Road to recovery: Cancer in the COVID-19 era
The disproportionate impacts on First Nations, Inuit and Métis
Colonialism and other determinants of health (social, economic, political and environmental factors such as lack of clean water, overcrowding, food insecurity, poverty, limited access to health care and systemic racism) have led to systemic and avoidable health inequities for First Nations, Inuit and Métis that have been further exacerbated by the COVID-19 pandemic.1
For example, First Nations, Inuit and Métis experience a disproportionate burden of chronic health conditions such as cardiovascular disease, diabetes, asthma and some cancers.2 These chronic conditions are the result of risk factors, the prevalence of which are driven in part by Indigenous-specific determinants of health such as colonization, the loss of traditional practices required for health and dispossession of land. Widespread and ongoing anti-Indigenous racism in the health-care system has also led to a legacy of mistrust among First Nations, Inuit and Métis, which negatively affects access to care.3 These factors contribute to poorer health status among First Nations, Inuit and Métis, which puts them at higher risk of experiencing serious complications if they contract COVID-19.4,5,6
During the pandemic, there have been specific challenges that have made it difficult for First Nations, Inuit and Métis to access healthcare services and advice:7,8
- Some First Nations, Inuit and Métis communities cannot fully implement health behaviours to prevent the spread of COVID-19, such as physical distancing and self-isolation, due to overcrowded housing.
- Those living in remote communities are less likely to be able to access timely health-care advice due to a lack of providers locally (or travel restrictions that did not allow doctors or nurses to travel into remote communities). For example, a nurse fly-in program for remote communities was stopped and replaced with virtual care, which may increase availability of physician and nursing visits but also causes barriers for those who cannot access virtual care.
- There is a lack of broadband internet access and infrastructure to support virtual care in many remote and isolated First Nations and Inuit communities. In addition, some community members do not have internet-ready devices or cell phones or cannot afford to have internet, which prevents access to virtual care.
- Inuit who live in Inuit Nunangat must travel long distances to receive cancer care in major urban centres, meaning they are faced with the difficult decision to leave their home, employment, family, friends and community, or opt out of treatment.9 This challenge has only been exacerbated by the pandemic. For example, since March 2020, people travelling to Nunavut were required to self-isolate for two weeks in isolation hubs, which has caused some to experience significant distress and refuse medical travel due the prolonged time away from home and stories of mistreatment at the hubs.10
- Some communities have limited or no access to COVID-19 testing, a critical tool for preventing the spread of COVID-19.
- Some communities did not have what they needed to manage the pandemic, including a stable supply of personal protective equipment, fully developed pandemic preparedness plans or emergency management training. A contributing factor may be the decrease in funding over the years that Indigenous communities rely on for public health planning.
- Past experiences of racism in health-care settings have led to some First Nations, Inuit and Métis feeling hesitant or uncomfortable accessing COVID-19 testing or other health-care services during the pandemic.
- The pandemic has intensified the need for Indigenous-led, community-driven and timely mental wellness supports for those who are struggling to cope with the added stress, anxiety, isolation and loneliness caused by the pandemic.8 Many First Nations, Inuit and Métis experienced increased challenges accessing cultural practices because of public health measures, were unable to travel to communities because of lockdown measures and experienced fear about contracting the virus, all of which have a negative impact on mental health and wellbeing.7
- Public health measures to prevent the spread of COVID-19, such as lockdowns and public health messaging urging people to stop taking part in ceremonies, caused some First Nations, Inuit and Métis to re-live and experience trauma resulting from past experiences of the government restricting the movement of Indigenous peoples and dictating what they can do.7 There is also a deep mistrust felt by many Indigenous peoples across Canada toward the government due to a history of broken promises and dismissed rights and freedoms.
