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On the inaugural National Truth and Reconciliation Day being recognized today across Canada, the Primary Care Collaborative values the opportunity and responsibility to acknowledge some of the actions that can help support better understanding of colonization, the trauma of residential schools for Indigenous people and communities, and the ongoing impacts of systemic racism, and the steps to create safer spaces and change for Indigenous health and wellbeing.

For our collaborative group of primary health care associations, ensuring our staff have the tools they need to support improving Indigenous healthcare experiences and outcomes, is an essential step towards truth and reconciliation. Through the Indigenous Cultural Safety (ICS) Program, offered by the Indigenous Primary Health Care Council, our associations are committed to taking concrete steps towards the respect and understanding at the core of de-colonization work. The ICS Program will help us to better understand our roles as individuals in supporting primary care providers to decolonize health care, and also in organizational change both within our associations and among the partners we work with.

Through a series of moderated and facilitated sessions, the program facilitates a deeper level of understanding of how colonialism is embedded in health systems and services, and how to motivate change at the organizational levels. The ICS Program also explicitly connects the impacts of racism and discrimination on the health and wellbeing of Indigenous people and communities, with real-world examples of how these impacts play out in people’s lives. Importantly, this program also includes follow-up steps for organizations and providers, and offers tools to deepen the learning of the initial program. Ultimately, the ICS Program supports a practical understanding of the truth of colonization for Indigenous people’s experiences, and then some paths for how to support reconciliation.

The Primary Care Collaborative believes that collective commitments to actions such as mandating Indigenous cultural safety training for public service organizations is what will ultimately change the culture and the mindset of individuals and organizations. Increasing awareness of both historical context and connections to the current environments and conditions that Indigenous people face in health care is an essential foundational step to moving forward together, and to ensuring that Indigenous people’s voices, concerns and trauma are heard and heeded within organizations, policy-making circles and governments alike.

The Primary Care Collaborative, therefore, remains committed to our own journey of Truth and Reconciliation this year, and on this inaugural day, by committing all of the staff at our associations to undertake ICS Program training, and to engage with other programs such as the University of Alberta’s Indigenous Canada program, or resources and modules from Cancer Care Ontario. In doing so, we also challenge and call on the wider public and government sectors across all of Ontario, who have also engaged with the ICS Program, to set out your organizational plans and commitments to ongoing learning and the steps being taken to promote organizational transformation.

Taken as a whole, it is these actions, which will outlast Truth and Reconciliation Day that will enable us to start moving on a path where Indigenous people and communities will be able to lead safer, healthier and happier lives, with lowered risk of violence and trauma from colonization’s impacts.

About the Primary Care Collaborative (PCC):

We are a coalition of primary care organizations collectively representing 14,000 family doctors, 1,000+ primary care nurse practitioners, 286 primary care teams, 28 Indigenous primary care teams, including northern, rural, and remote teams in Ontario. This alliance of comprehensive primary care organizations joined together by common purpose to build on the collaborative work during the COVID-19 pandemic as we move towards recovery in a time of health system transformation. The PCC provides a collective and cohesive voice with the purpose of advancing equitable person-centred primary care in Ontario and is focused on influencing policy by creating a unified voice towards resolving barriers or challenges that prevent comprehensive primary care from being the foundation of the health system.

The number of unmarked graves uncovered currently stands at more than 1,300 across Canada, with many Indigenous children still to be brought home to their peoples, and with many residential schools still unrecognized by Canada’s leaders, who’ve only focused on the 139 schools funded directly by the federal government.

Since May, we are reckoning with the truths that Indigenous communities have shared with us for years. Canadians are also coming to face the fact that more than 150,000 Indigenous children endured hardships and atrocities in Indian residential schools over a period of more than 100 years. 

From the “Idle no more” to the “Every Child Matters” movements, we are all bearing witness to the undeniable evidence of genocide and the ongoing traumatic impacts of residential schools, as well as the violence that colonization wrought for thousands of Indigenous people and communities throughout these lands. On the inaugural National Truth and Reconciliation Day in Canada, it’s these truths which we have long ignored that must remain in the spotlight.

Decades of law and policies rooted in racism, colonialism and white supremacy, decades of apathy and excuses from government and community leaders, corporations and business owners and others, are on full display. Decades spent ignoring the testimony and pleas of Indigenous leaders and communities, of ignoring how children’s and families’ suffering continued with the Sixties Scoop and with foster care programs, are being called out for enabling colonization’s systems to continue unchecked. Despite the Truth and Reconciliation Commission’s 94 calls to action and more calls to action since, more Indigenous children are under foster care than there were during the Sixties Scoop. We continue to see inaction and pushback against attempts to achieve justice for missing and murdered Indigenous women and girls. Everyone in Canada is implicated in truth and reconciliation. Everyone has a role to play in these processes, whether they choose to acknowledge it and walk the path or not.

With the first National Truth and Reconciliation Day now upon us, we need to ask ourselves: what do our initial reflections, calls to action and commitments mean? What does the path through truth, and towards reconciliation, really look like? How do we ensure the road to reconciliation is embedded in the rights-based approach? What does “land back” mean and how could it support Indigenous healing? Specific to health care systems, how do we ensure spaces are safer for Indigenous people to support their health and wellbeing? How do we decolonize systems, policies and institutions that themselves were modelled in the image of residential schools? What does self-determination in health and wellbeing look like, and what are the steps needed to support more self-governance and Indigenous health in Indigenous hands?

Seeking truth and surfacing erased histories are prerequisites to beginning to answer these questions. The story of Joyce Echaquan, an Atikamekw woman who was subjected to degrading, racist treatment in a Quebec hospital before she died, is a recent example of how racism can be lethal in Canada’s health systems. It is one story among many others of Indigenous people killed by the systemic racism rooted in Canada’s colonial systems – health, justice, education and others -- enabled by decades of inaction, repeated again as generations continue to pass along prejudices, indifference, hatred and ignorance.

The Alliance and its members are committed to disrupting colonization’s impacts on Indigenous health. That’s why we are committed to implementing the Indigenous Cultural Safety (ICS) program of the Indigenous Primary Health Care Council (IPHCC). This comprehensive training helps people unlearn colonial structures, to build awareness and respect of Indigenous experiences and history, and the intergenerational trauma and racism experienced in health care today. We commit to a deeper understanding of the truth to support reconciliation through improving the health care experiences of Indigenous people, and ensuring safer spaces and accountability within health care contexts. From Indian hospitals, to Jordan’s Principle, to the impacts of climate change on community health and wellbeing, there is a lot of complex history and present-day experiences and truths to uncover and understand. The Alliance is also committed to continuing to support the shift to Indigenous-led, designed and governed health care, through the process of returning Indigenous health to Indigenous hands. We also stand shoulder to shoulder with our IPHCC colleagues, in their own advocacy for health equity and decolonization, and in our own organizational efforts to decolonize the Alliance.

The last several months contain a powerful message: the process of reconciliation demands that we take time and space to understand what happened, and what’s still happening and how it impacts all of us, and how we’re contributing to it by our actions (or inaction). The impact and legacy of residential schools, the child welfare system, the justice system and incarceration, healthcare, and how we respect treaties and rights, and colonial violence embedded in our systems and policies, is ongoing. These truths are not chapters in a history book – they’re the lives we’re living now. It’s why the Alliance is committed to understanding our own roles in uncovering truth and realizing reconciliation more deeply, towards healing, understanding and respect between Indigenous leaders, people and communities and non-Indigenous people.