ABSTRACT
| Indigenous communities in rural Canada face persistent barriers to accessing equitable healthcare services. These challenges stem from a confluence of factors, including geographic isolation, systemic racism, jurisdictional complexities, and cultural insensitivity within healthcare systems. This narrative review examines these multifaceted barriers and proposes an interdisciplinary framework to enhance healthcare access for Indigenous populations in rural settings. Drawing predominantly from 2016-2025 and resources from the National Collaborating Centre for Indigenous Health (NCCIH), the framework emphasizes cultural safety, community engagement, policy reform, and technological integration as pivotal components for transformative change. | |
1. Introduction
Healthcare disparities between Indigenous and non-Indigenous populations in Canada are well-documented, with rural Indigenous communities disproportionately affected. Factors such as historical colonization, systemic discrimination, and under-resourced healthcare infrastructures contribute to these inequities. Addressing these challenges necessitates a comprehensive understanding of rural and healthcare access definitions and an interdisciplinary approach incorporating Indigenous perspectives and knowledge systems.
This paper examines the disparities between Indigenous and non-Indigenous populations in rural Canada and the interdisciplinary approach needed to address these challenges.
2. Definitions and Terms of Reference
Understanding and addressing the issue of healthcare access for Indigenous communities in rural Canada requires an interdisciplinary approach grounded in precise definitions and conceptual clarity.
2.1. Definition of Rural
The concept of ‘rural’ is complex and lacks a single agreed-upon definition in health literature.[1] Some researchers define rural areas based on their distance from urban centers of a particular population size. Others, such as Ontario’s Ministry of Health and Long-Term Care (MOHLTC), describe rural communities with fewer than 30,000 residents located more than 30 minutes away from larger urban hubs. Given these varied classifications, rurality influences healthcare access in structural and situational ways.
2.2. Rural Canada
Within the Canadian context, Statistics Canada defines rural areas as locations outside census metropolitan areas and census agglomerations, accounting for approximately 9,197,138 km² of the country’s land area as of 2015. While these regions cover vast territory, their low population density makes healthcare delivery especially challenging, disproportionately affecting Indigenous peoples as they often reside in remote locations with fewer healthcare facilities and providers. In this paper, rural refers to the composite of rural, remote and northern.
2.3. Indigenous Peoples or Communities
According to the Government of Canada, Indigenous peoples are recognized as the original inhabitants of North America and are categorized into three distinct groups: First Nations, Inuit, and Métis.[2] The 2021 Census reports that more than 1.8 million individuals in Canada identify as Indigenous, constituting 5% of the total population. Their geographic distribution varies, with Inuit primarily residing in the Arctic regions of Inuit Nunangat, Métis populations concentrated in the Prairie provinces and Ontario, and First Nations communities spread across various territories, predominantly south of the Arctic.[3] Sehgal et al. further note that Indigenous populations in Canada have a faster growth rate than non-Indigenous populations, reflecting shifting demographic trends.[4]
2.4. Healthcare Access
Healthcare access is pivotal in shaping health outcomes within Indigenous rural communities. The 2021 National Healthcare Quality and Disparities Report defines healthcare access as “the timely use of personal health services to achieve the best health outcomes.”[5]The National Collaborating Centre for Indigenous Health (NCCIH) defines accessibility as “the availability of good health services within reasonable reach of those who need them and allowing people to obtain the services when needed. Healthcare access involves a range of determinants, including insurance coverage, availability of providers, timeliness, and continuity of care.”[6] Ideally, residents should be able to conveniently and confidently access primary care, dental care, behavioral health, emergency care, and public health services.[7] However, access is not merely about availability, but is also contingent on factors such as financial barriers, geographic location, and culturally appropriate service delivery. The NCCIH elaborates on this concept, emphasizing that accessibility depends on the proximity of healthcare services, operational structures such as appointment systems, and the adequacy of healthcare personnel to meet population needs.[8]
By establishing definitions of rurality, access and Indigenous communities and contextualizing the disparities within an interdisciplinary framework, this discussion lays the groundwork for a deeper analysis of healthcare accessibility in Indigenous rural communities.
