Alison Reiheld calls attention to André Picard’s assertion that Indigenous health is currently the most urgent issue in Canada.

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In a recent interview in Chatelaine with André Picard, a well-known Canadian health columnist for the Globe and Mail, Picard discusses the deficits and merits of Canada’s healthcare system. For anyone working on Canadian healthcare or on health policy anywhere, it is worth reading. He discusses dental care, home care, long-term care, the effect of an aging population, and more. One of his takeaway quotes no doubt is “Nearly 40 countries in the world have universal healthcare, and it’s all more universal than ours.” But something interesting, important, and under-attended is raised when the interviewer asks Picard, “What is the most urgent issue in Canada right now?” Picard’s answer:

Indigenous health. It’s been a problem for more than 100 years. There’s a real opportunity to make a dramatic difference, quickly. The indigenous community is young and the fastest growing by far – more than 50 percent of indigenous people in Canada are under the age of 15. This is the time to stop generation after generation of disaster, poverty, isolation, addiction and suicide – we’ve created all that. We have an apartheid system designed to oppress people and it’s given the exact results it was designed to produce. Take away their culture, their language, their ability to earn money, their ability to have land, and then, oh, we’re surprised they’re the most unhealthy people in our country? It’s not a surprise at all.

Island Lake, First Nations Community

The problems are many for Canada’s indigenous people (Aboriginals, including First Nations, Métis, and Inuit). They range from higher incidence of mental health problems and lower access to appropriate care despite greater willingness than the general population to seek mental healthcare, to systematic public health issues like precarious access to clean drinking water. As Picard indicates, the history of interactions between settler-colonial peoples and indigenous peoples is a key part of the current and past health history of indigenous people in what is now Canada. You can find an indigenous perspective on health and wellness, and on that history, here. And the Canadian Indigenous Nurses Association has further information, which advocates for indigenous health. You might also consider Harold Cardinal’s (Cree) book The Unjust Society, written in response to Pierre Trudeau’s claim that Canada was a “just society.” These are just some of the indigenous voices that have been calling for attention to indigenous health.

Other voices also join Picard in this call for increased attention to indigenous health. Chantelle Richmond and Catherine Cook argue that “the persistence and growth of Aboriginal health and social inequity signals that we are at a critical public health policy juncture” and that the relationship between First Nations peoples and Canada “fails the contemporary health needs of Canada’s Aboriginal peoples.” They go on to identify structural challenges to health including social inequities. Similarly, Madison Powers and Ruth Faden urge us to look to social inequality as a condition in need of remedy if we are to achieve justice in health, precisely because of the way that social inequalities undermine six dimensions of well-being which in turn compound injustice and undermine each other. These dimensions are health, reasoning, respect, attachment, self-determination, and personal security.

Health, Powers and Faden argue, is core and is not solely a matter of personal responsibility: “Being healthy matters to our well-being whether or not that state is achieved by our action or by the action, say, of governmental bodies that secure for us potable water.” They claim that inequalities in health that are a part of systematic patterns of disadvantage and that justice demands aggressive public health intervention to document and help remedy these systematic disadvantages. Let us now bring this back around to Richmond and Cook, who close by recommending community self-determination in healthcare and community-led research as advocacy for policy reform, with reconciliation as “a fundamental precursor for Aboriginal health equity.” As they rightly note, systemic change requires collaboration and burden-sharing across relevant moral agents. If we are to take seriously Powers and Faden’s injunction and Richmond and Cook’s recommendations, Canada as a whole must step up to the plate to repair relations with indigenous communities. And while Justin Trudeau’s administration has at least pledged to do so, this will require widespread and sustained social commitment.

Colonial nations (such as Canada, the United States, Australia, Bolivia, and places in Latin American and the Caribbean) face the problem of indigenous health. In many cases, health issues in these populations are irrevocably tied to historical patterns of exploitation and disenfranchisement with respect to resources and access to healthcare. Who else, besides Canada, needs to be looking at indigenous health? Do the remedies go beyond the healthcare system, itself? It seems that they must. What can healthcare do? It can play an essential role in justice. True, justice requires more than healthcare. But without healthcare, there can be no justice.

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Alison Reiheld is an Associate Professor of Philosophy and Director of Women’s Studies at Southern Illinois University- Edwardsville. @AlisonReiheld

*A version of this commentary was published on the IJFAB Blog as a post from the Editor