Welcome to the Irish Medical Times website
This site is aimed at healthcare professionals.
Are you a healthcare professional?
NB: We use cookies to help personalise your web experience and comply with Irish healthcare law. Whatever your choice, you are agreeing to our use of cookies. Please close this browser tab if you don't want to proceed.
This site contains information, news and advice for healthcare professionals.
You have informed us that you are not a healthcare professional and therefore we are unable to provide you with access to this site.

June 25, 2016

Native Canadians’ health suffers due to inequality

Dr Cindy Blackstock from Canada tells delegates her story

Dr Cindy Blackstock from Canada tells delegates her story

Lloyd Mudiwa concludes his Special Report on brave campaigners for health, this time shifting his gaze to the prairies of Canada, where the government reportedly targets campaigners for health equality for First Nations children.


Some 146 years after Canada’s independence, its Aboriginal peoples are still suffering from the health effects of social and economic inequities.

On virtually every measure, the health of Canada’s Aboriginal people, also known as the First Nations, ranks well below that of the general Canadian population.

Canada is one of the wealthiest countries in the world, but the benefits of that wealth are far from equally distributed.

These long-standing disparities in health outcomes between Aboriginal and non-Aboriginal Canadians are a powerful fundamental impact of the broad determinants of health.

Aboriginal people are overrepresented among those living in historical poverty in the North American country, and many First Nations, Inuit and Métis communities are struggling with high unemployment, low incomes and overcrowded housing.

Today, these determinants continue to take a significant toll on the health and life expectancy of Canada’s indigenous people, with Aboriginal people suffering from chronic diseases, obesity, diabetes, HIV/AIDS, mental health problems, suicide and infectious diseases in much greater proportions than Euro-Canadians (their rate of tuberculosis is six times greater than for the overall Canadian population).

A 2009 UNICEF report noted that children from Aboriginal communities are seven times more likely to die in infancy than others, and 50 times more likely to be hospitalised with preventable illnesses, such as chicken pox.


Hero for health

Dr Cindy Blackstock, a Gitxsan activist for child welfare and Executive Director of the First Nations Child and Family Caring Society of Canada, has taken the Canadian government to court because of its neglect of Aboriginal children’s health and welfare services.

Campaigning to end the institutional bias that is in part responsible for this inequality, her organisation filed a human rights complaint against the government in 2007, arguing that First Nations children do not receive the same health, education and welfare services as other children.

In 2011, she got hold of records which showed the government had been systematically monitoring her professional life and her personal online activity to try to “dig up dirt” to use against her. It is unclear whether the government has stopped its surveillance.

Dr Blackstock was among the heroes of health movements from around the world recently in Ireland at the behest of Dublin-based organisation Front Line Defenders, which is dedicated to the protection of human rights defenders at risk, to attend Dublin Platform 2013, one of the largest gatherings of human rights defenders in the world.

She told IMT there are 633 First Nations in Canada speaking 50 different languages and since the time of colonisation and then the evolution of Canada, there has been a very difficult relationship between indigenous peoples and the government.

Originally, Canada started a policy of assimilation of First Nations into wider society and they primarily targeted children.

Dr Blackstock said the government would forcibly remove these children from their families at age five years and place them in Christian-run residential schools where they were told that their own culture and language and ways of living were something to be ashamed of and were indoctrinated with a new approach.

Residential houses

Describing this as a rather recent phenomenon, Dr Blackstock said the last residential school closed in her country in 1996 and the Prime Minister apologised for them in 2008. Now, she said, there is a lot of talk about reconciliation between First Nation people and the government.

“To me, reconciliation means not having to say sorry twice so what really counts is, how is the Canadian government treating this generation of children?”

Dr Blackstock outlined that on Crown Lands set aside as reserves where First Nations can live, provincial child welfare, health and educational laws will apply, replacing traditional laws, which the government does not recognise.

But unlike for other Can-adians who get the funding for these services at provincial level, the federal government funds education, health and welfare services on reserves.

