‘Closing the gap in disparities is not enough’

Dr. Nadine Caron, this years’ Chanchlani Global Health Research Award winner, challenges healthcare professionals to remove inequities, not just decrease them.

Closing the gap in disparities is not enough, says Dr. Nadine Caron, this year’s Chanchlani Global Health Research Award winner. 

The annual Chanchlani award recognizes the work of an outstanding scientist whose research impacts global health. 

A member of Sagamok Anishnawbek First Nation, Caron is the first female First Nations general surgeon in Canada. She is also the First Nations Health Authority Chair in Cancer and Wellness at UBC, and is a founding co-director and consultant of the UBC Centre for Excellence in Indigenous Health. 

She accepted her award on International Women’s Day, delivering her keynote address — Perspectives of a First Nations physician in Canada: Do you ever wonder what we think? — via Zoom, to a crowd of medical students, researchers, professors and health professionals.

“Picture the last federal election, municipal election, provincial election,” Caron asks the group.

“When you’re walking up to vote and a woman walked out of the polling station, did you cheer? Did you break down in tears? Were you amazed that a woman could vote, or did you just think that was her responsibility to vote because she’s a citizen? Did you not think that that was the norm, that if it was a male or female, did it matter to you at all? 

Caron says the definition of success in this context is when “you no longer hear that it’s a First Nations physician, but it’s a physician.”

“I think that’s important that we all are free to grow to our own potential… and that we give those messages to five year olds,” she says, adding that it’s also important to “give those messages to our politicians and to our community leaders and to those in our health care profession.”

In Caron’s speech, there were echoes of “The Other Side of ‘Being First,” a TedX Talk she gave on Dec 13, 2017, in which she talks about how equity and representation should be the norm — expected, rather than the exception. 

The problem with ‘closing the gap’

There’s a problem with trying to ‘close the gap’ in health disparities, Caron says. 

As an example, she points to the disparity between youth suicide rates for Indigenous youth and their peers — which has gotten smaller, but the disparity remains.

“The suicide rate for Status Indian youth has fluctuated over time, but shows an overall downward trend,” according to a joint 2015 report by the province and the First Nations Health Authority.

While the gap is closing on health indicators like youth suicide and infant mortality rates, the inequity persists. Image from Dr. Caron’s keynote address on Mar. 8.

 

To further illustrate the problem, she offers an anecdote, describing herself at five, wanting to catch up to her brother’s height. She did, and guess what? He had grown also. Finally she caught up, only to find now he wasn’t a child, but a teen. She hadn’t calculated his growth spurt. The goal posts have been moved. 

Health care is an innovation, Caron describes — technology advances, there are more tools, increased services and resources. It increases for Indigenous communities and individuals, but the gap remains. Again, the goal posts have been moved. 

“And that’s what we have to be careful about if we don’t set our goals properly. Let’s say that we’re going to actually not just aim to eliminate the disparities, but calculate into it, that moving goal post phenomenon,” Caron explains.

True equity removes the gap completely, and without others determining what’s equitable, she says. 

“Sometimes what I hear is you can be healthy … you can have the same education… you can have the same health care outcomes, but not better,” she says.

“When is it okay for one group of people to set limits on another, based on their own? When is it okay for one group of people —meaning in this case, the rest of Canada — to set limits on Indigenous people’s health status or access to health care or research or determinants of health based on their own [limits]?”

Changing the mindset of an entire profession 

Caron suggests reframing what we consider to be “visionary” and “proactive” as what’s expected and non-negotiable. For example, cultural safety and humility curricula should be a mandatory expectation, she says.

“Ten years ago, it was visionary. It was proactive. It was compassionate to have this type of curriculum in your schools. Now it’s expected. And quite frankly, non-negotiable. I don’t think you should be a healthcare provider in Canada, unless you have that training.”

To Caron, it’s a matter of moving beyond disparities, and refusing to accept gaps as an inevitable reality.  

“We’re more as Indigenous people than what we’re not. I think we’re more as a country than our disparities,” she says. 

“I think we need to move the entire dialogue into a space that’s powerful and enriching and empowering and something that means more than just fixing problems. It’s actually preventing them from the beginning.”

Bringing Indigenous ways and concepts of wellness and holistic health into clinics, practices and hospitals is one way of doing this, she says.

“I think we can bring our ways of doing research to improve the way that all Western institutions do research.”

Caron is setting a different expectation. 

“We will expect to be part of the solution, not just the subjects anymore. We don’t want to be just at the table, articulating what our problems are. We want to be partners and innovators. In fact, we want to be on the board, not just in the boardroom…at the top of the board.”

She invites her colleagues to envision the gap in health care outcomes as a chasm. 

“We’re talking about changing the mindset of an entire profession, of an entire nation in terms of what health and wellness means for Indigenous peoples in Canada and for all citizens,” she says. 

“You can’t cross the chasm in two small jumps. You’ve got to realize when sometimes it’s worth taking a running leap and getting to the other side.”

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