Public Health Truths and Context

These self-guided learning modules provide information about the experiences of First Nations, Inuit, and Métis with public health.
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​These learning modules are designed to support the truth-telling goals of BCCDC’s Thee eat Initiative to listen, learn, and act by naming and understanding truths that have been shared. 

They help contextualize the systemic and ongoing harms caused by past and present colonial policies and practices within BC’s public health systems. They are designed to support honest dialogue, deepen understanding, and encourage critical reflection on how public health has caused harm and how our work must change.
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These modules are self-guided learning tool​s that can be used by anyone seeking to deepen their understanding, reflect critically on the role of public health institutions in perpetuating harm against Indigenous peoples, and how public health institutions—including BCCDC—can do better in upholding Indigenous rights, applying Indigenous knowledge, and creating safer, more accountable systems for Indigenous Peoples. 

Overview of Learning Modules

Modules one through six focus on a specific area of harm, offering a curated selection of summarized articles, books, reports, and discussion papers that speak to the truths – thee eat –and the experiences of First Nations, Inuit, and Métis with the public health system. 

The seventh module provides a timeline of Indigenous-specific racism, white supremacy, and settler colonialism within public health or factors impacting population health since Europeans arrived.​
The learning materials are organized around key themes that emerged from the BCCDC Thee Eat Initiative and are meant to guide reflection and conversation as part of a broader truth-telling process.  

The modules are not exhaustive; they support honest dialogue, informed learning, and collective accountability.  

Content Note 
The subject matter covered in these resources includes impacts of colonialism and health related harms to Indigenous people. This content can be distressing or triggering. We encourage you to take your time, step away as needed, and prioritize your well-being. Please consider accessing mental health supports or engaging in self-care as you reflect on this material.

Module 1: Smallpox epidemic

Objective: Learn how the 1862–1863 smallpox epidemic devastated First Nations in BC, and understand that it was made worse by deliberate colonial actions. The spread of smallpox is remembered today as an act of violence.

Smallpox outbreak of 1862–1863

The smallpox outbreak of 1862–1863 devastated First Nations’ communities throughout BC causing immense loss of life. In response, settlers largely prioritized their own interests, expressing a blend of superficial sympathy, moral distancing, and a pervasive belief that the devastation was both ‘natural’ and ‘unavoidable.’ 

Many Nations, including the Tsilhqot’in, Heiltsuk, Haida, and Stó:lō Nations maintain oral histories of the 1862 epidemic. These accounts highlight both the devastation and the colonial strategies that exacerbated its spread. Many assert the epidemic was not a natural disaster, but an act of colonial violence. These voices of truth are also supported by historical accounts that document how settlers deliberately distributed infected materials to Indigenous communities, making the spread an act of calculated harm rather than an inevitable tragedy.

In October 2014, BC Premier Christy Clark formally apologized to the Tsilhqot’in Nation in the Legislature for the wrongful arrest, trial, and hanging of six Tsilhqot’in chiefs in 1864–1865, Within this apology, she also acknowledged reliable historical accounts indicating that smallpox was deliberately spread among Indigenous communities as part of the colonial violence they faced. 


Module 1 learning materials

​Book: The Smallpox War Against the Haida  by Tom Swanky (2022)

This book explores a Haida oral account known as The Story of Bones Bay, which tells how Governor James Douglas deliberately used smallpox in 1862 to weaken Indigenous governance and pave the way for colonial rule in BC. It offers a critical reading of historical documents in conversation with Haida memory, revealing how the Crown established control over Haida Gwaii through violence and mass depopulation. The narrative sheds light on the roles of figures like Francis Poole and MLA Robert Burnaby, who helped mask the true nature of these actions through deliberate deception. By bridging oral history with archival sources, the book exposes the use of disease as a calculated instrument of colonial land acquisition.

This article outlines the smallpox epidemic of 1862–63 and how it devastated First Nations in B.C., especially impacts on individuals and communities. This article also demonstrates how colonial discourse at the time framed First Nations people’s suffering as ‘inevitable,’ using racist beliefs about Indigenous biology and morality to justify settler indifference and dehumanization. 

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​​​​​Module 2: Tuberculosis

Objective: Understand how segregated Indian Hospitals caused harm and lasting mistrust in Indigenous health care.​

Tuberculosis
​In BC, the tuberculosis crisis in the early to mid-20th century led to the establishment of racially segregated Indian hospitals and sanatoria specifically for Indigenous Peoples. Indian Hospitals operated separately and segregated from mainstream healthcare institutions non-Indigenous people accessed, often under poor conditions, limited oversight, and were at times subjected to human experiments for vaccinations (Blackburn, 2013). Three of the 22 Indian Hospitals across Canada operated in BC: Nanaimo Indian Hospital, Coqualeetza Indian Hospital, and Miller Bay Indian Hospital.

Indigenous patients were often isolated from their families and communities for months or even years, and many have shared accounts of mistreatment, medical experimentation, and cultural loss. These institutions reflected broader colonial policies that prioritized control over care, leaving a legacy of mistrust that continues to affect Indigenous health and well-being in the province today.

Module 2 learning materials
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Healing Histories is an in-depth collection of Indigenous truths on tuberculosis and Canada’s Indian Health Services. Through oral accounts from patients, families, and healthcare workers, it offers an Indigenous view of the Indian Hospital system and challenges colonial narratives. Centering Indigenous storytelling, it presents a new ethical model for researching and writing Indigenous health histories.
 
This book is an investigative account of BC’s segregated Indian hospitals, this work weaves together memoir, archival research, and survivor interviews. It sheds light on decades of systemic racism, medical neglect, and the lasting impacts on Indigenous communities. Through these truths, it uncovers a hidden history and calls for accountability. 

Memo: Tuberculosis Memo found at BCCDC

This document was found in an unlabeled box at 655 W 12th Ave, the BCCDC office in Vancouver, BC in 2018. It is believed to have been published in 1937 by the Bureau of Special Preventive and Treatment Services in the 1930s when public health bureaucrats warned of the perceived threat to Canadian society posed by what they called ‘Indian Tuberculosis.’ 

First Nations, Inuit, and Métis people were often depicted as ‘careless’ about their own health and as a ‘menace’ to the health of non-Indigenous Canadians. This memo reflects the racist narratives promoted by public health officials at the time, which were used to justify the creation and operation of state-run, racially segregated Indian Hospitals.

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Module Three: Unethical research

Objective: Understand how unethical research on Indigenous Peoples caused harm, ignored consent, and created lasting mistrust in health and research systems.​​

Unethical Research

​Unethical research involving Indigenous Peoples often disregards consent, causes harm, and prioritizes non-Indigenous interests. Examples include nutritional experiments in Indian Residential Schools, unauthorized medical testing, and the collection of biological samples without permission. These practices reinforced systemic racism, created deep mistrust in healthcare and research systems, and caused lasting harm to Indigenous communities.

Module 3 learning materials
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Newspaper: Ha-Shilth-Sa. (2004, December 16). Canada’s Oldest First Nations Newspaper - Serving Nuu-chah-nulth-aht since 1974. BC, Canada.

In the early 1980s, Dr. Richard Ward collected 883 blood samples from Nuu-chah-nulth individuals in the community of Ahousaht on Vancouver Island for a study on arthritis. Despite initial consent for arthritis research, the samples were later used without community approval for unrelated genetic studies, including those on HIV/AIDS and population genetics. As Dr. Ward moved to institutions in the U.S. and U.K, the Nuu-chah-nulth community remained unaware of these secondary uses and did not receive test results or updates. 

After Dr. Ward's death in 2003, efforts led to the return of the samples in 2004. This incident underscored ethical concerns regarding informed consent and the misuse of Indigenous biological materials, prompting the Nuu-chah-nulth to establish their own research ethics committee to oversee future studies. 

“It was only supposed to be used for arthritis research and to help others,” said Marla Jack, a Nuu-chah-nulth community member who was only 13 years old when she was volunteered to participate in the study. “Just because we’re First Nations doesn’t mean you can do whatever you want with us.” 


