Alan Katz | Guided by Social Conscience

Alan Katz: I’ve been in Canada for over 30 years now, close to 40 but, I grew up and did my medical training in Cape Town.  This was during the apartheid years and this had a profound impact on me, my life, my values, and where I have landed.

I knew, from probably my late teens, that I was living in a society that was unjust, that the oppression that apartheid brought was just not something I could support. I was benefiting from this and had a lot of guilt about that. My colleagues and I had a choice- those of us who opposed apartheid at that time- if we stayed and fought apartheid the likelihood was that we’d land up in trouble with the law.  This was a police society and, to be honest, as a white South African I understood that this wasn’t my battle. I was part of the problem not the solution.  

Once I graduated I decided to leave the country.  My wife and I and our six-month-old daughter spent four months in rural Canada working in a village of 500 people, with the intent of earning some money to travel, and we fell in love with Canada.  What we fell in love with was a society that seemed to strive for equality, for equal opportunity and the health care system was the key factor. The single-payer system in Canada provided care to people based on need, not based on what you could afford and, at that stage, my understanding was that there was no discrimination.  It’s not quite that simple and I’ve learned over the years that this was not the case.  But that’s been an important part of my journey too.

DMacA: That journey brought you to Manitoba and, of course you’ve done a lot of work looking at the life and health of the First Nations.  That sounds as if it resonates with your background.

AK: Absolutely.  I became aware, through interaction with First Nations people, of significant discrimination, racism, and the impact of colonialism. I thought I was coming to a country where there was equal opportunity but I had no understanding of the residential school system, its impact on First Nations, the intergenerational trauma, and the ongoing racism within our Health Care system. I have vivid memories of really bad things happening to First Nations people in emergency rooms and the outcry around discrimination and thinking… well, was that really discrimination or was that basically somebody who had some real problems and the emergency room didn’t respond appropriately. As my understanding grew, I came to understand that the lack of appropriate response was, in fact, racism and that there is still significant racism in the system. This led me to put more energy into those relationships, into understanding where racism comes from but, more importantly, to understand the impact on the experience of First Nations people.  And it is profound. It is something that is really hard for a white settler to understand, and I work hard to understand it but, more importantly, to do the little things that I can do to make other people aware of the impact.  That’s been a big part of the research that I try to do now.

DMacA: Based on that research and on your experience and knowledge, how can Canada improve health care for the indigenous people in the future?

AK: I am hopeful.  Based on talking to people, First Nations people, who have a good understanding of the reality. I think there’s been a significant awakening of activism on the part of First Nations.  I cannot speak for First Nations, I have no right to do that, but, First Nations people are speaking out on their own behalf much more vigorously, and proposing solutions.  It is, to a large extent, about publicizing and engaging with racism, being aware of its impact and, at the same time, looking towards improvements in the socioeconomic status and education level of First Nations people themselves.  They are going to bring about this change through their actions. This is not something I can do for them and I have never intended to do that, but I will say that the Truth and Reconciliation Commission in Canada, which was a federal commission looking into their impact predominantly of the residential schools on First Nations people, can.

Here is my history coming back. The leading Truth and Reconciliation Commission in my mind was in South Africa, led by Reverend Tutu, and it had a profound impact on removing the true hatred between blacks and whites in South Africa.  It really was quite profound. It was about people describing what they had done, admitting to it, and getting forgiveness.  The Canadian experience was very different and I initially thought that the Canadian experience wouldn’t have the same impact until I interacted with a few First Nations Elders. They said – it’s up to ‘you’ now, you’re responsible, for the harms. You have to correct some of those problems-  And that message, I think, is now reverberating within Canada.

About 10 years ago I was at a meeting in British Columbia where First Nations communities have a lot more power, and not in such dire economic circumstances as in Manitoba. The meeting started off with a land acknowledgement. This was a new phenomenon to me and I had no idea where it came from or what impact it would have. But, now I do not start a single meeting outside of my own research group without a land acknowledgment. That’s the kind of change that’s happening amongst white Canadians in terms of understanding our place in this country. It’s a wonderful country, a great country to live in, but we have a long way to go to fix some of the harms that were done in previous generations.  And I will say, and I say it in my land acknowledgment all the time, that those harms are continuing.  We’ve got to fix this.  My land acknowledgment is not the ritual acknowledgment that everybody reads out about harms from the past, these harms are happening now and our job is to try and work to change that.

DMacA: I am incredibly impressed with your work in that field, but there’s something else I’d like to ask you about. I’ve been so impressed your incredible research career and, let’s be honest, it hasn’t been easy to do it in Manitoba. What’s been the secret?

