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Opinion: Primary health care for Indigenous Albertans still falls short

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Before Minister Adriana LaGrange’s announcement last Friday there was great anticipation from both Indigenous people and clinicians. We hoped for new money and meaningful support for primary care for Indigenous Albertans.

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Those unfamiliar with the background might be fooled into thinking that this announcement might even include Chief Crowfoot and Louis Riel in the delivery of a bright new penny for Indigenous health. But the $34 million falls far short of what Albertans were led to believe.

The province receives health-care funding from Ottawa for every resident — including Indigenous people — and $200 million for provinces specifically to plan, prioritize, and course-correct Indigenous health equity.

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But there is no accountability to Indigenous peoples of Alberta. No report on where these monies are used and for what outcomes. And certainly no elected community representation. This colonial model makes the Indian like a beggar at his own table.

Treaties 6, 7 and 8 as well as the promises of the 1934 Ewing Commission, which provides for services for the Métis people in Alberta, need to be understood and exercised; they are not mentioned or clarified in this announcement. Minister LaGrange said, ”No matter who they are or where they live, people in Alberta deserve reliable high-quality primary care. First Nations, Métis, and Inuit peoples … must have a health-care system that is built with them and meets their needs.”

The reality is that many Indigenous communities are geographically distanced from tertiary facilities, specialists and primary care. For Fort Chipewyan, which is five hours from Fort McMurray, a physician must fly in and fly out and must stay usually for days if not weeks to adequately serve the primary care needs of this population.

The community raises funds for physicians’ travel and housing. Otherwise it’s a $1,000 airfare or five hours by ice road or by boat to the nearest hospital. At Paul Band, one hour from Edmonton, patients have to hitchhike on the busy highway to access primary care; some have been killed on the road.

None of Alberta’s eight Métis settlements have a primary care clinic; it’s egregious we don’t even hear crickets. Nearly a decade ago, Telus donated a fully functioning mobile clinic for the Metis settlements but there’s still no physician to drive the five hours between communities to see patients then carry out their own orders because there is no nurse to do it.

The $2.9 million announced for Indigenous-led cancer prevention and screening initiatives? Cancer prevention, screening, diagnosis and treatment is highly dependent on the existence of primary care physicians. If there’s no primary care, there’s no access to any of this.

Sixteen million dollars was announced to support initiatives delivered through the Indigenous Health Division for Indigenous communities and not-for-profit organizations to recruit and train patient navigators to help patients access clinics, hospitals and community services.

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The gap that defies the intent of hospital physicians discharging Indigenous patients is there’s often nobody to receive and carry out the orders in the community. What good is a navigator if there’s nowhere to land your boat?

A 2023 advisory panel heard that even in cities with numerous care options, Indigenous people still chose not to visit community-based clinics, largely due to racism, stereotyping, transportation barriers, long wait times, and lack of culturally safe options. This announcement doesn’t come close to addressing the panel’s 22 recommendations.

Maybe worse, some of the $35 million seems to represent just a re-branding of this year’s federal funds received on behalf of Indigenous peoples, not a new investment.

Minister LaGrange promised $16 million next year to support 95 physicians to deliver reliable and accessible primary care in 18 communities and Edmonton and Calgary.

This sounds like new money and a new initiative. But the Indigenous Wellness Program Clinical Alternative Remuneration Plan was started by five doctors in 2012. I and other Indigenous and allied physicians recruited for under-served communities under a payment model focused on better care, not volume. This eventually grew to over 95 physicians, in a strategy fully supported by AHS and welcomed by Indigenous communities. It spread from a handful of communities to 45. The $16 million reported as new funding is old.

None of these developments are new, nor are they the concepts of this government.

In the minister’s words, ”More is needed; too many Indigenous peoples still face barriers to primary care. Too many avoid the system because they don’t trust it.”

This is absolutely true, minister.

Dr. Esther Tailfeathers is a family physician and member of the Kainai First Nation.

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