2.5. Canada’s Health Act and Healthcare Access
Canada’s Health Act ensures reasonable access to healthcare services without financial or systemic obstacles. As Nguyen et al. note, the Act aims “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers while embracing diversity, creating healthy and respectful environments and reducing health inequities.”[9] Despite this ideal, Indigenous communities across Canada—particularly those in rural and remote areas—First Nations, Inuit, and Métis— face disproportionate challenges or barriers to healthcare access, reflecting a persistent gap between policy and lived reality.[10] Many of the obstacles faced stem from systemic barriers and historical inequities. These range from affordability, geographical and transportation difficulties to linguistic and cultural barriers that prevent Indigenous people from obtaining care. Scholars such as Williams and Kulig highlight the stark health disparities between rural and urban populations, noting that rural Canadians, particularly Indigenous peoples, experience higher mortality rates, shorter life expectancy, and increased population health risks.[11] These inequalities are not unique to Canada; similar trends are observed globally, reinforcing the broader structural challenges associated with healthcare access in geographically isolated communities.[12]
As Nguyen and colleagues posit, the barriers encountered by Indigenous people are typically categorized as proximal (geographic and infrastructural), intermediate (systemic and financial), and distal (social and cultural).[13] Each level reflects a different facet of the access problem, though they are deeply interrelated and reinforce one another. While the Canada Health Act promises equitable access to care, the historical context of colonialism reveals why this promise often falls short for Indigenous peoples. Understanding how systemic barriers are rooted in colonial legacies is essential to grasping the current healthcare disparities they face.
2.6. Historical Context and Systemic Barriers
Lying at the heart of the challenges that Indigenous people experience is the legacy of colonial policies, which continue to shape the health and well-being of Indigenous peoples in Canada. Bourque and colleagues describe the current healthcare systems and structures as colonial and hierarchical, grounded in Eurocentric and patriarchal ideologies that perpetuate racial discrimination.[14] They further explain that Western medical philosophies dominate Indigenous models of wellness, creating barriers for Indigenous people who seek care that respects their values, knowledge systems, and ways of life. These colonial foundations continue to deepen health inequities, often re-harming and re-traumatizing Indigenous Peoples, both those receiving and providing care. Over time, this has led to widespread distrust and burnout within the healthcare system, contributing to care that is often inappropriate, unresponsive, and culturally unsafe.[15]
The NCCIH emphasizes that “colonization is directly linked to the burden of disease, poverty, and disadvantage experienced by Indigenous peoples.”[16] Smallwood and colleagues explain how, through the process of colonization, Indigenous peoples were displaced from their land, culture, and resources—a deliberate act that many scholars describe as ethnic and cultural genocide. Colonial practices such as war, massacres, forced displacement, forced labor, the forcible separation of children from their families, and the establishment of residential schools and the near-erasure of Indigenous traditions not only devastated traditional ways of life but also set in motion the stage for social and health inequities and a legacy of deep mistrust toward institutions, including the healthcare system.[17]
Historically, colonial policies affected healthcare delivery long before contemporary issues emerged. Indigenous peoples were frequently relocated or forced to seek care in inferior, racially segregated Indian hospitals. Such experiences of substandard treatment have left deep scars and molded Indigenous perceptions of the mainstream healthcare system. Many Indigenous individuals continue to harbor mistrust and apprehension toward health services—a sentiment that persists into the present, as negative interactions with healthcare providers worsen their overall health and well-being.[18]
Sehgal and colleagues observe that for Indigenous peoples, “health is inextricably tied to the determinants of health that have arisen from colonization.”[19] Burnett and colleagues concur that the spatial and political challenges faced by rural and northern Indigenous communities in Ontario are inextricably linked to historical and ongoing relations with the settler state. The British North America Act of 1867 further complicates healthcare governance by placing Indigenous healthcare under federal jurisdiction while leaving most healthcare delivery to the provinces.[20] Some Indigenous communities have access to federally funded primary healthcare, while others struggle with limited provincial support.[21] This jurisdictional fragmentation creates uncertainty regarding Indigenous healthcare entitlements, service availability, and significant gaps.