While the COVID-19 pandemic continues to have a disproportionate impact on their health and well-being, data about the impact of the pandemic on First Nations, Inuit and Métis is limited. Most health databases do not contain First Nations, Inuit and Métis identifiers; are based on colonial ways of knowing; and have been determined outside of First Nations, Inuit and Métis communities and therefore do not advance Peoples-specific priorities. The limited data that does exist shows:
- First Nations, Inuit and Métis communities have led self-determined, community-based responses to the pandemic, such as physical and mental health supports and additional restrictions,1,11 which have contributed to lower COVID-19 case and fatality rates in some communities.12, 13
- In Ontario, the pause in cancer screening services may be disproportionately felt by First Nations people. Individuals living on a First Nations reserve may be more likely to experience diagnostic delay following an abnormal screening test.14 That means their cancer will be detected at a later stage when chances of cure and survival are lower.
- CADTH Health Technology Review. CADTH custom request: Impacts of COVID-19 on First Nations, Inuit, and Métis populations in Canada. 2021. Available from: https://cadth.ca/sites/default/files/covid-19/CI0157-Impacts-of-COVID-19-on-Indigenous-Populations-e.pdf
- Turpel-Lafond ME. In plain sight: Addressing Indigenous-specific racism and discrimination in B.C. health care. 2020. Available from: https://engage.gov.bc.ca/app/uploads/sites/613/2021/02/In-Plain-Sight-Data-Report_Dec2020.pdf1_.pdf
- Allan B, Smylie J. First peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. 2015. Available from: https://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Summary-First-Peoples-Second-Class-Treatment-Final.pdf
- Earle L. Understanding chronic disease and the role for traditional approaches in Aboriginal communities. 2013. Available from: https://www.nccih.ca/docs/emerging/FS-UnderstandingChronicDisease-Earle-EN.pdf
- Centers for Disease Control and Prevention. Underlying medical conditions associated with higher risk for severe COVID-19: Information for healthcare professionals. 2022. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html
- Public Health Agency of Canada. People who are at risk of more severe disease or outcomes from COVID-19. 2022. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/people-high-risk-for-severe-illness-covid-19.html
- Mashford-Pringle A, Skura C, Stutz S, Yohathasan T. What we heard: Indigenous Peoples and COVID-19: Supplementary report for the Chief Public Health Officer of Canada’s report on the state of public health in Canada. 2021. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19/indigenous-peoples-covid-19-report/cpho-wwh-report-en.pdf
- Indigenous Services Canada. Government of Canada is responding to immediate Indigenous mental wellness demands during the COVID-19 pandemic. 2020. Available from: https://www.canada.ca/en/indigenous-services-canada/news/2020/08/government-of-canada-is-responding-to-immediate-indigenous-mental-wellness-demands-during-the-covid-19-pandemic.html
- Jull J, Zehr M. Inuit cancer patients often face difficult decisions without support far from home. The Conversation. 2021 Jun 7. Available from: https://theconversation.com/inuit-cancer-patients-often-face-difficult-decisions-without-support-far-from-home-160586
- Rohner T. Security at Nunavut’s isolation hubs contributed to stress, tension, gov’t emails show. CBC News. 2021 Jun 9. Available from: https://www.cbc.ca/news/canada/north/nunavut-government-security-isolation-hubs-1.6058375
- Assembly of First Nations. COVID-19 virtual forum: Sharing lessons learned and supporting a new path forward. 2021 Sep 16, 21, 23. Available from: https://www.afn.ca/covid-19-virtual-forum/
- City of Vancouver Social Policy and Projects Research and Data Team. Populations disproportionately impacted by COVID-19: Current state assessment. 2021. Available from: https://vancouver.ca/files/cov/pdi-covid-current-state-report-january-2021.pdf
- Indigenous Services Canada. Update on COVID-19 in Indigenous communities. 2020. Available from: https://www.canada.ca/en/indigenous-services-canada/news/2020/07/update-on-covid-19-in-indigenous-communities.html
- Walker MJ, Meggetto O, Gao J, Espino-Hernandez G, Jembere N, Bravo CA, et al. Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: A provincial, population-based study. Prev Med. 2021; 151:106586.
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