When Alika Lafontaine was in primary school, he was labelled "developmentally delayed." The principal summoned his parents and told them, grimly, that their son would never graduate from high school. His parents, thankfully, did not accept that label. "I remember my mom holding me in the car and telling me, over and over again, that I wasn't broken," he said.
Dr. Lafontaine, an anesthesiologist (meaning he excelled not only in high school, but medical school and postgraduate training), shared that touching anecdote last week when he received the prestigious Emerging Indigenous Leader award from the Public Policy Forum. He told the story not to sound triumphant, but to make a point: We don't have to live down to expectations foisted on us by outsiders, either individually or collectively.
"Of all the things we believe when we create public policy, expectations are probably the most important," Dr. Lafontaine said.
So what are our expectations when we discuss the health and welfare of indigenous peoples? In short:
- The situation is so grim that it will take decades for health disparities to disappear;
- The health crises that plague First Nations, Inuit and Métis peoples – suicide, diabetes, addiction, etc. – are so complex that they can’t be fixed quickly;
- Indigenous peoples need a lot of help from outsiders – they can’t possibly resolve these problems themselves.
"These aren't facts, these are expectations," Dr. Lafontaine said.
If we accept, as fact, that change will take forever, that improving the health of Indigenous peoples is impossible, then it becomes a self-fulfilling prophecy.
The Truth and Reconciliation Commission of Canada, in its final report, reminded us of the devastating impacts of colonialism on the country's 1.4 million First Nations, Inuit and Métis peoples. Colonialism is about extinguishing rights, stripping people of their land, language and culture – in short by keeping them sick, individually and collectively.
In Canada, we have done that masterfully. We have created a state of perpetual crisis for many First Nations. Yet, in recent decades, we have become more benevolent; we have started responding to these crises, especially when things get so dire they pop up in the mainstream media, i.e. La Loche, Attawapiskat, Kashechewan, etc.
But all we've done really is become more efficient at responding to crises, not at fixing fundamental structural problems. Dr. Lafontaine – and other powerful Indigenous leaders such as Cindy Blackstock – are rejecting incrementalism, and for good reason. Saying "it will take time" is the same as saying we are willing to sacrifice another generation or two or three to poor health outcomes. Equity and justice cannot be doled out one spoonful at a time, Prof. Blackstock reminds us – they are all-or-nothing propositions.
The health and social-welfare systems we have in Indigenous communities produce precisely the outcomes they were designed to achieve. The health services provided on reserves and in other indigenous communities are particularly poor and the main reason is that providers and patients have little or no power. The bureaucracy is as oppressive as it is patronizing. We need to radically transform these systems, not simply burnish them around the edges.
Dr. Lafontaine speaks eloquently about the social determinants of health – about the importance to our health of having a good income, housing, education, a healthy environment and a sense of belonging. But he reminds us, too, that broad-stroke, long-term policies are not enough. We also need to care for people in the here and now, to have targeted goals to improve maternal mortality, suicide rates, diabetes outcomes and many other health issues that plague Indigenous peoples, and the resources to meet those targets.
In short, we know what's wrong, we know how to fix it and we have to get on with it. "Change is going to happen regardless," Dr. Lafontaine told the high-powered audience at the Public Policy Forum dinner. "The choice we have is whether we work together, or work apart, and the consequences of that choice will shake the very foundation of the Canadian health-care system."
With those words, Dr. Lafontaine showed he is the kind of leader Canada needs today – someone who speaks truthfully in the hope of advancing reconciliation. It's as if he's taking the nation – nay, nations – in his powerful arms and telling us all that we are not broken. Or, maybe more precisely, that we are a bit broken, but not unfixable.
He is changing expectations.