The Thee eat Initiative surfaced truths of how Indigneous-specific racism has shown up in past and present work at BCCDC.
Indigenous leaders and communities across Canada have long emphasized that truth must come before reconciliation. Thee eat, meaning truth, is also the first of six Coast Salish teachings gifted to the PHSA by Coast Salish Knowledge Keeper Siem Te Ta-in, Shane Pointe, affirming that truth-telling is the necessary first step toward reconciliation.
“You need to say the truth all the time. How you act and show up must be truthful. We need to be truthful in our work and we need our truth to be heard and not denied. We all must not deny the truth of the history and we must remain committed to addressing it.”
Taking the time to understand how settler-colonialism is present and operates is necessary to take steps to address the harm and move toward reconciliation. A foundational step in this journey is the BCCDC Thee eat Initiative.
- Truth-telling (thee eat): Identify and name truths about how Indigenous-specific racism, settler colonialism, and white supremacy show up in BCCDC’s history, structures, and practices, and “do our homework” by learning from truths already shared by First Nations, Inuit, and Métis communities.
- Apology and commitment: Issue a formal apology and leadership commitments to Indigenous People at an event in December 2025 to acknowledge past and ongoing harms and commit to sustained action.
- Our Journey: Begin relational and reciprocal accountability by sharing BCCDC’s reconciliation journey, including key milestones, learnings, and commitments through an external-facing platform.
This initiative aligns with the
Truth and Reconciliation Commission Calls to Action (#18), the In Plain Sight report (#1 and #22), B.C.’s Cultural Safety and Humility Standard (#1.1.1), B.C. DRIPA Action Plan (#3.7), the 2025 B.C. Ministry of Health mandate letter which makes a commitment to “advancing reconciliation, implementing the Declaration on the Rights of Indigenous Peoples Act and working in partnership with First Nations rights-holders to advance shared interests”, and PHSA’s North Star priority to eradicate Indigenous-specific racism.
The BCCDC Thee eat Initiative asked every part of the organization to do their homework and surface truths about how Indigenous-specific racism, settler colonialism, and white supremacy have shown up in our past and present work in public health. These truths reflect both historical and ongoing harms that continue to affect First Nations, Inuit, and Métis, peoples in B.C.
The frameworks
The BCCDC is using two closely aligned frameworks shared by a BC First Nations leader and a Black Public Health leader to help the organization learn and understand how Indigenous-specific racism is operating across structures, policies, practices, norms and values to act.
The activity was developed to support teams in identifying and examining examples of Indigenous-specific racism within their work and to deepen collective understanding of how colonial structures continue to shape public health. The activity can be replicated by other organizations or teams seeking to engage in truth-telling and reflection within their own contexts.
Step 1: Identify and describe the Thee eat (truth)
T
eams begin by reflecting on organization-specific thee eats—examples of how Indigenous-specific racism or colonial harm may have shown up within their program or service area. These reflections can include:- Current or past examples drawn from program area, team, unit etc.
- Historical experiences or knowledge connected to the organization’s role
Teams summarize their reflections by creating one or more slides or visuals that:
- Use either a text-based or visual format to describe the example,
- Show a timeline of when and how the example occurred, and
- If historical, identify how the example continues to have present-day impacts
Step 2: Analyze the example using Dr. Camara Jones’ framework
T
eams analyze their identified thee eat using the Dr. Camara Jones framework to explore how Indigenous-specific racism operates across the organization. Teams reflect on and discuss how racism shows up through five dimensions, paying special attention to the “absence of”:- Structures (who, what, where, when)
- Policies (written how)
- Practices (unwritten how)
- Norms (unwritten how)
- Values (why)
The goal is to move from identifying harm toward understanding its roots and developing actions to untie the systemic “knots” that continue to uphold racism and inequity.
Thee eat examples
The summary below includes examples that emerged at BCCDC through this activity.
