Do less harm: Brittany Bingham on Indigenous-centred health care
Across Canada, Indigenous peoples experience some of the poorest health outcomes of all demographic groups. This comes as no surprise to Brittany Bingham, Director of Indigenous Research at Vancouver Coastal Health and Centre for Gender & Sexual Health Equity Assistant Professor, Division of Social Medicine at the University of British Columbia.
“Indigenous wellness must be considered within the context of our colonial past and the continuing impact [colonial] policies have, while also acknowledging Indigenous peoples’ profound resilience in the face of systemic inequities,” Bingham says. “Colonial policies such as residential schools, the Indian Act and Indian Hospitals continue to have a profound impact on Indigenous communities’ health and wellbeing, and they significantly influence how Indigenous peoples interact with and access health and wellness services.”
Negative experiences deter Indigenous persons from seeking care
As an Indigenous researcher focused on the social and structural factors that affect Indigenous health in Canada, Bingham understands the challenges Indigenous communities face in the health care context.
“Indigenous people experience barriers to accessing the mainstream health care system, including systemic, cultural, physical, and economic barriers,” she says.
“In B.C., Indigenous peoples’ negative experiences accessing the mainstream health care system due to racism and discrimination were widely documented in Dr. Mary Ellen Turpel-Lafond’s 2020 report In Plain Sight. [And] when these barriers are compounded with negative experiences of health care, it can make individuals less likely to return to a care centre, which can then lead to poorer care, no care, and even death,” Bingham adds.
Institutional and individual changes can support equitable health outcomes for Indigenous peoples
To ensure more equitable health outcomes and positive health care experiences for Indigenous peoples, Bingham says that both individual and institutional changes in health care settings are needed.
“Cultural safety policies and training for all staff are essential to creating culturally safe spaces — and it’s so important that this includes all staff, from first point of contact to doctors and specialist care,” says Bingham. “Training for health care workers requires looking at unconscious bias and how that impacts care and learning. It also requires looking at Canada’s colonial history that often was not taught in schools, but is now being explored on a deeper level as we embark on the truth-telling part of our reconciliation journey in Canada.”
According to Bingham, providing appropriate health care also involves cultivating community connections. “[There should be] two-way conversations and extended experience working in, and with, [Indigenous] communities to better understand who we are and what we actually need,” she notes.
On an institutional level, Bingham sees value in implementing policies that create culturally safe spaces for Indigenous patients and discourage discrimination.
“Indigenous perspectives on health and wellness are holistic and often consider community, land, family, and nations as influences, not only physical wellbeing,” Bingham points out. “At times, western health care has dismissed traditional Indigenous practices and beliefs and taken the view that Indigenous health practices are ineffective, which can make receiving care a negative experience. [But] Indigenous patients report more positive health care experiences when their perspectives and priorities are considered.”
Bingham also suggests moving towards greater inclusivity in terms of hiring practices.
“It’s important that health systems work towards more Indigenous staff and representation, so more Indigenous patients can receive care from Indigenous care providers who understand the complex colonial context on that deeper level,” Bingham says.
Indigenous-centred health care is expanding, but more is needed
Facilities such as Anishnawbe Health Toronto, Southwest Ontario Aboriginal Health Access Centre, Lu’ma Medical Centre, and Kílala Lelum Urban Indigenous Health and Healing Cooperative currently provide patients with more holistic, Indigenous-centred care — and more are on the way.
“There are many exciting things happening in Indigenous health, with Indigenous leadership paving this path forward,” Bingham says. “And there are many exciting projects underway both in health systems and being led by Indigenous communities, drawing on approaches to care that privilege Indigenous ways of knowing and doing and incorporate elders, traditional medicines, and healing.”
Still, Bingham acknowledges that larger, system-wide changes will require time and effort to enact.
“Now that we’ve heard the stories of many Indigenous peoples experiencing discrimination in health care, it’s time to take action by finding innovative ways to incorporate an Indigenous lens into how we build more equitable systems of care,” says Bingham. “Moving towards equitable and culturally safe health systems for Indigenous peoples will ultimately create better systems for everyone.”
