Health (18-24): Current Problems

Health Care Reform


December 9, 2020


MB

“Our Children, Our Future: Knowledge Keeper Recommendations”

“Our Children, Our Future: The Health and Well-being of First Nations Children in Manitoba” released by Manitoba Centre for Health Policy (MCHP) looks at the health and well-being of registered First Nations children living on-reserve and off-reserve in Manitoba. The purpose of this report is to provide a sound baseline measure of how First Nations children in Manitoba are doing in order to determine if the children’s lives are improving as a result of these calls to action.

Summary of Results: (Indigenous vs Non-Indigenous)

  • Teen Pregnancy (per 1000): 107 vs 18 (6 x greater)
  • Teen Births (per 1000): 87 vs 11 (8x greater)
  • Breastfeeding (per 100): 61 vs 90 (33% less)
  • Diabetes (per 100K): 875 vs 43 (20 x greater)
  • Dental Surgeries (per 1000) 32 vs 1 (32 x greater)

These findings clearly show that an enormous amount of work is required in virtually every area – health, social, education and justice – to improve First Nations children’s lives. There is an urgent need for equitable access to equitable services, and the nature of these services should be self-determined, planned and implemented by First Nations people. An important aspect that should be included in this work is a clearer understanding and articulation of the traditional knowledges, languages and values that were stripped from so many First Nations by colonialist practices and policies. First Nations Peoples hold these cultural knowledges and values in their memory and within themselves. Collectively, as First Nations and as Manitobans, we should revive them as we begin to address gaps in the key areas this report describes and work to improve First Nations children’s health, education and social outcomes.

The data presented in this report can inform and guide us in changing our approach to First Nations programming, policies and decision-making. The profound hope of the research team is that this report will promote equity in funding for First Nations children and that Indigenous and non-Indigenous people can work in a more collaborative and unified way to address the gaps. In so doing, and in the true tradition of honoring First Nations ways of doing, knowing and being, we strive to be “wholistic” in our approaches to clear the path for First Nations children to live and thrive in our province.

Knowledge Keeper recommendations: It is with this in mind we make these declarations:

  • Urgent action is needed in the development of a unified and seamless health care system to ensure our children have equitable access to all provincially funded health and social services.
  • Urgent action is needed to eliminate discrimination and racism at all levels of the health care system, beginning with health care providers and extending to policies that place First Nations people at an unfair advantage.
  • Urgent action is needed in the educational system that allows for the provision of equitable funding.
  • Urgent action is needed to fund and support land-based or culturally appropriate educational models.
  • Urgent action is needed in the creation of fair and culturally appropriate assessment tools in the educational system.
  • Urgent action is needed to restore our languages by the wide implementation of First Nations language programs in all schools and support for full language emersion in our schools on reserve.
  • Urgent action needed for supports and services that are planned by and put in place by First Nations people and must be funded at the same level as services for other Canadian children in the child welfare system.
  • Urgent action is needed to completely overhaul the child welfare system and discontinue the colonial practice of child removal and any incentives that support this practice.
  • Urgent action is needed to acknowledge existing Knowledge Keepers grandmother’s and grandfather’s circles so that they have meaningful and legitimate authority to oversee and ensure that all proceeding urgent calls for action are implemented.

http://mchp-appserv.cpe.umanitoba.ca/reference/FNKids_Report_Web.pdf


April 19, 2021


MB

Bill 56 “The Smoking Act”

CBC – The Canadian Cancer Society – which actively campaigns to discourage smoking — has written to the province to withdraw its support of Bill 56 until First Nations are properly consulted. “While we are committed to reducing rates of lung cancer, we cannot do so in the absence of a consultative process that honours First Nations’ right to self-government,” Andrea Seale, Canadian Cancer Society CEO, said in a statement to CBC News.


