Doctors need to examine any biases they may have against indigenous patients, says a new guidance document from the College of Family Physicians of Canada that addresses systemic racism in health care.
"It's a silent topic, really," said Darlene Kitty, one of the document's authors. "People don't like to see if there's racism existing in the health-care system, but there definitely is."
It also says more education and training are key to addressing the issue.
"It should start at the very beginning of medical school, or nursing school," Dr. Kitty said. "Sometimes it boils down to lack of knowledge, lack of appreciation of the challenges that indigenous people face."
Dr. Kitty is the director of the Indigenous Program at the University of Ottawa, which teaches medical students about indigenous health and social issues to ensure they are applying cultural awareness and sensitivity to their work.
Most medical schools have such components in their curriculums already, she said, although they are not mandatory.
The Truth and Reconciliation Commission has recommended that all levels of government augment "cultural competency training" in medical schools and the health system itself.
"It's important to engage in the genuine interests of the indigenous patients," Dr. Kitty said, "and doing so by giving culturally safe care and especially at the interface where patients and health professionals meet. If the experience is bad, some patients may disengage."
The guide asks physicians to acknowledge and change any negative perception of indigenous people so they can respect their patients' individual needs.
Ontario Regional Chief Isadore Day, who manages the national health file for the Assembly of First Nations, said the solution is twofold.
"The relationship with the health-care community and First Nations definitely needs to be reflective of the [TRC's] calls for action," he said, "but I will also suggest that things need to change fundamentally with respect to the health-care system itself and investment."
A 2015 Auditor-General's report highlighted disparities in health care provided to First Nations people in remote areas. It found about 400 nurses serve roughly 95,000 First Nations people in 85 indigenous health facilities in Ontario and Manitoba. The report found some facilities were in substandard states and that nurses were not thoroughly trained to deal with the needs of certain communities. Of 45 nurses studied, only one had completed compulsory courses in indigenous health offered by Health Canada.
First Nation leaders from Ontario, including Mr. Day, declared a public-health emergency last week, calling on the federal government to act within 90 days to address deficiencies in the system in northern indigenous communities.