Transcript: Indigenous Health: Communities at Risk | Mar 30, 2020

Steve sits in a room with white walls, a low slanted ceiling and several framed pictures on the walls including one of George Drew and one of Walter Kronkite. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a cream shirt and a checkered beige tie.

A caption on screen reads "Indigenous health: Communities at risk."

Steve says VIRTUALLY EVERY COMMUNITY IN THIS PROVINCE FINDS ITSELF SQUARING OFF WITH THE COVID-19 PANDEMIC. THAT'S TRUE FOR INDIGENOUS COMMUNITIES AS WELL, OF COURSE, SO LET'S PUT THE SPOTLIGHT THERE FOR OUR NEXT CONVERSATION. VIA SKYPE IN THE PROVINCIAL CAPITAL, WE WELCOME: SUZANNE STEWART, SHE'S THE DIRECTOR OF THE WAAKEBINESS-BRYCE INSTITUTE FOR INDIGENOUS HEALTH AT THE UNIVERSITY OF TORONTO'S DALLA LANA SCHOOL OF PUBLIC HEALTH.

Suzanne is in her forties, with long straight black hair and bangs. She's wearing a black sweater and pendant earrings.

Steve continues SUZANNE, GOOD TO SEE YOU AGAIN. HOW ARE YOU MAKING OUT DURING ALL OF THIS?

Suzanne says THANKS SO MUCH FOR HAVING ME. I'M DOING OKAY. I'M ISOLATED AT HOME WITH MY CHILDREN AND MY DOG AND WE'RE KEEPING QUITE BUSY.

Steve says GOOD TO HEAR. LET'S START WITH THIS: ARE INDIGENOUS COMMUNITIES, IN YOUR VIEW, PARTICULARLY AT RISK OF COVID-19?

The caption changes to "Suzanne Stewart. Dalla Lana School of Public Health."

Suzanne says ABSOLUTELY, STEVE. ALL INDIGENOUS POPULATIONS IN CANADA ARE MORE VULNERABLE TO COVID-19, COMMUNITY SPREADING IN PARTICULAR, AS WELL AS SERIOUS COMPLICATIONS AND EVEN FATALITIES, AND THAT'S LARGELY BECAUSE OF THE SOCIAL AND HEALTH MARGINALIZATION THAT INDIGENOUS PEOPLE EXPERIENCE, AS WELL AS THE HIGH BURDEN OF DISEASE AND SOCIAL MARGINALIZATION.

Steve says WELL, LET'S TALK, FIRST OF ALL, ABOUT... I GUESS WE'LL TALK ABOUT THIS IN TWO DIFFERENT CATEGORIES. FOR FIRST NATIONS PEOPLE, FOR EXAMPLE, WHO LIVE ON RESERVE, SO THAT WOULD BE IN MUCH MORE REMOTE AREAS, PERHAPS THE THINKING WOULD BE, THEY'RE NOT IN DENSELY POPULATED CITIES, THEY'RE IN MORE REMOTE AREAS, SO THEORETICALLY, ON THAT SCALE, THEY SHOULD HAVE LESS OF A CHANCE OF CONTRACTING IT. YOU SAY THAT'S NOT THE CASE?

The caption changes to "Suzanne Stewart. University of Toronto."

Suzanne says WELL, THAT'S NOT EXACTLY THE CASE BECAUSE POVERTY AND HOUSING AND WATER ARE ISSUES ON RESERVES. SO MANY INDIGENOUS PEOPLE WHO LIVE ON RESERVES LIVE IN OVERCROWDED SITUATIONS. THAT'S DEFINITELY GOING TO BE A PROBLEM WHEN IT COMES TO SELF-ISOLATING OR SOCIAL ISOLATION. COMMUNITIES THAT ARE REMOTE MAY NOT GET HEALTH CARE PROVIDERS COMING IN TO MANAGE THE SITUATION, AND THEY MAY HAVE DIFFICULTY IN GETTING SUPPLIES IN AND OUT OF THE COMMUNITY. AS WELL, WITH THE WATER, I MEAN, MANY FIRST NATIONS COMMUNITIES DO NOT HAVE SAFE DRINKING WATER, AND THAT REALLY CONFUSES THE ISSUES AROUND HAND-WASHING AND SANITIZING FOR PEOPLE, BECAUSE WHILE THEY MAY NOT BE ABLE TO DRINK THE WATER, IT MAY BE POSSIBLE THAT SOME COMMUNITIES CAN'T USE THAT WATER FOR HAND-WASHING. IT'S JUST THAT THE WATER IS NOT COMMUNICATED... IT'S NOT COMMUNICATED CLEARLY WHETHER THAT WATER IS USEABLE FOR SANITIZING.