The Alberni Indian Residential School in Port Alberni, BC, was one of six residential schools across Canada where nutritional experiments were conducted on Indigenous children in the 1940s and 1950s (Lavoie, 2013). These experiments were part of a broader series of studies led by Canadian government researchers aiming to investigate the effects of vitamin and mineral deficiencies. 

Children were deliberately subjected to nutritional deprivation, including the withholding of essential food items to observe physical and developmental outcomes. At the Alberni Indian Residential School, researchers wanted to give children a low amount of milk for two years, enough to substantially deprive growing children of the calories and nutrients they needed for healthy growth and sustenance (Daniel, 2021).

The experiments were conducted without the informed consent of the children or their families, violating fundamental ethical standards. These practices have since been widely condemned as a disturbing example of state-sanctioned medical abuse and racism.


This article examines how colonialism has negatively impacted the cardiovascular health of Indigenous Peoples in Canada. The authors assert that colonial policies and practices have contributed to systemic marginalization, and that the ongoing erasure of Indigenous Peoples in health research has led to significant disparities in heart health outcomes. They emphasize the need to move beyond biomedical framework to one that incorporates the broader socio-political and historical contexts, centering Indigenous voices, experiences, and worldviews.

Drawing on two studies funded by the Canadian Institutes of Health Research, the authors underscore the importance of privileging Indigenous perspectives in health research to more accurately understand and address cardiovascular health inequities in Indigenous communities. 

“Colonization and enforced genocidal strategies changed our lives in profound ways and collectively fractured Indigenous people by attempting to erase and dismiss our knowledge. Even with this, we continue to understand that the heart is more than a physical organ but also it is its own living entity within the human body. It has its own way of having a relationship with the human body both inside, with all the other organs, and outside the body, with others, the land, and the creator. For us, the heart worked best with the mind, so much so that if the mind died, the heart could keep the body living; however, if the heart died, all else ceased to live. This is how powerful the heart is for us; we know if it is not looked after through relationships to other humans and the earth that it could be broken, die, or today, it can be replaced. We also know acknowledgement of the previous relationship must occur. Without that acknowledgement, “rejection” could happen. We also understand the different ways you see the heart, and we invite you to hear about and see how we view the heart. Our vision is that, together, new perspectives and knowledge can create a different path towards heart health.”
 - Dr Moneca Sinclaire Nēhinan, (Cree) Health Researcher

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​​Module 4: Communicable and non-communicable disease reporting and the “at risk” label​

​​​​​Objective: Recognize how framing Indigenous identity as a health “risk factor” reflects colonial and deficit-based narratives in public health.​

The “at risk” label
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Indigenous Peoples are frequently portrayed in public health literature and surveillance systems as “at risk” for a range of health conditions. This framing is grounded in stereotypes about substance use, sexual activity, and deficit-based narratives rather than on the colonial and structural determinants of health. Within public health contexts, epidemiology also perpetuates colonial narratives through negative statistics, serving colonial agendas, including deficit framing that positions Indigenous peoples as struggling and in need of being "saved" (Gebhard, McLean, & St. Denis, 2022).

Module 4 learning materials
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Within BCCDC and broader public health contexts, Indigenous identity itself is often implied or explicitly noted as a “risk factor,” particularly in relation to sexually transmitted and blood-borne infections (STBBIs), tuberculosis, hepatitis, and chronic diseases like diabetes.

Provincial immunization guidelines developed by the BCCDC in 2012 as well as public facing resources informed by BCCDC read:
Highlighted text: The hepatitis A vaccine is provided free to people at high risk of infection ... Indigenous children and adole
 
This deficit-based framing reinforces harmful stereotypes such as Indigenous people being inherently irresponsible, unhealthy, or prone to high-risk behaviour and/or Indigenous culture or identity, rather than colonization, is the root of poor health outcomes. 

​Communicable and non-communicable disease contexts
In communicable disease surveillance such as for HIV, hepatitis A, and syphilis reporting, Indigenous identity is often listed alongside behavioural risk factors like injection drug use or unprotected sex without sufficient contextualization of structural inequities like lack of access to culturally safe care or housing insecurity.

In non-communicable disease contexts, such as with diabetes or heart disease, higher prevalence rates among Indigenous populations are sometimes reported without acknowledgment of the socioeconomic conditions, environmental dispossession, and systemic racism that underpin these outcomes.

When identity is treated as a risk factor, it causes broad and lasting harms including:
  • Stigmatization: Indigenous Peoples may avoid seeking care due to fear of being stereotyped or judged, especially in contexts involving sexual health or substance use
  • Surveillance: Framing identity as the problem can justify increased monitoring or interventions without community consent or leadership, reinforcing colonial control over Indigenous bodies and data
  • Misaligned interventions: Public health strategies may focus on individual behaviour change 
Ultimately, labeling Indigenous identity as a “risk factor” obscures​ the structural and colonial roots of health inequities. Public health must shift toward equity-based approaches that honour Indigenous self-determination, data sovereignty, and systemic change.

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​​​​​Module 5: COVID-19 pandemic​

Objective: Learn how COVID-19 and related public health measures worsened existing inequities for Indigenous Peoples, limiting access to care and reinforcing systemic racism in the health system.​

COVID-19 pandemic
BC’s COVID-19 response has had harmful effects on Indigenous Peoples, specifically where public health measures have reinforced longstanding inequities. 

During the pandemic, many Indigenous People, especially First Nations in rural and remote areas, experienced reduced access to essential health and wellness services, including primary care, screenings, assessments, and immunizations. Preventative care and surgeries were often delayed or deferred, and some individuals chose to postpone or cancel appointments due to concerns about COVID-19, according to the First Nations Health Authority. Indigenous Peoples have been disproportionately affected not only by the virus itself but also by the public health measures implemented in response, which further entrenched existing inequities, discrimination, and systemic racism in the health system.

Module 5 learning materials

This report was released in March 2021 by the Tŝilhqot’in National Government in collaboration with researchers from the University of British Columbia. The title translates to “I am going to tell you about a very bad disease,” reflecting the report’s focus on the Tŝilhqot’in Nation’s experiences and responses during the COVID-19 pandemic. 

The report outlines the Tŝilhqot’in Nation’s proactive measures in exercising their jurisdiction to implement pandemic responses, such as establishing checkpoints and public health bylaws. It also delves into systemic challenges faced, including Indigenous-specific racism in healthcare, inadequate infrastructure, and limited access to timely health data. The document emphasizes the importance of Indigenous data sovereignty and the need for meaningful partnerships with government entities. The report concludes with 40 calls to action.

The report says: “The Tŝilhqot’in Nation exercises inherent jurisdiction to care for its traditional territory and the Tŝilhqot’in people. Leadership exercised this jurisdiction in response to the COVID-19 pandemic in a coordinated and effective fashion. The Nation did so despite the many limitations and constraints of historic and ongoing ​ colonialism.”  (Tŝilhqot’in Nation, 2025, p. 21).​


This video features Tyrone Joseph (Carrier and Sekani Nations), a board member and spokesperson for the Clarity Foundation Advisory. He reflects on how trauma, colonialism, and discrimination shaped vaccine confidence during the COVID-19 pandemic, highlighting the harmful effects of misinformation and Indigenous-specific racism on his community’s and family’s trust in both vaccines and the health care system.


This policy brief explores how the COVID-19 pandemic disproportionately impacted Indigenous communities in Canada, worsening pre-existing health inequities and increasing rates of mental health challenges, domestic violence, and isolation. It highlights how Indigenous women and gender-diverse people were particularly affected due to systemic barriers and reduced access to essential services, including healthcare and digital connectivity.


This report highlights how COVID-19 disproportionately impacted First Nations, Métis, and Inuit youth by increasing stress, isolation, and mental health challenges. Systemic inequities like inadequate housing, limited healthcare access, and food insecurity worsened these effects during the pandemic. The report also provides an in-depth timeline of Indigenous–colonial relations in “Canada,” offering important context for understanding the roots of these ongoing inequities and the resilience of Indigenous youth. 


