Addressing Systemic Bias and Improving Specialist Access for Indigenous Communities

Systemic Bias and Discrimination in Healthcare Access: A Policy Lens

Indigenous populations in Alberta face significant healthcare disparities, deeply rooted in systemic policies and structural inequities. Historically, Canadian policies, such as the Indian Act, have marginalized Indigenous communities by creating jurisdictional ambiguity in healthcare responsibilities, leading to patchwork services that are inconsistently funded and fail to provide equitable access (Government of Alberta, 2023). The Indigenous Primary Health Care and Policy Research Network has emphasized that fragmentation within Alberta’s healthcare system disproportionately affects Indigenous populations, reinforcing inequities in primary care access (Crowshoe et al., 2021). The jurisdictional divide between federal and provincial healthcare responsibilities creates inconsistent service delivery, leading to delays in treatment, poor care coordination, and reduced trust in the healthcare system.

One of the most alarming indicators of this systemic failure is the decline in life expectancy for First Nations people in Alberta. Between 2019 and 2021, life expectancy dropped from 70.3 years to 63.2 years, creating an 18.2-year gap between Indigenous and non-Indigenous Albertans (Government of Alberta, 2023). This disparity is not only a reflection of chronic disease prevalence but also the direct result of racism in medical practice and limited access to specialized care.

Racism in Medical Practice and Disease Burden

Indigenous patients in Alberta frequently experience discrimination within healthcare settings. A University of Calgary study found that two-thirds of Alberta physicians surveyed held implicit anti-Indigenous biases, leading to misdiagnoses, inadequate pain management, and delayed treatment (Government of Alberta, 2023). Indigenous patients who experience discrimination or poor treatment in healthcare settings are significantly less likely to return for future care. Trauma-informed care is essential in ensuring that health professionals recognize the impact of intergenerational trauma and provide culturally safe interactions that foster trust (British Columbia Ministry of Health & Ministry of Mental Health and Addictions, 2024).

The disease burden among Indigenous populations remains disproportionately high. Chronic illnesses such as diabetes, cardiovascular disease, and infectious diseases like tuberculosis are significantly more prevalent in Indigenous communities compared to non-Indigenous Canadians (Government of British Columbia, 2022). Additionally, chronic otitis media and hearing loss are widespread among Indigenous children, often leading to long-term speech, language, and cognitive developmental delays (Nash et al., 2023). These issues are exacerbated by limited access to ENT specialists, leaving many children without timely interventions.

ENT Challenges in Indigenous Children

A physician working in a rural Indigenous community in Alberta shared firsthand observations about the high prevalence of inner ear conditions in Indigenous patients. Many older Indigenous adults have experienced trauma to their ears due to residential school abuses, resulting in chronic tympanic membrane (TM) perforations, infections, and middle ear disease. These patients often require ongoing ENT care to manage chronic otitis media, conductive hearing loss, and other complications. Alberta Health Services’ Indigenous Health Program recognizes that chronic otitis media and hearing loss among Indigenous children often go undiagnosed or untreated due to geographic barriers and a lack of culturally informed ENT specialists (Alberta Health Services, n.d.). The program has called for greater integration of telehealth solutions and Indigenous-led screening programs to address this disparity.

The ability to capture and share high-quality otoscopic images with ENT specialists has been particularly beneficial in supporting care for these patients.

Alethea’s Role in Bridging the Gap for Indigenous Healthcare

The Vision Behind Alethea: AI-Driven ENT Solutions

Alethea was founded by Dr. Devon Livingstone, an ENT surgeon who pursued a Master of Translation Medicine program through the University of California San Francisco and Berkeley. His work led to the development of an AI-powered diagnostic tool for ear diseases, designed to assist primary care providers in accurately identifying and treating common ENT conditions. What began as an ENT-focused platform has since expanded into an eConsult service, connecting primary care physicians (PCPs) with specialists across multiple fields, enabling faster, more efficient referrals and specialist advice.

Expanding Indigenous Access to Specialist Care

As I have researched how Alethea can better serve Indigenous Canadians, two primary areas of impact have emerged:

1. Improving access to specialists—particularly ENT, cardiology, and endocrinology, which are critical for managing the high disease burden in Indigenous communities.

2. Providing culturally sensitive care, ensuring that Indigenous patients receive respectful, trauma-informed healthcare that acknowledges their unique experiences and historical challenges.

Alethea collaborates with physicians working with the Virtual Indigenous Clinic, who provide invaluable insights into the challenges Indigenous patients face in healthcare. One physician noted that finding the right specialists is crucial:

"Not all specialists can work well with patients who have a history of trauma. If a patient has one bad experience, it can take years to get them to go back. It’s a big deal for them to make the time and arrange transportation. We need to screen for specialists who are open and understanding. Alethea has helped me identify safe providers, which is something I wasn’t getting with traditional referral networks."

