Spring 2022 (Volume 32, Number 1)
Truth and Reconciliation and the
Arthritis Community:
A Call for Collective Action
By Terri-Lynn Fox, PhD; and Cheryl L. Koehn, President, Arthritis Consumer Experts
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The theme of the recently held 2022 Canadian Rheumatology
Association and Arthritis Health Professions
Association Annual Scientific Meeting was
“Towards Equity: Rheum for Everyone.” To move towards
equity in arthritis, the community must take meaningful
action beyond working to provide equitable care. It must
come together and take meaningful and respectful action
on Truth and Reconciliation.
Arthritis affects Indigenous peoples more significantly
and more severely than non-Indigenous populations. Specifically,
Indigenous peoples in Canada experience:
- Higher rates of inflammatory arthritis such as lupus,
rheumatoid arthritis and ankylosing spondylitis;1
- Higher rates of death from lupus and its complications
compared to non-Indigenous patients;2
- Worse disease outcomes in early rheumatoid
arthritis compared to white patients. This means
slower improvements in pain and swelling and
less likelihood of achieving remission;3
- Fewer visits to specialists than the non-Indigenous
population as well as significantly more
hospitalizations due to arthritis complications;4 and,
- Lower rates of evidence-based inflammatory
arthritis therapies being used among Indigenous
people despite the disease being more severe;4
Yet today, the path to appropriate, timely care for an
Indigenous person dealing with debilitating symptoms of
inflammatory and non-inflammatory arthritis continues
to be rooted in systemic racism, implicit bias and geographical
challenge.4,5 To address this, the arthritis community
— rheumatology researchers, healthcare professionals,
and patient organizations and their members — needs to
start at the beginning by learning about and understanding
the historical and intergenerational trauma and pain
Indigenous peoples with arthritis survived and continue to
deal with because of policies such as the Indian Act (1876)
and Indian residential and day schools.
The Truth and Reconciliation Commission was formed
to address and reckon with the horrific legacy of forced assimilation
and abuses brought on Indigenous peoples by
the residential school system. The Commission’s final report
contained 94 Calls to Action that Canadians must take for
Truth and Reconciliation to truly occur. Calls to Action #18
to 246 are specifically related to Indigenous peoples’ health.
Call to Action #22 requires us — those who can effect
change within the Canadian healthcare system — “to recognize
the value of Aboriginal healing practices and use
them in the treatment of Aboriginal patients in collaboration
with Aboriginal leaders and Elders, where requested
by Aboriginal patients.” Bridging academic/institutional
medical practice with Indigenous healing practices and
belief — the intentional and respectful merging of two
worldviews — will facilitate bringing together mainstream
society and Indigenous peoples’ paths in unity, equity,
fairness and harmony, and begin to address harmful gaps
in arthritis models of care.
The Truth and Reconciliation Commission Calls to Action
are a starting point to guide our arthritis community
that numbers six million-plus in Canada. If we work and act
together on Call to Action #22, we can meaningfully contribute
to efforts towards “Reconcili-ACTION” and the design
and delivery of healthcare that is knowledgeable of, and
supports, Indigenous approaches to health and wellness.
The Truth and Reconciliation Commission's Final Report
is a testament to the courage of each survivor and
family member who shared their story, which continue to
resonate today six years after the report’s release.
The time for arthritis community action is now. Walk
with us.
Dr. Terri-Lynn Fox is an Indigenous Scholar and Indigenous
Person living with rheumatoid arthritis.
Cheryl L. Koehn is the president of Arthritis Consumer Experts
and a settler-colonial living with rheumatoid arthritis
References:
1. McDougall C, Hurd K, Barnabe C. Systematic review of rheumatic disease epidemiology in the
Indigenous populations of Canada, the United States, Australia, and New Zealand. Semin Arthritis
Rheum. 2017; 46(5):675-686.
2. Hurd K, Barnabe C. Mortality causes and outcomes in Indigenous populations of Canada, the United
States, and Australia with rheumatic disease: a systematic review. Semin Arthritis Rheum. 2018;
47(4):586-592.
3. Nagaraj S, Barnabe C, Schieir O, et al. Early rheumatoid arthritis presentation, treatment, and
outcomes in Aboriginal patients in Canada: A Canadian early arthritis cohort study analysis. Arthritis
Care & Research. 2018;70(8):1245-1250. https://doi.org/10.1002/acr.23470.
4. Loyola-Sanchez A, Hurd K, Barnabe C. Healthcare utilization for arthritis by Indigenous populations
of Australia, Canada, New Zealand, and the United States: A systematic review. Semin Arthritis
Rheum. 2017; 46(5):665-674.
5. Thurston WE, Coupal S, Jones CA, et al. Discordant indigenous and provider frames explain challenges
in improving access to arthritis care: A qualitative study using constructivist grounded theory.
International Journal for Equity in Health. 2014; 13(1). https://doi.org/10.1186/1475-9276-13-46.
6. Government of Canada. Truth and Reconciliation Commission of Canada: Calls to Action. Available
at https://publications.gc.ca/site/eng/9.801236/publication.html. Accessed March 7, 2022.
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