Josh Swain, MSc’23, reflects on his role in creating the groundbreaking Indigenous World Views in Health Delivery and Research course at McGill’s School of Population and Global Health and sheds light on the ongoing effort to decolonize health care and improve cultural safety for Indigenous communities in Canada.

An inaugural McCall MacBain scholar, Josh Swain (MSc’23), who is Red River Métis from Manitoba, is a tireless advocate for Indigenous communities. While studying for his master’s at McGill’s School of Population and Global Health (SPGH), he was part of the student-led initiative that led to the creation of the Indigenous World Views in Health Delivery and Research course now offered to graduate students in the School. During his undergrad at the University of Winnipeg, he helped run .caISES, a campus group that supports Indigenous students in STEM, and taught biology and financial literacy to Indigenous students. After a placement with the Cree Board of Health and Social Services of James Bay, and in parallel to his role as Indigenous Clinician Research Coordinator at the Research Institute of the MUHC, Swain now works as Special Projects Manager at Anishnawbe Health Toronto where he is involved in providing health services to urban Indigenous populations.

We caught up with Swain after he presented about the course at the Victor Dzau and Ruth Cooper-Dzau Distinguished Lecture in Global and Population Health on May 18, 2023.

What led you to public health?

I used to work in finance, which was not fulfilling, so I went back to university with the understanding that I wanted to work in health care in some capacity. I was blessed to be awarded a McCall McBain Scholarship that enabled me to complete a graduate program at McGill, where I completed my Master of Science in Public Health. What attracted me to this field was, on the one hand, the underrepresentation of Indigenous people in public health and in health care in general. On the other, because so few Indigenous people work in this space, there is an opportunity to have that much more of an impact. I wanted to do something that has a positive impact on my community.

Could you provide an overview of the new Indigenous Worldviews in Health Delivery and Research course?

The course was very much a student-led initiative. We designed a lot of it ourselves with help from faculty members, many of them Indigenous. The course is the first of its kind and fills a huge gap: we have never had an Indigenous health course at the SPGH! Whether or not they plan to work in Indigenous health, SPGH graduates will affect the lives of Indigenous people and need to be able to practise safely, part of which involves understanding Indigenous health. The course is an introduction to the main topics surrounding Indigenous health: Indigenous worldviews, data governance and sovereignty, Indigenous research practices and ethics. We are hoping to give students foundational knowledge that they can consider within their programs but also take into their practice once they graduate, whether they go into research, become a clinician or a practitioner, or a public health policymaker. We hope that the course will help them decolonize the spaces they end up in, that they can practise cultural safety and drive change not only at the University, but also revolutionize the landscape of public health practice in Canada.

Could you explain why the current healthcare landscape is not safe for Indigenous people?

One of the most important things to understand is the history of medical colonialism in Canada. Many Indigenous people do not trust the healthcare system because they have not been treated the same as others in this country. This is ongoing: Joyce Echaquan died horrifically in Quebec in 2020 and Brian Sinclair died in Winnipeg in 2008. I do not want to make a blanket statement about every healthcare practitioner because a lot of them are doing extremely meaningful work to decolonize the spaces they are working in. However, many are still biased.

Currently, we lack cultural safety. Anti-oppression and Indigenous perspectives should be part of the training of physicians, nurses, healthcare administrators and politicians who are coming up with the policies that dictate the way health is delivered. Indigenous voices need to be heard. I always say that reconciliation is not just about dwelling on the wrongs, but also about celebrating the resilience and the desire for Indigenous people to take care of their communities and to advocate for themselves. Decolonizing health spaces requires Indigenous people in the health system and curriculum. One of my classmates was working with the Public Health Agency of Canada to change the core competencies that public health practitioners are supposed to learn. These will soon involve Indigenous health education.

What could help transform health care into safer spaces for Indigenous patients?

Looking to the future, I really want to see more Indigenous people in positions of authority with the power to influence the way institutions operate. There are still many instances of racism and I want to be part of the wave of people, Indigenous and allies, who are trying to shape healthcare delivery. As a white-presenting Indigenous person, I do not feel any sort of hesitancy going into the doctor’s office because I know that I am not going to be prejudiced against as soon as I walk through the door. I have a lot of family members that do not have that same privilege and who have had very different experiences, and the only difference between us is that I have a lighter shade of skin. Indigenous people seeing themselves represented in the systems they find themselves in, from educational institutions to hospital settings, would make a world of difference. Imagine the difference it would make for a patient to meet with their Indigenous physician and be treated by Indigenous nurses. I think that would help change the way our community feels in those spaces.

I also want to add that we must recognize that Indigenous people are a large group. There are many different nations across Canada who all have very different experiences. However, these groups have higher rates of underlying health conditions or mental health issues and experience health inequities at a much higher rate than any other group in the country. Many refuse to acknowledge that this stems from generations of mistreatment and systemically racist policies. People tend to dismiss Indigenous people by thinking that they do not take care of themselves. It is time to rewrite this narrative: it is not that they do not take care of themselves, it is that they have been let down by the system.

How could Western medical approaches benefit from Indigenous healing practices?

Indigenous nations are relearning or reclaiming many of their traditional healing practices that were lost or suppressed, which is extremely exciting. In addition, there is a rising recognition that these practices need to be integrated into a biomedical approach. I do not have the expertise to speak to how biomedical approaches to medicine could be influenced by traditional healing, but I know for sure that their combination generates far better patient outcomes. Traditional practices, like sitting in ceremony, doing a sweat or smudging, are about connection to people, connection to space, connection to the earth. Indigenous healing perspectives recognize that healing is not just about the body, but also about the mind and the soul – and the healing of the mind and the spirit comes from community: speaking with elders, designated safe spaces in hospitals, Indigenous community rooms. When Indigenous people go to the hospital for certain procedures, they are often thousands of kilometres away from their home territories and are removed from their communities. Having someone within the care team that can provide a connection to where they come from or to their people would have a tremendous impact.

What does “Indigenous excellence in health care” mean to you?

I see Indigenous excellence as leading the way in your field. Of course, I want to see people doing the absolute best in their fields regardless of their race, ethnicity or Indigenous identity, and a big component is driving change specifically for your community. However, there are so many systems in this country that are built for and by settlers. To me, Indigenous excellence in health looks like carving dedicated spaces for your community to receive the best possible treatment and making sure that you are working towards ensuring the safety of your community.

Do you have any advice for Indigenous people entering the health professions?

Many Indigenous people feel that they do not belong in this space, but they do. They have the same right as anyone else to occupy that space, they deserve it, and they should have the confidence to know that they can do it. My number one piece of advice is to occupy that space and to not listen to what anybody else says. You might stumble along the way, and maybe that comes from having had a harder journey to get to where you are than some of your colleagues and classmates, and that is okay. What you are doing matters. I applied to a scholarship that changed my life on a whim, thinking that there would be thousands of other candidates. If I can do it, so can you.



Students take lead in developing Indigenous Health course

Meet the Grads, Spring 2023: Josh Swain, MSc in Public Health