Physicians perceive themselves as caring professionals who want to do their best for their patients, but the experience of many Indigenous patients in Canada hasn’t borne out this perception.

In recent years, medical professionals and organizations have begun to acknowledge their role in harms caused by the healthcare system to generations of Indigenous peoples, including in a 2024 apology by the Canadian Medical Association (CMA).

The harms identified by the CMA include the Indian hospital system, in which Indigenous patients received substandard care and were subjected to abuse, experimental treatments, and forced sterilization. Although most Indian hospitals are now closed, the damage to Indigenous communities remains.

Other harms were inflicted by the residential school system, where medical experimentation, such as withholding necessary care and studying the impact of malnourishment, was conducted on Indigenous children. In addition, Inuit patients were forced to relocate to tuberculosis sanatoriums far from their homes and communities.

Ongoing Harms

In its apology, the CMA acknowledged that some harms to First Nations, Inuit, and Métis peoples continue to this day.

“None of this exists only in history,” Jaris Swidrovich, PharmD, PhD, assistant professor of pharmacy at the University of Toronto, Toronto, told Medscape News Canada. For Indigenous people, “it’s [still] happening to us, our relatives, and our communities.”

Incidents of forced sterilization of Indigenous women in Canada continue to be reported, according to a study by the Standing Senate Committee on Human Rights. A bill introduced in 2025 to criminalize this practice has not yet been passed into law.

In 2020, Joyce Echaquan, a 37-year-old Atikamekw mother of seven from the community of Manawan, died in a Quebec hospital after recording a Facebook Live video of racist behavior from hospital staff. A coroner’s inquiry determined that racism had played a role in Echaquan’s death.

These examples illustrate some of the harms that Indigenous patients face today. Research also shows that discriminatory attitudes and systemic challenges are common in the healthcare system. Supporting this finding, data from a recent Statistics Canada survey found that about 1 in 5 Indigenous people reported experiencing unfair treatment, racism, or discrimination from a healthcare professional over the previous year.

Surveys like this don’t show the whole picture because Indigenous patients who experience harm in the healthcare system may not be willing to answer a phone call from the government, said Swidrovich.

Mistrust can prompt Indigenous patients to avoid care, which directly affects their health, Terri Aldred, MD, family physician for Carrier Sekani Family Services in British Columbia and academic lead for the National Collaborating Centre for Indigenous Health, told Medscape News Canada. This avoidance, along with intergenerational trauma, has led to health disparities among Indigenous peoples, such as higher rates of chronic diseases like cardiovascular disease and diabetes compared with the non-Indigenous European population.

Nevertheless, “being Indigenous is not a risk factor for any of these conditions,” said Swidrovich. “There’s this perception that [Indigenous peoples] are unhealthy, which is completely false. The only risk factor here is racism.”

Reconciliation and Addressing Harms

Margot Burnell, MD, CMA president and medical oncologist, said that the association’s apology represents “the beginning of a journey with the Indigenous peoples to build back trust. Moving forward, it is critical to identify truth and work with Indigenous peoples toward self-determination with respect to the medical system.”

The CMA developed a ReconciliACTION Plan outlining its next steps, with guidance from a group of First Nations, Inuit, and Métis leaders, experts, elders and Knowledge Keepers. This plan includes providing funding to Indigenous-led organizations and initiatives and updating its code of ethics to strengthen provisions against racism and discrimination.

“Indigenous peoples are going to be looking at how we are doing,” said Burnell. “When their communities feel comfortable visiting health institutions and when they report no racism or discrimination, then we will have been successful.”

Aldred said that she appreciates elements of the CMA’s apology, such as “recognizing Indigenous peoples’ inherent right to be leaders or co-leaders in their health.” But “we’re probably not going to dismantle systems of oppression, particularly in our current challenging environment, within a year or 2.”

Culturally Safe Health Spaces

It’s going to take more than an apology for Indigenous peoples to feel like the healthcare system can provide care without prejudice and hold itself accountable, agreed Swidrovich.

There needs to be “zero tolerance for extreme acts of racism like forced sterilization, with consequences for people who have committed those acts,” he said. He also supports mandatory skills-based antiracist training for medical education programs and strict guidelines for health clinics and hospitals on tracking and addressing incidents of racism.

Culturally safe health spaces are also needed, he continued. These spaces could be as simple as a clinic with an Indigenous name, artwork, or imagery. But such a space would only be the beginning.

“If a clinic doesn’t have Indigenous employees, they could at least have some Indigenous consultants or work alongside people with lived experiences to inform their work,” said Swidrovich, “until they reach a point where they have Indigenous folks to lead or co-lead.”

Aldred pointed to recent successes in British Columbia. For example, the First Nations Health Authority is opening a series of First Nations-Led Primary Health Care Centres, and the province has a virtual services program that provides culturally safe care for patients who don’t have a family doctor or nurse practitioner.

In addition, clinics such as the Lu’ma Medical Centre in Vancouver are leading the way in taking a “two-eyed seeing” approach to primary care that incorporates both Indigenous and Western healing.

These kinds of initiatives must be made sustainable, but Aldred “imagines that eventually some of these safe spaces may start blending together as they grow.”

At the end of the day, “when we go to a provider, we all want to feel like we can trust what they say and that the system is going to serve us if we get sick,” she said.

Swidrovich, Aldred, and Burnell reported having no relevant financial relationships.

Shawn Radcliffe is a freelance health and science journalist based in Ontario, Canada, with more than 15 years writing about general health, medical research, mental health, and other topics for print and online publications. Prior to this, he did laboratory and clinical research, and research administration at universities in Philadelphia and Portland, Oregon. He has a master’s degree in science education from Drexel University.