Exclusion in Healthcare, Education, and Governance: Racializing and Positioning Indigenous Peoples at the Margins of Canadian Society

The assimilation project of the European settlers left a most excruciating legacy among Indigenous peoples in Canada. The afflictions brought by the residential schools reverberate from generation to generation of Indigenous peoples, exacerbated by discoveries of unmarked graves of children participants in various regions of the country. Such an event ruined the fabric of the Indigenous rich culture, social structure, and way of life and nearly erased the Indigenous population. In 1996, the last residential school in Saskatchewan was closed. Since then, the government has taken steps to heal the pains the residential schooling inflicted on Indigenous survivors, families, and communities and mitigate the aversions of the past by implementing policies relative to their inclusion in mainstream society.

However, the settlers’ values, norms, and culture are the foundations of social structures or institutions that accentuate the blueprints of the colonial era. The interests of white settlers are still implanted in laws, public policies, and legislative agendas while setting aside the concerns of Indigenous populations. Some scholars argue that the post-colonial era has not commenced yet. It means colonization transforms into new forms, such as globalization and neoliberalism over time. Therefore, the exclusion of Indigenous peoples is part of the ongoing colonization project under the pretext of the inclusion agenda. Indigenous peoples’ everyday experiences of racism and discrimination at all levels of personal and institutional interactions, for instance, in hospitals, schools, and government agencies, are indicators of exclusion and otherness. The exclusion of Indigenous peoples in healthcare, education, and governance racializes and positions the Indigenous population on the margins of Canadian society.

One of the devastating aftermaths of colonialism in Indigenous peoples’ lives is its adverse effects on their individual and community health up to this day – healthcare. Unfortunately, there are only some studies on the health conditions of the Indigenous peoples for the simple reason that they are inconsequential against the dominant settlers, and the impact of political discourses sway comprehensive research initiatives in their goodwill. Related studies show that the health gap between the Indigenous peoples and non-Indigenous counterparts is significantly broad. Also, the literature demonstrates that the current healthcare system alienates Indigenous peoples’ traditional medicines and healing practices in Canada and worldwide.

Non-Indigenous peoples should learn from history, as  Gracey and King suggest, to better understand how profound colonization has affected Indigenous peoples’ health today (2009: 65). Colonizers, current settlers, and the ensuing immigrants must recognize colonization’s powerful effect was the estrangement in all aspects of Indigenous lives, affecting their total wellbeing. It destroyed the fabric of the traditional way of life dependent on land and the environment, such as conventional farming, food gathering, hunting, and fishing practices, making them reliant on unfamiliar foods introduced by the settlers (Gracey and King, 2009: 66). The colonization process involved brutal dispossession of traditional lands, resulting in subsequent poverty, exploitation, unemployment, and increasing dependence on welfare or begging; thus, oppressive conditions caused severe disparities in Indigenous health status (Gracey and King, 2009: 66). Yet, Gracey and King speculate that some nations deny the existence of this population group due to ignorance, mortification, or political expediency (2009: 65).

As a result, Indigenous peoples adopted a modern sedentary lifestyle (Gracey and King, 2009: 70). Such a way of life hooked them and gave them no option; then, exacerbated by economic growth, commercialism, and industrialization of food production, globalization explains the risks to Indigenous health. For example, change in diets such as low intake of fruits and vegetables in exchange for processed foods available in the market, including harmful substances like tobacco and alcohol, absence of adequate physical activities, and lack of potable water. Therefore, the health inequalities of Indigenous peoples are products of classic socioeconomic and connectivity deficits related to colonization, globalization, migration, loss of language and culture, and disconnection from the land (King et al., 2009: 76). Moreso, King, Smith, and Gracey emphasize that Indigenous people’s disruption or disjuncture of ties to the land weakens or destroys cultural practices and participation in their traditional economic activities essential for holistic health and wellbeing represented in their four directions of the medicine wheel (2009: 76), which illustrates the four elements of life: physical, emotional, mental, and spiritual. Moreover, isolation from this identity and environmental deprivation means having negative repercussions on their health (King et al., 2009: 77)

