Equality versus equity: Barriers to health care access for Indigenous populations in Canada
Abstract Canada's universal and publicly funded health-care system aims to promote universal and equitable access to care based on the needs of individuals, rather than on their capacity to pay for these services. Despite these principles, some groups, such as Indigenous peoples, experience significant and persistent social inequalities in health compared to the general population. This situation results from the continuing impacts of colonialism, which has an undeniable influence on social determinants of health, including access to care. This is surprising for many health professionals because it contradicts the democratic ideals of justice and equality that underlie the health-care system, as well as the rhetoric of their professional practice which asserts that 'everyone is treated the same'. Based on literature and on research findings, this presentation will demonstrate several ways in which a universal and homogeneous approach to health-care can contribute to creating social inequalities in health for Indigenous populations. First, health professionals tend to favor socially and culturally neutral practice, which can hinder the recognition of the influence of historical and socio-cultural factors on patients' health. This kind of practice may encourage a distorted reading of patients' issues and can lead to inappropriate responses. Second, a homogenous approach to care refers by default to health-care models and practices that are rooted in values and perspectives of the dominant culture, which contributes to the provision of culturally unsafe care for Indigenous patients. Finally, this type of approach overlooks the critical and specific needs of vulnerable groups, who often require more than the general population to achieve the same results. We will conclude by outlining some potential solutions, mainly how cultural safety as a transformative approach to care allows health professionals to better consider the needs and cultural identity of Indigenous patients.