The Indigenous Primary Care Advisory Panel’s final report stresses that virtual healthcare and eConsult platforms could be key solutions in ensuring timely access to specialists, particularly in remote communities where in-person visits are limited (Indigenous Primary Care Advisory Panel, 2023). Alethea’s eConsult network aligns with these recommendations, helping to reduce barriers and improve culturally appropriate specialist access.

Innovating Culturally Sensitive Care Models - A New Idea: Cultural Navigators in Consults

One innovative idea that has emerged is to integrate culturally trained clinicians into specialist consults. These individuals would act as navigators, ensuring that consultations between primary care providers (PCPs) and specialists are conducted in a culturally competent manner. This approach could:

• Reduce medical trauma by ensuring specialists understand Indigenous patients' historical and cultural contexts.

• Improve patient trust in the healthcare system by providing safe, respectful interactions.

• Enhance specialist collaboration by offering guidance on how to communicate effectively with Indigenous patients.

By embedding culturally sensitive supports directly into the consultation process, Indigenous patients can receive fair and equitable care at all levels of the healthcare system.

Tackling This Gap Through Technology and Collaboration

While Alethea is working to bridge healthcare gaps through virtual access and culturally safe consultations, other health systems—like Fraser Health Authority (FHA) in British Columbia—are also making strides in improving Indigenous healthcare through technology and targeted services.

FHA has developed several mental health and crisis support resources specifically designed for Indigenous patients. This includes an Indigenous mental health nurse phone line, which offers counselling, referrals, and mental health education for both clients and the public (Fraser Health Authority, n.d.). They also operate the Métis Crisis Line, available 24/7, and the Tsow Tun Le Lum outreach line, which provides culturally sensitive counselling.

In addition to these services, FHA offers toolkits such as Hope, Help, and Healing for suicide prevention and the Wise Practices program, which promotes healthy living from a culturally grounded lens. These tools represent how technology, direct outreach, and culturally relevant frameworks can be combined to improve access to care and patient trust—a model that aligns with the goals of Alethea’s virtual consultation platform.

Conclusion

Indigenous communities in Alberta face systemic barriers in accessing healthcare, leading to higher disease burdens and lower life expectancy. Conditions like chronic otitis media, cardiovascular disease, and diabetes require specialist intervention, yet access to trustworthy, trauma-informed care remains a challenge.

Alethea’s AI-powered diagnostic tools and specialist eConsult platform are actively bridging these gaps. The ability to match patients with culturally competent specialists has already made meaningful improvements for Indigenous physicians and their patients. As we continue exploring solutions, integrating cultural navigators into consultations could be a game-changing approach to ensuring Indigenous patients receive equitable, respectful, and effective healthcare.

The healthcare system must adapt to the unique challenges Indigenous patients face, not the other way around. By leveraging technology, Indigenous-led initiatives, and trauma-informed care models, we can work towards true health equity for Indigenous communities.

References

Alberta Health Services. (n.d.). Indigenous health program. Retrieved March 8, 2025, from https://www.albertahealthservices.ca/info/Page11949.aspx

Bacic, A. (2025). Fraser Health Authority: How Does This Health Authority Support Indigenous and Marginalized Populations? Retrieved March 25, 2025, from https://amberbacic.wordpress.com/

British Columbia Ministry of Health & Ministry of Mental Health and Addictions. (2024). Indigenous cultural safety: Trauma-informed care. https://www2.gov.bc.ca/

Crowshoe, L., Sehgal, A., Montesanti, S., Barnabe, C., Kennedy, A., Murry, A., Roach, P., Green, M., Bablitz, C., & Tailfeathers, E. (2021). The Indigenous primary health care and policy research network: Guiding innovation within primary health care with Indigenous peoples in Alberta. Health Policy, 125(7), 725-731. https://doi.org/10.1016/j.healthpol.2021.02.007

Fraser Health Authority. (n.d.). Indigenous mental health and wellness. Retrieved March 20, 2025, from https://www.fraserhealth.ca/

Government of Alberta. (2023). Honouring our roots: Growing together towards a culturally safe, wholistic primary health care system for Indigenous peoples: Final report to the Ministry of Health. Government of Alberta. Retrieved from https://open.alberta.ca/publications/

Government of British Columbia. (2022). Indigenous cultural safety and trauma-informed care. https://www2.gov.bc.ca/

Indigenous Primary Care Advisory Panel. (2023). Honouring our roots: Growing together towards a culturally safe, wholistic primary health care system for Indigenous peoples: Final report to the Ministry of Health, Government of Alberta. https://open.alberta.ca/

Nash, K., Macniven, R., Clague, L., Coates, H., Fitzpatrick, M., Gunasekera, H., Gwynne, K., Halvorsen, L., Harkus, S., Holt, L., Lumby, N., Neal, K., Orr, N., Pellicano, E., Rambaldini, B., & McMahon, C. (2023). Ear and hearing care programs for First Nations children: A scoping review. BMC Health Services Research, 23, 380. https://doi.org/10.1186/s12913-023-09338-2