In addition, racism and discrimination affect Indigenous peoples’ health. Unfortunately, research on Indigenous health has mainly defaulted on non-Indigenous health notions rather than Indigenous health contexts (King et al., 2009: 66). Therefore, such an ingenuity implies Indigenous peoples’ exclusion or inconsequentiality in the healthcare system. Phillips-Beck et al. argue that despite Canada’s international reputation as having one of the best healthcare systems, racism exists within its institutions; as a result, health inequities persist, and their effects intensify on Indigenous populations (2020: 2). Further, Phillips-Beck expanded its gaze from healthcare to governance structure described as institutional racism ingrained and established in laws and practices that reflects racial inequality and discrimination, reflecting the white peoples’ supremacy (2020: 3), and reinforced by the healthcare structure and political discourses (2020: 5). It only means that voices could be heard or silenced, while some issues could be selected or ignored for discussions. For example, Indigenous patients’ conversations with physicians – perceived health experts – about their health create distrust because responses are scripted based on discourses.

Consequently, in Phillips-Beck et al.‘s study, consistent evidence with pieces of literature unfold racial discrimination in the healthcare system against First Nations, where organized data and interconnected themes geared toward greater comprehension of racism’s root causes and factors bridging its perpetuation (2020: 13). To illustrate, the contradiction between Canada’s healthcare system and the First Nation’s culture, languages, institutions, and overall governance hinders an equitable and just healthcare system that prioritizes the interest of the Indigenous populations (Phillips-Beck et al., 2020: 13). Furthermore, the lack of consideration for First Nation realities, for instance, accommodation of the native languages and traditional medicine over the healthcare’s English and biomedicines preferences, further aggravates racial discrimination (Phillips-Beck et al., 2020: 14). In addition, the study of Phillips-Beck et al. illustrates that residential schools, the Indian Act, health and welfare policies and practices, displacement and isolation, and intergenerational trauma were historical records that prove as root causes of the fundamental problems the Indigenous peoples face today (2020: 14): prejudices, stereotyping, racism, and discrimination that stigmatize their identity.

In the same way, Phillips-Beck et al. observe that inadequacy in healthcare emanates from Indigenous stereotyping, such as being alcoholics and drug addicts, interfering with a proper diagnosis that may result in maltreatment and becoming more detrimental to Indigenous peoples’ wellbeing (2020: 15). In this sense, Indigenous individuals avoid interacting or participating in medical institutions as much as possible, considering their bad experiences of perceived racial discrimination aggravated by socioeconomic status and geographical difficulties. The socioeconomic and geographical obstacles (Phillips-Beck et al., 2020: 15) or distal barriers (Nguyen et al., 2020: 7)  accentuate distant locations of healthcare facilities that entail financial issues for the Indigenous people. So, conflating the former conditions and circumstances, such avoidance is a fatal response to medical conditions that require immediate interventions. It only reflects that Canada and its colonizing and white supremacist policies be accountable for all the causes and ongoing damages it instigated and the failed healthcare practices for the interests of the First Nations (2020: 15). All the preceding accounts and research outcomes are strong evidence of systemic racism and racialization of Indigenous peoples that intensely excludes the Indigenous population in the healthcare organization, mirroring social inequity and system of hierarchy.

The study by Nguyen et al. shows that despite several mitigation strategies to attain healthcare equality between Indigenous peoples and their non-Indigenous counterparts, Canada still faces barriers and challenges to making healthcare equitable and accessible, requiring extensive work to eradicate discrimination (2020: 9). They used the Social Determinants of Indigenous People’s Health Framework and found nine barriers to Indigenous communities’ access to healthcare. The identified barriers fall into three major groups: first, proximal barriers include geography, educational attainment, negative bias, and insufficient healthcare providers (that might have lower qualifications); second, intermediate obstacles entail employment and income, healthcare professionals’ lack of culturally relevant education; and finally, distal barriers consist of colonialism, racism, and social exclusion (Nguyen et al., 2020: 9). In addition, Nguyen et al. emphasize that these barriers intensified by negative interaction experiences with healthcare institutions discourage not seeking or delaying seeking healthcare services and establish distrust of providers (2020: 9). In general, knowledge-sharing, culturally related education and the language preference of healthcare providers and recipients are crucial in the healthcare services and all stages of institutional participation.

