The State of Indigenous Health in Canada — Dr. Evan Adams

Alex Maheux:

Hi. Welcome to the CHIP, the Canadian Health Information Podcast. I’m your host, Alex Maheux.

In this show from the Canadian Institute for Health Information, we’ll give you an in-depth look at Canada’s health systems and talk to patients and experts you can trust. Join me as I go beyond the data to find out more about the work being done to keep us all healthy.

Today, I’m talking with Dr. Evan Adams, who is Coast Salish from Tla’amin First Nation near Powell River in British Columbia. Dr. Adams is a renowned physician, a public health expert, and an actor you might recognize from many popular TV shows and movies.

We’re sitting down with Dr. Adams to discuss Canada’s first National Day for Truth and Reconciliation, how residential schools have left a lasting impact on Indigenous health, and how his personal experience has affected his desire to help and to heal.

In these most uncertain times, we find ourselves connecting remotely from across the nation. I’d like to collectively acknowledge the lands we all occupy, whether treaty or unsurrendered.

As a reminder, the views expressed by the guests of the Canadian Health Information Podcast do not necessarily reflect those of the Canadian Institute for Health Information.

Hi, Evan. Welcome to the CHIP. Thanks for joining us today.

Evan Adams:

Hi, Alex. So nice to see you.

Alex Maheux:

I have to say, it’s not often I get to sit down with a doctor, a public health expert, and also get to say that I’m a fan of their movies. Anything lined up for a third career?

Evan Adams:

I hope not. Oh, my gosh. I hope I get to sit around very soon.

Alex Maheux:

I hope that for you too.

Well, I want to ask you how you’re doing, given your role as the Deputy Chief Medical Officer of Health for Indigenous Services Canada. I’m curious. It’s been a difficult year for everyone. But how have you experienced, you and your team experienced COVID?

Evan Adams:

Well, definitely, my team is getting tired, and I’m hearing that teams all over the country — mostly clinical teams — are getting pretty tired. So, I do think that one of the major pieces of work as we deal with COVID is to ask the workforce, how can we help you stay, how can we keep you happy; we know that you went all out for the last 19 months, but how can we do better.

I’m definitely a bit droopy. I think I was pretty strong up until maybe a month-and-a-half ago, and I’m starting to feel the wear and tear of it. It really has been 80-hour weeks for months and months and months with virtually no breaks, virtually no vacation, because it’s a world-wide pandemic. It’s a really important time to be focused. Yeah.

Alex Maheux:

There’s no breaks from it. Well, thank you very much for your hard work during such a difficult time.
The first official National Day for Truth and Reconciliation on September 30th is an important milestone, but it comes during a very heavy year. Many people are still processing the recovery of multiple mass graves at residential schools this summer and learning more generally about the horrors and pain that Indigenous people in Canada have endured.

I know that for me personally, it’s been hard to understand that residential schools were still operating when I was still in school. I’m wondering if you’d be willing to share your personal connection to the system, and maybe how that’s impacted your life and your career.

Evan Adams:

Yeah, for sure. The residential school system has been running for, actually, at least 6 generations, so it’s long established and its effects are long established, and I certainly was aware of it in my extended family. And in my immediate family, both my parents went to residential schools. My mother from Grade 2 to Grade 12, and before that, she was in an Indian hospital for 2 years. And my father went for a single year when he was 15.

So, my father’s early life was defined. My father was an orphan, and so his maternal grandmother — and he said she was a very honest woman, I have no reason not to believe her — she said she felt would die without me. So she kept him, and she wouldn’t surrender him to the residential school system. And so, his early life was moving around so that they wouldn’t take him. And finally, when he was 15, he was found and sent away. But in his mind, he was a man. And he met my mother there, and they’ve been together ever since.

So yeah, they were 15 and 12, if you can imagine.

Alex Maheux:

Wow.

Evan Adams:

And my dad turns 85 soon, and my mother is 80–81, so.

Alex Maheux:

That’s quite the story.

Evan Adams:

Yeah. I can’t believe it. So, definitely they had stories about how horrible it was, particularly for my father. Absolute silence from my mother about what happened to her in her many years there.

And these recent discoveries of these unmarked graves has definitely reminded all of us about that very important chapter in Canadian history. It was heinous. And I think for many people, hurting children is hard to contemplate, and so their reaction is to deny it. Maybe that’s what’s happened before. But now, with the graves, it’s hard for us to deny it. But I do think some are already minimizing what those graves mean.

Alex Maheux:

So you obviously have a very direct connection to residential schools. Do you think that that’s impacted your wanting to go into medicine and help people?