Steve says YOU KNOW, DR. STEWART, TVO.ORG/THEAGENDA, OUR WEBSITE TWICE A DAY, IN THE MORNING AND LATE IN THE AFTERNOON, PUTS OUT HERE'S WHAT'S GOING ON ON COVID-19 IN ONTARIO AND ALL OVER. WHEN I LOOKED AT IT THIS MORNING, IT SAID THERE WAS AT LEAST ONE FIRST NATION THAT HAD BASICALLY CLOSED ITSELF OFF, IT HAD DECIDED THAT IT WAS GOING TO SHUT ITSELF DOWN FROM THE OUTSIDE WORLD IN ORDER TO PROTECT ITSELF FROM COVID-19, AND ANOTHER ONE WAS COMPLAINING THAT THEY WERE ALREADY EXPERIENCING SERIOUS FOOD SHORTAGES. SO I WONDER WHAT YOU'RE HEARING IN TERMS OF FIRST NATIONS' ABILITIES TO TRY TO FIGHT OFF THE POTENTIAL RAMIFICATIONS OF COVID-19 RIGHT NOW?

Suzanne says WELL, I THINK THIS VARIES A LOT FROM COMMUNITY TO COMMUNITY AND IT ALSO DEPENDS ON HOW MUCH RESOURCES INDIVIDUAL COMMUNITIES HAVE. THE FEDERAL GOVERNMENT HAS SAID IT'S EARMARKING SOME OF THE LARGE POT OF MONEY... I THINK IT'S EIGHTY-SOMETHING MILLION DOLLARS TO FIRST NATIONS OR TO INDIGENOUS, BUT IN FACT IT'S NOT REALLY ENOUGH RESOURCES TO ADDRESS WHAT THESE ISSUES ARE AROUND FOOD, WATER, SUPPLIES, AND PERSONNEL BECAUSE THE AMOUNT OF MONEY THAT'S ACTUALLY EARMARKED FOR FIRST NATIONS IS LESS THAN .4 PERCENT OF THE OVERALL BUDGET, THE FEDERAL BUDGET, THAT'S GOING TO THIS. SO THIS IS A HUGE ISSUE FOR THE SUPPORT FOR FIRST NATIONS TO BE ABLE TO DO THINGS THAT THEY WANT TO DO IF THEY WANT TO CLOSE THEIR COMMUNITIES OFF TO PEOPLE COMING IN AND GOING OUT AND IF THEY EVEN HAVE THE POLITICAL AUTONOMY TO MAKE THOSE DECISIONS IS ALSO UNCERTAIN. WHAT IS CLEAR IS THAT URBAN INDIGENOUS POPULATIONS ARE ACTUALLY BEING IGNORED BY GOVERNMENT AND HEALTH CARE RESPONSES RIGHT NOW AND THIS IS VERY ALARMING FROM A PUBLIC HEALTH PERSPECTIVE BECAUSE MORE THAN HALF OF OUR POPULATION, DEPENDING ON WHICH REGION OF THE COUNTRY YOU'RE IN, LIVE IN URBAN AREAS AND NOT ON RESERVES. AND INDIGENOUS COMMUNITIES, INCLUDING THOSE IN URBAN AREAS, ARE NOT GETTING DIRECT MESSAGES FROM THE GOVERNMENT ABOUT WHAT THIS IS, WHAT TO DO, HOW TO MANAGE THINGS IN OUR COMMUNITIES, AND MUCH INFORMATION IS BEING CIRCULATED... MUCH MISINFORMATION IS BEING CIRCULATED IN INDIGENOUS COMMUNITIES RIGHT NOW.

