Coordinated approaches to address the health needs of First Nations, Inuit, and Métis and health care delivery amongst all levels of government including Indigenous governments, remain an ongoing challenge. Improved clarity and a shared understanding of the role of various levels of government is needed, including for off-reserve First Nations and urban populations of Inuit and Métis.
Delivering on TRC Calls to Action, April 1 2022 – Official Federal Government website
Health leaders in Canada can work within their organizations to implement wise practices that address the TRC’s recommendations. The most important element in both the design and delivery of these changes, however, is that health leaders are guided by and work with local, provincial, and national Indigenous leaders and organizations. Otherwise, they risk reproducing existing colonial structures in the health care system.
Healthcare CAN “Bringing Reconciliation to Health Care – Wise Practice Objectives, April 2018
“Bringing Reconciliation to Health Care” identified “three inter-related potential areas of action for Canadian health leaders…that address the Truth and Reconciliation Commission recommendations to address Indigenous health”:
- Re-align authorities, accountabilities and resources;
- Eliminate racism and increase cultural safety;
- Ensure equitable access to health care
Almost five years later, on February 7, 2023 federal, provincial and territory government leaders met in Ottawa to discuss improving the Canadian Health Care system – and ignored the repeated requests from national Indigenous organizations for a seat at the table to address long-standing Indigenous issues. As stated 27 years ago in 1996, the Royal Commission on Aboriginal Peoples advocated for a health strategy based on:
- equitable access to health services and equitable outcomes in health status;
- holistic approaches to treatment and preventive services;
- Aboriginal control of services; and
- diversity of approaches that respond to cultural priorities and community needs.
Does that sound familiar? These headlines from national media over the last two weeks could just as easily have been from 27 years ago:
- Feb. 14: Northern, Indigenous communities need better access to organ transplants, say Saskatchewan advocates (CBC)
- Feb. 13: Indigenous advocates call for more culturally informed addictions treatment in B.C. (CBC)
- Feb. 13: Frustrations mount in Cross Lake, Man., where ambulance service has been in limbo for 2 years (CBC)
- Feb. 8: Indigenous man furious after mother put in storage room after being discharged from Calgary hospital (from palliative care where she had been given 18-months to live) (NationTalk: Global News)
- Feb. 7: First Nation leaders pan Trudeau’s letter ducking request for seat at health care talks (CBC)
- Feb. 4: First Nations’ right to health care is being compromised (First Peoples Law Report: Saskatoon StarPhoenix)
- Feb. 2: Manitoba medical group apologizes to Indigenous people for racism (NationTalk: CHVN – 95.1FM)
What does that say about “Bringing Reconciliation to Health Care”?
Given governments lack of attention to Indigenous complaints about Canada’s health care system over the last three decades, what has changed? Why now the push and accelerated response from all levels of government to address shortcomings in Canada’s health care system?
In short, COVID-19 and its profound impacts on the country as a whole.
Now that mainstream Canada is suffering, politicians of all parties and all levels of government want to see systemic improvements to address:
- Timely access to health care services
- More efficient delivery of quality heath care when and as needed
- Improved medical staff availability and coverage
- More cooperation between federal government and provincial and territory “partners” in delivering heath care services
The overall needs of Canadians as a collective are aligning with the long-standing needs of Indigenous people. That being said, what exactly is on the table?
At the working meeting with premiers, the federal government announced it will increase health funding to provinces and territories by $196.1 billion over 10 years, including $46.2 billion in new funding.
What are Indigenous people getting?
$2 billion over 10 years to address the unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services.
That amounts to $110.68 per capita of new spending for Indigenous healthcare versus $120.80 per capita of new healthcare spending transferred to the provinces and territories over the same 10 year period. That’s $200M in new spending per year to be divided among three distinct groups with different needs: First Nations, Métis and Inuit, for whom three of the seven Truth and Reconciliation Calls to Action directed at Indigenous health are currently stalled – as they have been for a considerable time.
Call to Action # 18: All levels of government to recognize and implement health care rights of Indigenous peoples
- Only Canada, BC and the Northwest Territories have made legislative commitments to the United Nations Declaration on the Rights of Indigenous Peoples that includes the healthcare rights of Aboriginal people
Call to Action # 19: All levels of government to establish measurable goals to identify and close health gaps
The government has committed $505 million over five years to the Canadian Institute for Health Information, Canada Health Infoway, and federal data partners to work with provinces and territories on developing new health data indicators: something Indigenous leaders have been asking for since June 2015 – almost eight years!
Call to Action # 20: Address distinct health needs of Métis, Inuit and off-reserve First Nations
Federal government has for the most part completely ignored the health care needs of off-reserve First Nations. The most recent update on “Delivering on the Truth and Reconciliation Calls to Action” (April 2022) focuses almost exclusively on COVID-19 funding. Of the initial allocation of $82B to combat COVID-19 only $305M was allocated for Indigenous people.
In conclusion, Indigenous Watchdog tracked and reported on 304 “Current Problems” in Indigenous Health between February 28, 2020 and December 31, 2022 versus 148 positive “Actions and Commitments” made by all levels of government over the same period:
- Systemic Racism = 150
- COVID-19 = 106
- Ongoing Health Crisis = 84
- Health Care Reform = 56
The government says that they invest approximately “$5 billion” per year in Indigenous health. Indigenous people make up 5% of the population of Canada so why isn’t 5% of the $196.1 billion in health funding directed to the provinces and territories re-directed to Indigenous health? That would be $9.81 billion or almost double what the government’s says it currently spends annually.
Or based on the total number of $7B ($5B current + $2B new), that investment would still be $3B more than the combined $7B the government now invests in Indigenous health.