Bridging the Gap: Indigenous Health Equity Across Ontario and British Columbia

Collaborators:

Noor Shawkat, Medical Laboratory Technologist (MLT), Ontario

Banveen Bhullar, Nuclear Medicine Technologist (NMT), British Columbia

Each case we are made aware of in Ontario and British Columbia is more than a clinical picture, and it is a person’s story that is influenced by the place where they live, the history that they carry with them, and the system they come into contact with. For Indigenous Peoples in Canada, this story continues to be one of harm due to colonialism, system-based inequities, and barriers to culturally safe care, as noted by Indigenous and Northern Affairs Canada and the National Collaborating Centre for Indigenous Health in 2022. Both provinces have Indigenous populations receiving care within them, but the very different organizational structures and governance of the two systems create very different pathways to care and more flexible care pathways and access options, consequently resulting in distinct experiences for those receiving care.

The First Nations Health Authority (FNHA) in British Columbia is a shining example of Indigenous-led health governance, and the FNHA provides First Nations communities with real voice and control over health services that are based on their priorities and combine clinical care with traditional wellness (FNHA, 2022–23; FNHA, 2023–24). This approach means things like programs for rural and remote communities, virtual care, and culturally safe navigation supports, while at Fraser Health, all new employees receive training on Indigenous history and cultural safety that supports care that is relational, respectful, and safer for patients (Fraser Health, 2021; Fraser Health, 2024).

In contrast, there is no single Indigenous-governed health authority in Ontario, rather, support is provided through frameworks, partnerships and regional initiatives (Ontario Health, 2022). However, these resources create real gaps, as many Northern and fly-in First Nations communities lack access to diagnostics, specialists and even primary care (Drazenovich, 2025; Mahabir et al., 2021), and systemic inequities and discrimination also continue to affect health outcomes (Drazenovich, 2025; Mahabir et al., 2021). Moreover, these same structural barriers also affect how we read and interpret lab results in our own work (Drazenovich, 2025; Mahabir et al., 2021).

The data also describes the challenge, and nationally, 20.3 per cent of First Nations people living off reserve did not have a regular health-care provider from 2017 to 2020, while that was 14.5 per cent for non-Indigenous Canadians (Yangzom et al., 2023). In Ontario, ICES found a similar pattern, because about 80 per cent of First Nations people living off reserve had a primary care doctor, compared with 93 per cent of non-Indigenous Ontarians (ICES, 2023). These disparities have very real consequences, since without stable primary care, follow-up on tests can lapse, continuity can be disrupted, and trust is more difficult to establish and maintain.

Both BC and Ontario have adopted goals of cultural safety and health equity despite their different health care systems, and in BC, the commitment to cultural safety and health equity is integral to the organizational structure. The clinics, such as Fraser Health’s Indigenous Primary Health & Wellness Clinic, are integrated into community care because the Fraser Health Equity, Diversity and Inclusion Strategy (2023–2028) defines the expectations for respect, accountability, and culturally safe practice in the delivery of daily care (Fraser Health, 2024). In Ontario, cultural safety frameworks are in place, however, implementation is uneven, and the legacy of discrimination continues to have an impact on the experiences of care and the care outcomes (Mahabir et al., 2021).

These structures guide routine lab and diagnostic care. Socio-economic factors of income, housing, and education determine who gets sick, who has which biomarkers, and who can return for follow-up, as noted by the Public Health Agency of Canada in 2022. In BC, lab delivery is often offered by Indigenous-led systems in culturally grounded, trust-based settings that foster engagement and outcomes, according to Borras in 2023. While in Ontario, technologists work in a more fragmented system, where they read results in social context, but also with historical trauma and systemic inequity in mind when interpreting findings, as discussed by Drazenovich in 2025.

At the end of the day, our work is very similar, even if our provinces and systems are different. As health professionals, we do more than read lab numbers, we interpret diagnostic data with fairness, cultural humility, and awareness of history. Lab values never exist on their own; they are shaped by social, political, and structural realities. When we look at a result, we also look at the story around it, this means we do more than provide numbers. We use them to help create meaningful and equitable care paths for Indigenous communities.

Bridging these regional differences requires both system-level change and personal commitment. Whether through Indigenous-led initiatives in BC or culturally reflective practice in Ontario, we are working toward the same goal. We aim to make diagnostics a tool for health justice, rather than a source of clinical data alone.

References:

Borras, A. M. (2023). The challenge of exposing and ending health inequities in Canada: Class, race/ethnicity and gender. Canadian Journal of Public Health. https://journals.sagepub.com/doi/10.1177/27551938221148376

Drazenovich, G. (2025). Discrimination in health care: A scoping review of the Ontario experience. HHR Journal, 27(1), 27–41. https://www.hhrjournal.org/2025/06/13/discrimination-in-health-care-a-scoping-review-of-the-ontario-experience/

First Nations Health Authority. (2022–23). Annual report 2022–2023. https://www.fnha.ca/Documents/FNHA-Annual-Report-2022-2023.pdf

First Nations Health Authority. (2023–24). Annual report 2023–2024. https://www.fnha.ca/Documents/FNHA-Annual-Report-2023-2024.pdf

Fraser Health. (2021). Aboriginal Health Strategic Plan 2019–2024. https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Topics/Aboriginal-Health/Cultural-safety/Aboriginal-Health-Strategic-Plan-2019-2024.pdf

Fraser Health. (2024). Fraser Partnership Accord – 2023. https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Topics/Aboriginal-Health/Cultural-safety/Signed-Partnership-Accord-2023-FSRCFHAMNBC.pdf

Government of Canada. (2024). Social determinants of health and health inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

ICES. (2023). First Nations and primary care use in Ontario: A report on access and disparities. Institute for Clinical Evaluative Sciences. https://www.ices.on.ca/wp-content/uploads/2023/06/Full-report-28.pdf

Indigenous and Northern Affairs Canada & National Collaborating Centre for Indigenous Health. (2022). Understanding Indigenous health inequalities through a social determinants of health lens. https://www.nccih.ca/Publications/Lists/Publications/Attachments/10373/Health_Inequalities_EN_Web_2022-04-26.pdf

Mahabir, D. F., O’Campo, P., Lofters, A., Shankardass, K., Salmon, C., et al. (2021). Experiences of everyday racism in Toronto’s health care system: A concept mapping study. International Journal for Equity in Health, 20(74). https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01410-9

Ontario Health. (2022). First Nations, Inuit, Métis, and Urban Indigenous health framework. https://ontariohealth.ca/content/dam/ontariohealth/documents/fnimui-health-framework-report.pdf

Public Health Agency of Canada. (2022, July 7). Inequalities in health of racialized adults in Canada. https://www.canada.ca/en/public-health/services/publications/science-research-data/inequalities-health-racialized-adults-18-plus-canada.html

Yangzom, K., Masoud, H., & Hahmann, T. (2023). Primary health care access among First Nations people living off reserve, Métis and Inuit, 2017 to 2020. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/41-20-0002/412000022023005-eng.htm