Steve says YOU KNOW, I HATE TO PERPETUATE MISINFORMATION, SO I HESITATE TO ASK YOU THE FOLLOW-UP QUESTION, WHICH IS: WHAT ARE THEY HEARING AND WHO ARE THEY HEARING IT FROM? BUT IF YOU WANT TO GO ON THAT, GO AHEAD.

Suzanne says WELL, SOCIAL MEDIA IS BOTH A GOLDEN EGG AND A CURSE SOMETIMES. SO I THINK THAT THINGS ARE GETTING CIRCULATED THAT MAY NOT BE EVIDENCE-BASED IN TERMS OF EVIDENCE FROM INDIGENOUS KNOWLEDGES OR EVIDENCE FROM THE BIOMEDICAL COMMUNITY. AND THAT ACTUALLY BRINGS ME TO ANOTHER MAJOR ISSUE RIGHT NOW, AND THAT IS INDIGENOUS HEALERS AND ELDERS ARE NOT BEING CONSULTED BY THE GOVERNMENT OR BY THE BIOMEDICAL SYSTEMS TO IDENTIFY SOLUTIONS AND SUPPORTS THAT COME FROM TRADITIONAL HEALING AND MEDICINE METHODS.

Steve says HOW COULD THAT INFORMATION BE USEFUL AT THIS TIME?

Suzanne says WELL, IT GOES BACK TO WHAT YOUR FIRST QUESTION WAS AROUND THE SUPPORTS AND THE SUPPLIES. SO INDIGENOUS COMMUNITIES IN URBAN, RURAL, AND RESERVE AREAS NEED TO BE MOBILIZED WITH ACTUAL RESOURCES TO BRING TOGETHER THE PEOPLE WHO HAVE THE KNOWLEDGE AND THE SKILLS AND THE UNDERSTANDING FROM TRADITIONAL KNOWLEDGES PERSPECTIVES ON HOW TO ADDRESS THIS, AS WELL AS OTHER COMMUNITY LEADERS WHO ARE BETTER POISED THAN NON-INDIGENOUS INDIVIDUALS AND COMMUNITY MEMBERS TO MAKE DECISIONS ABOUT WHAT INDIGENOUS PEOPLE ARE GOING TO DO AROUND PROTECTING THEMSELVES AND TREATING THEMSELVES. SO IN THAT VIEW, THE OTHER ISSUE THAT I SEE IS REALLY BIG RIGHT NOW IS THAT THE GOVERNMENT IS CONTINUING TO IMPOSE COLONIAL METHODS AND MODELS OF HEALTH CARE AND PUBLIC HEALTH ON BOTH RESERVES AND INDIGENOUS URBAN SETTINGS. SO, IN OTHER WORDS, DROP-IN DOCTORS AND NURSES, DROP-IN MENTAL HEALTH WORKERS, BIOMEDICAL SERVICES ONLY. WE NEED THE RESOURCES TO MOBILIZE OUR OWN SUPPORTS THAT CAN BE OFFERED IN ADDITION OR ALONG WITH WESTERN BIOMEDICAL SERVICES.

Steve says NOW, YOU AND I HAVE KNOWN EACH OTHER FOR A WHILE AND YOU'VE BEEN A GUEST ON THIS PROGRAM MANY TIMES, SO I HOPE YOU UNDERSTAND THAT I'M GOING TO ASK THIS FOLLOW-UP QUESTION NOT FROM THE POINT OF VIEW OF BEING A SMART ALEC BUT BECAUSE I GENUINELY WANT TO KNOW THE ANSWER, AND THAT IS, YOU KNOW, THERE ARE GOING TO BE PEOPLE WATCHING THIS SAYING, HOW CAN HISTORICAL INDIGENOUS TRADITIONAL KNOWLEDGE POSSIBLY BE OF ANY VALUE IN THE FACE OF A GLOBAL PANDEMIC? IF THAT'S A REASONABLE QUESTION, WHAT'S THE ANSWER?

