Shifting thinking about Indigenous health
When Dr. Alika Lafontaine talks about innovation in Indigenous health, he doesn’t talk about biotech, digital health or new medical technologies. Instead, he talks about shifting mindsets.
“I think one of the most innovative things we could do is move beyond just talking about equity and equality, to actually articulating what that looks like.”
Listing off the concepts embraced by many health care systems (safety, quality improvement, patient-centred care, the medical home), Dr. Lafontaine says very few are being applied to Indigenous health.
“When you do a comparison of what we would accept in the mainstream versus what we would accept within our Indigenous health services, it’s pretty clear that we accept things we would never accept in the mainstream,” says Dr. Lafontaine.
Challenging this paradigm was one of the reasons Dr. Lafontaine got involved with health transformation work in 2014, as the lead for the Indigenous Health Alliance project, and he will be sharing the approaches and solutions he learned from that project at the CMA Health Summit in August.
“One thing we really pushed against was a belief that nothing could ever change, and the status quo was the only option,” he explains. “Two years later, everyone believed in change. So the fact we moved from hopeless, to hopeful, was an enormous success.”
The goal of the Alliance was to help territorial and provincial Indigenous organizations learn “the language” of health transformation and to move forward projects on their own. And it’s working.
In this year alone, both the Manitoba Keewatinowi Okimakanak and the Nishnawbe Aski Nation signed agreements with the federal Indigenous Services Ministry to undertake health transformation in their own communities.
“We are just at the beginning of the arc of change in Indigenous health, and the reason there is even possibility is because there is hope there now,” says Dr. Lafontaine.
He says the next step is challenging mindsets in mainstream medicine. As an example, he points to the practice of only discussing Indigenous health access within the frame of social determinants of health.
“We can talk about housing, we can talk about water, we can talk about food security, and those things are important. But when it comes to what we can really control in the health system, we can’t control any of those things. So, we end up wasting a lot of our space and energy talking about things we can’t control,” explains Dr. Lafontaine.
“When I am looking at innovation, I am looking at the innovation to recognize what our limits are, the innovation to recognize what we can and cannot change, and the innovation to take existing innovations, and bring them into Indigenous health.”
Dr. Lafontaine says the broader health community also needs to shift mindsets about its role in Indigenous health care, a need he’s hoping to address with the founding of a design lab called Alignment by Design.
“When there’s a national health emergency, it’s common for major health associations in Canada to say something publicly, but that doesn’t always happen on Indigenous health,” says Dr. Lafontaine.
“People often feel like they don’t have the right to comment, and I think if you are looking at things that have never been done before, you have to ask ‘Why don’t all these other groups feel like they have ownership of the problem? Why do they feel restricted?’”
Despite all this, Dr. Lafontaine sees more possibilities than problems, mainly because Indigenous patients are now telling their own stories about the health system and are refusing to accept the status quo.
“With the advances in technology and the way we transfer knowledge these days, it’s now achievable to create change in systems, and change mindsets, without needing these enormous platforms we used to need. Patients, especially Indigenous patients, are feeling more and more that they have a voice, and that they can come out and talk and people will actually listen. And because of that, that’s why I think change can happen.”