Indigenous physician writes "Put an end to racism in the ER"



Janet Smylie

Janet Smylie: Put an end to racism in the ER

JANET SMYLIE - Contributed to The Globe and Mail - Feb. 11 2015

What actions could end the shocking disparity between the prosperity of Canada and the deprivation of First Nations? In our series Rich Country, Poor Nations, a range of contributors argue for one idea that could make a difference.

Janet Smylie is a family physician and research scientist at St. Michael's Hospital, an associate professor in the Dalla Lana School of Public Health at the University of Toronto, and a CIHR applied public health research chair.

Universal access to medical care and the right to live free from racial discrimination are two underlying principles that are highly integrated into the fabric of Canadian society. A challenge to either is bound to incite heated debate. Calling an individual or group "racist" is highly insulting and predictably rejected by those on the receiving end. The recent response to accusations of racism in Winnipeg is a good example.

Most readers will be aware of the striking, persistent health inequities faced by aboriginal people in Canada. For example, infant mortality rates two to four times higher than those of non-aboriginal Canadians, and the fact that as many as 36 per cent of aboriginal households are food insecure. It may be news to some that these particular inequities do not improve with urban residence, which is where most aboriginal people now live.

Clearly, there is tension between these highly regarded social values and the existence of such inequities. How is it that First Peoples continue to experience such striking inequities in accessing Canada's relative wealth of health and social resources?

The evidence points toward an epidemic of faulty logic. Let me explain.

There is a universal and deeply rooted tendency for humans to discriminate by sorting people they meet into "in groups" and "out groups" based on appearance. Our automatic responses tend to favour in groups over out groups. Our automatic associations about new information are based on what we have previously learned.

If we take the case of non-aboriginal people's views of aboriginal people, the starting point will be a tendency toward discrimination as a result of "out group" sorting. Add to that the constant barrage of negative images and stories about aboriginal people generated by the news media and our public education systems and we have perfect-storm conditions. It is almost impossible to live in Canada and not have underlying automatic negative associations about aboriginal people.

Not buying it? Try listing the first three social problems that you associate with aboriginal people and then three social strengths or assets. Which list takes you longer? One set of assets built into many aboriginal societies is the highly valued concept of respect and protocols that guide interactions with "out groups." If followed, these teachings and protocols can effectively mitigate the problematic human tendency to discriminate and preferentially share resources with those who we perceive as most like us.

The problem with underlying and unacknowledged negative associations is that they lead to unfair treatment. For example, one of the most common negative associations made about aboriginal people in Canada is links with alcohol abuse. In fact, studies have shown that rates of both abstinence and problem drinking are higher in aboriginal populations than in the general population. Unfortunately, in health-care settings, the misdiagnosis of aboriginal people as suffering from alcohol intoxication is far too common. For Brian Sinclair, who died of a treatable bladder infection after a 34-hour wait in a Winnipeg emergency room in 2008, this misdiagnosis proved fatal.

Such faulty logic allows Canadians to pretend that the principles of equitable access to health care and freedom from racial discrimination are being upheld despite striking evidence to the contrary. Aboriginal people can be blamed for their own health and social conditions, rather than blaming the failure to uphold these principles. It is reminiscent of the "civilizing" rationale used by European colonists to justify the appropriation of aboriginal lands and the abduction of aboriginal children to residential schools.

It is a good thing that racism carries a strong social stigma in Canada. The energy of this rejection needs to be put toward weeding out false assumptions, rather than burying them. We must sharpen our minds and actively challenge our assumptions. In order to move forward, aboriginal people must been seen as holding the solutions, not the problems.