Report on the Saskatchewan Health Authority’s Indigenous Hair Cutting Policy and Alignment with Sustainable Development Goals

The Saskatchewan Health Authority (SHA) has instituted a new policy, effective August 1, concerning the practice of cutting patients’ hair. This report analyzes the policy’s provisions and its significant contributions to achieving several United Nations Sustainable Development Goals (SDGs).

Policy Provisions and Mandates

The Indigenous Hair Cutting Policy establishes clear protocols for all healthcare staff. It is designed to protect and respect the cultural and spiritual significance of hair, particularly for Indigenous patients.

Core Requirements

• Informed Consent: Staff must engage in discussions with patients and their families regarding the spiritual importance of hair and obtain informed consent before any cutting occurs. This applies to both emergency and non-emergency medical situations.
• Medical Necessity: The policy clarifies that hair cutting is not a required treatment for conditions such as lice and should only be performed for urgent medical reasons, including head trauma or essential surgeries.
• Respectful Handling: In instances where cutting is medically unavoidable, the policy mandates the respectful handling, collection, and return of the patient’s hair.

Alignment with Sustainable Development Goals (SDGs)

The SHA’s policy is a direct action that supports progress toward key SDGs by embedding principles of equity, justice, and well-being into institutional practice.

SDG 3: Good Health and Well-being

The policy advances SDG 3 by promoting a holistic approach to healthcare that extends beyond clinical treatment to include mental, spiritual, and cultural well-being.

• It recognizes that for many Indigenous peoples, “hair is a symbol of Indigenous personhood and guides the quality of relationships and connection to self and community.”
• By respecting these cultural tenets, the SHA fosters a healthcare environment that improves the overall patient experience and contributes to positive health outcomes.

SDG 10: Reduced Inequalities

This initiative is a critical measure in addressing SDG 10 by targeting systemic inequities within the healthcare system that disproportionately affect Indigenous peoples.

• The policy is an explicit response to the Truth and Reconciliation Commission’s Calls to Action, aiming to create a culturally responsive and safe environment.
• As noted by former patient advocate Bonnie Marwood, past incidents, such as the case of Ruben St. Charles, highlight the historical lack of such protections. The policy seeks to rectify these service gaps.
• While the policy is focused on Indigenous practices, its principles of respect and consent are universally applicable and can reduce inequalities for other cultural groups, such as Sikh patients, for whom hair also holds deep significance.

SDG 16: Peace, Justice and Strong Institutions

The policy strengthens the SHA as a public institution, making it more accountable, inclusive, and just, in line with the objectives of SDG 16.

1. Accountability: The policy establishes that non-compliance will result in consequences, ranging from disciplinary action under collective agreements to potential termination of employment, ensuring institutional accountability.
2. Responsiveness: By implementing this policy, the SHA demonstrates its commitment to learning from past failures and responding to the needs of the communities it serves. Jennifer Ahenakew, SHA’s vice-president of First Nations and Métis Health, stated the policy is “grounded in shared responsibility.”
3. Inclusivity: It formalizes the need for cultural competency among all staff, fostering an inclusive institution that respects diverse cultural values.

Implementation and Stakeholder Perspectives

The successful implementation of the policy depends on comprehensive staff education and consistent enforcement. Stakeholder response has been cautiously optimistic.

Key Perspectives

• SHA Leadership: Views the policy as a reaffirmation of the organization’s commitment to reconciliation and the creation of a culturally safe healthcare system.
• Patient Advocates: Bonnie Marwood expressed approval for the policy as a positive step but questioned the delay in its formalization. She emphasized the importance of genuine implementation to avoid “tokenism” and ensure meaningful respect for all patients.

Relevant Sustainable Development Goals (SDGs)

The issues discussed in the article, primarily the implementation of a culturally sensitive policy within a healthcare system, are connected to the following Sustainable Development Goals:

• SDG 3: Good Health and Well-being

  The article is set entirely within the context of the Saskatchewan Health Authority (SHA), a healthcare provider. The new policy aims to improve the quality of care for Indigenous patients by ensuring their spiritual and cultural needs are met. This goes beyond physical treatment to encompass mental and spiritual well-being, which is a core component of good health. The article notes that for Indigenous peoples, “Hair is a symbol of Indigenous personhood and guides the quality of relationships and connection to self and community,” directly linking cultural practices to well-being.

