Reflecting on the Lalonde Report

More than 50 years on from the publishing of the historic Lalonde Report, leads at the Kahnawake Schools Diabetes Prevention Program (KSDPP) say that systemic barriers to closing gaps in health outcomes for Indigenous people remain.

A new article in a special edition of the Canadian Journal of Public Health written by KSDPP’s scientific director Treena Wasonti:io Delormier examines the impacts of the Lalonde Report, which was released by the Canadian government in 1974. The report identified key determinants of health, arguing that health outcomes are impacted by areas like a person’s social and economic environment or the quality of medical care they can receive, not just by government spending on public health.

While the report was hailed by many as a landmark document, Delormier said that it largely left Indigenous people out of the conversation, with references to Indigenous communities mostly being to identify them as high-risk communities and to mention federal responsibilities for service provisions.

“It doesn’t really address Indigenous health inequities at all,” Delormier said.

She notes for instance how the report links high infant mortality rates to the remoteness of some Indigenous communities.

“The conditions of those communities are shaped by centuries of colonial policies that have disrupted the way people used to care and have children with midwives and traditional medicine,” she said.

Despite the shortcomings of the Lalonde Report, Delormier’s article in the Canadian Journal of Public Health also focuses on how the document has shaped the way in which Indigenous communities and federal entities think about determinants of health.

“In that way, the report actually opened the door to start thinking about what social conditions shape our health,” Delormier said. “There was this opportunity, where we realize health is actually influenced by more than just healthcare services. It opened doors to thinking, ‘All right, how do we actually try to improve conditions that allow our people to live healthy lives?’”

The KSDPP has been an example of how Indigenous-led healthcare initiatives can make tangible change in communities. Established in 1994, KSDPP was started as a research project to figure out how to mobilize Kahnawake to live healthy lifestyles and combat high rates of Type 2 diabetes.

Since then, the community has seen declining rates of Type 2 diabetes diagnoses and an increase in public awareness of the illness.

Delormier said that Kahnawake can be looked to as proof of the positive impact of Indigenous-led healthcare initiatives. She hopes that 50 years on from the Lalonde report, more communities can launch similar projects that enact real change – but she said that can only happen if the federal government is willing to right the wrongs of the past.

“We’re not going to be able to address the inequity until we reach a place where we have real reconciliation with governments. Until we have enough land, until we’re equal partners in developing what has now become Canada,” Delormier said. “The gap is going to remain until we see equity in our opportunities for having a healthy lifestyle.”

Delormier’s full paper is titled “Honoring Indigenous self-determination, and Canada’s responsibility to address health inequities: Reflections on the Lalonde Report” and is available in the Canadian Journal of Public Health’s special issue titled The Lalonde Report @ 50: Historical Reflections and Future Directions.

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