April 14, 2021


MB

Bill 56 “The Smoking Act”

Assembly of Manitoba Chiefs – The Manitoba government scheduled a 30-minute meeting at 4:30 on a Friday afternoon “the weekend before Bill 56 is going to Standing Committee prior to third and final reading…we did not want Manitoba to use that meeting as ‘checking a box’ to say that they had consulted First Nations”.


March 5, 2021


MB

Bill 56 “The Smoking Act”

Assembly of Manitoba Chiefs – The AMC stands in condemnation of the Province’s unjustified intrusion on the jurisdiction of First Nations through the tabling of Bill 56. Bill 56 removes section 9.4 of The Smoking and Vapour Products Control Amendment Act (the “Smoking Act”), which “exempts lands reserved for Indians and federal lands” from the application of the Smoking Act. The tabling of Bill 56 follows the Province’s underhanded attempt in July 2020 to ban smoking in VLT areas on First Nations reserves under COVID-19 emergency orders. In response to that attempt, AMC Grand Chief Arlen Dumas stated, “it is unacceptable and disheartening that the Pallister government and the Province would attempt to use the current COVID-19 health crisis to unilaterally usurp First Nations autonomy under the guise of a public health order.” In response to the COVID-19 emergency order, Brokenhead Ojibway Nation filed a judicial review against Manitoba and the Manitoba Liquor and Lotteries Corporation.

Bill 56 is the Province proceeding with further steps to usurp First Nations jurisdiction. The Province failed to consult with any First Nations and is seen as a further attempt by the Province to control and limit constitutionally recognized and protected rights of First Nations. AMC and its members will continue to bring jurisdictional challenges through the court systems and fight as long as it takes for First Nations to receive autonomy. The Premier continues to refuse all First Nations attempts to resolve jurisdictional conflicts and appears content to continue his government’s thinly veiled practices of systemic racism,” said Grand Chief Dumas.

“Any attempt by the Province to change the Smoking Act regarding First Nations reserves in Manitoba is illegitimate and unconstitutional. This issue goes far beyond smoking bans as it holds ill-considered constitutional ramifications and sets negative precedence of provinces overstepping and interfering with constitutionally recognized and protected rights of First Nations


June 5, 2020


QC

Bill 61 and COVID

Bill 61, an omnibus bill (An Act to stimulate the economy of Quebec and mitigate the consequences of the state of health emergency), declared on March 13, 2020 due to the COVID-19 pandemic and tabled earlier this week by the CAQ government cannot be misused by the Quebec government to minimize its duty to consult First Nations and reduce the application of already low environmental standards to a minimum. It cannot take advantage of the current context to put the health of our populations on the back burner, nor can it more openly infringe First Nations’ Aboriginal and treaty rights,” said AFNQL Chief Ghislain Picard.

There is an opportunity here for the provincial government to put its words into action and listen to First Nations who are looking for a balance between their own economic recovery and the protection of their territories. In any case, as we have decades of experience of being excluded from the decisions that affect our communities, we will continue to do what it takes to ensure that our governments have a voice when it comes to the development of our non-ceded territories and resources,” concluded the Chief of the AFNQL.


March 1, 2019


ON

Bill-74 The People’s Health Care Act, 2019

Bill-74 “The People’s Health Care Act, 2019” does not contain recognition of First Nations jurisdiction in health area and specifically Articles 18 and 23, of the United Nations Declaration on the Rights of Indigenous Peoples, have not been recognized, as there has been no consultation with First Nations in developing this legislation. (Chiefs of Ontario)

This legislation is set to create a new Agency called Ontario Health, which will be formed by dissolving the province’s 14 Local Health Integration Networks (LHINs) and merging their duties with those of six other health agencies, including Cancer Care Ontario and eHealth Ontario. First Nations must be involved in the conversation if we are to improve the overall health of First Nations in Ontario,” said Ontario Regional Chief RoseAnne Archibald. “We hope for a continued collaboration between First Nations and the Government of Ontario, so First Nations can provide a recommended approach that will lead to overall healthcare improvement and address the gap within First Nations healthcare. “


