada that provides medical, scientific and public health advice on the use of vaccines, has developed its recommendations on delivering the COVID-19 vaccine.  One of the factors that must be considered is equity. An equitable approach should integrate the values and preferences of Indigenous communities in vaccine program planning and build capacity to ensure convenient access to immunization services. As Caroline Lidstone-Jones, chief executive officer of the Indigenous Primary Health Care Council, told the Toronto Star, “If you engage with us effectively and appropriately, there are real ways that we can get better uptake and engagement of our population.”

In the months ahead, we will see the outcomes of a conscious effort to not repeat history by working with Indigenous leadership in the rollout of the COVID-19 vaccination. 

But there is not much time. During a pandemic, isolation might work to the advantage of Indigenous rural communities, but it could also be their greatest weakness. Failure to take immediate and substantive action, even if it may seem like an overreaction now, might mean a repeat of the H1N1 pandemic poor management, or worse. This is where a balance between collaboration and centralized rapid action comes into play.  

In the Long Run

Despite many attempts by Ottawa and provincial governments, as well as the solidarity and resilience of Indigenous communities, Canada’s health policies and legislation have failed to address systemic racism and they have contributed to worsened health outcomes among Indigenous Peoples for almost a quarter of a century.

All government levels in Canada must address the social determinants of health through investments in infrastructure, food security, and chronic disease prevention and management. But quantitative and qualitative data is still missing, and commonly used federal indicators are largely deficit-based. In other words, without an adequate understanding of structural factors that impact Indigenous communities, indicators that focus solely on the issues can reinforce discriminatory attitudes towards Indigenous Peoples. 

A robust Indigenous public health response to COVID-19 in Canada might be the first step towards reconciliation with the country’s colonial history in upholding Indigenous Peoples’ self-determination as stated in article 3 of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), declaring that “by virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development.”

The next step will require the courage to undertake a more comprehensive dismantling of systemic racism throughout the Canadian health care system.

Edited by Kate Miller.

The opinions expressed in this article are solely those of the author and they do not reflect the position of the McGill Journal of Political Studies or the Political Science Students’ Association.

Photo by Kevin Kobsic and obtained via Unsplash.