Study identifies anti-Indigenous bias among Alberta physicians

A recently-published University of Calgary study found two-thirds of Alberta physicians surveyed have implicit anti-Indigenous bias.

The survey was sent to every practising physician in the province in 2020.There were 375 doctors who participated in the surveywith the largest group 40 per cent being white cisgender women.

Four researchers from the university foundthat respondents shared concerns about "reverse racism"targeting white people and discomfort discussing racism.

Pamela Roach, leadresearcher of the study with the U of C'sCumming School of Medicine, said the study's findings further validate the numerouspatient reports of anti-Indigenous bias in health-care.

"What we did find was that levels of anti-Indigenous bias within Albertan physicians are unacceptably high," Roach, who is a member of the Mtis Nation of Alberta, said in an interview Friday.

The study's goal was to measurethe source ofinterpersonal bias, whether explicit or implicit,among Alberta physicians nuances that havenotbeen widelystudied,Roach said.

Physicianswere posed with two sliding scale questions to understand the level ofexplicit bias they held.

The first questionasked physicians how they felttowardIndigenous people and the second question looked at preference between white and Indigenous people.

The results showed eight per cent of participants felt unfavourably toward Indigenous people while25 per centpreferred white people to Indigenous people.

Implicit anti-Indigenous bias

Implicit anti-Indigenous bias was assessed by askingparticipants to match images of Indigenous peoplein Canada and European specifically whitepeople with positive and negative characteristics in a randomized fashion.

The study found 67 per cent of participants showedimplicit preferences for white people with only 13 per cent demonstrating a preference for Indigenous faces.

It found participants practising in remote settings had the most neutral implicit preferences and those in urban and large rural settings had the greatest implicit preference for white faces. Older participants, those in surgical disciplines and those without an academic affiliation also had strongerpreferences for white faces.

"I am aware that a 67 per centfeels really bigand it is and part of the reason for that is because of the messages that society tells us," Roach said.

"Even people who would have answered the explicit bias questions in a way that they felt positive towardIndigenous people, what the implicit bias does is gives us a baseline of how people are reacting."

Roach said this is critical information for a clinical setting given that doctors routinely make life-altering decisions in a matter of seconds.

Jessica Kolopenukis the Alberta Health Services research chair in Indigenous health at the University of Alberta and was not involved with the study. She said it is a valuable contribution but reinforces what has already been established.

"It is unfortunate that a scientific study evidencing racism is needed and perhaps even regarded as more solid proof than are the stories and testimonies of Indigenous peoples ourselves," the Cree researcher from Peguis First Nationsaid.

"Providing 'equitable'healthcare to Indigenous patients might not be an adequate framework and goal given that it maintains white measures of health as the norm to be striving for."

Kolopenuk said focusing on Indigenous governance, leadership and expertise in health and policy can lead to better outcomes.

Training and allyship

In a statement in response to the study's findings, AHS spokespersonJames Wood pointed to the organization's "Indigenous Health Commitments: A Roadmap to Wellness" guidelines.

"All staff are required to complete mandatory Indigenous awareness and sensitivity training as part of their employment with AHS, and there are a number of additional diversity and inclusion education programs available to employees," Wood said.

Dr. James Makokis, who is a two-spirit Nehiy (Plains Cree) family physician from Saddle Lake Cree Nation, said often times examples of bias can include omissions of care.

"If someone presents to the emergency room, and their vital signs are not taken, there's some perceptions made about somebody based on their skin colour or a sexual orientationand then that patient leaves because they're not being treated properly.

"That's an instance of discrimination and potentially racism."

Makokissaid a crucial component that needs to be addressed is non-Indigenous physiciansremaining complicit by not reporting discriminatory situations.

"That really speaks to allyship, and how to be an ally, you have to be an active participant."