Evan Adams:

I should have mentioned, I was part of the Truth and Reconciliation Commission. I was one of the honorary witnesses. And that was definitely in part because I’m a doctor. And when I was younger, I was quite aware that my mother’s father had TB, and why my mother was sent to a TB hospital, I don’t know. And my father was orphaned by TB. Yeah. Definitely, those experiences shaped why I wanted to go into medicine. I wanted to help, and I was very aware that so many of my extended family had really difficult lives.

The residential schools scarred minds and spirits, not just bodies. I think it’s really important for people to remember that that trauma inflicted upon them was long-lasting. So I really don’t tolerate people minimizing it. In fact, residential school minimizers always get a response from me. I feel like it’s part of my duty from being a part of the Truth and Reconciliation Commission and being an honorary witness.

I talk about residential schools and I’m really glad to because, of course, I love my parents, and they deserve better lives than they got, and everyone should know it. It’s an important part of Canadian history.

Alex Maheux:

You talked about the maltreatment of Indigenous people and how that is still happening to this day. I think it’s also important to mention that residential schools have had a lasting impact on Indigenous people, and also, that systemic racism exists in the health care system, still to this day.

Evan Adams:

Yes, that’s right. And that’s an important part of my work.

I used to think of it as decolonizing the system so that people wouldn’t have colonial experiences going into health institutions when they needed help. Sometimes Indigenous people used to, and maybe still do, go into a hospital and be demeaned or humiliated or blamed or told off, just when they needed help the most.

And I thought, why does that occur? That should not be happening for people. So, I was thinking of decolonizing the system, but really, it’s antiracism work. For us to realize that some of the structures that we’ve inherited, including our workplaces, can be inherently racist.

And I remember, in the midst of my training, an orderly just speaking quite racistly, and frankly, just to everyone in the workplace like it was normal. And I said to him, I don’t think you’re allowed to speak like that. In fact, I think maybe it’s not even legal. So maybe just drop it. And then he backpedaled like crazy. I guess no one had every called him on it in his workplace.

And that’s really just an example of kind of a systemic antiracism that needs to be — well, first of all, we need to be able to identify it, and then knock it out of the way. Because health equity, equity of outcomes, and not harming patients is part of the work.

Alex Maheux:

Absolutely. Well, and you’re talking about this as a whole structure, but ultimately what we’re talking about is personal stories and the impact on individuals.

I’m curious as to your thoughts on how important is the need to collect both stories and data in order to have a more comprehensive understanding of Indigenous health in Canada.

Evan Adams:

Yeah. Stories are data, and I had a really interesting experience of that recently, meeting with a group of Indigenous physicians. I was meeting with them once a week during the time of COVID for the last 18 months, and as we spoke together — we were supposed to be talking about COVID, but we kept hearing from each other about some bad experiences they had in the midst of their training.

And so, there’s no data on negative experiences by Indigenous medical trainees, but by talking together, it was very clear that things had happened to them, in fact, to all of them, to all of us, that were pretty egregious, like not cool, that should not be happening. And we decided that we would take a closer look at that and that we would alert the medical schools, that this seemed to be a common story. It’s not data, but it’s a common story from all of us.

So how do we look at antiracism in the midst of medical training? So a very specific look at antiracism, a very specific look at a certain set of structures, medical schools, and we found those. And of course, in public health, which I’ve been working in for the last 14 years, collecting Indigenous-specific data lets us know how we’re doing; we, the structures that are supposed to look after people, how we’re doing as marginalized populations or populations that live on the edge of the dominant culture. But it also lets us know what the differences are. And if you know the differences, then you can take action.

And I just look at the very simple example that men and women have very different lives, and we need to make room for that. It’s really important to be able to speak fluently about the different roles of fathers and mothers within a nuclear family, let alone diversity within those families, let alone about —

Alex Maheux:

That’s quite a big extra layer.

Evan Adams:

Yeah. That’s right. And there are lots of different kinds of families. Why can’t we talk about those, where there’s more or something different than one mom and one dad.

Alex Maheux:

Absolutely. One of CIHI’s missions is to measure and to compare what’s working in our health care systems and, obviously, what’s not.

What are some of the unique circumstances that need to be considered in Indigenous communities? And maybe how can things be improved? Realize that’s a big question for you.

Evan Adams:

No. That’s great. I think COVID has really sharpened the point on this, that we need to be able to see those differences. We know from looking at the data that First Nations people, for instance, have an active case rate 3 or 4 times higher that of other Canadians. And so we ask, why is that.

And I think some of the early answers were actually kind of blamed on Indigenous people; they must be going out; they must be skipping vaccination. And then we had to go back to our basic principles to say, well, actually, blaming the patient all of the time is not helpful and it’s very simplistic. Usually, when marginalized people are overly affected, it’s because of the social determinants of health.

And so, marginalized populations all over the world don’t have similar genetics or similar physiologies; they have similar social context where there is a lack of equity, where there is racism, where there’s poorer access to the social determinants of health, things like clean water for good hygiene, things like adequate housing so you’re not overcrowded. And being overcrowded in the midst of COVID can be disastrous.