This webinar is in partnership with the BC Office of the Provincial Health Officer (OPHO) and the Unlearning & Undoing White Supremacy and Indigenous-specific Racism Lab (U&U Lab at the BCCDC). It explores a 360° review that was conducted of the OPHO’s COVID-19 response through the lens of Indigenous rights, truth, and reconciliation.

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​Module 6: Land, climate and public health

Objectives: Understand how settler colonialism has disrupted Indigenous relationships with land and water, driving climate and ecosystem harms that affect public health, and how Indigenous-led stewardship and restoration support healing, resilience, and community well-being.

Land, climate and public health
This section explores how healthy ecosystems, lands, and waterways are inseparable from the health and well-being of Indigenous peoples. When these environments are degraded through settler colonialism, the impacts extend beyond ecological loss to include cultural, social, and public health harms. Restoring and protecting these interconnected systems supports environmental resilience, and the wellness of Indigenous communities and future generations.​​

Module 6 learning materials


This collaboration, involving Indigenous and settler researchers, examines the impacts of the draining of Xhotsa (Sumas Lake) in 1924 that devastated a thriving Indigenous ecosystem and uprooted the Semá:th Nation’s food systems in the Fraser Valley. The lake’s removal replaced an Indigenous food system with a settler agricultural one, causing lasting cultural and ecological harm. The authors also explore how flooding from the 2021 atmospheric river temporarily refilled the lake and how the response prioritized protecting farmland over restoring natural water systems. 

Through Indigenous laws, oral narratives, and economic analysis, ​​​this article argues that restoring Xhotsa through managed retreat would not only support climate adaptation and ecological renewal but also advance reconciliation by re-establishing the floodplain ecosystem and honouring the Semá:th people’s enduring relationship with the land and water.


This YouTube video features members of the səl̓ilwətaɬ (Tsleil-Waututh Nation) sharing who they are as a people and their deep connection to səl̓ilwət (Burrard Inlet). The video highlights their ongoing efforts to restore the inlet and surrounding waterways, reflecting Indigenous-led stewardship and the Nation’s vision for ecological and cultural revitalization.  


Building on the video Tsleil-Waututh Nation—People of the Inlet, this journal article presents a collaborative, Indigenous-led study by the səl̓ilwətaɬ (Tsleil-Waututh Nation) examining the cumulative ecological and human impacts of colonization on the səl̓ilwət (Tsleil-Wat, Burrard Inlet) ecosystem. Using archaeological, historical, and ecological data alongside səl̓ilwətaɬ science, the researchers model environmental stressors from 1750 to 1980, including smallpox epidemics, settler overfishing, habitat loss, and pollution. The findings reveal severe declines in ecosystem health and biomass linked to colonization and the disruption of Indigenous stewardship, underscoring the deep and lasting ecological consequences of colonialism.


This three-part film series (2019 to 2020) documents gatherings across the Fraser Salish, Northern, and Vancouver Coastal regions where Elders and youth share what connects them to their lands, waters, and territories. Grounded in the Indigenous practice of humble listening and walking together, the project supports the development of a new wellness-based indicator that measures First Nations’ connection to land as an essential (yet previously unreported) aspect of health and wellness in British Columbia.

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Module 7:  Timeline of truths & acts of reconciliation through the lens of public health 

Objectives: Recognize and reflect on how racism, discrimination and white supremacy show up in key moments in public health history​.

Upholding thee eat (truth)

This timeline lays out the truths of public health in the relationship between First Nations and colonizers, settlers, and newcomers in BC. Naming these truths is an important step on the path toward meaningful reconciliation. 

Within population and public health in BC, we have unmet responsibilities when it comes to monitoring and reporting on racism as a public health crisis and becoming anti-racist as a public health system. It is a unique context, as we are complicit in racism: our public health institutions are a risk factor in the determinant of health we seek to address.

Acknowledging Indigenous-specific racism as a public health crisis

White supremacy (advantages for white settlers, or white privilege) and Indigenous-specific racism (denial of Indigenous rights for the purpose of dehumanization and dispossession) are inherent in the settler colonial structure of BC and Canada (the laws, the institutions). This includes the legislation and policies that shape population and public health.

Being subjected to Indigenous-specific racism and settler colonialism is detrimental for health. In other words, health disparities between Indigenous people and other people living in BC have been “created not just by faceless pathogens but by the colonial policies and practices of Canadian governments.


Indigenous-specific racism is embedded within the structures and practices of public health systems themselves. In the timeline below, we document racist beliefs, actions, and narratives by settlers in public health and the broader system in every decade from contact up to present day. Indigenous-specific racism is resistant to intervention and does not go away on its own. The late Truth and Reconciliation Commissioner Mi-zhana-Gheezhik Murray Sinclair said, “Systemic racism is the racism that is left over after you get rid of the racists.” Unless deliberate steps have been taken to transform the structures, policies, practices, norms and values of public health, Indigenous-specific racism remains active. The relationship between public health, settler colonialism, Indigenous-specific racism and white supremacy consists of many elements and follows different threads through time.

​Public health responsibilities to name and eradicate Indigenous-Specific Racism

The 2020 In Plain Sight: Addressing Indigenous-Specific Racism and Discrimination in BC Health Care report provided specific evidence and recommendations, including a call for monitoring and truth telling about Indigenous-specific racism across BC’s health system. 
  • TRC Call to Action 18: We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge [Thee eat] that the current state of Aboriginal health in Canada is a direct result of previous [and current] Canadian government policies, including​ residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.​
  • In Plain Sight Recommendation 22: “That the B.C. government, in consultation and co-operation with Indigenous peoples, consider further truth-telling and public education opportunities that build understanding and support for action to address Indigenous-specific racism in the health care system; supplemented by a series of educational resources, including for use in classrooms of all ages and for the public, on the history of Indigenous health and wellness prior to the arrival of Europeans, and since that time.”
  • BCCDC Action Plan for Reconciliation 1.1.1: Enhance our understanding of the role of public health and BCCDC in the history of colonization and the ongoing experiences of racism within the healthcare system.
The timeline below is a first step to begin to name the truths of the origin story of public health. Truth and Reconciliation Commissioner Marie Wilson shared the healing power of the words, “I see you, I hear you, I believe you.” In naming these truths, we recognize BCCDC’s responsibility to consciously, consistently, and coherently eradicate Indigenous- specific racism from every nook and cranny of our organization and our sphere of influence.

To learn more about the importance of truth-telling in public health, visit:Ten-year anniversary of the Truth and Reconciliation Commission of Canada’s Calls to Action: Truth telling in public health in the British Columbia Medical Journal.

1700s

1770s

First European contact in the region colonially claimed as British Columbia

When our colleagues described the story of public health in BC in a 1934 article in the Canadian Public Health Journal, they began at European contact. In their telling, they failed to acknowledge the long-established health and wellness systems that existed prior to European arrival. This reflects the colonial narrative or script of “terra nullius” (land belonging to no one) that has been used to dispossess First Nations in BC.  (References​: 1-3)


1782

Smallpox epidemic kills an estimated one-third of the population of Coast Salish Nations around the Salish Sea
Epidemic disease was introduced to Turtle Island by Europeans. Smallpox reached the Salish Sea (Strait of Georgia) in 1782 with devastating consequences. The Union of BC Indian Chiefs reported, “A smallpox epidemic spreads overland from Mexico and kills one-third of affected communities in BC, mostly in Salish territories. By 1840, smallpox, influenza and other diseases kill roughly 65 to 95 per cent of Indigenous populations in the area.”

In his article, Voices of Disaster: Smallpox around the Strait of Georgia in 1782, geographer Cole Harris shares:
  • “The idea of disease-induced depopulation runs counter to the long-held conviction that Europeans brought enlightenment and civilization to savage peoples. It turns the story of the contact process away from rhetorics of progress and salvation and toward the numbing recognition of catastrophe.”
  • Karl Butzer, quoted in the same article, invites us to consider what impacts depopulation of this scale would have had in the homelands of White settlers: “Demographic collapse, in short, led to widespread settlement discontinuity. To grasp the implications of such discontinuity, one must imagine what almost total depopulation would mean in Italy or Spain ca. 1500 - silent villages, decaying cities, fields lying waste, orchards overgrown with brush.”

