Six months after the tragic death of a 37-year-old Atikamekw woman at a Quebec hospital, the federal government's response to ongoing systemic racism in Canada's health-care system remains partial and ad hoc. The death of Joyce Echaquan, who bravely recorded her own racist encounter with two health-care workers, proves that cultural change is needed in Canada's health-care system to prevent further deaths and harm to Indigenous and other racialized patients. Unlike the absence of response in the death of Brian Sinclair, the federal government acted on pleas from Echaquan's family and community, as well as individuals and groups across Canada, to address racism in Canadian health care. Federal Indigenous Services Minister Marc Miller and Crown-Indigenous Relations Minister Carolyn Bennett hosted a series of national dialogues. The most recent, held in late January, brought together more than 400 people representing Indigenous partners, governments, educational and professional institutions, and health-care organizations to share calls to action and discuss plans, with the premise that substantial interruption of ongoing racism can only happen through dialogue. We acknowledge and value this national dialogue. However, the government of Canada's response remains tepid. Tangible commitments are minimal. WATCH | A Jan. 28, 2021, report on Ottawa's promise to address racism in health care: They include supporting the co-development of distinctions-based (First Nations, Inuit, and Métis) Indigenous health legislation, $4 million to improve physician training, and $2 million to the First Nations governing authorities of Manawan Atikamekw Council and Atikamekw Nation Tribal Council in Quebec for training and education on the right to access equitable social and health services. These commitments are inadequate. First, distinctions-based legislation does not address jurisdictional issues and may not have helped someone like Brian Sinclair, who died in 2008 after sitting ignored for 34 hours in the emergency department at Winnipeg's Health Sciences Centre. Mr. Sinclair was a non-status Anishinaabe man who accessed services as a citizen of Manitoba. Second, all health-care staff share a responsibility to confront Indigenous-specific racism. Directing funding only to physician training misses the fact that the fatal racism suffered by Brian Sinclair, Joyce Echaquan, and many, many others occurred in encounters with nurses and other hospital staff. Furthermore, education, while valuable, is insufficient without broader structural transformation in conjunction with accountability mechanisms, policy directives, and organizational change. Enshrine anti-racism in Canada Health Act Alongside education, we recommend a direct and universal measure: adding anti-racism as a sixth pillar of the Canada Health Act. The act outlines five pillars that provinces and territories are bound by in order to receive health-care funding: universality, comprehensiveness, accessibility, portability and public administration. We came together as the Brian Sinclair Working Group during the inquest into the 2008 death of Brian Sinclair, in which a judge ruled that racism would not be considered as a factor. We hosted provincewide discussions on structural racism and the inadequate provincial response. We also issued a report with recommendations. The Brian Sinclair Working Group released its interim report in 2017. The group also hosted provincewide discussions on structural racism and the inadequate provincial response. (Brian Sinclair Working Group) Since Joyce Echaquan's death, we renewed our efforts and proposed that anti-racism be a guiding value for all health-care systems, organizations, and providers. More specifically, we as a group asked that all stakeholders in the health-care system (including the federal government, the provincial government, health authorities, unions, professional organizations, and post-secondary institutions that deliver services and train the next generation of health professionals) adopt anti-racism policies and implement meaningful strategies. This will require resources committed to providing anti-racism training, accountability mechanisms, program review and independent investigations to hold institutions accountable to these mandates. We concur with the recommendations from recent inquiries, reports, and guidelines that eradicating racism in health care requires a national effort. We contend that adding anti-racism to the Canada Health Act would trigger the development of universal policies and programs to interrupt systemic and interpersonal racism in health care across health systems throughout the country. To date, more than 2,000 individuals and organizations have signed our open letter calling on the federal government to adopt anti-racism as a pillar of the Canada Health Act. (The letter can be found on the Anti-racism as a Sixth Pillar of the Canada Health Act Facebook group.) A denial of basic human dignity On Nov. 5, 2020, Sen. Mary Jane McCallum tabled a motion to call on the government to adopt anti-racism as the sixth pillar of the Canada Health Act, stating that "concerted action at the highest levels of influence and authority in Canada is required to disrupt racism in the Canadian health-care system." While Indigenous Services Minister Marc Miller has not officially ruled out this approach, his department maintains a "carrots over sticks" (education, not law) approach to addressing racism in Canada. Although every Canadian is entitled to constitutional and human rights protections against discrimination, the horrific treatment of Indigenous individuals within health-care systems demonstrates an ongoing denial of basic human dignity that is deeply rooted in Canada's history of colonialism and segregation. Measures to increase accountability to the Canada Health Care Act are needed to raise standards of care to existing commitments to public administration, accessibility, comprehensiveness, universality and portability. Enshrining anti-racism as a sixth core principle would acknowledge the cultural change needed to prevent further deaths and harm to Indigenous and other racialized patients.