3. Barriers and Facilitators to Healthcare Access
Barbo and Alam note that historical biases rooted in colonial practices continue to manifest in Canada’s healthcare policies. Indigenous patients frequently face bureaucratic challenges, including inadequate health resources, funding shortages, and discriminatory treatment in medical facilities. These colonial and systemic forces shaped perceptions and policies and laid the groundwork for the current geographic and infrastructural barriers.[22] Nelson and Wilson’s work illustrates that colonial legacies complicate the notion of “rurality.” For many Indigenous communities, physical location itself has become a significant obstacle to accessing timely and adequate healthcare.
3.1. Geographic and Infrastructure (Proximal) Barriers to Healthcare Access
Physical, or proximal, barriers remain among the most immediate challenges, particularly for Indigenous people living on reserves and in remote areas. Indeed, more than 80% of First Nations and most Inuit communities are in remote areas, with many Métis also living in rural or remote regions.[23] An Auditor General Report (2015) noted that healthcare services in remote communities of Northern Canada are not equivalent to those available in other rural areas, thus exacerbating health disparities. Many Indigenous communities are so remote that they can be reached only by plane or seasonal ice roads, a reality highlighted by Burnett and colleagues.[24] Lavoie and Gervais’ paper underscored that no health office existed in remote, isolated communities with no scheduled flights or road access.[25] Other research suggests that reserves often lack essential primary care infrastructure. Even in non-isolated Indigenous communities, there were fewer health centers for emergency screening and prevention. Several Indigenous communities remain isolated not only geographically but also in terms of the health services available to them. Residents often travel long distances to urban centers for emergencies, specialist services, diagnostic testing, and basic medical appointments. This burden has long-term repercussions, increases stress, and can deter individuals from seeking timely care. All of which can exacerbate health issues.[26]
In rural Indigenous communities, access is further complicated by provider shortages (nurses play a more immediate role in place of medical doctors). However, in some remote communities, no resident nursing staff were in the health office or station.[27] Additionally, remote communities struggle to attract and retain health professionals,[28] often resulting in short-term transitory care.[29] Furthermore, access to a regular healthcare provider is notably lower in these areas, with studies reporting that nearly half of First Nations and Métis individuals in the Territories lack a consistent doctor, in stark contrast to much lower rates in jurisdictions like Ontario.[30]
First Nation adults living on reserve often experience long wait lists for health care. In addition, they are limited by needed services not being covered or approved by the federal Non-Insured Health Benefit Plan (NIHB) and by doctors or nurses not being available in their area. Reports that the healthcare provided was inadequate or not culturally appropriate are also frequently mentioned barriers. Thus, geographic isolation leads to delays in screening, late diagnoses, and poorer health outcomes.[31]
While physical distance and geographic isolation present immediate obstacles to healthcare access, these challenges are compounded by financial and systemic barriers. Even when care is available, the ability to afford, navigate, or trust the system remains a significant hurdle for many Indigenous individuals.
3.2. Financial and Systemic (Intermediate Barriers)
Indigenous people in Canada, both on reserve and in urban areas, experience difficulties accessing health care services. Financial and systemic or intermediate barriers further exacerbate the geographic challenges faced by these people. Davy and colleagues underscore the high cost of healthcare, particularly for Indigenous peoples who may face out-of-pocket expenses not covered under provincial plans.[32] Those living in remote areas may also incur additional costs related to travel and accommodations when seeking care and may not be able to afford specific treatments.