Aside from the implied exclusion of the Indigenous peoples in Canada’s healthcare system, a systemic exclusion in the education institutions is stealthy in place. However, on the one hand, the vital role of education is a positive change, for example, pro-active participation or involvement and inclusion. On the other hand, education might reinforce inequality and exclusion, depending on accessibility, motivational factors, and level of engagement. Nevertheless, a collective purpose and reciprocated trust among its players is the initial success of schooling, for instance, between the teachers, school administrators, students or school participants, and students’ families.

From an Indigenous perspective, common purpose and mutual trust have been a long-standing issue in history in healing their most excruciating experiences in residential schools, such as abuses, discrimination, and intergenerational trauma. Focusing on school children, Milne accentuates the challenges of Indigenous families connecting with schools and the dynamics of educational disparity associated with family-school relationships (2016: 271). Despite these facts, Milne says that Indigenous participants in her study chose their children’s involvement in public schools and graduated from the formal public school system, believing this would allow their offspring to post-secondary school and become competitive in the labour market (2016: 273). Further, Milne explains that parents’ efforts to gain educational advantages became successful: it is the inclusion moment, while if it fails, it is an exclusion moment (2016: 273). This process involves compliance (inclusion) and no-compliance (exclusion) to the school norms, involving institutionalized standards of evaluation (Lareau & Weiniger, 2003 cited in Milne, 2016: 272), and parenting behaviours aligned to set institutional expectations (Lareau & Horvat, 1999 noted in Milne, 2016: 272); that is, based on eurocentric standards.

In the review of literature, the decolonization of the school system was advocated by several scholars through acknowledgment and infusion of Indigenous ways of being, knowing and doing into student learning, which the current colonial school system excludes (Alfred, 2005, 2009, 2014; Battiste, 1998, 2013; Dei, 2012; Donald, 2009, 2012; Munroe et al., 2013 mentioned in Milne, 2016: 272). This Indigenous-based approach to education gives importance to the Indigenous culture and the Indigenous peoples’ involvement in reconnecting with their lands, knowledge, languages, and ways of life (Alfred, 2005, 2009, 2014; Wildcat et al., 2014 cited in Milne, 2016: 273). This paradigm could also be a healing process of residential schools’ afflictions and agonies inflicted on Indigenous lives, which might recuperate trust in the educational system and teachers. Thus, making schools more meaningful and welcoming creates a harmonious family-school relationship strengthened by the active and accommodating role of the school staff (Kovach et al., 2015, cited in Milne, 2016: 285).

Furthermore, it is not only in the primary and secondary schools that Indigenous learners and parents struggle against the school system; instead, racialization, discrimination, and perceived exclusion persist even in the post-secondary or higher learning institutions. Therefore, it would be a  best practice of inclusiveness and healing preparation for the Indigenous people is equal representation in all major institutions, particularly at different levels of educational dynamics, including faculty members. Unfortunately, only a few studies focus on the unequal representation of racialized and Indigenous faculty in Canadian universities. Available literature shows that the said faculty and the discipline or areas of their expertise are low in numbers and even lower regarding power, prestige, and influence (Henry et al., 2017: 300). Notwithstanding the diversity initiatives of contemporary universities, they fail to approach equity, denying the need for change in institutional culture (Mohamed & Beagan, 2019: 338).

