GNWT outlines 13 steps to improve healthcare for Indigenous residents

A new report from the NWT’s health authority maps out 13 action items to improve healthcare for Indigenous residents of the territory.

The report, Honouring the Voices of Indigenous Peoples, conducted interviews and focus groups in each of the territory’s regions. It draws on Indigenous residents’ lived experiences and details the impact of interpersonal and systemic racism in clinical health services.

“Many participants reported encounters of outright racism from HSS system staff,” the report states, using an initialism for the Department of Health and Social Services.

Some people said they were automatically asked by staff how much they had to drink that day or disbelieved when they gave an answer. Others felt healthcare providers doubted their reports of pain. Some respondents didn’t believe their loved ones were receiving appropriate care because of their race.

The report found a lack of accountability within the system for reporting incidents of racism, slow updates, a lack of transparency, and a failure to provide steps to mitigate similar occurrences in the future.

Several participants said they experienced challenges finding legal representation when they believed negative health outcomes had occurred due to racism.

Among its actions for change, the report recommended developing a “framework for responding to and meaningfully addressing reports of interpersonal and systemic racism.”

Other recommendations include enhancing language support so patients can make more informed decisions, noting some have experienced being transported after hours when access to interpreters is not available. Without access to language support and denied a family escort outside their community, the patients shared the challenges they experienced in trying to navigate the medical system.

The report also recommends more work to incorporate traditional foods, not only because they’re integral to the cultural identity of Indigenous patients, but also because studies have shown they’re nutrient-dense and minimally processed.

End-of-life care, birthing and traditional healing practices are not always acknowledged or respected, participants said. Additionally, some healthcare providers did not seem to acknowledge the impact of intergenerational trauma when removing a patient from their community to receive treatment.

Statistics Canada has previously reported that Indigenous people from the three territories have disproportionately limited access to healthcare compared to the rest of Canada.

Releasing the report, the territorial health authority stated it would make a commitment to “creating a healthcare system that is inclusive, equitable, and grounded in the principles of cultural safety” by embracing the 13 overarching recommendations.

Those recommendations are:

1. Develop a framework for responding to and meaningfully addressing reports of interpersonal and systemic racism. 
2. Provide Indigenous patients with enhanced language support and communication with HSS providers.
3. Identify and address barriers that prevent the inclusion and promotion of traditional foods.
4. Respect the value and sacred nature of traditional healing practices for Indigenous patients and provide autonomy to integrate this into their care journey. 
5. Provide Indigenous patients with more support when needing to travel for care.
6. Improve the experience for Indigenous patients accessing care and services in Stanton Territorial Hospital’s Emergency Department.
7. Support and value Indigenous Wellness Program (IWP) staff for their contributions towards improving culturally appropriate care and supporting residents.
8. Provide IWP and HSS system staff with additional targeted professional development opportunities.
9. Support the IWP and its staff to innovate and grow, enabling them to continually address the needs of Indigenous patients and families.
10. Track and measure statistics to guide continuous improvement.
11. Prioritize and establish senior leadership positions specifically for Indigenous professionals. Ensure that Indigenous perspectives and needs are consistently represented at the highest decision-making levels.
12. Use the Health Standards Organization (HSO) British Columbia Cultural Safety and Humility Standard to assess the HSS system’s progress to achieve a more culturally safe organization that better responds to the health and wellness priorities of First Nations, Inuit, and Métis peoples of the NWT.
13. HSS system leaders work towards dismantling systemic racism to advance cultural safety efforts, both individually and systemically.

The purpose of the report was to inform public policy decision-makers and reflect the lived experience of the Indigenous people in NWT, the health authority stated.

The report was commissioned as part of a Healthcare Excellence Canada program named the Cultural Safety Design Collaborative, which “supports non-Indigenous health service delivery organizations across Canada to work alongside First Nations, Inuit and Métis to address systemic racism and improve cultural safety and quality healthcare.”