Addressing anti-Indigenous racism in Canadian health systems: multi-tiered approaches are required

Interpersonal and structural racism is a significant contributor to pronounced and widespread health inequities affecting Indigenous peoples in Canada. Recent events surrounding the tragic death of Ms. Joyce Echaquan in Quebec have renewed attention to the devastating harms of Indigenous-specific racism. A recent series of meetings convened at the federal-provincial-territorial levels resulted in the identification of short- and long-term actions to eliminate anti-Indigenous racism. While these represent important starting points, we raise concerns about the shortcomings of these actions. In presenting our commentary, we highlight additional strategies and recommendations for embedding anti-racism into Canada's health sector, including a call to adopt anti-racism as a sixth pillar of the Canada Health Act. We contend that adding anti-racism to the Canada Health Act will prompt national dialogues, trigger the development of universal policies and programs to interrupt systemic and interpersonal racism in health systems, and be sustainable over time despite changes in governments and political ideologies. In taking this position, our aim in presenting this commentary is to intensify the dialogue in Canada regarding the need for multi-tiered, system-level efforts to address anti-Indigenous racism with the explicit aim of transforming healthcare cultures, policies, and practices in support of health equity and reconciliation.