AK: There are two things that I can put my success down to, if there is success. One is that I had a good fortune to rub shoulders with my research mentor, Noralou P. Roos. Dr Roos was the founder of the Manitoba Center for Health policy.  Hers is also interesting story.  She was a political scientist and she came from the U.S to Manitoba because of the data that we have in Manitoba. We’ve been collecting administrative data for over 30 years.  She saw the wealth of this data and the opportunity that it brought within the health care system.  Early on in my academic career I was asked to join the research ethics board at the University and that’s where I met Noralou and we became colleagues.  She saw something in me that she respected and I certainly saw the opportunities of working with her and she recruited me to the Manitoba Center for Health Policy which was the opening to my research career.  I think that what she saw in me, and this is the second point, is somebody who is a reflective and a critical thinker and I know where that came from.  It came from my upbringing in South Africa, from coming home every day and wondering what is going on here, how do we deal with this, and how do we change this. And, asking myself, what did I do today that may have been a good thing, and what did I do today that I could have done differently that would have been a better thing.

DMacA: Tell me about the collaborations you’ve built because that is clearly one of the foundations on which you’ve built this career.

AK: When I joined the Department of Family Medicine at the University of Manitoba there was no active research and I didn’t have any mentors, which was why Dr Roos was so important to me.  But I started going to meetings like NAPCRG where  I met like-minded people and we got talking. I also became very engaged with the College of Family Physicians of Canada and met people there that I respected immensely, that taught me so much.   I think back now on people like Rick Glazier, who is a tower of achievement and strength in Primary Care Research in North America, not just in Canada.  I remember going to a meeting of the research department, and Rick wasn’t active in the research department at that time, but he came to the meeting and spoke to us and I thought this is an interesting guy.  You meet these people, you learn how smart they are, how much they’ve got to offer, and somehow, surreptitiously or through somebody else you meet, you rub shoulders a little closer and you start working together.  People like Brian Hutchison who is, once again, somebody who’s done so much over the years. 

It’s all about doing little things, and reaching out, meeting with others and looking at how you might work together. I’ve been very fortunate really.  I once had the experience of working with somebody who said-  you know, it’s not about planning a research career over 20 years and then implementing it, it’s about taking advantage of opportunities-  and that has been a big part of what I’ve been fortunate to be able to do.

That’s been behind my success in funding very often too. It’s seeing an opportunity that speaks to me.  It’s so difficult to get CIHR funding but sometimes something looks like it’s almost intended for me, so I go for that one, put together a team to apply for it and  that’s been quite successful.

DMacA: And, to the Future for Family Medicine.  It’s coming under quite a lot of pressure at the moment and I know you’ve done work on, for example, on consultation behavior. Where do you see Family Medicine going in the future?

AK: Family Medicine in Canada is at a bit of a crossroads. One of the unique things about Family Medicine in Canada is the multiple roles played by the College of Family Physicians. There are six organizations in the U.S that do the work of one organization in Canada.  It is a large organization, with different divisions, divided into different categories, with people working on all of them, but that has led over the years, perhaps, to a lack of innovation because of the size and lack of focus.  At the same time now, I’m see some evolution in the organization and this is a good thing. I think it’s bringing us as family physicians, and our discipline, to the table in terms of the need for change. There are many family physicians who, up to a few years ago, had been practising in the same way for the last 30 years. Some of the pressure is based on the lack of evolution in Family Medicine in Canada.  We haven’t kept up with the needs of society and our health care system has, in my view, not been primary care focused. Barbara Starfield did so much work on this and when you see the work of somebody like that – and she was not a direct mentor of  mine. I met her twice, and I met Ian McWhinney twice-  when you read their work, it just speaks to you in a way that you can’t help but be inspired. 

One of the things that Barbara Starfield showed was that Canada healthcare is not a particularly primary care based system. WE need to fix that. There is pressure on us from the system, which is now struggling and in crisis, for Family Medicine to play a bigger role so the system can evolve.  If more people had a meaningful relationship with their family physicians our emergency rooms wouldn’t be in the trouble they’re in. It’s not the only problem, it’s not the only solution, but it’s a solution and it’s something that’ll make a significant contribution.  That means that we have to learn to work better in teams.  You cannot click your fingers and have a whole bunch of new family docs who can provide comprehensive care overnight.  Indeed, many of my colleagues have moved away from comprehensive care because of the challenges in providing comprehensive care in our system, so we need to do it differently. That means teamwork and it means us changing our approach to doing teamwork, which means that we have to be funded differently. 

There are some solutions and I think we’re heading in that direction but it’s going to take time, it’s going to take energy and strong leadership.  I’m doing my best to play my very small role as a researcher, I write op-ed articles, and I talk to my colleagues, but it’s going to take leadership at a higher level to bring about those changes.

DMacA: Alan, it’s always fascinating to talk to you. Thank you so much for sharing your past, your reflections on the community in which you live, and your thoughts for the future.  And indeed for quietly sharing your personal philosophy, and that is – what did I do today that I could do better. Alan thank you very much indeed it’s been such a pleasure .