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home / 世界杯决赛2022

opinion: quebec health care plan fails to respond to indigenous concerns

there was no mention of cultural safety, which should be enshrined in our health-care legislation.

by nazila bettache, samir shaheen-hussain

apr 7 2022
read time 3 minute read
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the legault government has once again broken a promise to indigenous people, scandalously disregarding the viens commission’s 2019 call for action to enshrine the notion of cultural safety in quebec’s law on health and social services.

when, last week, health minister christian dubé announced a major health-care reform , promising a “more humane” system and pledging to move beyond reports and take action, there was no mention of cultural safety in his 79-page plan. ending systemic anti-indigenous racism was not even a footnote. this omission was quickly denounced by indigenous leaders and health-care workers.

after joyce echaquan’s brutal death in a joliette hospital in september 2020, tens of thousands of people marched in cities across quebec to honour her memory and express their solidarity with her family, her community and her nation. within days, hundreds of health-care workers signed our open letter highlighting that s ystemic racism against indigenous people is endemic in the health-care system.

since then, there have been many calls for implementing cultural safety measures, including from indigenous people who have courageously spoken out about their experiences of discrimination. joyce’s principle prescribes cultural safety practices, calling on the government to recognize anti-indigenous systemic racism more broadly. indeed, following the public inquiry into echaquan’s death, coroner géhane kamel’s first recommendation was for the quebec government to recognize the existence of systemic racism within our institutions, and to commit to eliminating it.

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several health-care establishments, faculties, professional orders and unions have adopted joyce’s principle. however, the health ministry has refused to do so. instead, it has chosen to promote its “indigenous awareness training” for all employees in the health-care system.
the mandatory component of this training, which was initially developed for all public-service employees, addresses the impacts of colonization and colonialism on indigenous peoples in quebec in a superficial and historically incomplete manner. it barely touches on health care at all. as such, it’s somewhat reassuring to learn that only 30 per cent of provincial health-care workers have completed it.
we were shocked not to find any mention about medical colonialism or systemic anti-indigenous racism when we completed the mandatory component of the training. there is no mention of echaquan’s death or of joyce’s principle. ian lafrenière, quebec’s indigenous affairs minister, insisted recently that cultural safety is “extremely important,” yet it is conspicuously absent from the mandatory component of the training!

the notion of cultural safety, developed in the 1980s by maori nurses and educators, is part of an analysis of structural inequalities and colonial power relations between health-care providers and indigenous peoples. it goes beyond the “interculturalism” lens favoured in the health ministry’s training.

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without relevant content or an analytical framework appropriate for health-care workers, how can the ministry claim to raise awareness of indigenous realities in contemporary quebec? this training must be overhauled from top to bottom.
ultimately, however, it will take much more than a mandatory online training session to eradicate the racism structurally embedded in our health-care system. we must adopt a decolonizing approach, which actually has the potential to improve the health care provided to the entire population of quebec. this begins with genuinely listening to the calls of indigenous communities and acting in solidarity with their movements for self-determination and autonomy.
if the coalition avenir québec government wants to begin repairing the harms suffered by indigenous people through medical colonialism, it has an obligation to respect its promise to enshrine cultural safety in our health-care legislation during this mandate. moreover, joyce’s principle must be an integral part of any reform of the health-care system. for “more humane” health care, we can expect nothing less.

nazila bettache in an internist and assistant professor at université de montréal. samir shaheen-hussain is a pediatric emergency physician, assistant professor at mcgill university and author of fighting for a hand to hold: confronting medical colonialism against indigenous children in canada . both are members of the caring for social justice collective.

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