Healthcare disparities among Indigenous communities are no foreign concept in Canada—these outcomes are deeply rooted in the determinants of health that must be addressed in order to build an equitable health system.
“Equity” should not be confused with “equality.”
It is worth noting that equity and equality are two entirely different concepts. While equity tends to rely on the ideology of fairness, equality promotes impartiality. According to Health Quality Ontario, “Health equity allows people to reach their full health potential and receive high-quality care that is fair and appropriate to them and their needs, no matter where they live, what they have or who they are… a high-quality health system recognizes and respects social, cultural and linguistic differences”. By definition, health care equity is a “sub-set of health equity” in which a health system is able to effectively provide equitable health care (Health Quality Ontario, 2019).
Indigenous Mental Health in Canada
The alarming rates of poverty, unemployment, child apprehension, poor education, and public services are all contributing factors to the declining mental health of Indigenous peoples. These communities are challenged with a “disproportionate burden of disparity” that comes with low income and substandard living conditions (Richmond et al., 2016). In a recent report from Statistics Canada, mental health disparities between the Indigenous and non-Indigenous populations in Canada have demonstrated to be directly linked to the intergenerational effects of residential schools, the forced relocation of communities and removal of children from families and communities, and mental health services gaps. The report also claims that the adverse mental health outcomes of the Indigenous have resulted from childhood adversity, trauma, discrimination, as well as social determinants of health such as unemployment, housing, poverty, and food security (Government of Canada, 2020).
Indigenous Mental Health and the Pandemic
According to Statistics Canada, 6 in 10 Indigenous participants report that their mental health has worsened since the onset of physical distancing (Arriagada et al., 2020). The COVID-19 pandemic has only amplified the mental health concerns of Indigenous communities as the inability to socialize in-person creates unfamiliar and stressful situations. The Public Health Agency of Canada (PHAC) also describes how factors such as geographical isolation, high levels of pre-existing health conditions and inadequate housing are associated with a higher risk of contracting or spreading the COVID-19 virus.
Understanding the Impact
A 2010 American research study indicates that patient race/ethnicity can influence physician interpretation of patients’ complaints and, ultimately, clinical decision making (Sorkin et al., 2010). Over time, these biases towards certain populations become rooted in healthcare systems and become significantly more difficult to eliminate. As such, it is crucial for healthcare institutions to prioritize Indigenous and other marginalized communities. In an era of healthcare transformation, moving towards a system that is equitable will help improve the quality of health services being provided and ultimately increase sustainability.
Arriagada, P., Hahmann, T., & O’Donnell, V. (2020, June 23). Indigenous people and mental health during the COVID-19 pandemic. https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00035-eng.htm.
Government of Canada, S. C. (2020, April 17). First Nations people, Métis and Inuit and COVID-19: Health and social characteristics. The Daily . https://www150.statcan.gc.ca/n1/daily-quotidien/200417/dq200417b-eng.htm
Health Quality Ontario. (2019). Health Quality Ontario’s Health Equity Plan. http://www.hqontario.ca/portals/0/documents/health-quality/health_equity_plan_report_en.pdf.
Richmond, C. A. M., & Cook, C. (2016, July 20). Creating conditions for Canadian aboriginal health equity: the promise of healthy public policy. Public Health Reviews. https://link.springer.com/article/10.1186/s40985-016-0016-5.
Sorkin, D. H., Ngo-Metzger, Q., & De Alba, I. (2010, May). Racial/ethnic discrimination in health care: impact on perceived quality of care. Journal of general internal medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855001/.
Bairavie Piravakaran (she/her) is a second-year undergraduate at the University of Toronto Scarborough. As a Psychological & Health Sciences student, she values the importance of sharing credible information and making health resources more accessible to the public. Her interests in population health, research, and design are also reflected in her non-academic pursuits—she currently volunteers with the Young Leaders of Public Health and Medicine (YLPHM) as a Social Media Manager for the Scarborough Chapter and is a Health Promotion & Analytics Member at Critical Health Innovations Lab (CHIL). At EMPOWER Health, Bairavie works closely with the Marketing Team in order to plan and execute strategies that help inform the public about current health-related topics.