These financial strains often lead individuals to delay or forego necessary medical attention, resulting in preventable complications, deteriorating health outcomes and worsening health disparities.[33] While “status” First Nations individuals living on reserves receive federally funded primary healthcare services, those living off-reserve must navigate provincial healthcare systems, leading to gaps in service coverage.[34] On reserves in rural areas, services are few and tend to be understaffed and underfunded.[35] This further exacerbates disparities and contributes to an environment where access is unpredictable at best.
Moreover, the disruption to traditional lands and culture from forced displacement has led to significant economic marginalization. Yangzom and colleagues, drawing on the work of Wilk et al. (2017), illustrate how such policies have curtailed economic development, leaving Indigenous communities disconnected from vital cultural and resource networks.[36] This economic disenfranchisement further limits access to healthcare and reinforces persistent mistrust in a system perceived as unsafe and unsympathetic. While geographic and financial challenges pose significant obstacles to healthcare access, Indigenous peoples also face deeper, more entrenched barriers rooted in social and cultural factors.
3.3. Social and Cultural Barriers (Distal Barriers)
Beyond geographic and financial constraints, Indigenous peoples face deep-seated structural discrimination and cultural insensitivity within the healthcare system, which significantly hinders access. Barbo and Alam assert that Indigenous patients face systemic racism rooted in colonial stereotypes that persist within Canada’s healthcare institutions.[37] These prejudices manifest in longer wait times for Indigenous patients, substandard care, and fewer follow-ups with specialists.[38] These issues are not limited by geography. Barbo and Alam highlight that Indigenous Peoples, whether residing in urban or rural areas, encounter numerous barriers to accessing primary health care (PHC). People face systemic racism and discrimination, culturally unsafe environments and general inaccessibility.[39] While a minority of participants reported respectful and supportive interactions with PHC providers, the majority described negative discriminatory experiences, especially in remote settings where a lack of provider awareness regarding Indigenous histories and social contexts exists.
In the research literature, a pervasive distrust of PHC providers was evident across urban and rural settings, as well as fears about confidentiality. In urban environments, many Indigenous individuals lacked access to a regular family physician and relied on walk-in clinics, which disrupts continuity of care. In contrast, rural and remote communities struggled with more severe provider shortages, limited access to specialists, inadequate health education and culturally appropriate services.[40]
Oosterveer and Young explain that nurse-based models dominate primary care in northern Canada through “task-shifting,” which is also common in underserved regions globally. Additionally, community health workers (CHWs) serve as vital frontline providers in remote communities lacking resident nurses, delivering initial care and bridging cultural gaps between Indigenous patients and the healthcare system.[41] A sense of alienation is fostered by these systemic and cultural disconnects, further deterring Indigenous patients from seeking care. Loppie and Wein discuss how many Indigenous individuals feel alienated in hospitals, where practitioners lack awareness of Indigenous traditions and perspectives. NCCIH, citing Wilkinson et al.’s 2022 work, emphasizes that the absence of culturally safe and respectful treatment discourages Indigenous patients from seeking care, leading to delayed diagnoses and poorer health outcomes.[42]
Davy et al. describe the experiences reported by Indigenous people regarding racism, poor communication between Indigenous patients and healthcare professionals, and a lack of cultural competency in medical settings. Such cultural misunderstandings, deepened by language barriers, lead to frustration, disengagement, and feelings of exclusion and mistrust.[43] The healthcare system’s failure to reflect Indigenous realities and histories perpetuates what Horrill et al. describe as “othering”[44] — a direct result of colonial legacies. Davy and colleagues, referencing Levesque et al.’s framework, outline five dimensions of access: approachability, acceptability, availability, affordability, and appropriateness—all of which are shaped by colonial structures that alienate Indigenous patients from care.
These dimensions are shaped by historical and ongoing colonial processes that deeply affect health-seeking behavior and engagement with care systems. Taken together, these systemic failures culminate in measurable disparities in health outcomes. Indigenous populations experience significantly poorer health compared to non-Indigenous Canadians. Transitioning to the broader impacts of these barriers reveals the full extent of their consequences on health and well-being.
