Region program aims to tackle racism in health care

In the video above, Jeanette Edwards talks about racism and the San'yas Indigenous Cultural Safety Training program.

Winnipeg Regional Health Authority
Published Thursday, September 1, 2016

"I'm racist."

It's an eyebrow-raising admission coming from someone who has spent the bulk of her 35-year career working collaboratively in the inner city trying to improve the health of people negatively affected by poverty, racism and inequality.

But for Jeanette Edwards, Regional Director of Primary Health Care and Chronic Disease for the Winnipeg Regional Health Authority, the admission is a simple statement of fact.

"The term 'racism' has such negative connotation, but we're in an environment where we need to have conversations about it in an open, constructive, learning way," she says. "For us not to use the word is to pretend that it isn't an issue."

Edwards explains, "My career has been about trying to understand why we had things like residential schools for Indigenous children. It's been about working within the community to combat the effects of social injustice. It's been about a personal commitment to health equity through which I strive to ensure that I am respecting the values of all races. So the word 'racism' has always felt uncomfortable to me. But it's a fact that I view the world from a privileged lens. I was raised in an environment of majority privilege. Racism sometimes means that we're susceptible to making faulty assumptions based on our personal biases and experience. And when we do that, we can be judgmental and unfair to without realizing it."

Confronting this type of unintentional racism is one reason why Edwards is eagerly anticipating the launch of the San'yas Indigenous Cultural Safety Training Program currently being customized for use in Manitoba.

Originally developed in British Columbia by the Provincial Health Services Authority's Aboriginal Health Program to increase cultural competency, this facilitated, on-line training for health-care workers features eight modules that provide participants with an understanding of the root causes of the health inequities Indigenous people experience. It also explores what is required of health service providers to provide culturally safe and competent care.

The curriculum for the Manitoba version of the program is currently being vetted by an advisory committee that includes Indigenous elders, First Nations, Metis and Inuit people, and senior staff from participating organizations that include the Winnipeg Regional Health Authority, other regional health authorities, the University of Manitoba, and Manitoba Health. Once the vetting process is complete, the program will be piloted to a select group of 100 leaders and decision-makers this summer. The rollout for general enrolment is currently scheduled for the fall.

Once the initiative is underway, skilled facilitators will guide and support each participant through the program's self-paced learning modules. Through interactive activities, online discussions and video presentations, participants will learn about Indigenous culture, stereotyping, and the legacies of colonization. They will also be introduced to tools for developing more effective communication and relationship building skills for their interactions with Indigenous people.

Edwards says she found the training program extremely helpful.

"I'm at a stage in my career where I want life experience," she says. "These modules were a profound self-learning experience for me. They offered me the opportunity to reflect on the attitudes I've developed through my life experience that I may be generalizing to another population. I think it will help participants understand that, despite our efforts, racism and inequities still exist within the health-care system. To think it isn't happening is naïve."

Dr. Catherine Cook, the Region's Vice President Population & Aboriginal Health, agrees, adding that as individuals, we often underestimate the scope of the problem.

"Part of the reason we have a racism problem is that people don't believe we have a racism problem," she says. "As individuals, we come by our biases quite naturally, based on the way we learned as children, the way we live our lives, and the people with whom we engage. The best thing we can do for ourselves and each other is to explore and reflect on some of the concepts and beliefs we hold true."

The same holds true of the health-care system, Cook says.

"We know there are barriers to access for Indigenous people, for a variety of reasons. Some involve geographic location, some are related to language access, some of it is based on assumptions of eligibility or lack of eligibility, and some of it is poverty-driven.

Part of the issue, she says, relates to a one-size-fits-all mentality.

"The health-care system is set up to meet the needs of the majority," Cook says. "But that doesn't mean we only have to meet the needs of majority. We have an obligation to look around the margins to discover what issues may exist. There are lots of things we can do to redesign our programs and services so that we can welcome more people into the system."

Sometimes, Cook says, it's not a question of actions, but attitude.

"Some people believe Indigenous people are non-compliant and that they don't follow instructions. That's almost never the case. Often it's more likely that we, as health-care providers, aren't asking the right questions or don't understand the cultural barriers that may exist."

That's why training in Indigenous cultural safety is so important, Cook says.

"We all have ideas, concepts or misconceptions that influence the way we treat others. This training will provide participants with an overview of the history of Indigenous people in Canada, particularly in Manitoba. And it will facilitate a process of discovery and self-reflection in which you're able to consider some of your own biases and beliefs. It's not about blaming, it's about learning about the issues that have influenced the way Canadians view Indigenous people today, and about how each of us can work toward providing a higher standard of culturally safe care."

The training program will enhance the Region's ongoing commitment to cultural proficiency and diversity, the goal of which is to create a health-care system that can deliver the highest quality of care to every person regardless of their race, ethnicity, culture or language proficiency. 

The new cultural safety training program complements other initiatives such as Dignity in Care, and Collaborative Care, that fit within and the Region's cultural proficiency & diversity framework. Together, these initiatives will help the Region and its staff move from "one-size-fits-all" health-care system to one that is responsive to the needs of an increasingly diverse population.

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