June 21 is National Aboriginal Day, so this is a suitable time to reflect on the massive harm that has been done to the health of aboriginal people in Canada — and around the world, for that matter. Canada’s treatment of aboriginal people is a national disgrace, as the report of the Truth and Reconciliation Commission has just made abundantly clear.
But it is important to understand that there is good news, in the astonishing strength and resilience that aboriginal people have displayed.
In at least some aboriginal communities, we are witnessing slow but steady improvements in health and in control over their own health.
To understand what has happened to the health of aboriginal people, we first need to understand they had been here thousands of years before Europeans showed up — which in the case of B.C. was just over a couple of hundred years ago — and dispossessed them.
Then, having taken their land, we tried to suppress their culture — what the commission rightly has characterized as cultural genocide. Some of that was deliberate — the outrages of the residential-school system are a prime example — but some was not. With the Europeans came infectious diseases to which aboriginal people had no prior exposure and thus no resistance — smallpox, measles, influenza, TB and others — so they died in droves.
For example, about 90 per cent of the aboriginal population of Haida Gwaii died in the period after contact, which began in the late 18th century. That level of loss is culturally devastating; communities lose their elders and much of their traditional knowledge, their rituals, their knowledge of the land and how to live with it.
The result of the loss of land and culture has been horrific. The health status of aboriginal people in B.C. has been well documented by the provincial health officer.
In a 2012 report, Dr. Perry Kendall noted that overall life expectancy in the 2006-10 period for Status Indians — the technical term for First Nations people who are recognized by the federal government — was 6.4 years less than for other B.C. residents. However, the gap was slightly smaller than in the 1993-97 period, when it was 7.7 years.
Small wonder that when ranked by the UN Human Development Index, in which Canada always scores very well, First Nations people ranked 63rd in the world.
My colleague Charlotte Loppie, a professor in the School of Public Health and Social Policy and director of the Centre for Aboriginal Health Research at the University of Victoria, has written on these issues.
One study, written with Fred Wien in 2009, reported not only on the inequalities in health status experienced by aboriginal people in Canada, but on the inequalities in access to those things that help make people healthy. Among other things, they noted poor-quality education and housing, low levels of employment and income, and inadequate access to health care. But they also identified loss of culture, language and land, as well as systemic problems such as colonialism, racism and structural barriers to self-determination.
This last factor is illustrated in a study by Michael Chandler and Christopher Lalonde at the University of British Columbia, who found that the more First Nations communities in B.C. had control over systems such as education, policing and health, the lower the rate of youth suicide.
In light of their findings, the recent creation of the First Nations Health Authority in B.C. is an exciting development that will help First Nations in the further extension of their self-determination, which in itself is good for health.
In the second study, Roots of Resilience, released in 2013, Loppie documented several wonderful examples of aboriginal communities across Canada that have “successfully pursued greater self-determination as an approach to target the structural causes of inequity.”
If we are to continue to see an improvement in the health of aboriginal people in Canada, we need to go beyond a simplistic focus on improving lifestyle and health-care services and tackle the fundamental roots of inequality.
We need to rectify the appalling legacies of colonialism and racism, cultural suppression and dispossession, and we need to support aboriginal people in re-asserting their self-determination, taking pride in their rich history and traditions and in their strength and resilience.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.