"Don't shut down, these conversations need to happen": Indigenous health professionals insights for advancing anti-racism in health care.

backgroundIndigenous peoples around the world continue to experience systemic racism and discrimination within health care, as a direct consequence of colonisation. In settler-colonial states, such as Canada, current approaches to tackling anti-Indigenous racism are often designed by non-Indigenous peoples. Combating racism necessitates that health care policies and practices be co-constructed with Indigenous communities.

objectiveThis study explored insights from Indigenous health professionals, educators and community members. It aimed to identify pathways for justice and equity-based medical curricular reform that, while being Indigenous-led, also engage practitioners in institutional accountability.

methodsSemi-structured interviews were conducted with 12 Indigenous individuals with extensive experiential, professional and academic experience with the health care system and health professions education.

resultsThis study highlights the ongoing impacts of anti-Indigenous racism in medical education and health care settings. Indigenous-specific racism within medicine manifests through the dehumanisation of Indigenous peoples, deficit-based approaches to Indigenous health education, and the erasure, omission, or other types of violence and epistemic injustices in educational settings and curricula design. Indigenous approaches to addressing it pivot around sovereignty and self-determination. These include nurturing the Indigenous principle of relationality within institutions, policies, education and interactions; challenging dehumanising narratives by centring Indigenous voices; and re-humanising medical practice through skills that foster connectedness and by embedding justice and equity as core tenets of medical practice.

conclusionIndigenous knowledge, principles and insights offer promising approaches for paving the way towards equity- and justice-centred medical practice and education. This study underscores the need to centre Indigenous voices, incorporate Indigenous knowledge and meaningfully engage with communities to embed health equity and justice at the core of medical education and practice.