​Learn more 

1800s

​1862

Intentional spread of smallpox (germ warfare) by colonial administrators and doctors

Smallpox was used to dispossess First Nations and clear the land for the benefit of Britain (its subjects, monarchy, and companies) in what would become known as BC. In a 2014 apology in the BC legislature, former Premier Christy Clarke recognized the substantial evidence that smallpox was spread intentionally.

The typical response to smallpox by British public health experts at the time was to limit movement of people who were sick and in contact with other people who were sick. In this case, however, the opposite approach was taken. Under British law there was a legal obligation to avoid the spread of smallpox. The actions of colonial officials below were illegal by their own legal standards.

Suspected use of illegal inoculation 
Inoculation (exposure to small doses of the virus), risks creating disease carriers who could spread the virus. Inoculation had been made illegal in Britain because it resulted in people carrying and spreading the disease. In 1862, two physicians operating in BC, Dr. John Helmcken (an MLA in the Victoria colony) and Dr. Henri Deschene, ran “vaccination” campaigns. The pattern of sickness that followed — which resulted in mass death among First Nations people — was consistent with unlawful use of inoculation. Had these doctors abided by British public health protocols and used vaccinations, we would have expected to see people develop immunity rather than be infected with smallpox, and therefore it is suspected that inoculation, not vaccination, was used.

Suspicion of paid disease carriers
On March 12, 1862, a steamship (connected to an MLA with expansionist ambitions) sailed from San Francisco to Victoria. While smallpox was not prevalent in San Francisco at the time, there were two people carrying the disease on board. One stayed in Victoria, while the other travelled to New Westminster. The person who stayed in Victoria headed immediately to an away-from-home village of Tsimshian People, without a known purpose for their visit.

Spread under guise of help
The Tsimshian responded right away and implemented communicable disease control procedures but were limited in success due to severe overcrowding. A quarantine house for Tsimshian people who were sick was set up by the colonial government, but the settler chosen to run it and control movement of the Tsimshian was carrying smallpox. His contact with the Tsimshian in this role likely contributed to further spread of disease.

Destruction of First Nations homes and forced expulsion
On May 13, 1862, upwards of 300 homes of northern First Nations (Haida, Tsimshian) in Victoria were systematically burned down by colonial police. This included the homes of people who were sick with smallpox. Of hundreds who had been “vaccinated” by colonial medical men, many became disease carriers. Disease was then spread further when infected people were forced (some by gunboat) back to their home communities. By 1864, First Nations communities throughout what would become British Columbia lost the majority of their population to disease.


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1864

Imposition of the apartheid Reserve System in BC 
In 1864, BC governor James Douglas devised a set of reserves between 162 and 3,885 hectares. Three years later, these small parcels of land were reduced by 92 per cent by the Chief Commissioner of Lands and Works, Joseph Trutch. Authors of an article about ​​Sumas Lake (Xhotsa) write: “Throughout this period of land theft, Indigenous leaders advocated for their rights and made clear that the reserves were too small for the needs of their people.”
  • Forcible confinement to small segments of traditional territories had a profound impact on First Nations food systems – the ability of families to provide food for themselves – and prevented meaningful participation in settler economies, leading to starvation.
  • Imposing the reserve system has also had tremendous consequences on health and wellness related to water quality and sanitation. By all accounts, the structure of the reserve system has contributed to the spread of tuberculosis and other diseases that thrive in conditions of overcrowding.
  • The size of reserves reflected community population. Thus, the devastating depopulation caused by European introduction of smallpox shaped the areas of BC and Canada allocated to First Nations people today. Embedded in these settler decisions was the belief that First Peoples would never recover to their previous numbers.
  • Settler public health organizations in BC often normalize the Reserve System in the way it presents geographical data. The term “First Nations lands” is sometimes used to refer to reserves and does not recognize the rest of BC as unceded territory of First Nations.
(References​: 3, 7, 8)

Learn more 

1867

Tuberculosis (TB) reported as leading cause of death in Canada 

Advances in western medicine and public health in the treatment and prevention of TB transmission caused a decline of TB in the general population in the early 1900s, but the epidemic continued in First Nations communities. Overcrowding and malnutrition imposed on First Nations reserves and in residential schools created conditions for the rampant spread of TB and increased individual vulnerability to severe outcomes. Settler narratives “blamed the victim for their sickness” by interpreting increased TB rates being caused by a “lack of sanitary knowledge or of how to live in houses.” (Reference​: 8)​

1871

BC becomes a province of the dominion of Canada​

First Nations Peoples and their governments were excluded from the decision for BC to become a Canadian province; it was decided entirely by white men. Dr. John Helmcken, who is implicated in the settler-made crisis of smallpox in 1862, played an instrumental role in BC joining Canadian Confederation. He negotiated the terms in Ottawa, alongside Joseph Trutch and Robert Carrall.
  • “After joining the Canadian federation in 1871, the BC legislature immediately passed revisions to the electoral code, prohibiting First Nations and Chinese Canadians from voting in 1872, leaving a minority of ten thousand white settlers to dominate the estimated forty thousand Indigenous and Chinese people then in the province.”
  • At this point, First Nations people (40,000) outnumbered white settlers (10,000) in BC.
  • Some people spoke out against the racism of limiting voting based on nationality, race or colour, but these objections did not carry.
  • In the Challenging Racist “British Columbia report, scholars described what followed as: “a particularly acute form of Indigenous dispossession amounting to genocide; everyday racism and policies that demolished and dispersed Black communities; voting laws disenfranchising Indigenous peoples and Asians in a manner that echoed the era of US slavery; anti-Asian immigration laws that allowed a white minority to become the majority; and the attempted ethnic cleansing of Japanese Canadians from the province.” They go on to say, "the colony joined the Canadian federation based on Article 13 that consolidated a specific regime of racial power in BC based on the repudiation of First Nations as people, outright rejection of any notion of Aboriginal title, and sustained opposition to negotiation of treaties."

1872

Dr. Israel Powell named BC’s First Superintendent of Indian Affairs

Powell trained as a physician at McGill University before opening a medical practice in BC in 1862. He became involved in provincial politics and was appointed to Superintendent of Indian Affairs in 1872, a position he held for 17 years.
  • Powell’s policies aimed to assimilate First Nations Peoples into settler society and played a central role in the acts of genocide committed against First Nations in BC.
  • He led campaigns that pushed for residential schooling, passed legislation to make traditional practices like the Potlatch illegal, and advocated for and oversaw the removal of sacred and ceremonial objects from Nations and communities.
  • His position of power as both a physician and Superintendent of Indian Affairs enabled him to dramatically influence and develop the racist and paternalistic structures and policies that governed First Nations peoples’ lives. The impacts of his policies continue to this day.

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1874-1996

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Residential ‘school’ system operates in Canada for over 100 years

The well-being of Indigenous children is undermined and eroded when they are forcefully removed from their families and communities, as they were through the residential ‘school’ system. Between 1874 and 1996, over 150,000 Indigenous children were taken from their families and placed in residential schools. The system was an assimilationist strategy designed to sever the link between children and their families, languages, customs, and beliefs, in order to “kill the Indian in the child."
  • Physical, mental, emotional, and spiritual health consequences of residential school attendance have been profound, including while children were attending the schools, after they had left, and for their descendants. Reports from the residential school era demonstrate conditions (e.g., overcrowding, shoddy construction, poor ventilation, inadequate nutrition) at the schools contributed to spread of illnesses such as tuberculosis, while also lacking medical services or facilities to deal with health concerns.
  • In a 2017 scoping review, Wilk et al. identified 61 articles examining associations between attending residential school (42 studies) or being a descendant of someone who attended (38 studies), and both physical and mental health outcomes.17 They found evidence of poorer general and self-rated health, increased rates of chronic and infectious diseases, mental distress, depression, addiction and substance use, stress, and suicidal behaviours associated with intergenerational residential school attendance.”
  • Kelm notes, “rather than preserving the bodies of the children who were entrusted to their care, the residential schools tended to further endanger them through exposure to disease, overwork, underfeeding, and various forms of abuse.”
There were 18 Federal-Church operated residential schools in BC: Ahousaht, Alberni, Alert Bay, Anahim Lake, Cariboo, Christie, Sardis (Coqualeetza), Cranbrook, Kamloops, Kitimaat, Kuper Island, Lejac, Lower Post, Lytton, Mission, Port Simpson, Sechelt, and Squamish.
 