• SDG 10: Reduced Inequalities

  The policy specifically addresses the needs of a marginalized group—Indigenous peoples—who have historically faced systemic discrimination in Canadian institutions, including healthcare. By creating a policy that acknowledges and protects their cultural rights, the SHA is taking a direct step to reduce inequalities in the quality of healthcare services. The article highlights this focus by quoting the SHA’s commitment to “advance a culturally responsive health-care environment.” Furthermore, the mention that the policy is also important to “our Sikh relatives” shows an awareness of reducing inequalities for multiple minority groups.

• SDG 16: Peace, Justice and Strong Institutions

  This goal focuses on building effective, accountable, and inclusive institutions. The SHA’s creation and implementation of the “Indigenous Hair Cutting Policy” is an example of an institution reforming its practices to be more inclusive and just. The policy is a response to past failures, such as the case of Ruben St. Charles, and is explicitly linked to the “Truth and Reconciliation Calls to Action,” which is a national framework for justice. The article also mentions that there will be “consequences for those who don’t follow it,” demonstrating a move towards accountability within the institution.

Specific SDG Targets

Based on the article’s content, the following specific targets can be identified:

1. Target 3.8: Achieve universal health coverage, including … access to quality essential health-care services…

   The policy is a direct attempt to improve the “quality” of healthcare services. It redefines quality not just in medical terms but also in terms of cultural safety and respect. The requirement for “informed consent” and “respectful handling” of hair ensures that the service delivered is holistic and respects the patient’s identity, thereby enhancing the quality of care for Indigenous patients.

2. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory … policies and practices and promoting appropriate … policies and action in this regard.

   The previous lack of a formal policy led to negative outcomes, such as the incident with Ruben St. Charles, where his braid was cut off without his consent or a clear medical reason. The new policy is an “appropriate action” designed to eliminate this discriminatory practice and reduce such inequalities of outcome, ensuring patients are not subjected to cultural or spiritual harm during their care.

3. Target 16.6: Develop effective, accountable and transparent institutions at all levels.

   The SHA is demonstrating a move towards becoming a more effective and accountable institution. The policy was announced in a newsletter to staff, making the new rule transparent. Crucially, the policy includes enforcement mechanisms, stating that non-compliance could lead to “discipline under union agreements, contracts, or even termination of employment,” which establishes clear accountability.

4. Target 16.b: Promote and enforce non-discriminatory laws and policies for sustainable development.

   The “Indigenous Hair Cutting Policy” is a clear example of a non-discriminatory policy being promoted and enforced within a public institution. Its purpose is to prevent discrimination based on cultural and spiritual beliefs within the healthcare setting. The article confirms its enforcement by stating it “went into effect Aug. 1” and that staff are required to follow it.

Implied Indicators for Measuring Progress

The article mentions or implies several indicators that can be used to measure progress towards the identified targets:

• Existence and enforcement of a non-discriminatory policy

  The primary indicator is the policy itself. The article confirms its existence (“the SHA announced the Indigenous Hair Cutting Policy”) and its official implementation date (“went into effect Aug. 1”). The enforcement measures, including potential termination for non-compliance, serve as a strong indicator of the institution’s commitment.

• Reduction in incidents of cultural disrespect

  The case of Ruben St. Charles, who had his hair cut without consent, serves as a baseline incident. A key indicator of the policy’s success would be a reduction or elimination of such incidents. Tracking patient complaints or reported incidents related to the disrespectful treatment of hair would be a direct way to measure progress.

• Adherence to the principles of Truth and Reconciliation

  The SHA’s vice-president explicitly states, “This policy reaffirms our commitment to the Truth and Reconciliation Calls to Action.” Progress can be measured by how well the institution’s actions, like this policy, align with the specific calls to action related to health and eliminating systemic racism against Indigenous peoples.

• Patient experience and feedback

  While not a formal metric in the article, the goal of creating a “culturally responsive health-care environment” implies that patient experience is a key measure. The apology issued after the Ruben St. Charles incident and the cautious optimism of the patient advocate suggest that positive feedback from Indigenous patients and their families would be a crucial qualitative indicator of success.

Summary of SDGs, Targets, and Indicators

Source: cbc.ca