Suzanne says WELL, I THINK THAT MEANS THAT YOU HAVE TO STEP OUTSIDE THE COGNITIVE... I THINK YOU HAVE TO STEP OUTSIDE OF UNDERSTANDING THAT WESTERN AND BIOMEDICAL KNOWLEDGE AND SCIENCE ARE THE ONLY SCIENCE AND KNOWLEDGE THAT EXIST. ALL MEDICINES ORIGINALLY COME FROM PLANTS. INDIGENOUS PEOPLE HAVE BEEN WORKING WITH PLANT MEDICINES AND OTHER SPIRITUAL MEDICINES FOR TENS OF THOUSANDS OF YEARS, AND PRIOR TO CONTACT WITH EUROPEANS, WHEN OTHER BACTERIAS AND GERMS AND FOODSTUFFS WERE BROUGHT HERE, COMMUNITIES HAD VERY SUCCESSFUL WAYS OF MANAGING THE HEALTH AND HEALTH SYSTEMS OF THEIR COMMUNITIES. SO IGNORING THESE IS NOT JUST CULTURAL ARROGANCE, BUT IT'S ALSO COMPLETELY COLONIAL AND RACIST.

Steve says OKAY. SO I UNDERSTAND THAT THEN, SUZANNE, THERE IS A PARTICULARITY TO INDIGENOUS HEALTH CARE, AND AS A RESULT, I WONDER WHETHER YOU THINK THAT CALLS FOR INDEPENDENT STANDALONE INDIGENOUS COMMUNITY-SERVED ONLY ASSESSMENT CENTRES IN THE BIGGER AREAS OF THE COUNTRY. WHAT DO YOU THINK?

Suzanne says WELL, YOU HIT THE NAIL RIGHT ON THE HEAD HERE AND THAT'S SOMETHING THAT MYSELF AND SOME OF MY INDIGENOUS COLLEAGUES AT THE UNIVERSITY OF TORONTO, ALONG WITH OUR INDIGENOUS COMMUNITY PARTNERS IN THE CITY OF TORONTO, ARE WORKING TOWARDS MOBILIZING RIGHT NOW. YOU KNOW, RESEARCH SHOWS THAT THERE'S A GENERALLY POOR INDIGENOUS EXPERIENCE OF HEALTH SERVICES DESPITE EFFORTS TO ENHANCE CULTURAL COMPETENCY AND CULTURALLY-BASED SERVICES BY BOTH INDIGENOUS ORGANIZATIONS IN SOME HOSPITALS AND COMMUNITY CENTRES, AND THIS IS PARTICULARLY CRITICAL IN THE CURRENT CONTEXT OF COVID-19 BECAUSE INDIGENOUS POPULATIONS ARE, AS I SAID EARLIER, EXTREMELY VULNERABLE TO HIGHER LEVELS OF COMMUNITY SPREADING, YOU KNOW, DUE TO POVERTY, OVERCROWDING, LACK OF RESOURCES, AND FATAL OUTCOMES OF THE VIRUS DUE TO THE SOCIAL DETERMINANTS OF HEALTH. SO REALLY IT'S CRITICAL THAT INDIGENOUS COMMUNITIES ARE ABLE TO MOBILIZE INDIGENOUS ASSESSMENT AND TREATMENT CENTRES THAT WILL NOT REPLICATE PREVIOUS COLONIAL EXPERIENCES OF HEALTH AND HEALTH CARE WHICH HAVE DRIVEN MANY INDIGENOUS PEOPLE AWAY FROM SEEKING HEALTH SERVICES AND THAT'S NOT WHAT WE WANT TO DO RIGHT NOW. WE WANT TO CREATE A CULTURALLY AND BIOMEDICALLY SAFE SPACE FOR INDIGENOUS PEOPLE TO COME AND GET TESTED OR GET ASSESSED AND TO GET TREATMENT SO THAT THEY CAN STOP THE COMMUNITY SPREADING AND NOT GO BACK TO THE COMMUNITY WHERE THEY FEEL SAFER.

Steve says IN WHICH CASE, WOULD YOU WANT THE FEDERAL GOVERNMENT'S ASSISTANCE IN SETTING UP THOSE INDEPENDENT ASSESSMENT CENTRES OR PREFER TO DO IT ON YOUR OWN, SO TO SPEAK?