The argument, “it was a different time,” is sometimes used to try to explain Indigenous-specific racism. There are multiple examples — including from public health professionals — of people raising concerns about the damage caused by removing First Nations children from their families during the residential school era. People have spoken up against Indigenous-specific racism throughout history, and settler public health professionals must continue to speak up and act as champions for Indigenous rights today.

Epidemiological evidence has affirmed what Elders have long asserted: intergenerational Residential school attendance is associated with worse health outcomes.

(References​: 8, 13-21)

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1876

Indian Act comes into effect​
The Indian Act is a race-based law that remains in effect in Canada. It was imposed without First Nations consent, in contravention to treaties. The Indian Act made First Nations people wards of the Canadian state and defined the term person as “an individual other than an Indian.” As settler historian Mary-Ellen Kelm writes, Indigenous “health problems have roots in the material conditions of wardship and therefore can be fixed once those conditions are removed.”

“In this part of the world we’ve had 150 years of colonial rule where everything from birth to death were ruled by government legislation.” 
– Wenecwtsin Christian, Splatsin te Secwepemc.

“I think it’s critical that non-Indigenous Canadians be aware of how deeply the Indian Act penetrated, controlled, and continues to control, most aspects of the lives of First Nations. It is an instrument of oppression.” 
– Bob Joseph (Gwawaenuk Nation)

Indian Act amended to outlaw ceremonies in 1884
Banning ceremonies, including the potlatch, had devastating consequences for the health and wellbeing of First Nations. In British Columbia, the ban on the potlatch was justified on health grounds. The same amendment compelled people in First Nations to attend residential ‘schools’ attendance.

Criminalization of ceremony 
As the Challenging Racist “British Columbia”  report explains: “Anyone caught engaging or assisting with such ceremonies was guilty of a misdemeanour and liable to imprisonment. This section of the Indian Act was amended several times between 1884 and 1933, extending extraordinary powers to Indian agents to arrest and punish anyone caught participating or assisting in such ceremonial spaces.” 

Seizure of sacred items 
Seized masks and regalia were burned or ended up in museums around the world. When Indigenous delegates travelled to the Vatican in 2022, they were able to view sacred objects in the Vatican Museum. There have been decades of calls for museums around the globe to repatriate items that were taken without consent from First Nations, Inuit, and Métis Peoples. In October 2025, it was reported that several items will be returned to Canada. While they are initially being received by a national institution and Catholic partners, it is expected that the items will ultimately be returned to the Nations they originate from.​

Denied right to vote
Prior to 1960, the Indian Act made it so First Nations could only vote if they gave up their ‘Status’ as Indigenous Peoples and fully assimilated. This was called “enfranchisement” and was one tactic that the Federal government used to eradicate Indigenous People for the benefit of settlers. Put another way, for the first nearly 100 years of Canada’s existence, First Nations people were prevented from participating in the country’s so-called “democracy.”

Assimilation through enfranchisement
Annual Indian Affairs reports published from 1864 to 1990, highlight the legislative genocide of the Indian Act. For example, the 1969/70 report documented that in the 1960s, 6,943 First Nations people were forced to revoke their Indian Status and become assimilated through the process of enfranchisement. Until the Indian Act was amended, any First Nations person who wanted to vote or go to university had to give up their Status. This was a coercive approach to fixing “the Indian Problem.” The report also shared that 981 children were permanently adopted out of their communities during this decade, part of the Sixties Scoop. In total, 7924 (6,943 + 981) First Nations people were erased as Indigenous between 1960 and 1970, through this legislated genocide.

(References​: 8,9,  22-24, 110)

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1869 -1889

Measles epidemic in Upper Skeena region creates opportunity to strengthen imposed colonial administrative structures following the Skeena River Uprising

In her thesis, Amanda Nicole Dinnes argues:
  • "Although mortality during the 1886-1888 measles epidemic did not reach the scale of earlier epidemics, it is historically significant because it occurred during a pivotal point in newcomer/Indigenous relations in the Central Interior of British Columbia, and contributes to our understanding of the expansion of white settlement and colonial authority in BC’s Central Interior region at the end of the nineteenth century." 
  • "The measles epidemic was an essential element in the construction of the settler narrative of the Upper Skeena, and a key influence on the expansion of the Department of Indian Affairs (DIA) into British Columbia’s Central Interior region." 
  • "The epidemic entered BC during a period of economic and administrative transition, and evidence strongly suggests that shifting wage labour patterns and the growth of settler economies facilitated the spread of the 1887-1888 measles epidemic." 
  • Dinnes says measles contributed to colonial anxieties that legitimized colonialism and notes that BC refused to provide aid outside areas deemed suitable for white settlement.

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1893

Precursor to BC Public Health Act: “An Act Respecting the Public Health”

This law was unilaterally imposed in BC without First Nations consent, despite existing First Nations laws and the fact that First Nations sovereignty had never been ceded to the Crown. The so-called authority to impose this law was rooted in the legal fiction of the Doctrine of Discovery, which is now recognized as racist in the Canadian legal system. It was created by the Legislative Assembly of BC, from which First Nations people were excluded, as they were not allowed to vote in BC until 1949. The Act created a Provincial Board of Health, a precursor to the Office of the Provincial Health Officer, made up exclusively of “prominent medical men.”

(References​: 2, 9, 26)​

Erasure of First Nations territories and governance

​First Nations territories stretch to every inch of the province now known as BC and have never been ceded or surrendered. Yet, while the Act recognized multiple jurisdictions, including province and municipalities, the First Peoples and their relationships to land and territory were erased. The Health Act goes further, to empower the government to expropriate land for health reasons. Consent from a municipality is required, but consent from a First Nation is not.

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1900 - 1949

​1900s

Unethical research conducted on First Nations and Inuit Peoples throughout the 1900s​

​Eight examples of unethical research that dehumanized First Nations and Inuit people were identified:

  1. 1925-1936: Vermont Eugenics Survey involving Abenaki Peoples, whose territory stretches into southern Quebec, was used to label people as "defective, delinquent and despondent."
  2. 1933-1945: Cree and Nakoda Oyadebi infants in Saskatchewan subject to 12-year trial of the experimental BCG vaccine for tuberculosis
  3. 1935-1948: BCG Ttuberculosis vaccine experiment undertaken on southeast Alaska Natives without informed consent, including Tsimshian, Tlingit and Haida children.
  4. 1941-1971: First Nations people in BC Indian Hospitals subject to abuse, detention and experimentation
  5. 1942-1952: Nutritional experiments in residential schools
  6. 1959-1963: Cohort of First Nations students attending a special day school in Alberta recall receiving medical care that did not align with guidelines. All students had cancer by 2000.
  7. 1967-1973: Skin grants as medical experimentation on Inuit in Igloolik
  8. 1982 Nuu Chah Nulth blood samples used without consent

For example, between 1967-1973, experimental medical skin grafts were performed on Inuit in Igloolik without consent as part of an international biological research program. Other medical experiments included exposure to extreme cold without adequate clothing and being prodded with sharp objects to observe cold tolerance and ability to withstand pain. Celebrated Canadian physician Dr John B Dossetor was involved in these experiments in Igloolik and went on to become an expert on medical ethics. He published a memoir in 2005, which angered Inuit who were subjected to these medical experiments. As of October 2025, the Government of Canada is trying to get the case dismissed based on legal limitation periods, which runs counter to the Truth and Reconciliation Call to Action 26 which calls on the federal government to review and amend their statute of limitation to ensure that they conform to the principle that governments and other entitles cannot rely on limitation defences to defend legal actions of historical abuse brought by Indigenous Peoples. (References​: 27 -34, 36)​

