It may be easier to topple monuments and memorials than erase the memories they evoke or the policies that sustain them.

Canada’s experience is not the Confederates’ in Charlottesville, yet it’s also in the process of renaming buildings and removing monuments across the country that evoke its colonial past and the abrogation of Aboriginal people’s human rights. Mainly at issue are Canadian government policies that established the Indian Reserves and abusive residential school systems. Among the statues and memorials targeted for dismantlement or renaming are those that memorialise the architects of the school system, a governor that issued a bounty for the scalps of Aboriginal people, a so called “hanging judge,” and others that wantonly and egregiously altered the life course of the country’s first peoples.

From a clinical and public health point of view, these two events ought to resonate since the most striking feature of these policies (which paradoxically marginalised and tried to assimilate people at the same time) is that their health effects (physical, emotional, behavioural) are now seen to be (1) intergenerational, (2) cumulative, and (3) becoming progressively worse in relative and absolute terms.

Recent research in the BMJ Journal of Epidemiology and Community Health, for example, shows that familial attendance at a residential school directly affects “health and mental health outcomes, and is associated with lower self-perceived health and mental health, and a higher risk for distress and suicidal behaviours.” A scoping review published this year of 61 studies details the impact of residential schools on health and wellbeing, including increased rates of chronic and infectious disease, and increased risk of anxiety, depression, and addictive and suicidal behaviour.

Common demographic indicators also suggest growing disparities. A population based study shows a rise in infant mortality among Aboriginal people between 1996 and 2010, but “more worrisomely, the widening disparities in infant mortality comparing Inuit vs. non-Aboriginal infants, and in postneonatal mortality comparing First Nations or Inuit vs. non-Aboriginal infants suggest worsening infant health inequalities over the recent decade.” A report on the health of people in Alberta found that the life expectancy of First Nations people is 12 years lower than the general population; although little trend data are available, life expectancy for First Nations people in Alberta is the worst it has been in five years.

A recent study (2017) shows that among off-reserve Aboriginal Canadians, relative (absolute) income related inequalities in health increased by 23% from 2001 to 2012. In terms of access to healthcare, the Wellesley Institute concluded that racism against Aboriginal people is key to explaining their poor health and wellbeing; a 2014 report from the United Nations (UN) concurs. It concludes that the quality of Canada’s relationship with its Indigenous peoples has deteriorated and that “human rights problems faced by Indigenous peoples in Canada . . . have reached crisis proportions in many respects.”

All of this ought to trigger an immediate policy response. Instead Canadians have witnessed just the opposite (at least until recently)—with cuts to social programming specifically aimed at Indigenous Canadians by the Conservative government (2006-2015) and a “law and order” agenda that also looks like it was aimed at Aboriginal people.

As in the United States, Canada’s “tough on crime” stance (penal populism) often seemed to target racial minorities. Observers have commented that “Canada’s justice system is set against Indigenous people” and that its prisons “are the new residential schools.” Data from the Office of the Correctional Investigator (OCI) show that between 2005 and 2015, the number of Indigenous Canadians in prison increased by 50% compared to an overall offender growth rate of 10%, and that Aboriginal people form 25% of the total inmate population despite only making up 4.3% of the Canadian population. Between 2001-02 and 2011-12 the number of Aboriginal women in prison grew by 109% and account for 33% of the female federal population (in provincial institutions this figure rises to 41%).

A recent case that captures the inappropriateness of a “tough on crime” approach when a mental health intervention is warranted relates to a 29 year man from Yellowknife, who discharged a firearm in attempting suicide while intoxicated. Based on the previous government’s “mandatory minimum sentence” laws, the Crown is pressing for a four year sentence while defence lawyers claim four years is disproportionate and a “cruel and unusual punishment”—unlawful under the Canadian Charter of Rights and Freedoms.

Yet there is more evidence to suggest that corrections facilities in Canada often represent places of “cruel and unusual punishment”—especially for Aboriginal people. An OCI report (2015) showed that 55.9% of the Aboriginal inmate population had spent time in solitary confinement. Suicide attempts and self-harm in prison have tripled over the past decade; in 2016-17 Aboriginal inmates accounted for 61.7%* of self-inflicted injuries. Many self-harm incidents are taking place in solitary confinement.

Indeed, cases of solitary confinement leading to the suicides of Aboriginal people have dominated the media over the past year—with the UN pointing out that solitary confinement is torture not punishment.

Canada does not have 1500 Confederate statues and memorials or political leadership that would defend their presence. Yet it does have a persistently bleak relationship with Aboriginal people—and a growing body of research showing the nature and extent of related health issues as they evolve. Prime Minister Justin Trudeau seems to acknowledge the challenge and has sought to reverse unjust law and order legislation, curtail or eliminate solitary confinement, and deal with the health and mental health of Aboriginal people in and out of their communities. Yet although his current investments in the social determinants of health are encouraging, they are but a fraction of what is needed.

As for most black Americans, statues and memorials would not matter quite so much to Aboriginal people and their advocates if there were fewer inequalities, yet the outsized statues seem to loom larger as more detail is learnt of past injustices and their ongoing repercussions.

*Obtained as data from the OCI pursuant to information request.

Dr Chris Simms teaches at Dalhousie University, School of Health Administration, Halifax, Canada; he spent many years living and working in Africa’s health sector.

Competing interests: None declared.