Canada’s latest auditor general’s report reveals an uncomfortable truth: billions of dollars adn countless commitments later,the federal government still cannot demonstrate meaningful improvement in health services for First Nations.
As a family physician working in my First nation, Tyendinaga Mohawk Territory in southern Ontario, I see the evidence of this failure not in spreadsheets but in people-patients navigating a health system that remains structurally unequal.
Nearly 10 years after the Truth and Reconciliation Commission’s (TRC) Calls to Actionit is clear that reconciliation without accountability delivers only rhetoric, not care.
The report states: “Increasing First nations’ capacity to deliver programs and services within their communities is critical to improving outcomes for First Nations people and supporting reconciliation.”
Yet the same report concludes that the department has taken a “passive and siloed approach” to supporting First Nations. It found unsatisfactory progress on five of 11 recommendations first issued in 2015 regarding access to health services for remote communities.
Encountering racism
A decade later, Braiding Accountabilityshows that Canada remains mired in performative progress. Institutions have reached the “strengthen” phase-hiring Indigenous staff or creating advisory councils-but rarely the “change” phase, where Indigenous nations co-develop priorities, indicators and accountability measures.
Under Call 19, the report notes, the goal of measurable progress toward health equity is undermined by the “absence of Indigenous data sovereignty.” Rather, “institutions report on activities, not results, using settler-defined metrics that obscure ongoing inequities.”
as a medical educator,I see this mirrored in our training systems. Under Call 23, governments were urged to increase Indigenous representation in health professions.
Yet, braiding Accountability points to ongoing gaps in representation and a lack of meaningful data on weather Indigenous professionals are actually being retained or advancing into leadership. It notes that recruitment efforts frequently enough amount to a revolving door: institutions bring Indigenous staff into environments that remain unwelcoming, and then attribute their departures to supposed cultural issues rather than addressing the systemic problems that drove them away.
And perhaps the sharpest critique of all: Failing to shift authority and decision-making to Indigenous communities simply continues the very colonial dynamics that made the push for Indigenous health professionals necessary in the first place.
At Queen’s, through the Queen’s-Weeneebayko Health Education Programme-which I lead-we are trying to do things differently by building pathways for Indigenous learners to study in their own regions, guided by indigenous leadership and values.
The goal of this program is to transform who holds power in the health system.Okay, I understand. Please provide the source material you want me to rewrite. I will adhere to all the guidelines you’ve outlined,focusing on accuracy,clarity,and a conversational yet authoritative tone. I will prioritize authoritative sources, avoid fictionalization, and ensure the final output is well-structured, grammatically correct, and optimized for readability.
I’m ready when you are!
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