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1918

Spanish Flu impacts First Nations in BC

Many First Nations across northern and central BC were hard-hit by the 1918 Spanish Influenza epidemic, suffering disproportionate morbidity and mortality compared to the rest of the population. As described in different accounts, this epidemic left villages empty, claiming the lives of hunters, mothers, and leaders – those key to community survival. Children in residential schools saw classmates die, and in some cases children were sent home to pass away with their family, presumably causing influenza to spread further. It would take several generations for First Nations populations to recover and these deaths also had serious long-term consequences to the health of those who survived the epidemic. (References​: 37 - 40)

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1922

Dr. Peter Bryce published “A National Crime,” highlighting the staggering death rates at Residential Schools – as well as government knowledge and inaction

In 1907, Dr. Bryce, Chief Medical Health Officer for the Government of Canada, determined the death rate from preventable disease in Residential “Schools” was 24% (46% over a 3-year period). When the report was published, the government response was to eliminate the Chief Medical Health Officer position.

A year after being forced to retire from the federal civil service in 1921, Dr. Bryce self-published a pamphlet in 1922 titled The Story of a National Crime. In it, he explains the context of his previous reports and how they were received by the government, as well as the findings and statistics found in the original reports. This book provides clear evidence of the government's role in creating and maintaining conditions that led to the huge number of student deaths at residential schools. (References​: 18, 41)

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1933 - 1979

Sexual Sterilization Act​
The Coercion and Consent: A health care provider’s guide for facilitating consent conversations with First Nations patients report by the First Nations Health Authority (FNHA) shares that, "the Sexual Sterilization Act was in effect in BC from 1933 to 1979. It gave the BC Eugenics Board the decision-making ability to sterilize individuals living in government-run housing without their consent or knowledge, if they were believed to have a mental disease or deficiency that could be passed to their children. While many people believe that coerced sterilization ended when the Act was repealed in 1973, this unfortunately is not true. Coercion in the health care system — and the failure to ensure patients provide informed consent to decisions related to reproduction and contraception — is ongoing, with Indigenous women disproportionately impacted. This was documented in a 2018 report from the United Nations Committee Against Torture​, the Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls, the investigations of the Canadian Standing Senate Committee on Human Rights, and the two reports published following their review. These egregious practices and clear violations of human rights must end. For many First Nations people, this is an example of the genocidal colonial practices developed in Canada.” (Reference​: 42)

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1936

Health Act, RSBC 1936, c. 114​
The Health Act impacts the health and wellness of Indigenous Peoples in the province. One example is that First Nations, Inuit, and Métis Peoples have been excluded from opportunities to become Medical Health Officers:
  • To qualify to be an MHO in BC, the Health Act stated that you must be a “Medical practitioner duly registered under the Medical Act to practice medicine and surgery.”
  • First Nations, Inuit and Métis people have been impeded from engagement in higher education, including medical education, through imposed settler colonial laws and policies.
  • From 1880-1920, any "Indian" who completed a university degree lost their "status". This was a tool of forcible assimilation through enfranchisement.
  • Starting in 1920, Residential School attendance was made compulsory for First Nations children. Again, this was a deliberate tool of cultural genocide with lasting impacts on educational attainment and participation in post-secondary education.
  • At the same time, policies were put in place to make it easier for White settlers to immigrate to BC and Canada, including opportunities to benefit from secondary education.
  • In 2023, just 0.39% of physicians practicing in BC identified as First Nations (no change since the first time this indicator was reported for the first time in 2019).
(References​: 9, 23, 43, 44)

1941

BC opens its first Indian Hospital​
Indian Hospitals were racially segregated tuberculosis sanatoriums that operated across Canada starting in the 1930s. Findings from the 2025 Federal Indian Hospital Class Action (Hardy v. Attorney General of Canada) affirmed that the purpose of these hospitals was to prevent the spread of TB to the white population.

Three Indian Hospitals operated in BC:
  • Coqualeetza Indian Hospital in Sardis (1941-1969)
  • Nanaimo Indian Hospital on Vancouver Island (1946-1966)
  • Miller Bay Indian Hospital in Prince Rupert (1946-1971)

Forced to attend
Amendments to the Indian Act in 1953 made it illegal for First Nations to refuse to go to a doctor or hospital or leave before discharge. Section 73.1.h of the Indian Act still gives settler governments the “authority” to compel medical treatment.

Deplorable conditions
Conditions at Indian Hospitals were deplorable. They were underfunded, understaffed, and overcrowded. Patients were subject to medical and nutritional experimentation. Enforced hospitalizations and physical restraints were common practice. Indigenous patients in these facilities experienced physical, sexual, and psychological abuse.

Held for years
Patients were admitted and held at Indian Hospitals against their will, often for years. During the In Plain Sight investigation, one Indigenous Elder shared that her mother was held at Nanaimo Indian Hospital for 18 years.20 In This is Public Health, the authors note that, “the average length of sanatorium treatment for the Inuit was two-and-a-half years, and when patients died, they were often buried without notifying their families.”

Links to residential ‘schools’ 
Indigenous children were shuttled between segregated institutions, from residential schools, where poor living conditions resulted in TB exposure, to mandatory treatment at Indian hospitals. 

Class action lawsuit
Hardy v. Attorney General of Canada was a national class action lawsuit brought on behalf of former patients of Federal Indian Hospitals and their families. A final Settlement Agreement was reached in 2025.

(References​: 20, 45-48)

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1942 - 1952

Nutritional experiments in residential schools 
  • Historian Ian Mosby writes: “Between 1942 and 1952, some of Canada’s leading nutrition experts, in cooperation with various federal departments, conducted an unprecedented series of nutritional studies of Aboriginal communities and residential schools.”
  • Nearly 1,000 Indigenous children at six residential schools (including the Port Alberni school in BC) between 1942 and 1952 were subject to nutritional experiments by the Department of Indian Affairs, led by medical doctor Lionel Pett. In these experiments, malnourished children were denied adequate nutrition, with treatment groups receiving nutritional supplements.
  • Pett, a medical doctor and lead of the federal Nutrition Services Division, played a major role in setting nutritional standards and policy in Canada. At the heart of experimentation was the ideology that Indigenous peoples, who were deemed racially inferior, might be fixed with proper nutrition. Nutritional experiments on First Nations children are directly connected to Canada’s Food Guide.
  • The Truth and Reconciliation Commission (TRC) concluded that: The federal government knowingly chose not to provide schools with enough money to ensure that kitchens and dining rooms were properly equipped, that cooks were properly trained, and, most significantly, that food was purchased in sufficient quantity and quality for growing children. It was a decision that left thousands of Indigenous children vulnerable to disease.
  • Evidence shows the connections between childhood hunger and chronic disease risk, both in adulthood and in succeeding generations. The elevated risk of obesity, early-onset insulin resistance and diabetes observed among Indigenous peoples in Canada arises, at least in part, from the prolonged malnutrition experienced by many residential ‘school’ survivors.
Impact on most recent Canada’s Food Guide. The most recent Canada’s Food Guide was released in 2019 and continues to be informed by experiments conducted by colonial health officials and health professionals on Indigenous children in residential schools who were deprived of adequate nourishment. “It is important to emphasize that the fields of nutrition and dietetics were not only complicit in colonization and genocide, but also that much of their foundational knowledge is derived from colonial research,” write University of British Columbia researchers in the Canadian Journal of Dietetic Practice and Research. This truth has not yet been fully reconciled within Canada’s food guide or related curriculum.

