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U of C study highlights anti-Indigenous bias in health care

Cara Roan had a miscarriage in Wetaskiwin but the hospital provided her with the wrong remains
(Stock photo)

By Jeremy Appel, Local Journalism Initiative Reporter, Alberta Native News

A new University of Calgary study shows two-thirds of Alberta physicians have an implicit anti-Indigenous bias, fuelling concerns about racism in the health-care system.

Every practising physician in the province was provided with a survey in 2020, with 375 participating. The largest demographic group represented was cisgender white women at 40 per cent.

The survey results showed widespread concern with “reverse racism,” the perception that white people are being discriminated against, and a general discomfort with discussing racism.

Pamela Roach, the study’s lead researcher, is a member of the Metis Nation of Alberta (MNA). She told the CBC the survey’s results validate Indigenous people’s concerns about widespread anti-Indigenous racism among health-care providers.

The numbers outlined in the survey are “unacceptably high,” Roach said.

The study looked at implicit and explicit bias among physicians. Participants were given two sliding scale questions to understand their level of explicit bias. The first question asked participants their feelings about Indigenous people while the second inquired about their preference for white or Indigenous patients.

According to the study, eight per cent of participants felt unfavourably towards Indigenous people while 25 per cent preferred white people to Indigenous people.

For implicit bias, physicians were asked to match photos of Indigenous and white European people with positive and negative characterizations, which were randomized.

The survey found that 67 per cent of physicians showed an implicit bias towards white people and 13 per cent demonstrated an implicit bias towards Indigenous faces.

“I am aware that 67 per cent feels really big – and it is – and part of the reason for that is because of the messages that society tells us,” Roach said.

“Even people who would have answered the explicit bias questions in a way that they felt positive toward Indigenous people, what the implicit bias does is gives us a baseline of how people are reacting.”

Additionally, the study found physicians in rural or remote settings had the most balanced implicit perceptions of Indigenous and settler patients while those in urban and large rural settings were more inclined to favour white faces.

Older physicians, those in surgical practices and those without academic affiliation were also more likely to favour white people.

This information is especially important, since physicians are expected to make life-altering decisions quickly.

Jessica Kolopenuk, the Alberta Health Services (AHS) research chair in Indigenous health at the University of Alberta, is from the Peguis First Nation. She told CBC the survey’s results were unsurprising.

“It is unfortunate that a scientific study evidencing racism is needed and perhaps even regarded as more solid proof than are the stories and testimonies of Indigenous peoples ourselves,” Kolopenuk, who wasn’t involved in the study, said.

“Providing ‘equitable’ health care to Indigenous patients might not be an adequate framework and goal given that it maintains white measures of health as the norm to be striving for.”

Reagan Bartel, the director of health for the MNA, told CityNews that Indigenous people’s experience in the health-care system is often their first experience of racism.

“Taking care of their chronic conditions on their own, waiting until a chronic condition is so bad that they have to access care through our emergency departments. We have an incredibly low attachment to physicians and that’s often because they tell us they don’t feel safe actually seeking out care in the communities they live in,” Bartel said.

Asked for comment on the study’s findings, AHS spokesperson James Wood emphasized the service’s “Indigenous Health Commitments: A Roadmap to Wellness” guidelines.

“All staff are required to complete mandatory Indigenous awareness and sensitivity training as part of their employment with AHS, and there are a number of additional diversity and inclusion education programs available to employees,” Wood told CBC.

Alberta Medical Association president Dr. Fredrykka Rinaldi told CityNews the survey results are “disheartening.”

“Such bias exacerbates health inequity that is already severe. It is also deeply rooted and will take time to eliminate but stating our intent to do so is the first step,” Rinaldi said in a statement.

Dr. James Makokis, a two-spirit Nehiyô (Plains Cree) family physician from Saddle Lake Cree Nation, told CBC that anti-Indigenous bias often results in negligent care.

“If someone presents to the emergency room, and their vital signs are not taken, there’s some perceptions made about somebody based on their skin colour or a sexual orientation and then that patient leaves because they’re not being treated properly,” Makokis said. “That’s an instance of discrimination and potentially racism.”

In one recent example of negligent health care for Indigenous people, Cara Roan had a miscarriage in Wetaskiwin, Alta., but the hospital provided her with the wrong remains, which she was informed of after holding a memorial service for her baby.

“To find out that it wasn’t … my baby I put away the first time, to have to do it the second time, it was hard,” she said. “I’m totally broken from this. I don’t even have the words for it.”

AHS and lab service provider Dynalife said it was the result of a lab error.

“We offer our deepest apologies to the two families who were impacted. This mistake should have not happened,” AHS and Dynalife said in identical statements to the CBC.

“AHS is taking this incident very seriously and is reviewing what happened in this case to determine how it occurred, and what can be done differently to ensure it never happens again … AHS is providing the family with a written apology and is available to listen to their concerns and answer any questions they may have.”

Digging up the remains of the baby she was initially given went against Roan’s culture, but she had a doctor assist her with the exhumation so those remains could be returned to the appropriate parents.

“You don’t go back and dig up a body. It’s not right in our culture,” she said.

Roan held a second burial service once she received the correct remains.