3.4. Health Outcomes and Broader Social Determinants
Across Canada, the cumulative effect of these barriers is reflected in critical health disparities. As cited in a Statistics Canada report, Indigenous peoples experience a higher prevalence of chronic conditions such as diabetes and asthma, higher disability rates and a consistently lower life expectancy than non-Indigenous Canadians. Broader social determinants—including limited educational and employment opportunities and historical trauma—further restrict healthcare access. While some Indigenous individuals move to urban centers seeking better healthcare services, Graham et al. show that they encounter the same systemic issues and discriminatory practices as in rural settings.[45] Loppie and Wien explain how ongoing assimilation efforts, socio-economic marginalization, and intergenerational trauma, rooted in historical colonialism, contribute to persistent disparities.[46] Chronic underfunding and healthcare provider shortages emerge as exacerbating factors. Despite these longstanding challenges, there are emerging examples of positive healthcare experiences and practical strategies that support Indigenous well-being. A shift in focus to facilitators and positive experiences offers insight into what works and what more can be done to improve healthcare access for Indigenous communities.
3.5. Positive Encounters and Facilities to Accessing Healthcare
In contrast to the many challenges outlined above, some Indigenous individuals report positive experiences with the healthcare system. Barbo and Alam highlight the accounts of respectful and supportive primary healthcare encounters where patients said they felt safe, heard and valued. Barbo and Alam further note that participants appreciated PHC providers who were dependable, supportive, and accessible. These providers took the necessary time to address all patient concerns and were valued for demonstrating respect for Indigenous cultural identity. Such healthcare professionals played a key role in building culturally safe environments.[47] Their willingness to learn about Indigenous histories and customs helped bridge gaps in care. Although the study by Graham et al. focused on facilitators of healthcare access for Indigenous Peoples in urban settings, many of the identified facilitators are applicable more broadly. Facilitators such as access to culturally appropriate care, traditional healing practices, Indigenous-led healthcare services, and support for food and transportation needs have been echoed in other studies as well.[48] These examples reveal that culturally sensitive care is possible and impactful when grounded in respect and Indigenous self-determination.
4. Structural Changes And Efforts Toward Culturally Safe Healthcare
Addressing Indigenous health inequities requires recognizing historical injustices and implementing systemic, community-driven structural reforms.”In their narrative review, Nguyen and colleagues discussed multiple mitigation strategies implemented across Canada to address health inequities experienced by Indigenous communities. Improving healthcare accessibility requires strengthening local services and building capacity by actively involving Indigenous voices in planning and decision-making. Key strategies include increased financial support for infrastructure development, such as building hospitals and ambulatory care facilities and ensuring year-round road access in remote communities. Additional measures include promoting Indigenous education and employment, developing culturally responsive educational and healthcare systems, and ensuring Indigenous representation in policymaking.
One crucial step toward reconciliation and systemic reform is fostering collaboration between federal and provincial health systems and Indigenous communities. This includes granting Indigenous representation in Regional Health Authorities and establishing permanent bilateral mechanisms to address the legacy of colonialism and advance Indigenous-led health governance.
The NCCIH outlines several policy initiatives to enhance cultural safety within mainstream healthcare. These include provider training programs, modifications to service delivery, and support for Indigenous-led healthcare frameworks.[49] Nguyen also cited additional strategies identified by other researchers to address disparities. These include the creation of socially accepting and culturally safe spaces in education, research, and healthcare; policy reforms across governmental levels to resolve jurisdictional conflicts and ensure equitable funding; encouraging Indigenous leadership in the development of healthcare policies; and implementing strategies to recruit and retain healthcare providers in rural, remote, and northern communities.[50]
5. Discussion: An Interdisciplinary Framework For Enhancing Equitable Healthcare Access
Building on the challenges outlined in earlier sections, this discussion proposes a multifaceted, solutions-oriented framework to guide structural reform and health equity. Indigenous peoples in Canada continue to face significant health inequities rooted in the enduring legacy of colonialism. Financial and systemic issues add further strain. Economic marginalization, tied to colonial dispossession and disrupted livelihoods, further limits access and reinforces mistrust in a system seen as unresponsive to Indigenous realities.