(References​: 13, 20, 50-54)

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1946

Superintendent says Indian Health Services exists to protect white people​
In a 1946 issue of the Canadian Journal of Public Health, P.E. Moore described the purpose of Indian Health Services to “prevent spread of disease to the white population.” (Reference​: 49)




1950 - 1999

​1951 

Legislative changes resulting in the Sixties Scoop are enacted by the federal government​
As the residential schools closed, wide-scale apprehension of Indigenous children into the child welfare system perpetuated removal of Indigenous children from their families and communities.

The TRC argued that through its impact on families, the residential school system created conditions that facilitated the next wave of apprehensions during what is known as the Sixties Scoop. Between 1951-1991, tens of thousands of Indigenous children were removed from their homes and placed – often permanently – with non-Indigenous families. Like the residential school system, the removal of Indigenous children from their homes and families was anchored in imposed settler government legislation and policy.

In 1951, Section 88 of the Indian Act was amended, effectively delegating responsibility for Indigenous health, welfare, and education to the provinces. Funding arrangements incentivized apprehensions as per capita amounts were only released once a child was in custody, and little money was available to support families to stay together. Between 1955-1964, the proportion of children in foster care who were Indigenous increased dramatically, going from less than 1% to over 34%, and continued to climb in the 1970s and 1980s. (References​: 41, 43, 56-59)​

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1953

Legislative changes authorize forced hospitalization and policing of Indigenous patients
The Indian Health Regulations: How tuberculosis played into Canada’s settler colonial genocide article by the UBC Indian Residential School History and Dialogue Centre shares that: “The Indian Act  was amended in 1953 to include the Indian Health Regulations​. These policies 'made it a crime for Indigenous people to refuse to see a doctor, to refuse to go to hospital, and to leave hospital before discharge.'​ It allowed the RCMP to arrest patients, forcibly hospitalize them, return patients who left against medical advice, and send patients who were “recalcitrant” to jail. Faced with imprisonment no matter what they did, Indigenous patients were forced to stay in Indian hospitals, where abuse and mistreatment were rampant." (Reference​:  112)

1979

Creation of federal Indian Health Policy
In 1979, the federal government formalized its responsibility for healthcare for Indigenous peoples through the creation of the Indian Health Policy. This resulted in a semi-segregated and fragmented system of care for Indigenous people. On-reserve services are funded by the federal government, and Indigenous people with status are covered by a federal Indigenous-specific insurance plan (i.e., non-insured health benefits). Indigenous people also access mainstream health services offered by provincial health systems.

The degree of segregation has shifted over time; however, in all manifestations, the system has contributed to healthcare inequities. Allan and Smylie argue that, “race-based legislation has normalized the uneven distribution of health funding, resources, and services.” (References​: 61 - 66)

1980

History of Public Health in BC booklet is published
This booklet is a celebration of the settler public health history of BC, emphasizing the triumphs, and determination of public health professionals. Like many public health narratives from the time, First Nations people and their contributions to public health in BC are nearly invisible. On the few occasions that First Peoples are mentioned, they are not referred to by name. (Reference​: 111)


​1984

Public health nursing texts across the 20th century display white benevolence 
Scholars have described dynamics of white benevolence as “a form of paternalistic racism that reinforces rather than challenges racial hierarchies” that is present across Canadian institutions. An excerpt from nurse Aileen Bond’s 1949 report was highlighted in the 1984 book Through the Years with Public Health Nursing in BC:



In a 1967 article Public Health Nur​sing Services for Indians, Casselman referred to First Nations home environments as “improper.” The uncited assertion that school children were the healthiest “under the surveillance of many interested teachers as well as our health team,” does not hold up against the substantial evidence that residential ‘schools’ increased risk of disease and death among children who attended​. (References​: 3, 15, 18, 19, 67, 68)

2000s

​2005 

BCCDC report on obesity one example of population health pathologizing Indigenous Peoples
The 2005 report describes obesity rates among Indigenous behaviour is framed as the problem in line with other public health narratives at the time. The onus for intervention is focused on “mothers, infants and pre-schoolers.” Characterizing Indigenous parents as unfit is one of the ways that settler colonial policies including the Residential School System, Sixties Scoop, and Millennial Scoop have been legitimized. (References​: 13,41,43, 53, 69)​

2009

H1N1 management fosters mistrust among Indigenous Peoples 
The 2009 H1N1 pandemic was another example of a communicable disease outbreak where Indigenous Peoples and communities were overburdened with critical illness and death. The response from health officials failed to include Indigenous Peoples in decision making and fueled distrust.

Northern First Nations communities waited on delivery of appropriate personal protective equipment (PPE) including gloves, masks, flu kits, and hand sanitizer for over a month as H1N1 began to take hold, while public health officials debated sending hand sanitizer due fear of alcohol misuse. This reflects deep, ongoing racist stereotypes held by government officials and a failure to include First Nations people in decision-making.7 When deliveries arrived, some were without the expected preventative measures such as hand sanitizer and antiviral treatments, and included body bags instead. When the vaccine rollout began, Indigenous Peoples were initially excluded from receiving priority access in some regions, despite being disproportionately impacted by the H1N1 virus, due to the ongoing impacts of colonization. In other regions, Indigenous Peoples were included as a stand-alone category in the prioritization, which left some reportedly feeling like guinea pigs. (References​: 70-73)​

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2010

Canadian Public Health Association publishes This is Public Health: A Canadian History ​
Only one of the experts highlighted in the history of public health in Canada is Indigenous. The book perpetuates three patterns that uphold the ‘status quo’ of white supremacy within the discourse of public health. First, there is no recognition of Indigenous public health systems and contributions.  Second, it speaks in a way that normalizes the lack of public health services and the impact of epidemics on Indigenous populations.  Third, it neutralizes the history of public health’s role within settler colonialism, failing to acknowledge that smallpox was deliberately used as a tool of dispossession and settlement. (References​: 5, 6, 8, 74)

2012

Criminalization of HIV non-disclosure disproportionately impacts Indigenous Peoples​
In 2012, the Supreme Court of Canada ruled that people living with HIV have a legal duty to disclose their HIV status to their sexual partners under criminal law. Canadian criminal law has been imposed on Indigenous Peoples without their consent, and it denies Indigenous law and legal traditions. Human rights advocates argue that this approach upholds punishment, not wellbeing. People subjected to settler colonialism (Indigenous Peoples) carry a greater burden of HIV than other people in Canada and are therefore more impacted by this decision. Research has found statistical relationships between being affected by the Sixties Scoop and Millennial Scoop and experiencing both HIV transmission and worse treatment outcomes. According to the HIV Legal Network, by December 2020, there had been at least 224 (at least 15 Indigenous) cases where a person living with HIV was criminally charged and accused of not disclosing their HIV status to a sex partner. (References​: 75-78)

2013 - 2018

Inaction impeded access to HIV PrEP (Pre-Exposure Prophylaxis) in BC

  • ​2013: HIV PrEP (Pre-Exposure Prophylaxis) became available at no cost, through the Non-Insured Health Benefits (NIHB) program and First Nations Health Authority (FNHA) for First Nations and Inuit. There were extremely limited efforts to disseminate this information, with no concentrated push for awareness and access to First Nations and Inuit or service providers. Over the following three-year period, a total of 23 people accessed HIV PrEP through NIHB and FNHA.
  • 2018: HIV PrEP becomes available for broader provincial access through the BC Centre for Excellence in HIV/AIDS, which is well publicized in the media. Over 2,000 people were prescribed HIV PrEP in the first year.
  • Community Impact: Inadequate promotion of HIV PrEP to First Nations and Inuit prior to January 2018 led to missed opportunities for targeted PrEP implementation with First Nations and Inuit in BC at risk of HIV infection and may have led to HIV infections that could have been prevented. 

(Reference: 84)

2014 - 2025​

Environmental crises have disproportionate impacts on First Nations communities in BC

Changes to the lands and water due to settler colonialism have disproportionately affected First Nations communities in BC. Environmental crises are not new in this decade; the disasters listed below represent an incomplete list of recent events that result from settler colonialism impacting the health of lands, waters, animals and people.  Devastation of forests, watersheds and salmon runs are leading to severe disruption of traditional food and medicine systems, including hunting, fishing, and harvesting practices. This is partially a result of settler criminalization of First Nations stewardship activities.