For decades, funding has been at a far lesser level than for all other Canadian children, despite the fact that these First Nationals’ children have higher needs owing to the multigenerational impact of the residential homes, charges Dr Blackstock.

“Even though Canada is one of the eight richest nations in the world, there are First Nations communities where there is no access to water, sanitation, and there are people living in tents in our northern climate,” she commented.

“So the things we take for granted in other parts of Canada are simply not available there and on top of that regardless of where your reserve may be and some of them are actually right next to urban centres like Montreal and Vancouver. The lack of funding, for example, means one child will get Canadian dollars (CAD)$2,000-CAD$3,000 (€1,341.86-€2,013.10) less for elementary and secondary education this year than other children just across the street.”

In addition, the child welfare system on a reserve is underfunded in a range of about 20 per cent and the cuts are made in services to keep the children in their families and resolve family issues, according to Dr Blackstock. Consequently, many of the First Nation’s children are dramatically over-represented in child welfare care.

They are 12 times more likely to end up in social care than a non-Aborigine child purely through neglect driven by poverty, poor housing and caregiver substance misuse relating to the residential school abuses, she said.


Health issues

Lumped on top of this is the health issue. There is inadequate healthcare. First Nations children can often be denied or delayed receipt of healthcare available to all other Canadian children because the provincial and federal governments will argue over who should pay because it is a First Nations child, claimed Dr Blackstock.

She said these problems have existed on these reserves for about 30 to 40 years, plus the residential schools themselves were underfunded so there was inequality for much longer than that.

Dr Blackstock said in their case against the government, First Nations Child and Family Caring Society of Canada did not believe in just criticising but in also finding a solution.

“So we worked as experts on First Nations with the government for over a decade to develop evidence-based solutions that would not only have dealt with the inequality but guided us all in spending those monies for the best impact for the children themselves.”

The government in both cases lauded these studies but allegedly never implemented them.

Her small non-governmental organisation (NGO) —comprising two part-time and two full-time staff — had considered whether to invest more time talking with the government “knowing that there would be no impact for the children, if not more hardship for the children”, or to try something different.

“We were alive to the fact that when we started this  campaign 10 years ago, a baby was born and that child really lost their childhood in this inequality,” Dr Blackstock commented.

She added: “I always say to the bureaucrats that a year or two may not be long to them but in the medical world, that can be the lifetime for a child in terms of their developmental outcomes. So we filed a human rights complaint against the government.”

Dr Blackstock said: “We alleged that the government’s provision of child welfare services to First Nations children was discriminatory and within 30 days we lost all of our federal government funding — at the time 30 to 40 per cent of our budget — that much we had predicted.”

The NGO was, however, able to survive on a very modest budget from other fundraising sources.

Currently working on a budget of CAD$400,000, Dr Blackstock estimates the NGO lost about CAD$250,000 in funding.

“But we wanted to press on with the case; the most important thing to us was the children… ”

Also, the government immediately tried to derail the court case based on technicalities as opposed to merits, because even its own reports had documented the inequalities, Dr Blackstock claimed.

The government would reportedly spend the next six years and at least CAD$3 million unsuccessfully trying to derail it on these legal loopholes.


Government espionage

In December 2009, two years after filing the complaint, Dr Blackstock was invited as an expert by a First Nations group to a meeting in the government offices, meant to discuss the welfare of First Nations children.

Despite clearing all the security staff and conducting herself peacefully and professionally, she says a government official told the First Nations group the meeting would not go ahead if Dr Blackstock entered the room.

This was regardless of assurances by the First Nations’ leaders and Dr Blackstock that she was not there to talk about the tribunal, but simply to provide support for the meetings.

Eventually, the activist voluntarily sat aside while the meeting went ahead because “it was about the kids” and she was guarded by a security guard the entire time.