In 1862, colonial officials in Victoria forced First Nations people infected with smallpox to leave the city, leading to the deliberate spread of the disease across First Nations communities throughout what is now British Columbia. Despite the availability of a vaccine, care and prevention were withheld from Indigenous Peoples, resulting in the deaths of an estimated 30,000 people, approximately 60% of the Indigenous population at the time. The intentional spread and denial of care constituted to an act of genocide that cleared the way for colonial settlement and expansion, leaving lasting intergenerational trauma and deep mistrust toward health authorities. In 2014, then Premier Christy Clark acknowledged historical evidence that smallpox had been deliberately spread, recognizing it as a deliberate and devastating act against First Nations Peoples in BC.
Analysis of smallpox spread in BC
Canadian colonial officials forced infected First Nations individuals out of Victoria, enabling the spread of smallpox and facilitating land dispossession.
Vaccines and medical care were deliberately withheld from First Nations communities, reflecting racialized policies of exclusion.
Infected blankets and displacement were used to intentionally spread smallpox among First Nations communities. Medical neglect used as a tool of settler colonial expansion.
Normalized dehumanization of First Nations and Indigenous Peoples. Indigenous deaths and suffering were accepted as necessary for settler gain.
Settler colonial values and capitalist values of land prioritized land acquisition over the life of First Nations and Indigenous Peoples. The intentional spread of disease reveals genocidal intent.
A memorandum from the organization that later became the BCCDC characterized tuberculosis (TB) as an “Indian problem,” portraying First Nations, Inuit, and Métis people as careless and a threat to white society. This framing fueled racist narratives that justified racially segregated Indian hospitals, where Indigenous Peoples were subjected to isolation, forced medical experimentation, sterilization, and substandard care, causing lasting mistrust of health systems and ongoing harms.
Analysis of tuberculosis memorandum
Colonial authorities brought TB to Turtle Island and created conditions (overcrowded reserves, poor housing, lack of sanitation and food) that allowed it to spread. They then failed to provide adequate medical care to First Nations people.
TB surveillance was sensationalized and lacked proper comparators. First Nations people were forcibly removed to ‘Indian Hospitals’, where many died in isolation or suffered permanent harm due to substandard care.
First Nations people’s health data were used without consent. Indian Hospitals provided substandard care and conducted forced experiments and sterilizations. Surveillance and neglect served settler colonial authorities.
TB data reinforced racist narratives portraying First Nations people as negligent and dangerous, normalizing their dehumanization and framing their suffering as deserved or necessary for settler benefit.
Settler colonial systems valued land and white lives over Indigenous lives. Despite clear evidence of poor health outcomes, care was withheld and data ignored, reflecting systemic disregard for First Nations well-being.
In the second edition of Social Determinants of Health: The Canadian Facts, “Indigenous ancestry” was listed as a determinant of health, the only racial or ethnic identity included as a risk factor. This framing reflects how Indigeneity is often pathologized within health research and policy, positioning Indigenous identity itself as a source of risk rather than naming settler colonialism and structural racism as the root causes of inequity. By treating Indigeneity as a variable to explain poor health outcomes, public health systems have reinforced deficit-based narratives and obscured the role of colonial violence in shaping the social conditions that determine health today.
Analysis of Indigenous Ancestry as a social determinant of health
Indigenous ancestry has been constructed as a risk factor in health frameworks, not because of inherent vulnerability, but because of the settler colonial system that continue to shape Indigenous Peoples’ lives such as the Indian Act, reserve system, residential schools, and jurisdictional divides between federal/provincial services.
Health and social policies often treat Indigenous ancestry as an explanatory variable for poor outcomes, without naming the underlying settler colonial and Indigenous-specific racist systems that produce those outcomes.
In practice, the identification of Indigenous ancestry in health systems is often used to justify surveillance, extract data, or offer limited services without structural change. It can lead to racial profiling, stereotyping, or even decision-making based on assumptions about risk, rather than relationships or context.
There is prevailing norm that equates Indigenous identity with poor health, reinforcing deficit-based thinking.