  • 2014: Mount Polley tailings dam breach
  • 2016: Nathan E. Stewart oil spill in Heiltsuk Territory
  • 2017: Decade of record-breaking wildfires begins
  • 2018: Big Bar landslide
  • 2021: Heat dome and wildfire in Lytton
  • 2021: Flooding of Sumas prairie
  • 2023: Bush Creen East wildfire
  • 2024: Tŝilhqox river Landslide
  • 2025: Study finds 90% of səl̓ilwət (Tsleil-Wat, Burrard Inlet) food ecosystems destroyed
  • 2025: 38 Drinking water advisories in effect across 32 First Nations in BC​

(References​: 7, 79-81, 82 83)

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2014

Indigenous Peoples positioned as “at risk” in BC HIV Testing Guidelines
The guidelines recommend testing all individuals 18 to 70 years old, with “Aboriginal people” among those listed as a priority population for testing. In the footnotes, it suggests a “higher burden of disease” among “Aboriginal people” as rationale for increased testing frequency. Previous research has highlighted Indigenous Peoples are subject to over testing, but are impeded from fully realized access to HIV treatment.
  • The data used for the guidelines emphasizes deficits, and the language is rooted in settler colonial constructs without acknowledging historical and ongoing racism as a structural determinant of Indigenous Peoples health.

(References​: 85-87)

2015 

Truth & Reconciliation Commission (TRC) final report and 94 Calls to Action ​
The Commission was a legal condition of the Indian Residential School Survivors Settlement Agreement. Six of the TRC Calls to Action (18 to 24) are related to health, and many more are related to the social determinants of health. Very few TRC Calls to Action have been implemented. In 2023, the Yellowhead Institute made the decision to stop issuing annual report cards because of a lack of year-to-year change. (Reference: 88)

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2016

Declaration of public health emergency related to the toxic drug poisoning crisis
Being subject to settler colonialism has been implicated as a risk factor for substance use. First Nations people were five times more likely to experience an overdose event and three times more likely to die of overdose in 2015/16, compared to other BC residents. Although just 3.4% of residents in BC are First Nations, 14% of all overdose events involved First Nations people and 10% of overdose deaths were among First Nations people. For the first time, First Nations leaders stood with settler health system representatives to present public health emergency data together in partnership. (References​: ​ 14, 89-92)

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2019

Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls (2SLGBTQQIA+)​
“The National Inquiry’s Final Report reveals that persistent and deliberate human and Indigenous rights violations and abuses are the root cause behind Canada’s staggering rates of violence against Indigenous women, girls and 2SLGBTQQIA people. The two-volume report calls for transformative legal and social changes to resolve the crisis that has devastated Indigenous communities throughout the country. The Final Report is comprised of the truths of more than 2,380 family members, survivors of violence, experts and Knowledge Keepers, shared over two years of cross-country public hearings and evidence gathering. It delivers 231 individual Calls for Justice directed to governments, institutions, social service providers, industries and all Canadians.” Each time the Unlearning & Undoing White Supremacy and Indigenous-Specific Racism Lab has asked people working in population and public health in BC about their engagement with the Foundational Obligations to Indigenous Peoples, the MMIWG2SLGBTQQIA+ is where they had least engagement. As of 2024-25, just two of the 231 Calls for Justice have been realized. (References​: 93-96)

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2020

Declaration of the COVID-19 public health emergency in BC 

On March 17, BC’s provincial health officer (PHO), declared a public health emergency. COVID-19 did not happen in isolation for Indigenous communities in BC; rather it intersected with and exacerbated existing public health crises already disproportionately impacting Indigenous Peoples, including toxic drug poisoning deaths, food insecurity, racism, mental health crises, climate injustice, and the uncovering of unmarked graves at residential ‘schools’.

Public health is not yet trustworthy. A BC Centre for Disease Control report on misinformation during the COVID-19 pandemic found just 38 per cent of Indigenous respondents looked to BC’s Provincial Health Officer Dr. Bonnie Henry for COVID-19 information early in pandemic, compared to 58 per cent of White respondents.

Cowichan Tribes subject to COVID-19 related racism. Community members shared that they had experienced appointments being cancelled and being asked during COVID-19 screening if they had been in touch with any Cowichan Tribes members. They also shared experiences of being subject to racism online. 

Seven ‘colonial knots’ were identified in BC’s public health response. The BC Office of the Provincial Health Officer (OPHO), and the Unlearning & Undoing White Supremacy and Indigenous-specific Racism Lab for population and public health (U&U Lab) partnered to complete a 360° review of the OPHO’s COVID-19 response through the lens of Indigenous rights, truth, and reconciliation.

(References​: 97-103)

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Pathologizing Indigeneity in social determinants of health models
Indigenous ancestry continues to be listed as a social determinant of health in The Canadian Facts textbook. Kelm argues that “portrayals that present [Indigenous] people as essentially pathetic, pathological and powerless” are fundamental to colonial scripts that dehumanize Indigenous Peoples by presenting them as inherently sick and/or vulnerable and therefore normalizing health disparities. In fact, Indigenous culture and identity is a source of strength and resilience that supports health and wellbeing. It is being subject to settler colonialism that is a negative determinant of health. (References​: 8, 90, 104, 105)

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  • REPORT: Social Determinants of Health: The Canadian Facts. By Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020).

In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care report released
This report illuminates the systemic racism and discrimination experienced by Indigenous Peoples accessing BC’s Health Care system, and provides 24 recommendations for comprehensive reforms, cultural safety, and accountability.

Two-Spirit leaders raise concerns related to the “missing chapter” of In Plain Sight. “The term Two-Spirit didn’t appear in any of the report’s initial 230-pages,” says Jessy Dame, Two-Spirit program manager with the Community-Based Research Centre. “And when the supplementary In Plain Sight gender update was released a few months later, there was only one sentence, and it stated that queer and Two-Spirit folks reported better health experiences than Indigenous men and women in our healthcare system—which we know to be false.”

(References​: 106 - 108)

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​2024

Manitoba bans incarceration under the Public Health Act
Manitoba’s chief medical officer signed a directive prohibiting incarceration under the province’s Public Health Act, following a CBC investigation. In BC, the Public Health Act provisions allowing incarceration remain in effect. This excerpt from “This is Public Health: A Canadian History” highlights how leaving out a critical settler colonialism perspective from considerations of public health’s “police-like powers” can be problematic. (Reference​: ​ 48)

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Life expectancy of First Nations in BC drops 
Life expectancy – perhaps the most important indicator of the success of public health systems in Canada – of First Nations in BC decreased by six years between 2017-2021. This is the result of disproportionate impact of public health emergencies (COVID-19 and the toxic drug poisoning crisis) on First Nations Peoples, and the failure of public health to address these impacts. Despite growing emphasis on ‘health equity’ in the last decade, the gap in life expectancy between First Nations and other residents in BC is widening. It is a unique context, as we are complicit: Canadian public health institutions are a risk factor in the structural determinant of health we seek to address. (References​:  6, 44, 109)

2025

​Braiding Accountability: A Ten-Year Review of the TRC’s Healthcare Calls to Action released
The report states Indigenous Peoples have articulated for generations that “genuine transformation requires the redistribution of power, resources, and decision-making authority.” The Yellowhead Institute reaffirms this Truth through their evaluation of federal, provincial and territorial health authorities’ response to the Truth and Reconciliation Commission’s Health Calls to Action (18-24 and 57) over the last decade (2015-2025). Using the Braiding Framework for Health Accountability, the report findings show how government institutions preform “reconciliation theatre”, symbolic gestures that project progress without addressing structural inequities or transferring authority to Indigenous Peoples.

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Additional Readings

These modules offer a glimpse into the lived experiences of many First Nations, Inuit, and Métis Peoples and communities within public health systems. To deepen understanding, additional readings may be necessary to further surface these truths. 

The following foundational reports are recommended for further exploration:























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