Anti-Indigenous racism in Canadian healthcare: a scoping review of the literature

• Published in: International Journal for Quality in Health Care
• Main Authors: Cooke, Martin, Shields, Tasha
• Format: Article in Journal/Newspaper
• Language: English
• Published: Oxford University Press (OUP) 2024
• Subjects: British Columbia; Canada; First Nations; inuit
• Online Access: http://dx.doi.org/10.1093/intqhc/mzae089; https://academic.oup.com/intqhc/advance-article-pdf/doi/10.1093/intqhc/mzae089/59022662/mzae089.pdf; https://academic.oup.com/intqhc/article-pdf/36/3/mzae089/59213975/mzae089.pdf

Abstract Health inequity between Indigenous (First Nations, Inuit, and Métis) peoples and other citizens is an important policy concern in Canada, as in other colonial countries. Racism in healthcare has been identified as contributing to poorer care and to worse outcomes. Despite a large literature regarding racism in other healthcare contexts, the dimensions of the existing literature on anti-Indigenous racism in Canadian healthcare are unclear. A scoping review examined the evidence of anti-Indigenous racist experiences in healthcare in the research literature, including the types of racist behaviours identified, settings studied, and Indigenous populations and geographic regions included. We identified English and French language journal articles on anti-Indigenous racism in Canadian healthcare settings in Scopus, PubMed, CINAHL, and the Bibliography of Indigenous Peoples in North America, and grey literature reports. A total of 2250 journal articles and 9 grey literature reports published since 2000 were included in screening, and 66 studies were included in the final review. Most used qualitative interviews with patients, but a large proportion included healthcare providers. Most were conducted in urban settings, a majority in Ontario or British Columbia, with mixed Indigenous populations. The largest proportion focussed on patient experiences with healthcare in general, rather than specific clinical contexts. Most racist experiences identified were ‘covert’ racism, including patients feeling treated differently from non-Indigenous patients, being ignored, treated more slowly, or not believed. Stereotyping of Indigenous peoples as substance users, poor patients, or poor parents was also commonly reported. ‘Overt racism’, including the use of racist slurs, was not widely found. Some quantitative studies did use standardized or validated instruments to capture racist experiences, but most did not result in generalizable estimates of their prevalence. The few studies linking racism to health outcomes found ...