When is a broken bone not a broken bone? When it belongs to a Indigenous person, apparently.
Nearly a month ago, a study of Alberta emergency visits was published in the Canadian Medical Association Journal.  Conducted by researchers from the University of Alberta (UofA) and the Alberta First Nations Information Governance Centre (AFNIGC), the study reviewed five years of emergency room triage reports - over 11 million of them.
The goal was to “understand the relation between First Nations status and triage scores” when presenting at the emergency room. Triage scores assess the severity of a patient’s presenting condition and determine the order in which patients are seen by a care provider. The study’s findings were not unexpected, but still surprising. Assessing triage scores for five disease categories and five specific diagnoses, the research did find a correlation between First Nations status and a patient being less likely to receive a higher triage score in eight of the ten categories.
What was surprising, however, was that the link held true even in cases where the presenting condition was more objectively obvious, such as long bone fractures. Surely, one could assume that a broken leg is a broken leg is a broken leg. Apparently, not.
The researchers were clear that, in their view, systemic racism is likely at play here.  From “derogatory stereotyping” by triaging staff, to a lack of access to primary care in First Nation communities, to a self-perpetuating cycle of patients encountering discrimination in the health system and then delaying seeking medical attention when they need it: Alberta’s health system is stacked against Indigenous people. 
So, as always, we ask, where do we go from here?
In 2020, the avoidable death of Joyce Echaquan was streamed on her facebook account, documenting the racism and abuse inflicted on her by the healthcare workers charged with her care. Following her death, the National Association of Friendship Centres (NAFC) hosted an online forum on systemic racism in healthcare. 
The report from that forum highlighted a need for data on the scope and nature of the problem so that targeted measures could be implemented to address this gap in equitable care.  The UofA/AFNIGC study goes some way to filling that gap, by, at the very least providing a baseline to measure against.
The intersections of the social determinants of health, Indigeneity and systemic racism weave a seemingly intractable web that creates differential outcomes for Indigenous people in the healthcare system. The TRC Calls to Action 18-24 set a frame for this work. They include education for healthcare workers as well as those in training; a call to increase the number of Indigenous people working in healthcare; and to include Aboriginal healing practices for Indigenous people receiving medical care. 
The next phase of the Alberta research project will be looking at ways in which partnerships with First Nations can be part of the solution.  Following Joyce’s death, the local Friendship Centre opened a medical clinic that saw patients twice a month, predictably, the demand for their services immediately overwhelmed their funding. Despite the obvious need for more hours, two years later, their hours are still only twice a month. 
In Edmonton, Alberta Health Services runs the Indigenous Wellness Clinic – “a culturally informed and safe environment for patients and their families to receive care and work towards their best possible health within a multidisciplinary team.”  While this is a great option for Indigenous peoples in and around Edmonton, family physicians at the clinic are not accepting new patients.
There is, for reasons we’ve already looked at this week, a broken relationship between Indigenous peoples and healthcare institutions. To address this, there needs to be better representation of Indigenous voices within healthcare. As the NAFC has pointed out “the answers to healthcare systems by and for our communities lay within our communities.” 
Dr. Janet Smylie, a lead researcher on the inequities of health care for Indigenous people, advocates for a dual approach that facilitates “Indigenous specific spaces within non-Indigenous organizations in combination with Indigenous specific clinics and services within Indigenous organizations.”  The colonial system has a history of segregating care (see Indian Hospitals). Although care is no longer blatantly segregated, systemic inequities have replaced structural segregation. Therefore, any effort to weed out the systemic racism in our health care systems, we must be ever cautious that any steps forward don’t further entrench “the existing apartheid system for health services in Canada.”
Until next time,
Team ReconciliACTION YEG
 Patrick McLane et al, “First Nations status and emergency department triage scores in Alberta: a retrospective cohort study”(2022) at E37, online (pdf): Canadian Medical Association Journal <www.cmaj.ca/content/cmaj/194/2/E37.full.pdf>.
 Ibid at E37.
 Ibid at E41. The disease category and specific diagnoses reviewed by the study were: trauma and injury, infection, substance use, obstetrics and gynecology, mental health, long bone fractures, acute upper respiratory infection, opioid-related diagnoses, spontaneous abortion and anxiety disorder. There was no correlation between First Nation status and a likelihood of receiving a lower triage score in the opioid diagnoses and spontaneous abortion cases.
 Gillian Rutherford, “First Nations patients triaged as less urgent than others in Alberta emergency departments: study” (17 January 2022), online (blog): University of Alberta Folio <www.ualberta.ca/folio/2022/01/first-nations-patients-triaged-as-less-urgent-than-others-in-alberta-emergency-departments.html>.
 Supra note 1 at E42.
 Ibid at 4.
 Truth and Reconciliation Commission of Canada, Calls to Action (Winnipeg: TRC Canada, 2015), numbers 18-24.
 Supra note 4.
 Supra note 7 at 8.
 “Clinique de proximité Mirerimowin”, online: 211qc.ca <www.211qc.ca/organisme/clinique-de-proximite-mirerimowin-70750190>.
 “Anderson Hall - Indigenous Wellness Clinic”, online: Alberta Health Services <www.albertahealthservices.ca/findhealth/Service.aspx?id=4838&serviceAtFacilityID=1045311>.
 Supra note 7 at 9.