These interconnected challenges—geographic isolation, financial strain, systemic racism, and historical trauma—lead to disproportionate rates of chronic illness, disability, and reduced life expectancy among Indigenous populations. Despite these barriers, some positive experiences have been reported. When care is delivered by providers who respect Indigenous culture, listen without judgment, and demonstrate cultural awareness, patients feel safer and more supported.
The numerous problems that Indigenous people experience with PHC services lead to calls for change in healthcare practice, structures and policy development.[51] This review proposes a four-pronged interdisciplinary framework to improve healthcare access for Indigenous communities in rural Canada while recognizing the interconnected roles of Indigenous Studies, Public Health, Political Science, Health Informatics, Engineering, Law, and Sociology in fostering systemic change. A holistic approach is necessary to address longstanding inequities and ensure culturally safe, accessible, and effective healthcare services. Together, these interdisciplinary strategies present a comprehensive path forward. When implemented in coordination with Indigenous communities, they offer a realistic opportunity to dismantle systemic inequities and create a more equitable healthcare future. The first prong of the interdisciplinary framework is Cultural Safety and Indigenous Knowledge Integration through Indigenous Studies and Health Education.
5.1. Cultural Safety and Indigenous Knowledge Integration
Implementing mandatory cultural safety and competency training for healthcare professionals is crucial. Such training should encompass Indigenous histories, languages, and health practices to foster respectful and effective care delivery. Indigenous healing practices should be integrated into mainstream care, supporting holistic health approaches when appropriate. The research literature is rife with information on what cultural safety means. Culturally safe environments prioritize relationships, respect, and integrating Indigenous healing practices.[52] Effective integration of cultural safety requires collaboration between Indigenous scholars, healthcare educators, and frontline workers. Institutions must partner with Indigenous elders and knowledge holders to shape curriculum development, ensuring cultural relevance and real-world applicability.
Despite the push for cultural competency training, institutional barriers such as a lack of funding, resistance from healthcare providers, and gaps in Indigenous representation within health leadership hinder widespread implementation. Studies reveal that some healthcare professionals struggle to consistently apply cultural safety principles, reinforcing the need for ongoing education and Indigenous-led guidance. While cultural safety training fosters inclusivity within healthcare environments, ensuring Indigenous community control over health services further strengthens autonomy and trust in care delivery. Community-led governance models offer a pathway to equitable healthcare access.
5.2. Decentralized Community-Based Health Authorities and Indigenous-Led Health Governance (Public Health and Political Science)
Indigenous communities should be empowered to manage their health systems, including budgeting, staffing, and service design. Models like the First Nations Health Authority (FNHA) and community health centers provide successful precedents. The FNHA in British Columbia, a self-governed healthcare model, represents a transformative model of Indigenous self-governance in health. The FNHA model increases responsiveness, trust, and cultural relevance by shifting decision-making power to Indigenous communities.[53] Jurisdictional disputes between federal, provincial, and Indigenous governments remain a significant barrier. Clarifying funding responsibilities and embedding enforceable accountability mechanisms are essential for sustained success.[54] Decentralized healthcare models strengthen Indigenous autonomy, but accessibility remains a concern, especially for geographically isolated communities. Digital health solutions provide an opportunity to overcome these physical barriers.
5.3. Digital and Mobile Health Innovations (Health Informatics and Engineering)
Investment in rural digital infrastructure, such as telehealth services, is essential, as these can mitigate geographic barriers to care. User-friendly telehealth platforms designed with Indigenous input can improve chronic care management, maternal health, and mental health access.[55] However, ensuring equitable access to technology and addressing digital literacy are essential to the success of such initiatives. Telemedicine has emerged as a partial solution for remote care delivery, enabling access to primary care providers and specialists without needing long-distance travel. However, many rural Indigenous communities have limited broadband access and digital literacy challenges.[56] Despite its promise, low internet connectivity, lack of culturally adapted telehealth platforms, and skepticism about virtual care hinder adoption.[57] Collaboration between engineers, Indigenous community leaders, and healthcare providers is needed to ensure accessible and user-centered technological integration. While technology-driven solutions can expand healthcare access, policy reform is critical to addressing jurisdictional barriers and embedding equity-driven approaches within health governance.
