Health care in Canada is under provincial jurisdiction, but Indigenous health care is a federal fiduciary duty under section 91 (24) of the Constitution Act. The federal government did not devolve its fiduciary duties for Indigenous health care to provincial and territorial authorities.
The federal government does provide per capita funding to provincial and territorial governments for citizen health care. Included in those numbers are Indigenous citizens. Unfortunately, provincial and territorial health care authorities are under no obligation to build Indigenous health care infrastructure or to deliver health care services to remote Indigenous communities. The poor coordination of health care between provincial/territorial and federal health authorities for Indigenous Peoples is one manner in which Indigenous health care services are dysfunctional.
The federal government created programs to provide in-community nursing services, transportation to provincial or territorial health care facilities and a number of other health care-related services under the broad program of Non-Insured Health Benefits (NIHB). NIHB was administered by the First Nation and Inuit Health Branch (FNIHB) of Health Canada, but is in the process of being transferred into the new federal department of Indigenous Services Canada.
FNIHB is indirectly responsible for all Indigenous health care service delivery deficiencies in Canada.1,2,3,4,5,6,7,8 However, it is directly responsible for the lack of modern equipment, poor or non-existent facilities, under staffing, inadequate or absent staff training, delayed access to out-of-community services, lack of in-community chronic care and lack of senior care residences in Indigenous communities. Keep in mind, this quagmire also includes services such as mental health, dental and eye care.
The underlying source of FNIHB’s failure to delivery adequate health care infrastructure and services to Indigenous Peoples is a lack of commitment by the Government of Canada to provide the same quality and levels of health care services to Indigenous Peoples that are available to non-Indigenous people in Canada. The root of that lack of commitment is the Doctrine of Discovery with its the Framework of Colonization and a policy to withhold infrastructure from Indigenous Peoples.
The fallacy that occurs when non-Indigenous people think of Indigenous health care is that they believe we are all talking about the same thing. Non-Indigenous governments can only think in terms of “western” medicine. Indigenous health care takes into account both western and “traditional” medicine.
The Government in Canada and provincial/territorial health authorities refuse to include traditional medicine into Indigenous health care. Yes, hospital facilities include “spiritual” ceremonies and traditional diets, but other than acknowledging medicinal teas, they do not work with traditional medicine and its healers. Indigenous Peoples have both sovereign and international rights to self-determination, including the right to create their own health care systems. They also have a right for their medicines and healers to be a funded part of their health care system. To do anything less, forces the assimilation of Indigenous Peoples from their traditional medicine to western medicine. The funding for an Indigenous health care system is part of the federal fiduciary duty to Indigenous Peoples.
In an oversimplification, First Nations define wellness with four interrelated components of the medicine wheel; mental, physical, social and spiritual health. To provide “culturally effective” traditional medicine services, an Indigenous health care system must integrate western and tradition medicine seamlessly. Unfortunately, western medicine does not understand medicine wheel components and sees them as physical health, mental health, social services and services for “other” determinants. In fact, all of western medicine fits within one area of the physical part of the four-component medicine wheel.
There are three basic steps to building an Indigenous health care system.
1. Indigenous Peoples need to own their health care delivery system with a governance system that is accountable to their community and its governance system;
2. Indigenous Peoples need to recapture the knowledge, wisdom and ways of their traditional healers and teach/train a new generation of healers; and,
3. Indigenous Peoples need to integrate their traditional medicine with western medicine within their health care delivery system.
We began work on step one in 2016 with Matawa communities in northern Ontario. We worked with community leaders to preparing a base model for co-operative ownership and integration into existing western medicine infrastructure.9,10
Building Indigenous-owned and directed health infrastructure can be done.
1. (2017) Report 4 – Oral Health Programs for First nations and Inuit – Health Canada, Fall Reports of the Auditor General of Canada, Ottawa, Canada. https://caid.ca/RepAudGenCanRep4_2017.pdf
2. (2017) Breaking Point: The Suicide Crisis in Indigenous Communities, Report of the Standing Committee on Indigenous and Northern Affairs, Ottawa, Canada. https://caid.ca/SuiCriIndComReo_SCIANAR2017.pdf
3. (2015) Allan, B. & Smylie, J. First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. Toronto, ON: The Wellesley Institute. https://caid.ca/FirPeoSecClaTre2015.pdf
4. (2015) Spring 2015 Reports of the Auditor General of Canada: Chapter 4 Access to Health Services for Remote First Nation Communities. Ottawa: Office of the Auditor General of Canada. https://caid.ca/RepAugGenCanCh4_Spring2015.pdf
5. (2012) First Nations Regional Health Survey (RHS) Phase 2 (2008/10): Ontario Region Final Report: Ontario Region Report on the Adult, Youth and Children Living in First Nations Communities. Ottawa: First Nations Information Governance Centre (FNIGC). https://caid.ca/FirNatRegHeaSur2008_10_Ont.pdf
6. (2012) First Nations Regional Health Survey (RHS) 2008/10: National Report on Adults, Youth and Children Living in First Nations Communities. Ottawa: First Nations Information Governance Centre (FNIGC). https://caid.ca/FirNatRegHeaSur2008_10.pdf
7. (2011) Status Report of the Auditor General of Canada to the House of Commons: Chapter 4 Programs for First Nations on Reserves. Ottawa: Office of the Auditor General of Canada. https://caid.ca/RepAugGenCanCh4_2011.pdf
8. (2011) MacDonald, N., Hebert, P. C., & Stanbrook, M.B., Tuberculosis in Nunavut: A Century of Failure. CMAJ 183 (7), p 741. https://caid.ca/NunTBCMAJ021411.pdf
9. (2017) Matawa Health Co-operative Initiative Report 2016-17. https://caid.ca/MHCIRep2017.pdf
10. (2016) Matawa Health Co-operative Initiative. https://caid.ca/MHCIProp2016.pdf
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