Despite the growing interest in equity and higher education research projects, the analyses of racism, racialization, and Indigeneity are still absent; for example, the status and everyday lived experiences of racialized academic scholars and scholarship (Henry et al., 2017:300): the fact that studies documents establish the persistence of systemic barriers and implicit biases faced by gendered and racialized minorities, Indigenous peoples and persons with disabilities (Carty, 1991; Mukherjee, 1994; Monture-Angus, 1995, 1998; Razack, 1998; Dua & Lawrence, 2000; Prentice, 2000; Dua, 2009; Henry & Tatur, 2009; Smith, 2010 cited in Henry et al., 2017: 300). Moreso, a recent enquiry illustrates racism at different levels the faculty face, such as micro-level interactions, systemic drawbacks, and overt hostility and exclusion (Henry & Tatur, 2009; Henry et al., 2017b, 2017a mentioned in Mohamed & Beagan, 2019: 338). For example, racialized faculty misread being students, stopped by security to ask for an identification card, and neglect or ignorance during a conversation with colleagues are forms of everyday racism and exclusion. The routine implementation of diversity and equity policies of universities veil the day-to-day processes of faculty exclusion (Ahmed, 2012; Henry et al., 2017a cited in Mohamed & Beagan, 2019: 338) based on race and ethnicity.

With the increasing active participation and hard work of the racialized and Indigenous groups, their exertions and efforts are not enough to achieve equal representation with their white counterparts in various levels of learning institutions. In this regard, racialization goes along with racism in the mundane academy life, in which the norms of whiteness prevail and set the foundation of higher education. The “whiteness” of the dominant group refers to beliefs, assumptions, and practices centred on white people and considered normal (Gillborn, 2015: 278 mentioned in Henry et al., 2017: 303) that convey academic elitism and superiority stance confirmed by a few presences of racialized and Indigenous faculty (Mohamed & Beagan, 2019: 343). In other words, being racialized and Indigenous faculty entail extra work or labour in institutions infused with whiteness to maintain their scholarship (Mohamed & Beagan, 2019: 350), for example,  mentoring and supporting marginalized, Indigenous and diverse students population, including other service demands such as articles for publication or chapter in a book, to be at par with their non-Indigenous counterparts – the whites. Besides, lots of instances demonstrate exclusion and unequal recognition in knowledge production. Henry et al. argue that as knowledge-generating entities in diverse contemporary communities, post-secondary institutions must be willing to accept and accommodate the participation of people of colour and Indigenous faculty; thus far, it is about engagement in intellectual exertions (Henry et al., 2017: 311). To put it another way, the production of new knowledge must be in the context of diversity and an amalgamation of different perspectives.

Unfortunately, income disparity is highly evident despite the extra labour and workload between the white and people of colour faculty members. For example, Henry et al. describe that Indigenous and racialized faculty, classified as immigrants, work fewer years in the academy in the field of Medicine, Dentistry, and Engineering other than in the Arts and Humanities discipline, showing evidence of the racialized-segmented-academic-labour market in Canadian universities (2017: 306). Thus, it also shows the precariousness of labour; for instance, such a group of faculty are part-time teachers or under a contract of service. Accordingly, despite the racialized and Indigenous presence on university campuses, they constantly struggle against historical yet ongoing exclusion in new forms to secure themselves from erasure, including faculty members they mentor, their students, the research projects, and the scholarship they produce (Henry et al., 2017: 312). Indeed, if given due recognition, incorporating Indigenous knowledge, such as language, culture, and learning practices like storytelling, in educational processes will enhance Indigenous learners’ learning capacity and motivation to engage in formal schooling. This knowledge-sharing is also beneficial in educational management and other systems of governance.

Another restrictive project the government put in place is excluding the Indigenous people from governing affairs – governance – that affect their lives as a distinct First Nations people, preventing them from practicing self-determination. According to Shrinkhal, self-determination is a notion that includes the self-government of peoples, which in its broadest sense means a breakup of colonial influence critical to advancement toward world revolution (2021: 75). As Lenin puts it, the people’s right to secede from tyrannical rule undermines the capitalist and imperialistic world order (Manela, 2007 mentioned in Shrinkhal, 2021: 75). Therefore, it is essential to understand the term in the Indigenous context. Also, self-determination refers to an action based on one’s volition that enables one to be the primary agent in their life to maintain or improve the quality of life (Wehmeyer,  2005: 117 cited in Shrinkhal, 2021: 75). Again, it is imperative to understand the term in the context and perspective of the Indigenous peoples. Shrinkhal infers that self-determination is the power of people to control their destiny, which Indigenous peoples see as an instrument to safeguard their human rights and scuffle for self-governance (2021: 79); for example, managing ancestral lands, watersheds, and forests. In this sense, environmental stewardship and protection are of their vital concerns.  

