ABOVE: A memorial at the Kamloops Indian Residential School in British Columbia where a mass grave was discovered.

Today (September 30) marks the first year that Canada observes a new federal holiday, a National Day for Truth and Reconciliation meant to honor the experiences of Indigenous people who attended the country’s residential schools, government-sponsored facilities tasked with assimilating and erasing Native culture. The last of such schools closed in 1996, but for many decades attendance was compulsory for Indigenous children between the ages of 7 and 15, and it’s estimated that roughly 150,000 First Nations, Inuit, and Métis children attended. The National Center for Truth and Reconciliation has documented thousands of accounts from survivors detailing physical and mental abuse that students experienced, bolstered by the recent discovery of mass graves at several residential schools throughout the country. 

Evan adams

Researchers are now beginning to quantify the longstanding legacy of residential schools, including their effects on the social fabric of Indigenous communities and the individuals and families within. Recent studies based on survey data and literature reviews have documented that residential school attendance is directly linked to poorer self-rated health and increased rates of chronic and infectious diseases, depression, addictive behaviors and substance abuse, stress, and suicidal behaviors. Furthermore, attendance by a family member has been shown to negatively affect the health and wellbeing of subsequent generations, including children, grandchildren, nieces, and nephews. 

The Scientist spoke with Evan Adams, the Deputy Chief Medical Officer of Indigenous Services Canada and a member of the Coast Salish tribe in the Tla’amin First Nation in British Columbia whose parents attended residential schools, about how the experience of residential schools continues to shadow Indigenous communities in Canada, and what changes he would like to see in the healthcare system to better address Indigenous health inequities. 

The Scientist: I often see Indigenous communities in Canada parsed into First Nations, Inuit, and Métis individuals. Can you walk me through what distinguishes each group?

Evan Adams: First Nations are really like American Indians and Alaska Natives, and the Inuit are what we used to call the Eskimo. And then the Métis are a distinct society with their own language that’s a mix of mostly French, European, and Central or North American Indigenous peoples. These three groups make up the Indigenous groups in Canada.

TS: Were all three of these groups subject to residential schools?

EA: That’s a really good question. I’m sure the Métis were subject to residential schools, but the main focus was on First Nations just because there were so many First Nations covering the entirety of the continent. And let’s not be naive—part of the impetus to take possession of those children was so that those lands could be accessed.

TS: What are some of the physical and mental health outcomes that have been linked to either personal or familial involvement in residential school?

EA: I would say that generally, Indigenous people come in last in almost every health indicator and socioeconomic indicator within our own lands, lands that give Canadians and Americans some of the highest standards of living in the world. So the Indigenous experience is to have been pushed off their own territories to live on the margins of a dominant culture and to get the very least from the resources that they used to totally and completely own. . . . I think Canada, and perhaps even the US, are definitely trying to address some of those inequities. Some would say maybe those efforts are not quite enough, because it’s taking us such a long time to achieve equity. And definitely some of the structures don’t value equity.  

One of the most startling realizations I made when I was a resident in . . . the inner city of Vancouver—and there were a lot of Indigenous people there—was that many of them had come from the residential school system, but no one within the healthcare system really knew how to discuss that with them. So [when healthcare providers] did intake for mental health or substance-abusing Indigenous people, they didn’t ask them, “Have you gone to a residential school?” 

I helped to add that, and I had to say [to non-Indigenous health professionals], ‘I suspect that you don’t really have a strong understanding of how Indigenous people live or their history.  You’re just thinking of them as being very similar to other people with mental health issues or substance abuse issues who live in this geographic area.’ And in fact, they’re quite unique. So definitely, a lot of studies have tried to qualify or quantify the Indigenous experience within the healthcare systems, everything from clinical outcomes to service utilization, [and] other epidemiological data like cancer survivability and life expectancy and all of the social determinants of health. 

TS: You had mentioned mental health outcomes, but what are some of the physical clinical outcomes that you see as well?

The classic example with Indigenous people [is] diabetes rates. Indigenous people have higher rates of diabetes, higher rates of complications from diabetes, higher rates of mortality from diabetes. . . . We are finally learning that diabetes is a disease of the poor, that food quality and the circumstances of one’s life—like their ability to have safe physical activity, the ability to achieve equity and justice and have opportunities for education and meaningful work—do color a person’s life and does color how much time they have to take care of themselves. It also affects their minds and bodies and spirits. So maybe diabetes is a disease of the body, but there are effects not just from diabetes, but from their life experience, things that are happening in their minds and their hearts and in their spirits that are a part of it. 

TS: How does the experience of someone in a family attending a residential school affect subsequent generations?

EA: We definitely talk about intergenerational effects of residential schools, whereby the experience[s] of the parents somehow are handed down or affect the children and the grandchildren. 

My parents both went to residential schools, and it definitely shaped them. My mother went to an Indian hospital and then to residential school, so from 5 to 18, she lived in an institution and not at home. And my mother’s very quiet. That’s one of the most important things she learned from being institutionalized. She was also very angry that her father died in the middle of that and that she didn’t know him, she didn’t spend time with him, she wasn’t allowed to attend his funeral. My father was an orphan raised by his grandmother, and his grandmother wouldn’t let him go. She said she felt she would die without him, if she had to surrender him to the residential school system. So my father went on the run. 