Reflects values of white superiority and deficit thinking, where the focus is on what’s “wrong” with Indigenous Peoples rather than what’s wrong with the systems harming them. These values keep white institutions in control and avoid naming settler colonialism as the root cause of health inequities.
In 2012, BC introduced a publicly funded Hepatitis A vaccine program for Indigenous peoples 6 months to 18 years of age related to outbreaks of hepatitis A infection in First Nations communities in the years prior. Provincial immunization guidelines developed by the BCCDC as well as public facing resources informed by BCCDC listed “Indigenous children and youth” as a high-risk group eligible for free Hepatitis A vaccine, without explaining why disproportionate risks exist. BCCDC has been informed of the possibility of vaccine hesitancy or low vaccine uptake due to perceived or real stigma as a result of this policy.
While additional context had been added to the provincial immunization guidelines in 2023, this has not been consistently applied across all resources for this program to adequately support culturally safe point of care conversations. The importance of relational communication and transparent rationale has been highlighted. There is ongoing work with Indigenous partner organizations to address the rationale for this program in healthcare provider and public facing resources, as well as identify opportunities for improvement to the program.
Analysis of Hepatitis A vaccine recommendations
Public Health often labels Indigenous Peoples as ‘high risk’ for various communicable diseases, leading to the conclusion of Indigeneity being the risk factor rather than acknowledging settler colonial practices and violence that create the risk.
Provincial immunization guidelines developed by the BCCDC as well as public facing resources informed by BCCDC listed “Indigenous children and youth” as a high-risk group eligible for free Hepatitis A vaccine, without explaining why disproportionate risks exist. A lack of due consideration on how to best frame or contextualize vaccine eligibility and a lack of consultation with Indigenous Peoples regarding a homogenous recommendation for all First Nations, Métis and Inuit youth in BC regarding eligibility for the vaccine may have resulted in reinforcement of perceived or real stigma.
Guidelines are issued often naming entire groups as eligible without naming the systemic and structural factors which place these populations at risk. The framing for this policy suggested that being Indigenous was the reason for the increased risk, rather than recognizing that ongoing settler colonialism structures, inequitable access to clean water, and systemic neglect have created these conditions.
By pointing to Indigenous identity instead of acknowledging the structural and systemic factors that place Indigenous Peoples at risk within provincial guidelines and resources, public health messaging reinforced colonial scripts and damaging stereotypes of Indigenous peoples and hid the responsibility of health systems in creating and maintaining these risks.
Ignoring (or failing to address) that Indigenous Peoples are disproportionately impacted by communicable diseases because of longstanding health inequities imposed through Canada’s settler colonial efforts—prioritizing institutional authority over relational accountability. By defining Indigenous youth as a high-risk eligibility group, the approach shifts attention away from the colonial policies that created unequal outbreak conditions in the first place and toward a deficit framing of Indigenous families and communities.
BCCDC’s analytic tools and reports have historically rendered Indigenous Peoples invisible by not having stratification by Indigeneity and no accompanying language to acknowledge this critical limitation. This omission perpetuates systemic harms by reinforcing the assumption that information about the dominant population is sufficient, while undermining Indigenous data sovereignty (OCAP®) and failing to meet obligations under DRIPA. The absence of accurate, respectful, and disaggregated data has contributed to inequities, mistrust, and harmful decision-making in public health and BCCDC acknowledges the need for continued partnerships with Indigenous data stewards on respectful approach to data governance, use, and reporting.
Analysis of Indigenous Peoples being made invisible in BCCDC analytic products
Very individualistic, privacy-oriented and risk-averse approach to data collection, sharing and use. Many structures are at odds with OCAP ®.
A lack of clear processes and complete misalignment of many laws and policies with the spirit and intent of DRIPA.
Information systems are not built to capture ethnicity. When available, has been used in the past in a way that caused harm.
Invisibility of data specific to Indigenous peoples in reports is acceptable.
The assumption that knowing the information for the dominant majority is sufficient and representative enough.