5.4. Policy Reform and Integrated Governance (Law and Sociology)
Addressing jurisdictional complexities requires policy reforms that promote integrated governance structures. Collaborative frameworks involving federal, provincial, and Indigenous authorities can streamline service delivery and enhance accountability.[58]
Systemic change must involve revising colonial-era policies, clarifying jurisdictional responsibilities, and embedding accountability mechanisms. The Truth and Reconciliation Commission’s Calls to Action and the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) should guide all reforms. Beyond governance, systemic racism and historical inequities must be explicitly addressed. As Greenwood and colleagues assert, policies should integrate anti-racist healthcare practices, ensuring Indigenous communities are not only given access but also empowered to lead and shape their healthcare futures.
Although policy reform is the foundation for long-term healthcare equity, actual change requires interdisciplinary collaboration between policymakers, educators, and Indigenous leaders to implement these frameworks effectively. Improving healthcare access and outcomes includes strengthening local infrastructure, increasing Indigenous representation in healthcare planning, and promoting culturally safe provider training. Indigenous-led healthcare initiatives and incorporating traditional healing practices are key steps toward healing systemic harm and creating equitable healthcare for Indigenous communities.
The focus of change should not be solely on healthcare practice and providers. Systemic transformation must happen concurrently, including more funding and support for Indigenous communities to establish meaningful traction toward better patient care.[59]
6. Conclusion
The convergence of a multifaceted set of conditions, including colonial history, systemic inequalities, geographic isolation, and cultural barriers, shapes healthcare access for Indigenous communities in rural Canada. These challenges are deeply interconnected and rooted in Canada’s colonial legacy.
Addressing them requires more than service delivery improvements. It demands a structural rethinking of how healthcare is conceptualized, funded, and delivered, grounded in principles of cultural safety, Indigenous self-determination, and reconciliation. Only through a comprehensive, interdisciplinary, culturally sensitive and decolonial approach can healthcare systems become truly equitable and inclusive for Indigenous communities across rural Canada. This requires sustained investment, meaningful collaboration with Indigenous peoples, and integrating Indigenous knowledge, rights, and values into the heart of the healthcare system.
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[1] Kristin Burnett et al., ‘Indigenous Peoples, Settler Colonialism, and Access to Health Care in Rural and Northern Ontario’, Health & Place 66 (November 2020): 3, https://doi.org/10.1016/j.healthplace.2020.102445.
[2] Government of Canada; Crown-Indigenous Relations and Northern Affairs Canada, ‘Indigenous Peoples and Communities’, administrative page; fact sheet; resource list, 12 January 2009, https://www.rcaanc-cirnac.gc.ca/eng/1100100013785/1529102490303.
[3] Michelle Filice, ‘Indigenous Peoples in Canada’, accessed 15 May 2025, https://www.thecanadianencyclopedia.ca/en/article/aboriginal-people.
[4] Anika Sehgal et al., ‘Advancing Health Equity for Indigenous Peoples in Canada: Development of a Patient Complexity Assessment Framework’, BMC Primary Care 25, no. 1 (29 April 2024): 1, https://doi.org/10.1186/s12875-024-02362-z.
[5] Agency for Healthcare Research and Quality, ‘ACCESS TO HEALTHCARE AND DISPARITIES IN ACCESS’, in 2021 National Healthcare Quality and Disparities Report [Internet] (Rockville, MD: Agency for Healthcare Research and Quality (US), 2021), https://www.ncbi.nlm.nih.gov/books/NBK578537/.
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