Moreover, environmental degradation is one of the serious concerns of the Indigenous communities. Their lives rest on their lands, adversely affecting future generations if not given immediate care or timely attention. Therefore, it only means that government should allow full Indigenous participation in managing and decision-making to preserve the natural resources while equally sharing its benefits. In addition, through land-claim agreements, Indigenous communities gain control over traditional lands, resulting in co-management and participatory environmental assessment as primary mechanisms for protecting Indigenous interests in their homelands (Bowie, 2013: 95). However, co-management only constitutes advisory roles for indigenous peoples (Bowie, 2013: 95) or fulfillment of state consultative requirements (Bowie, 2013: 100), while the federal, provincial, and territorial governments have the final decision-making power (Mulrennan and Scott, 2005; Goetze, 2005; White, 2008 mentioned in Bowie, 2013: 95), putting Indigenous interests in a highly vulnerable position (Mulrennan and Scott, 2005: 47 cited in Bowie, 2013: 95 & 98). More recent scholars argue that recognizing the heterogeneity, interconnectedness, and dynamism of local people who hold rights to resources could establish an appropriate decision-making body to support conservation initiatives, adaptive management, and knowledge (Wyatt et al., 2011; Diduck et al., 2015 cited in Egunyu et al., 2020: 1152).

Unfortunately, the Indigenous knowledge of environmental conservation based on holistic, experiential, and qualitative dimensions contrasts with the reductive, experimental, and quantitative western approach (Bowie, 2013: 96). Thus, white scientific managers view Indigenous peoples and their traditional resource management knowledge as “objects suitable for study rather than people for working with” (McGregor, 2009: 77 cited in Bowie, 2013: 97). Such treatment of the Indigenous and their knowledge as data sets are a practical and systematic exclusion of the people who created the knowledge, giving scientific managers efficacy in decision-making (Stevenson, 2006: 173). Here, Indigenous knowledge is merely data or information to augment and link scientific research gaps. It demonstrates the exploitation and alienation of Indigenous peoples and the corruption of their knowledge.

At the same time, ecological management organizations display that local or Indigenous peoples are underrepresented. For instance, most environmental or pertinent forest and water governance managers are non-Indigenous, locating Indigenous representatives as government instruments just for legislative compliance. In other words, the only means to ensure greater compliance with state resource management policies or the only alternative for confrontation (Spak, 2005: 240 cited in Bowie, 2013: 99). Here, Egunyu et al. found that they describe the exclusion of local people and Indigenous peoples in different ways, such as “often identified as missing,” “only just been added as a requirement to consult,” and “absence of those groups of people,” and “were not reflected” (2020: 1155 & 1157). Moreover, the disproportionate number of members in committee or board management contrasts with the large portion of Indigenous populations who reside in forested regions, considering a proper representation (Egunyu et al., 2020: 1157).

The exclusion of Indigenous Peoples of Canada in healthcare, education, and governance racialize and positions them on the margins of Canadian society. In light of conflict theory, the Indigenous peoples’ exclusion is the focus of the discussion and my analysis. Filtering the social exclusion lived experiences of the Indigenous communities from the literature, I perceive that the class system, power relations, and dominance contribute to institutional participation, reinforcing inequality and racialization of Indigenous peoples. For instance, Indigenous parents’ socioeconomic status (SES) demonstrates the opportunity for their children to study in formal schooling and obtain post-secondary education to be competitive in the labour market. It is also an advantage to seek quality healthcare services. Thus, low-SES families are more likely to experience racialization and marginalization. Hence, as a signifier of social class, SES reinforces social inequality. In addition, the underrepresentation of the Indigenous group in institutional participation is another example of inequity, which the areas of governance demonstrate. For instance, many faculty and school administrators in learning institutions are white. It has the same patterns in healthcare industries and government. Alienation of the Indigenous way of life is the core of the assimilation project to adhere to the culture of the western settlers. That also displays exploitation in the co-management of resources and the environment – Indigenous knowledge exploitation is a perfect case.

