Indigenous Healthcare in Canada - Complex & Critical Issues

I wish to humbly acknowledge at the onset of this article series that I do not consider myself an expert in Indigenous healthcare issues – I am honored to have learned many of the issues as a community guest, neighbor, family member, care provider, technology designer, and advocate.? I read, I listen, and I learn, but I will never truly understand the depth of what the Indigenous experience has been and continues to be.? It is my goal to raise awareness of some of the challenges and issues faced in First Nations communities in Canada and by Indigenous, Metis and Inuit persons living throughout Canada in the hopes that those of us working in the digital health field may contribute in some way to co-designing meaningful solutions.

While we tend to use catch-all phrases such as Indigenous or First Nations, we must understand that there is incredible range of diversity and cultural variation across the traditional lands we now identify as Canada.? There are more than 630 First Nations communities in Canada, representing over 50 Indigenous Nations and 50 Indigenous languages, accounting for over 1.1 million people in Canada’s 2021 Census.?

Many of these communities are remote or isolated which adds significant healthcare challenges, while others are located within short distances of major urban centers.? However, regardless of location, the jurisdiction of healthcare coverage is funded by the federal government but administered in partnership with provincial and other agencies, which can cause a complex web of approvals.?

According to Statistics Canada, in 2024 over 30% of Indigenous people have unmet health care needs and face barriers to health care that contribute to health disparities, including navigating complex health care policies and funding and the challenges of traveling outside their communities to access services.

Healthcare in Canada has become challenging for many, with 1 in 5 residents no longer having access to a family physician and wait times for common procedures climbing.? Indigenous people in Canada have faced these and many other healthcare issues for decades, including:

Access:

Geographic barriers and lack of access to regular care or specialists in remote communities

Socioeconomic barriers leading to inability to afford healthcare services, medication, transportation, or childcare

Racism and Discrimination:

Historical abuses in the healthcare system, as recently addressed in the apology from the Canadian Medical Association

The legacy of colonialism continues to impact the health of Indigenous people, with 1 in 5 Indigenous survey respondents reporting discrimination or racism in health care in a 2024 StatsCan survey.

Social Determinants of Health:

Social Determinants of Health including education, employment, income, housing, family structure, food security and other factors are major contributors to health outcomes and longevity.? A look at Indigenous Services Canada’s Community Well-Being Index Map is incredibly revealing when comparing scores of these factors between First Nations, Inuit and Non-Indigenous communities across Canada.?

According to the report "Primary Health Care Access Among First Nations People Living Off Reserve, Métis and Inuit, 2017 to 2020," compared to non-Indigenous population, health outcomes are more likely to be lower including:

·?????? Poorer physical and mental health status

·?????? Higher prevalence of chronic conditions

·?????? Higher prevalence of disabilities

·?????? Lower life expectancy (the average life expectancy for First Nations in BC in 2021 was 67.2 years compared to 82.5 years for non-Indigenous BC residents)

No conversation about Indigenous digital healthcare would be complete without first discussing two very critical issues:? Jordan’s Principle and the First Nations data governance principle of OCAP (ownership, control, access and possession).? My next articles will take a closer look at these principles and how these serve as the bedrock well-designed care together with a framework of respect, humility and partnership.