Indigenous-led health care partnerships in Canada

The CMAJ runs a monthly print version of their weekly online journal, and this excellent analysis deservedly ran as the cover story for their June 2020 issue. I was moved to see this timely analysis of systemic anti-Indigenous oppression and the early steps taken towards eradicating anti-Indigenous barriers in modern Canadian health care on the cover of the national medical journal. And yet, I was shocked. What lay before me was an obstructed view of the cover photo; an Indigenous Elder’s face exactly blocked by a permanent half-cover pharmaceutical ad for Lixiana. Not only have drug companies historically failed our most marginalized communities in Canada, they also represent an antithesis to traditional knowledge, therapies, and healing practices. This construct of Indigenous practices as scientifically inferior continues to influence deeply held stereotypes that perpetuate discriminatory health inequities against Indigenous peoples. What ensued was an attempted correspondence between myself and the editor-in-chief, Dr. Andreas Laupacis, to acknowledge and reconcile this oppressive handling of an important analysis. Although Dr. Laupacis insisted the permanent half-advertisements had been cancelled in March, I argued for the importance of public accountability as a means of creating space for owning discriminatory harms and resolving to strengthen anti-discrimination policies. Notwithstanding expressed support from the authors of this analysis to publish my response, Dr. Laupacis relayed that the letter would be irrelevant to online subscribers as they "won’t have a clue what you are talking about in the letter.” Despite redundant efforts to have this letter reach a broader audience and engage a larger dialogue about Indigenous representation, Dr. Laupacis told me to not “always assume maliciousness when simple stupidity could explain something that is dumb or insensitive.” We could chalk thousands of years of oppressive and racist behaviour up to "simple stupidity", or we can own our unconformable mistakes and resolve to eliminate health disparities and dismantle anti-Indigenous rhetoric. Learning and healing will take more than cancelling the sale of permanent half-page advertisements; we need to transform society by outwardly challenging oppressive ideologies and systems, and acknowledge when we get it wrong. To not do so maintains the status quo, perpetuating trauma and undermining health equity. To not do so says that what happened doesn't matter. To quote the 2015 Calls to Action of the Truth and Reconciliation Commission of Canada, those who can effect change within the Canadian health care system must recognize the value of Indigenous health practices. If these types of dialogues are considered futile by the editor-in-chief and irrelevant to readers, then we must ask ourselves to what are we subscribing? I implore the CMAJ to take their national responsibility seriously.