New research confirms what many Indigenous women have known all along: First Nations, Inuit and Métis females face many disparities in accessing health care.
A study, led by the Public Health Agency of Canada and published in the CMAJ on Monday, found that First Nations, Inuit and Métis females have less access to a regular health care provider than their non-Indigenous counterparts in Canada, they wait longer for appointments, and have more unmet needs, particularly for mental health.
“The main take-away here is that everyone deserves regular, easy-to-get and high-quality care to stay healthy. And unfortunately, that’s not the case for Indigenous females – that they often struggle to get the care that they need,” said lead author Sebastian Srugo, an epidemiologist with the public-health agency.
Mr. Srugo said the purpose of the study was to address a lack of data on the barriers and challenges Indigenous females encounter in the health care system. While members of an Indigenous advisory committee, created for this research, were keenly aware of them, these issues were not represented in the scientific literature, he explained.
The study looked at survey data from 2015 to 2020, and included 2,902 First Nations, 2,345 Métis and 742 Inuit females of reproductive age, from 15 to 55 years old. (This included all people who were assigned female at birth, and was limited to those considered to be living “off reserve.”) The researchers compared their data with that of non-Indigenous females.
They found a higher percentage of First Nations, Métis and Inuit females reported being in poor health than non-Indigenous females. A larger proportion of First Nations and Métis participants had diabetes and asthma, and along with Inuit females, they had higher rates of mood or anxiety disorders.
Compared with 85.6 per cent of non-Indigenous females, 81.4 per cent of First Nations and 44.9 per cent of Inuit females had a regular health care provider. Among Métis females, the proportion was higher at 86.1 per cent. However, all Indigenous females tended to experience longer waiting times than their non-Indigenous counterparts. And the proportion of all Indigenous females for whom not having a health care provider in their area was a reason for lacking regular care was greater than among the non-Indigenous group.
The health care system in Canada relies on people having a health care provider who can guide them through it, prescribing treatments and referring them to other specialists, Mr. Srugo explained. Without that provider, Indigenous females were found to use hospital services more often for non-emergencies, have less access to specialized care, and be more likely to see nurses than medical doctors, he said.
These disparities remained, even after adjusting for factors such as education, income and where participants lived.
Lee Clark, director of health at the Native Women’s Association of Canada and a member of the Indigenous advisory committee for the study, said these findings are unsurprising to those who are well aware of the prevalence of anti-Indigenous racism.
“You walk into a doctor’s office and there’s preconceived notions that are put on you,” such as assumptions about drug and alcohol use or that you want the contraception injection Depo-Provera when you are coming in for travel vaccines, Ms. Clark said. “It’s just constant anti-Indigenous racism, humiliation, distress. That happens almost every time an Indigenous person goes into a physician’s office or a hospital setting or whatever the health care setting may be.”
To begin addressing these disparities, Ms. Clark said education models for nursing, dental and medical schools and schools for allied health professionals need to change. They should include learning about cultural relevance, being trauma-informed and gender-specific, and taking a distinctions-based approach to ensure First Nations, Métis and Inuit peoples are not treated as homogeneous, she said.
She also raised the need to support Indigenous-led health initiatives.
On a broader level, the system of delivering health care needs to change, since many Indigenous people, especially in remote locations, must rely on a medical resident who visits periodically instead of a regular family doctor who can provide a continuum of care, Ms. Clark said.
“We need to really think about how we’re servicing those locations because right now it’s very hodgepodge,” she said.
Measurement tools and further studies like this one, for which Indigenous advisers were included as equal partners, are important for helping provide baseline data and assessing progress, she added.