Suzanne says WELL, THEIR ASSISTANCE NEEDS TO COME IN FINANCIAL SUPPORT AND OTHER RESOURCES LIKE THAT AND FULL AUTONOMY AND SELF-DETERMINATION HAS TO COME FROM INDIGENOUS COMMUNITIES, BOTH URBAN AND RURAL AND FIRST NATIONS TO SET UP THESE INDIGENOUS ASSESSMENT AND TREATMENT CENTRES. WE'RE APPLYING FOR A SMALL AMOUNT OF MONEY TO DO THAT. MY COLLEAGUES AND I AND OUR COMMUNITY PARTNERS ARE HOPING TO HAVE AN INDIGENOUS ASSESSMENT AND TREATMENT CENTRE RUNNING VERY SOON HERE IN TORONTO BECAUSE THIS IS GOING TO HAVE A HUGE IMPACT ON OUR COMMUNITIES IF WE DON'T DO THIS.

Steve says YOU KNOW, I DO NOTE THE OTHER DAY THAT... MAYBE IT WAS A WEEK AGO ALREADY, THAT THE PRIME MINISTER OF CANADA DID ANNOUNCE A... I THINK IT WAS MORE THAN 300 MILLION dollars THROUGH THE INDIGENOUS COMMUNITY SUPPORT FUND. CERTAINLY THE GOVERNMENT OF CANADA THINKS THAT IT IS STEPPING UP TO TRY TO ACHIEVE SOME OF THOSE GOALS THAT YOU JUST LISTED. HOW WOULD YOU GAUGE THAT SUPPORT?

Suzanne says WELL, I DON'T THINK THE GOVERNMENT REALLY CLEARLY UNDERSTANDS WHAT INDIGENOUS COMMUNITIES NEED. THEY UNDERSTAND WHAT THEY NEED IN ORDER TO MEET WHAT THEIR TARGETS BOTH FOR OUTCOMES AND BUDGETS HAVE BEEN, AND THAT'S BECAUSE THE FEDERAL GOVERNMENT AND OTHER NON-INDIGENOUS GOVERNMENTS DON'T THINK IN TERMS OF WHAT INDIGENOUS COMMUNITIES' NEEDS ARE BECAUSE THEY'VE NEVER ACTUALLY REALLY ASKED PEOPLE IN A SUBSTANTIVE WAY WHAT THAT IS OR PROVIDED THAT TYPE OF SUPPORT BECAUSE THESE DECISIONS ARE NOT INDIGENOUS-DRIVEN DECISIONS, THESE ARE DECISIONS DRIVEN BY THE NEEDS AND INTERESTS OF THE FEDERAL GOVERNMENT, WHICH, AS WE KNOW HISTORICALLY AND CURRENTLY ARE NOT IN THE BEST INTERESTS OF INDIGENOUS PEOPLE.

Steve says WELL, YOU MENTIONED THE WORD "HISTORICALLY" THERE, AND LET ME FOLLOW UP ON THAT. I DON'T WANT TO PUSH THIS ANALOGY IF IT'S NOT THERE. BUT HAVING SAID THAT, I'LL PUT IT ON THE RECORD AND GET YOU TO REACT TO IT. YOU KNOW, IT WAS SEVERAL HUNDRED YEARS AGO, OF COURSE, THAT EUROPEANS CAME OVER HERE, FOUND INDIGENOUS PEOPLE, BROUGHT WITH THEM VARIOUS DISEASES THAT WIPED OUT THOUSANDS UPON THOUSANDS OF INDIGENOUS PEOPLE, AND I WONDER WHETHER OR NOT THAT HISTORICAL OVERLAY IS A PART OF THE THINKING OF THE AVERAGE INDIGENOUS PERSON IN THE COUNTRY TODAY, MAKING HIM OR HER SUSPICIOUS ABOUT ANY ATTEMPTS TO HELP FROM THE FEDERAL GOVERNMENT... I DON'T KNOW. YOU TELL ME.