Consequently, it reproduces the disparity in decision-making on critical issues, absences during meetings due to financial and geographical obstacles, and values representation that usually strongly supports utilitarian ideals against the shared intrinsic forest values (Egunyu et al., 2020: 1158). Therefore, the study of Egunyu and her team could determine the constraints placed on community forests by multiple levels of government and industry and help us better understand the power interplay among critical actors in the process while identifying the included and excluded group through demographic composition (2020: 1158). Furthermore, at all levels of interactions, the state government’s values, norms, and priorities still supplant their engagement with the Indigenous representatives. This ploy is exclusionary stealth in the guise of representation and co-management in institutional governance. The Indigenous peoples’ exploration of new space and engagement in collaborative environmental management efforts face considerable challenges because colonial power structures persist and remain largely intact (Bowie, 2013: 107). Therefore, unless the co-governance model involves Indigenous self-determination and influence in decision-making at all levels of participation, Indigenous peoples are mere guest performers in the circus of spectacular exclusion in Canadian society. Yet, inclusion is the famous or popular magic.

In summary, I found out that the dichotomy of exclusion emerged. First, the involuntary exclusion is consequential or unknowingly excluding oneself from the legacy of assimilation, particularly in the residential schools, the lived experiences of discrimination, racialization, and low socioeconomic status. An example of this type is less participation in formal public schooling. The second is systematic exclusion from legal and institutional instruments, such as public policies, judicial systems, healthcare, and other social structures. Overrepresentation in the criminal justice system and unequal representation in co-governance are good examples of this type of exclusion. Generally, this dichotomy of exclusion surrounds the mundane of Indigenous peoples.

It is undoubtedly a reality that the colonization project situated the Indigenous peoples – their families and communities – in significant harm, from past to present (Wotherspoon and Hansen, 2013: 28). Furthermore, Indigenous peoples’ ongoing racialization and periphery, resulting from various forms of discrimination and racism, manifest as social exclusion deeply rooted in government structures and all levels of institutional interactions. However, both processes of exclusion and inclusion are crucial to locating within practices and legacies frameworks associated with colonization, including the struggles to define and realize the distinct Indigenous peoples’ legal status and rights (Wotherspoon and Hansen, 2013: 22). Further, Wotherspoon and Hansen expound that policy documents and social analysis widely described that Indigenous peoples represent some of the most disadvantaged populations in Canada, yearning for self-determination differs from western notions of representation, integration, and success ( 2013: 27). Then, the insistence on those European-based ideas excludes Indigenous peoples within the space and core of public life maintained by forms of symbolic violence such as racism and discrimination to impose a western framework. At some point, laws are stealth exclusionary measures to sustain the dominant group’s ideologies, values, culture, and interests, while reinforcing racialization and reproducing marginalization.

While Canada is progressively diverse ethnically and racially and recognizes diversity and inclusion in governance, the exclusion project evolves and changes its form over time. The government must take an enormous step toward reconciliation with the Indigenous communities to seriously yield the calls to action reports. The 94 Calls to Action, a comprehensive compendium of solutions to the problems associated with the harmful repercussions of colonialism and residential school systems, is still waiting to be realized. Nevertheless, these concrete resolutions from the affected groups might lead to victims’ gradual recovery and healing. In addition, it challenges Canada’s global identity and reputation as an equal society. The legislative agenda, based on inclusivity and equity, must be enforced to the best capacity and efficacy of the government. Finally, the essence and spirit of the treaties between the white settlers and Indigenous peoples, recognizing the sovereignty of the Aboriginal population during the signing, must be revisited and reconsidered. Henceforth, Indigenous rights to self-determination could revive their autonomy in terms of land, identity, and political representation. Exploring Indigenous people’s journey or lived experiences of high socioeconomic status (high-SES) is a thought-provoking topic for future research.



One thought on “Exclusion in Healthcare, Education, and Governance: Racializing and Positioning Indigenous Peoples at the Margins of Canadian Society

  1. Pingback: Exclusion in Healthcare, Education, and Governance: Racializing and Positioning Indigenous Peoples at the Margins of Canadian Society — Thoughts and Insights | Barbara Crane Navarro

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