Article: Tackling bias to improve Indigenous health care

Profile from the Medical Post

Medical professionals often need to make quick decisions when faced with crisis situations. But when these decisions are based on stereotypes instead of evidence, they can actually compromise the health of patients.

Dr. Alika Lafontaine, an anesthesiologist of Ojibway and Cree descent, has made challenging assumptions around indigenous health care his life’s work. He sits as president of the Indigenous Physicians Association of Canada and travels the country spreading the message that confronting the bias, discrimination and racism faced by First Nations, Métis and Inuit Peoples is the most important step in improving their health outcomes.


His parents worked hard to instill in him the value of education, hard work and community service, and they also set him on a direct course to his future profession. Dr. Lafontaine’s mother taught her children the rich history of indigenous medicine, and stressed how they needed a doctor in the family to make sure they could get the right kind of care should anything happen to them. It was a message he now describes as “clairvoyant.”

Dr. Lafontaine knows the danger of assumptions firsthand. Growing up in Regina, teachers labelled him “developmentally delayed” due to a slur in his speech—an issue that was identified years later as a treatable hearing problem. Dr. Lafontaine received speech therapy and was placed in a class for students with learning difficulties before his family ultimately chose to handle his studies themselves.

Dr. Lafontaine flourished in this supportive learning environment, diving into his studies and devoting his free time to assisting the elderly in his community. At 16, he became one of the youngest recipients of a prestigious undergraduate NSERC research grant from the University of Regina, and his commitment to volunteering was recognized with a National Aboriginal Achievement Award. To this day, he’s the youngest recipient of the Indspire Award, the highest honour Canada’s Indigenous Peoples give their own.

Despite his many accolades, Dr. Lafontaine found himself adrift after completing his MD and a five-year fellowship in anesthesiology at the University of Saskatchewan—jobs in his specialty proved difficult to come by in the major prairie cities. With a wife, two young children and a hefty student debt load to manage, he begrudgingly accepted a position in Grande Prairie, the northern Alberta community of 50,000. Dr. Lafontaine admitted that while the decision first felt “like a series of things falling through,” his assumptions around rural health-care provision were quickly proven wrong. “I see very complex cases, and a lot of volume. You can make a major impact in a smaller community,” Dr. Lafontaine told the Medical Post. “My advance to trainees is to take a chance and go rural.”

Dr. Lafontaine has found contentment in Grande Prairie, but he certainly hasn’t settled down. A renowned public speaker and advocate for indigenous health, he’s delivered speeches and workshops across the country that challenge systemic bias and discrimination. For example, the belief that Indigenous Peoples are genetically predisposed to diabetes, addictions or mental health issues is common among many medical professionals, despite no scientific evidence to support it, and often leads to misdiagnoses. “The idea that there is something that the patient brings with them, that they can’t change, that all falls in the realm of myth,” explained Dr. Lafontaine. “In medicine, we have to move beyond the idea that if you look a certain way, you act a certain way.”

Of course, getting people to admit and confront their assumptions is challenging work. “Talking about discrimination is a very sensitive subject, especially with health professionals,” said Dr. Lafontaine. “These are people who are high-functioning, intelligent and have sacrificed a lot. It’s challenging to sit down with them and say, ‘We know that you mean well, but you’re still causing harm.’ ” He finds self-reflective learning to be a particularly effective method, where providers are encouraged to frequently ask themselves, “Am I making a decision based on evidence, or on what I think is evidence?”

Bias is entrenched in many of our systems and institutions in Canada, but there have been signs of progress on the national level. Prime Minister Trudeau has said indigenous health and wellbeing is a priority for his time in office, and has announced $382 million in new funding to ensure equal access to health and social services for indigenous children who were previously left in limbo between federal and provincial jurisdictions. Dr. Lafontaine sees it as a positive step, but warned that such investments don’t get to the heart of health discrepancies. “Indigenous Peoples have often been acted on, they haven’t been acted with,” he said. “Shifting from the approach of acting before unpacking the problem is one of the major challenges that the government is going to have as it addresses indigenous health.”

To spread this message, Dr. Lafontaine spent close to a quarter of the last year on the road. The jet-setting lifestyle is challenging for the now father of four, but Dr. Lafontaine sees an incredible opportunity for indigenous-led health leadership that hasn’t existed previously—one that he can’t possibly pass it up. “Indigenous leaders are at the point where they feel they don’t have to accept the system for what it is,” he said. “Now is the time for Indigenous Peoples to be full partners in health.”

Fast facts

  • Green thumb: Dr. Lafontaine is an avid gardener (that is, when he manages to find some free time). It’s a habit born from his youth, when his mother would encourage her children to weed “to keep us out of trouble.”
  • Music and martial arts: He holds a black belt in taekwondo, and used to perform with a Jackson 5-influenced musical group, 5th Generation, with his four siblings.
  • Political promise: Dr. Lafontaine was chosen as the winner of CBC’s “Canada’s Next Great Prime Minister” competition during his anesthesiology fellowship, but he laughs off the suggestion that politics might be in his future. “The interest is always there, but I feel like I’m being very effective at making an impact in the scope that I’m in right now.”
  • Family fun: Both music and medicine run in the family. Brother Leemai is both a dentist and an R&B artist based in Regina.

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