Suzanne says WELL, I MEAN, I CAN'T SPEAK FOR OTHER INDIGENOUS INDIVIDUALS OR COMMUNITIES, I CAN REALLY ONLY JUST SPEAK FOR MYSELF AND MY EXPERIENCE AND THOSE THAT PEOPLE HAVE SHARED WITH ME. HOWEVER, I THINK FOR MYSELF AND WHAT THE RESEARCH SAYS IS THAT INDIGENOUS PEOPLE VIEW THE GOVERNMENT AND THE BIOMEDICAL SYSTEM WITH SUSPICION AND MISTRUST DUE TO THESE HISTORICAL EXPERIENCES THAT YOU'RE TALKING ABOUT. IT WASN'T THAT LONG AGO THAT INDIGENOUS COMMUNITIES, LIKE IN MY LIFETIME, HAD INDIVIDUALS WHO WERE FORCIBLY REMOVED AND ISOLATED FROM THEIR COMMUNITIES ON THE PRETEXT OF ILLNESS AND HEALTH PROBLEMS WHICH THEY MAY OR MAY NOT HAVE HAD, AND WE SEE THAT TYPE OF THING BEING REPLICATED RIGHT NOW WITH VERY VULNERABLE AND MARGINALIZED INDIGENOUS PEOPLE WHO ARE HOMELESS, WHO ARE LIVING ON THE STREET, WHO MAY BE LIVING IN SHELTERS, THAT WHEN THEY'VE BEEN ASSESSED OR TREATED, THEY'RE CARTED OFF SOMEWHERE WHERE THEY DON'T KNOW WHERE THEY'RE GOING SORE WHY THEY'RE GOING THERE OR HOW LONG THEY'RE GOING TO BE, IN AN EFFORT TO ISOLATE THE INDIVIDUAL TO PROTECT THEM AND OTHERS FROM THE COMMUNITY SPREADING. HOWEVER, THAT TYPE OF THING IS REPLICATING THESE HISTORICAL EXPERIENCES OF HARMS THROUGH THE MEDICAL SYSTEM, AND THAT'S THE CRITICAL REASON WHY OUR COMMUNITIES NEED TO TREAT CULTURALLY SAFE AND CULTURALLY BASED ASSESSMENT AND TREATMENT CENTRES THAT WILL BE MANAGED BY OUR OWN PEOPLE AND WILL BE FUNDED BY THE GOVERNMENT THE WAY IT'S FUNDING THE TREATMENT CENTRES FOR EVERYONE ELSE. THAT'S OUR TREATY RIGHTS, TO HAVE MEDICAL SERVICES THAT WE THINK ARE APPROPRIATE. WE HAVE A RIGHT TO THAT, AND WE NEED THAT RIGHT NOW.

Steve says UNDERSTOOD. SUZANNE STEWART, ALWAYS GOOD OF YOU TO JOIN US ON TVO. WE APPRECIATE YOUR TIME VERY MUCH, AND GOOD LUCK GOING FORWARD, OKAY?

Suzanne says THANK YOU VERY MUCH. AND I JUST WANT TO ADD ONE OTHER THING. YOU KNOW, WE'VE BEEN TALKING ABOUT THIS PANDEMIC AND ITS EFFECTS ON INDIGENOUS COMMUNITIES, WHICH ARE VERY SERIOUS. BUT THERE IS SOMETHING GOOD HAPPENING, AND THAT IS THE COMING TOGETHER OF ALL OF OUR PEOPLE. WE'VE ALL COME TOGETHER. WE'RE ALL WORKING TOGETHER TO TRY TO FIND SOLUTIONS BOTH FROM WITHIN OUR COMMUNITY AND TO WORK WITH THE BIOMEDICAL AND SOCIAL SERVICE SYSTEM BECAUSE WE BELIEVE THAT WE CAN ADDRESS THIS AND WE CAN BEAT THIS AND WE CAN SURVIVE, AND HOW WE BEST KNOW HOW TO DO THAT IS TO WORK TOGETHER, AND THAT'S WHAT WE'RE DOING RIGHT NOW.

Steve says MIIGWECH AND THANKS FOR PUTTING THAT ON THE RECORD.

Watch: Indigenous Health: Communities at Risk