Background
In the early twentieth century, the Canadian federal government established a sprawling system of racially segregated medical institutions to treat First Nations and Inuit peoples across the country. Prior to this, little – if any – Western medical care was available to Indigenous peoples outside the traditional missionary or church settings.
The introduction of “Indian Hospitals” was spurred, in part, by the panic over rising tuberculosis (TB) rates in Indigenous populations in the 1900s-1930s. To quell concerns from the greater public, the federal government initially established a mobile nurse visitor program in 1922, followed by on-reserve nursing stations in the 1930s. Despite this, the establishment of separate, isolated treatment facilities for Indigenous peoples suffering from TB remained a key topic of debate among health officials, which led the first “sanatorium,” the Coqualeetza Indian Hospital, opening in Sardis, British Columbia, in the mid-1930s.
“Indian hospitals emerged from deep anxieties about Aboriginal people and their perceived threat to the public’s health.”
Separate Beds, Maureen K. Lux
The government-imposed system of Indian Hospitals soon expanded aggressively in the post-WWII era, with 29 institutions and over 2200 beds by 1960. In Manitoba, six Indian Hospitals and one sanatorium operated in the twentieth century. Today, two federally-run (former Indian hospitals) remain.
Though never consulted about their creation or location, some First Nations communities interpreted the creation of Indian Hospitals as the state’s concrete, if belated, recognition of its legal and treaty responsibility for health care. Others were hopeful Indian hospitals – particularly those located near or on-reserve – could provide long-sought relief from the socioeconomic conditions of deep poverty and ill-health.
“It is a ‘powerful fiction’ then as now, to treat as distinct and unrelated two enduring twentieth century narratives: the progressive march towards improved health care for Canadians and the seemingly intractable ill-health in Aboriginal communities.”
Separate Beds, Maureen K. Lux
In reality, Indian hospitals were chronically understaffed, the staff onsite were often undertrained (at times unlicensed), overcrowding was rampant, and Indigenous peoples often experienced experimental, painful, and disabling treatments. Practices seen as not permissible in a general hospital setting – such as the physical restraining of patients and non-consensual sterilization – were considered common practice at Indian hospitals. Indian hospitals may have reflected the changing role of health care in an emerging welfare state, but they remained firmly rooted in persistent, centuries-long government policies that sought to “protect,” civilize, and assimilate Indigenous peoples.
Policy Shift
In the early 1960s, the federal government recognized, to a certain degree, the serious deficiencies of the separate “Indian Health Service,” housed in the Department of National Health and Welfare, and its accompanying segregated hospitals. Indian hospitals remained underfunded and understaffed with public funds being directed to build, equip, train, and staff modern (non-Indigenous) hospitals across the country. Resistance to the closing of Indian hospitals grew as many, particularly those near or in First Nations communities, had become valued institutions. The federal desire to close such institutions was viewed by First Nations as a government attempt to sever their promise of health care represented by the “medicine chest.” Also threatening, was the introduction of national health insurance (Medicare) in 1966, which would absorb First Nations into provincial programs, ultimately dissolving the links between the economic and political roots of ill-health on reserves and the state’s responsibility for health care. Activism coalesced to protect Indian hospitals as the only concrete acknowledgement of the Crown’s legal and treaty promise.
First Nations Resistance & Resilience
In 1979, the Indian Health Transfer Policy was introduced, partly in response to the determined resistance by First Nations to the Government of Canada’s attempts to shift their responsibilities to the provinces, evidenced in the North Battleford Indian Hospital protest, and later, the Sioux Lookout Zone Hospital hunger strike. The transfer policy pledged to preserve the “special relationship” between Canada and Indigenous peoples while striving to, “achieve an increasing level of health in [First Nations] communities, generated and maintained by the [communities] themselves.” The transfer policy was, and at times still is, considered warily: is the policy, couched in self-determination, merely another way for the federal government to offload responsibility for health care, this time onto the shoulders of First Nations communities themselves? Others question how merely the transfer of health governance to communities alleviates ongoing social, economic, and environmental sources of poor health outcomes.
Despite reservations, the last Indian hospital was either closed or converted to desegregated institutions by 1981. By the 1990s, many First Nations communities had regained some limited autonomy in health care, and Indigenous-informed medicine re-emerged notwithstanding the years of state assimilationist policies that sought to effectively eliminate it.
More recently, First Nations and Indigenous-led health authorities have asserted their right to self-determined health care. Several federally-run health care facilities have been transferred to local community control, such as the Sioux Lookout Meno Ya Win Health Centre in Sioux Lookout, Ontario and the All Nations Healing Hospital in Fort Qu’Appelle, Saskatchewan. Both First Nations administered health care centres report high levels of patient satisfaction, are recognized for their excellency in care provision, and have been successful in closing health care gaps and introducing culturally competent care.
The harm and systemic failure of Canada’s “Indian Hospitals” live on. In January 2018, former patients of the hospitals filed a $1.1 billion class-action lawsuit against the federal government. In January 2022, the class action was certified. The claim includes 29 hospitals, including all six Indian Hospitals from the province of Manitoba.