COVID-19 and Indigenous children in Canada: What can paediatricans do?

By Ryan Giroux MD, Cindy Blackstock PhD, Radha Jetty MD, Susan Bennett MD, Sarah Gander MD

Many First Nations, Métis, and Inuit children and families are facing a colonial catch-22 when it comes to COVID-19. Enduring colonial legacies mean they are more prone to pre-existing conditions, placing them at higher risk for poor outcomes from the virus. At the same time, many of their communities have inequitable resources to respond to the virus and to the disruptions caused by public health measures.  To make matters worse, cultural practices that are core to resilience and wellness—such as Elders looking after children—have also been disrupted. 

With COVID-19 amplifying inequities for many marginalized groups in Canada, these gaps will continue to widen without coordinated action between communities, Indigenous leaders, health providers, and governments. During this pandemic, paediatricians must be aware of the specific challenges that exist for Indigenous children and how they can contribute to their patients’ well-being.

Have we learned from the past?

Past pandemics and epidemics foreshadowed the higher risk Indigenous peoples have to COVID-19. European settlers brought foreign diseases to the Americas, leading to the deaths of over 90% of Indigenous people. In the early 20^th century, Dr. Peter Bryce, Chief Medical Health Officer of the federal Indian Department, found that tuberculosis outbreaks in some residential schools resulted in death rates of up to 69% of children—a direct outcome of inequitable health care funding and poor health conditions. The Canadian government systematically silenced this evidence, and First Nations and Inuit people (including children) continue to have tuberculosis rates significantly higher than other groups.

More recently, the H1N1 pandemic in 2009 saw higher proportions of Indigenous children hospitalized and in intensive care, as well as higher mortality among all Indigenous people. These outcomes were also linked to poorer underlying health status, challenges in accessing health care, as well as systemic inequities. Despite the lessons from past pandemics, Indigenous families and communities continue to lack basic necessities: clean water, access to health services, and adequate housing, among others.

Why Indigenous children need a special focus

While in general, children tend to have fewer direct health consequences from COVID-19 than older people, they bear a heavy burden due to the public health response and outcomes. Indigenous communities, particularly remote Inuit and First Nations, also face heightened vulnerability during a crisis situation because of the cumulative effects of compounding emergencies (see, for example, Auditor General of Canada, Spring 2015). Table 1 shows how challenges multiply to create difficulties for Indigenous children and families.

Supporting Indigenous children in your practice

Paediatricians often advocate for both individual patients and families as well as specific populations. The Canadian Paediatric Society supports the Many Hands, One Dream Principles  that describe principles of effective advocacy for Indigenous children. The Truth and Reconciliation Commission Calls to Action (2015) is another sentinel document with 94 distinct recommendations for priorities and solutions that Indigenous communities have identified.

Here are some actions paediatricians can take to identify and support Indigenous children during COVID-19 and beyond.

• Promote a culturally-safe and trauma-informed care environment, and ensure patients and families can identify whether they have achieved safe health care.
• Learn about and address the structural inequalities and colonialism that undermine child and family wellness.
• Learn about each Indigenous patient and family’s background and work to understand how this affects their health needs.
• Screen children and their families for poverty, vulnerable housing, clean water availability, and other social determinants of health.
• Partner with Indigenous community organizations to help support high-risk families, through measures such as such as phone check-ins, mental health counselling, food delivery or grocery gift cards, or by ensuring the availability of internet and technology to maintain healthy relationships with isolated family members.

If a patient’s family member is at the end of life (due to COVID-19 or other causes), ensure there is a safe process for families and communities to complete ceremony and death protocols. Help coordinate competing interests from communities, health care institutions, and other Indigenous health organizations.

Not all the same: Patient-level advocacy for specific groups of Indigenous children during COVID-19

Advocacy for Indigenous children requires an understanding of the similarities and differences between and within First Nations, Métis, and Inuit communities, and specific populations within these groups. “Pan-Indigenous” approaches fail to capture how these distinct differences affect child health. For example, the federal government funds public services on reserves, whereas provinces/territories fund these services off reserve. Repeated reports by the Auditor General of Canada and repeated decisions by the Canadian Human Rights Tribunal point to significant and ongoing inequalities in the funding of these services. Table 2 describes distinct challenges for specific groups.

COVID-19 has highlighted existing structural inequities and created new challenges for Indigenous children, families, and communities. Despite this, Indigenous families and communities have remained resilient and have raised strong and healthy children for thousands of years. Paediatricians must contribute to justice for all Indigenous children during the COVID-19 pandemic in our offices and hospitals, and recognize continued advocacy will be essential after this crisis. If we fail to do both, then we fail to learn from yet another pandemic, and risk the health and well-being of First Nations, Métis and Inuit children and families across Canada.

Additional resources

• References and resources for health professionals on First Nations, Inuit, and Métis culture, history, current socio-political context, and healthcare provider clinical resources. Compiled by the CPS First Nations, Inuit, and Métis Health Special Interest Group.
• What paediatricians can do to support children and youth during the COVID-19 pandemic: Social Paediatrics Section, May 2020
• Local Indigenous service providers and organizations:
  • Friendship Centres
  • Community health centres
  • Aboriginal Health Access Centres (Ontario)
• Canadian Paediatric Society letter to Indigenous Services Canada re COVID-19

Ryan Giroux is Métis from the Métis Nation of Alberta and is a third-year paediatrics resident at the Hospital for Sick Children in Toronto.

Cindy Blackstock is a member of the Gitxsan First Nation who serves as the Executive Director of the First Nations Child and Family Caring Society and is a professor of social work at McGill University.

Radha Jetty is a general paediatrician at the Children’s Hospital of Eastern Ontario in Ottawa and is the chair of the Canadian Paediatric Society's First Nations, Inuit, and Métis Health Committee.

Susan Bennett is the Director of Social Paediatrics at the Children’s Hospital of Eastern Ontario in Ottawa.

Sarah Gander is a general paediatrician in Saint John, New Brunswick and President of the Canadian Paediatric Society’s Social Paediatrics Section.

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