Dr Blackstock said: “So I am standing there in the Minister’s office considering why I was being guarded by a security guard; I am a size 6 and I don’t even have a parking ticket, let alone a criminal record, and I am wondering, what is it about me that gives this kind of a response?”

There is a Privacy Act in Canada, which is its form of a Freedom of Information Act, where citizens can apply to government departments to get information about themselves, so Dr Blackstock did that. It took her a year-and-a-half, but she finally got a DVD in the post.

“I will never forget opening that DVD because on the one hand you hope that there is nothing there other than just correspondence you might have sent in a professional capacity to the government, but there were literally hundreds and hundreds of pages talking about what event I was attending and what I was saying.”

There were notes about when she was not at an event. There were also snapshots of her personal Facebook page, or they had somebody copy and paste the material and send that along to other government officials.

There was mention of a human rights case in the mail correspondence but nothing explicit, so Dr Blackstock went on a national radio programme to talk about the content of that DVD publicly.

As she had suspected, it created some conversation within the government when they heard the programme so she then requested the documents that were produced during the time of the radio programme and that was when she found out about their agenda.


The agenda

Dr Blackstock got email correspondence between the Department of Aboriginal Affairs and the Department of Justice, with Aboriginal Affairs owning up that they had been on her personal Facebook page for six months, but gave up when they realised the Department of Justice was also on there collecting data and they could just share the information.

There was some correspondence by a lawyer in the Department of Aboriginal Affairs, saying the reason they were doing this was to try and find other motives for their child welfare case, and prove that it was filed on frivolous and vexatious grounds.

There was a whole other series of monitoring of her movements — even her personal events.

One of the events that was shocking to her was that when the Australian Aborigines invited her in 2010 to their conference in Alice Springs in the desert of Australia, the Canadian government had notes of her talk given there.

On her Facebook page, Dr Blackstock was disturbed by an entry where she was discussing the baking of cookies with friends. Some of them, based internationally, commented and the government copied their URLs and comments and passed them to other government departments of justice and Aboriginal affairs.

A message by a 12-year-old child who had seen Dr Blackstock’s video about First Nations children in her class and just wanted to thank the campaigner was also copied and passed on to about 10 or 11 lawyers at the Department of Justice without that child’s/child’s parents’ consent.

Dr Blackstock updated the media, prompting Canada’s Privacy Commissioner, an independent body supposed to protect the privacy of Canadians, to seek her consent to pursue the case.


Vulnerable people

“Of course I said ‘yeah’ because my primary concern at the time was I am an indigenous woman and expect these kinds of things to come at me, but I worry about the deterrent effect it would have on more vulnerable people.”

There were many citizens of other cultural groups in Canada who were experiencing violations and should not have the government trying to dig up dirt on them as part of its defence, she said.

In April, the Privacy Commissioner found that the government of Canada had violated privacy law.

When asked what he was doing about it, the Minister of Aboriginal Affairs responded that they take the privacy of Canadians very seriously and have already implemented the recommendations of the Act, hence they did not need to take any further action.

But he had not bothered to contact her to apologise and pledge it would not recur, so she wrote to him demanding a public apology and commitment to implement the recommendations for the protection of all Canadians and she did not get a response back until many months later, which was a non-response.

Dr Blackstock then applied to the Tribunal that the complaint be amended and the Tribunal agreed, despite the government’s protestations. So in July for two weeks they had a hearing on whether or not the government espionage amounted to retaliation for their case.

Eight-to-10 government employees, including civil servants, were called to testify. It was revealed that they have a one-page form which they got signed by their supervisors, allowing them to ‘log in’ as personal citizens to collect information for government purposes.

“The period of access does not terminate,” Dr Blackstock said. “They also could not explain about notes taken in the Australian desert, with the Canadian government saying they had just happened to be in Australia because, ‘like her’, they also had an interest in Aboriginal affairs.”

Dr Blackstock sought assurance that they were no longer on her Facebook page, but her government was reportedly unwilling to do so. So she suspects it is ongoing.