Reconciliation in Healthcare: The Work We Still Haven’t Done

March 23, 2026

In 2015, the Truth and Reconciliation Commission released 94 Calls to Action. Seven of them were directly focused on health. They were not abstract. They were specific, measurable, and grounded in decades of evidence about the inequities Indigenous people face in healthcare systems across Canada.

We do not need more studies. We do not need more reflection.
We already know what needs to be done.

And yet, nearly a decade later, much of that work remains incomplete.

Call to Action 18 begins with a fundamental truth: the current state of Indigenous health in Canada is a direct result of previous Canadian government policies, including residential schools. It calls on governments to acknowledge this and to recognize and implement the healthcare rights of Indigenous peoples.

This is not fully realized.

Indigenous people in Canada continue to experience lower life expectancy, higher rates of chronic illness, higher infant mortality, and significantly poorer access to care. These disparities are not new. They have been documented for decades, including in federal reports and by organizations such as the Auditor General of Canada. The TRC did not introduce these facts. It confirmed them and demanded action.

Call to Action 19 calls for the establishment of measurable goals to close these gaps. While there have been commitments and frameworks introduced at various levels of government, there is still no consistent, transparent national reporting system that demonstrates meaningful progress across all key indicators.

Call to Action 20 speaks to the distinct health needs of Indigenous peoples. This includes recognizing jurisdictional complexities that have historically resulted in delayed or denied care. The legacy of this failure is well known. The case of Jordan River Anderson, a young boy from Norway House Cree Nation who died in hospital while governments argued over who should pay for his care, led to Jordan’s Principle. Yet even today, access to services under Jordan’s Principle is uneven and often delayed.

Call to Action 21 calls for sustainable funding for Indigenous healing centres. While some investments have been made, access to culturally grounded healing services remains limited, especially in urban settings where the majority of Indigenous people now live.

Call to Action 22 calls on healthcare systems to recognize the value of Indigenous healing practices and to integrate them into care where requested. This remains largely aspirational. In many healthcare environments, Indigenous knowledge systems are still treated as secondary, optional, or symbolic rather than essential components of care.

Call to Action 23 calls for increased numbers of Indigenous professionals in healthcare. There has been some progress in recruitment and training, but Indigenous representation remains significantly below what is needed to reflect the population and to transform systems from within.

Call to Action 24 mandates cultural competency training for healthcare professionals. This is one of the most widely implemented actions. Hospitals and institutions across Canada now require some form of Indigenous cultural safety or awareness training.

But here is the uncomfortable truth: training alone is not enough.

Training can raise awareness. It can introduce history. But it cannot, on its own, undo bias, change behaviour, or transform systems. In some cases, those who most need to reflect on their assumptions engage with training at the most superficial level. When training becomes a requirement rather than a responsibility, its impact is limited.

Cultural safety is not a certificate. It is a practice.

It shows up in how quickly someone is assessed.
In whether pain is believed.
In whether symptoms are investigated or dismissed.
In whether a patient is seen as someone in need of care, or as someone who is part of the problem.

This is where the Calls to Action move beyond policy and into practice.

Because the issue is not whether we know what to do.
The issue is whether we are willing to do it fully.

The inquest into the death of Heather Winterstein sits within this reality. Her experience reflects many of the gaps the TRC identified: assumptions about social circumstances, failure to recognize the severity of illness, and a system that did not respond with the urgency her condition required.

This is not a failure of knowledge. It is a failure of implementation.

Reconciliation in healthcare cannot be performative. It cannot be limited to statements, training modules, or symbolic gestures. It requires structural change, accountability, and a sustained commitment to doing things differently.

That includes: