Opinion: AI offers opportunity for better Indigenous health care

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Prior to contact, Indigenous populations were some of the healthiest in the world. As a result of colonization, Indigenous populations are now disproportionally affected resulting in high mortality rates and increased prevalence of conditions such as diabetes, tuberculosis and cardiovascular disease.

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These poor health outcomes are exacerbated by a Canadian health-care system that has been in trouble for a generation, with a shortage of front-line doctors and increasing wait times for diagnostic procedures and specialist care.

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Advances in virtual care, 5G connectivity, robotics and artificial intelligence (AI) provide an opportunity to improve health care access to Indigenous and underserved populations.

However, the deployment of AI in health care must be approached within caution to avoid bias when applied to Indigenous and other marginalized populations.

As AI solutions are increasingly employed in health care, we have become aware that Western frameworks prioritize empirical knowledge and exclude Indigenous knowledge that integrates lived experience, oral traditions and relational accountability.

With this in mind, at the Virtual Health Hub we have adopted a “two-eyed seeing approach” for the development of AI-driven health-care solutions in Indigenous communities.

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We have incorporated meaningful, collaborative partnerships with Indigenous communities and organizations, ensuring that processes are culturally informed.

For example, AI-driven virtual health assistants can be designed to provide advice and support that aligns with traditional practices and beliefs, enhancing the cultural appropriateness of care.

This approach advocates for the use of both Indigenous and Western perspectives to create a more holistic and inclusive health-care model.

Yet, while two-eyed seeing offers a reconciliatory framework, the broader equity implications of AI in health care remain at a tipping point. This is not just a technological limitation — it reflects power imbalances entrenched in our health-care system.

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AI often disregards the collective social determinants of health that shape well-being. This is a critical oversight.

To build AI systems that truly serve Indigenous communities, we must move beyond inclusion as a tokenistic gesture and actively dismantle the extractive approaches that have long exploited Indigenous knowledge.

Two-eyed seeing must not be treated as a philosophical add-on, but rather as a transformative lens that reshapes how we define, collect and apply health data. If AI is to be a tool of equity it must be rooted in the ways of knowing of the people it serves.

This requires a paradigm shift that recognizes and ensures that Indigenous nations have full sovereignty over their data, their health policies and their technological futures.

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We want to make sure that we positively impact the health of the communities we serve, without unintended consequences. To do this ethically, we have implemented a collaborative relationship that ensures that Indigenous communities maintain sovereignty over their information. Data is power.

We prioritize community interests by implementing frameworks such as the CARE principles (collective benefit, authority to control, responsibility and ethics). With two-eyed eeeing, we acknowledge the inherent value of Indigenous teachings.

The Virtual Health Hub advocates for an integrated holistic approach that incorporates things that we can learn from our Indigenous partners and provides us an opportunity to live “in treaty.” The medicine services that we deliver must be inclusive, interconnected and encompassing.

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This is the meaning of the Cree term wâhkôhtowin, which refers to our relationships with all things — earth, plants, animals, the cosmos and each other.

Using a two-eyed seeing AI approach, we aim to create a health system to address Call to Action 19 of Canada’s Truth and Reconciliation Commission: “To establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities.“

Developing AI health-care solutions that braid together western medicine with traditional Indigenous knowledge could offer important benefits to both Indigenous and non-Indigenous people, and it may be essential to the long-term health of our communities.

Cassandra Opikokew Wajuntah, Amal Khan, Jarol Boan and Ivar Mendez are members of the Virtual Health Hub, a highly innovative, Indigenous-led health-care project designed to increase the availability of health services to Saskatchewan’s Indigenous communities.

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