When they met each other, my mother was very quiet, and she could read and write, but she didn’t know anything about our territories. My dad spoke English as a second language, knew our territories, and was furious about having to be in school. He was 15 when he was finally caught and sent [to a residential school], and in his mind, he was a man. When they got together, how they raised their children to value education but also value traditional knowledge, and how they brought together their very different value systems—I mean, that’s absolutely colored where we find ourselves. I know I’m a doctor because my mother was in school. I absolutely know that, but I also know I survived because my dad taught me to fight. 

I know it sounds crazy, but all of that stems from those experiences. Others would say, you know, the parents were treated badly, so the kids learn to be broken and disempowered and have mental health issues and trauma and substance use, but that’s really quite simplistic. Absolutely, that happens. But there are thousands of expressions of those residential school experiences that still color families.

TS: What are the implications of those experiences in terms of clinical practice and public health?

EA: One of the main things that we’re seeing, that we’ve always seen, is mistrust of the system—mistrust of leadership, mistrust of government, and mistrust of Big Pharma. That’s a problem when you have a magic bullet, like a COVID vaccination, and people won’t take it because they think you’re literally a killer, an agent of a malevolent government. People can’t believe that you’re trying to do good [and that is] definitely the result of residential school[s] where the relationship between the Canadian government, the system, and Indigenous peoples is in disrepair. So yeah, you have to work on relationships, not just your clinical ability or your research ability. And I think any researcher who’s worth their salt knows that at the basis of human interaction is our relationship, not just, ‘I’m the smart one, you should listen to me.’

The Kamloops Indian Residential School in British Columbia, where the graves of 215 Indigenous children were found.

TS: In one of the recent reviews, the authors noted that many of the studies assessing First Nations or Indigenous health and residential schools have really been more recent, maybe in the last 20 years. I was curious if it’s been your experience that [researchers] are now focusing more on the longstanding health impacts?

EA: I think it’s definitely easier to look at the modern consequences of the residential schools. But I really would like to look deeper than that. I’m in my 50s, and I’ve been looking at survivors of residential schools literally all my life. The finding of unmarked graves in residential schools tells us that . . . those children deserved better and it didn’t happen for them and they died. And if you listen to any survivor from residential schools, they will tell you that they were severely abused. You can listen to any of the 6,000 testimonials of those children that exist in the National Center for Truth and Reconciliation. 

For most of us, we don’t have the capacity to hold that reality. This child abuse that’s happened in generation after generation is very unique. For most people, trauma is a single event . . . but the repeated trauma of individuals generation after generation is kind of unprecedented. So what are the deep psychic effects? What are the physiologic aspects? What does that do to the spirit of a nation to be subjugated? I think research can go bigger than just: What are the incidence rates of this particular disease in this small population in this small time period?

TS: When you talk about going deeper, what does that look like for you?

EA: For me, going deeper means setting the table where researchers and communities can sit together and say, ‘What are the issues?’ And I know, because I’ve sat at hundreds of those tables, they will say mental health is at the center of this. For many of them, they will say terrible care within the dominant culture’s care system is a profound factor. So how do you measure that psychic trauma and how do you measure racist care within the healthcare system? Those are not well understood or well documented. And I think for most people, it’s going to be hard to quantify or qualify that kind of improvement.

TS: What is needed to address these health inequities or otherwise make progress?

EA: Whenever I have difficulty understanding Indigenous issues, I look at the lives of women, because feminism and inequity against women is something that we’ve been trying to talk about for a generation. And if you hear women describe their lives, they can be quite different from those of men. I know even now, female physicians have to fight for their place, because the system doesn’t make enough room. And so the conversation constantly goes, ‘Are we doing enough for women?’ but it’s a simple progression to ‘Are we doing enough for equity for Indigenous people or people of color or other marginalized groups? Or are we still just serving the hallowed few who’ve held the upper echelons of power and resources for a really long time?’ 

I know people hate talking about that, but . . . we do need to consider how we can do better by each other. As a gay man and as a health planner, I know the planning around gay men is insufficient. It’s very easy to see that the structures still don’t do enough for women and other groups that are marginalized. We need to evolve our thinking. For instance . . . if we think of doing something about women’s health as being all about pregnancy, then we’ve missed the complexity of women’s lives. Just like with Indigenous people, [where some people] are hyper focused on their trauma—that is insufficient. 

One of the things that I absolutely love to do is to look at traditional ways of being and knowing, because there’s such diversity amongst Indigenous people. In Canada alone, there are over 600 villages that have many different ways of being and knowing. You can go there and learn . . . local knowledge about how to be strong, how to thrive, how to raise great children, how to be strong in your heart. By engaging in conversation, you get access to this library of information that you wouldn’t normally have access to. Western culture is wonderful, it has lots of different kinds of knowledge, but I like to privilege Indigenous knowledge because there are so few students that have that. If I’m going to study diabetes, I’m just going to be one of tens of thousands of students looking at diabetes, but if I’m going to look at Indigenous ways of having a strong body, I’m going to be just one of a handful, and that’s where I’m gonna go. Not just because of some weird allegiance to people who are brown like me, but because it’s incredibly interesting. I don’t know if there’s anything new to be found out in diabetes, but there’s definitely a lot to be found out about resiliency in Indigenous populations.

Editor’s note: This interview has been edited for brevity.