And a number of other issues like burden of disease. If a marginalized group is sicker than the dominant group, then they’re going to do worse in the midst of a communicable disease event like COVID.

So, it’s just a reminder that we need to look at all of the factors around people and not just blame them, which doctors actually can tend to do if they’re not in public health because they’re so overly focused on the single individual patient; what can the patient do to make themself well versus they live in a particular set of circumstances.

Alex Maheux:

Perhaps we all need a bit more humility. I want to ask another kind of large question, maybe a hard question for you.

What’s your hope for both the short and long term when it comes to Indigenous health in Canada?

Evan Adams:

I definitely would like for there to be parity. I think race-based outcomes are actually immoral, where more White babies survive than Indigenous babies, is unfair.

You must deal with that. And if you don’t want to deal with it, at least get out of the way so that we can deal with that kind of inequity.

A worst-case scenario is the structures protect themselves and say, well, we’re not going to do anything and we’re actually going to make sure that you’re not involved in this kind of situation. It’s not fair for race-based outcomes to be protected by institutions because they’re embarrassed or because they don’t know what to do. We have to be really honest and say this is an untenable situation. We can improve our services and outcomes, so let’s go there.

And second of all, what I dream about is the recognition that Indigenous peoples and Indigenous health are unique. There’s no need to melt it all together into Canadian approaches.

And I really saw this very frankly when I went to Hawaii, and there were Hawaiians and then there were mainlanders who came to Hawaii. Hawaiian culture and Hawaiian people are really very beautiful. Why would they forget Hula and the Hawaiian language, and everyone acts like they’re from New York? It just doesn’t make any sense whatsoever.

So, Indigenous peoples have ways of being and knowing, ways of being well, ways of dealing with how to take care of their minds and bodies and spirits, how to raise good, strong people. They have culture and language that should not be erased. And so, yeah, there needs to be room for that in the multicultural pluralistic success story that’s Canada.

Alex Maheux:

That needs to be embraced.

I guess on the flipside of that question, I’m curious. Is there anything that keeps you up at night?

Evan Adams:

I definitely have something that keeps me up at night and I’m still learning to enunciate it. It’s very easy to complain and be negative about some of the bad things that happen, and there are lots of bad outcomes in COVID. This massive an effort, there are mistakes, there are players who are not quite where they should be, efforts that weren’t perfectly successful.

And I wonder about my part in those. Am I doing enough? Am I smart enough? Am I fast enough? Am I strong enough? Am I contributing to inequities? I’m tired and maybe I shouldn’t be tired. And can I work better, not harder? Constantly reevaluating where I am to try and make things better.

Because there’s a way to play the game so that you can leave the game and say, I absolutely did my very best in that. And then there are other times where you come out of a game and you say, I just kind of faxed it in, or really, my head wasn’t in it. And so, yeah, so I’m constantly thinking. And I think many of us are feeling the same way.

I don’t know why, for instance, people who are afraid of the vaccine think that government or physicians are trying to do bad things when I know in my heart, I’m working really hard to do extraordinarily good things. And I lose sleep wondering, am I doing enough good? Is there more that I could do?

Alex Maheux:

I think the sheer fact that you’re evaluating and thinking about it means you are making things better and you are improving the system.

Evan Adams:

Thank you.

Alex Maheux:

If there’s one thing you’d want our listeners to know about Indigenous health that you haven’t mentioned, like one thing we’d want to leave our listeners with, what would it be?

Evan Adams:

I think the average Canadian, who doesn’t really learn a lot about Indigenous people except those really facile, very shallow stereotypes, doesn’t quite see the beauty of us. There are long-entrenched institutions and structures that stand between us.

So, for instance, none of my White friends would come on the reserve and see where I lived and would meet my family. And I think even my close friends didn’t have a strong idea of who we are. And I know, and it’s why I’m there working, my people are very wonderful and beautiful and warm and funny, and I love working with them, I love helping out. And I wish sometimes Canadians didn’t see us as a social problem or as their poor cousins down the road, that they would see us truthfully in our complexity. And in that complexity is a lot of beauty and honour and resilience.

Alex Maheux:

Evan, thank you so much for joining us. Thank you for sharing your stories and your heart with us. And we look forward to talking to you soon.

Evan Adams:

Thanks, Alex, and thanks for the chance.

Alex Maheux:

Thanks for listening. Check in next time when we bring you more valuable health care topics and perspectives.

If you want to learn more about CIHI, visit our website, cihi.ca. That’s cihi.ca. And if you like what you heard, subscribe where you find your podcasts and give us a follow on social media.

This episode was produced by Sushanna Smith, and our Senior Producer is Jonathan Kuehlein. I’m Alex Maheux. Talk to you next time.

<End of recording>