October 15, 2020


Fed. Govt., NL, NT, NU, QC

Canada Health Act fails Inuit

Pauktuutit Women of Canada – President Kudloo calls for additional funding to improve health determinants for Inuit women and girls and a focus on youth to increase Inuit health providers. She will also will highlight how the Canada Health Act is failing Inuit women and girls when she participates in a national meeting to address racism in the healthcare system on Oct. 16. Kudloo will also table recommendations to address racism experienced by Inuit women and children in the healthcare system. In addition, she will highlight the role systemic racism plays in health determinants for Inuit women which lead to poorer health outcomes, relative to other women in Canada.

“For Inuit women and girls, healthcare services fail most of the five basic principles of the Canada Health Act: accessibility, comprehensiveness, universality, portability, and public administration,” said Kudloo. “This is important because under the federal legislation, provincial and territorial health insurance programs must conform to the conditions of the legislation to receive federal transfer payments, under the Canada Health Transfer.” Systemic racism is also a key factor in many of the well‐known determinants of health, including employment, education, justice and income. Racism negatively impacts Inuit students’ success in graduating high school. It also limits their goals for post‐secondary education, including becoming a health professional. In addition, racism contributes to a lack of employment opportunities and the marginalization of Inuit in the workplace, including in well‐paying jobs in the healthcare system.

Recommendations

  • Increased funding to ensure the principles of the Canada Health Act ‐‐ including accessibility, comprehensiveness and universality ‐‐ are upheld for Inuit women and girls wherever they live, and that there are sufficient and sustainable health resources in each community.
  • Ensuring anti‐racism and cultural safety in education so Inuit children and youth receive STEM outreach programs; high school students receive counselling about the path to becoming a health professional; safe and respectful post‐secondary classrooms; as well as clinical settings that are free of racism and discrimination.
  • Training, recruiting, retaining, and mentoring Inuit staff and healthcare providers at all levels of the health system; as well as creating working and learning environments where Inuit knowledge, leadership and enterprise are valued.
  • Culturally aware and appropriate training to ensure all students training to work in healthcare, as well as present‐day healthcare staff, receive cultural awareness training regarding Inuit history and culture. Students and healthcare workers should also receive gender‐based violence training and those working in Inuit communities should receive Inuktut language training.
  • Inuit‐informed delivery of healthcare so that Elders, community leaders, women and youth are involved in the design and delivery of healthcare programs and services for their people and communities.

September 21, 2017


AB, BC, Fed. Govt., MB, NB, NL, NS, NT, NU, ON, PE, QC, SK, YT

Canada Health Act flaws

Healthy Debates – “Indigenous health services often hampered by legislative confusion“. The federal and provincial governments negotiate health transfers based on the Canada Health Act, which specifies the conditions and criteria required of provincial health insurance programs. It doesn’t mention First Nations and Inuit peoples, Métis and non-status or off-reserve Indigenous peoples who are covered by the Indian Act.

This lack of clarity – and lack of policies for providing Indigenous health services – has historically been used by both the federal government and provinces to narrowly define their responsibilities toward Indigenous health. It’s created bureaucratic delays that leave Indigenous peoples waiting for care or medications readily available to non-Indigenous Canadians. And it’s created gaps in care between Indigenous and non-status and First Nations people living off-reserve.

“The move to a new fiscal relationship is significant,” Grand Chief Doug Kelly, chair of the First Nations Health Authority of BC says. Leaving Indigenous people out of health care discussions and program design hasn’t worked. Instead, he says, First Nations communities should be empowered to identify their priorities and develop a plan. Once costs are attached, communities would negotiate with the government for transfer payments. Groups like the First Nations Health Managers Association that Marion Crowe, Executive Director represents, have been working to prepare communities for the eventual transfer of responsibility, focusing on developing health human resource and health administrative capacity within First Nations communities.


November 2, 2020


AB, BC, Fed. Govt., MB, NB, NL, NS, NT, NU, ON, PE, QC, SK, YT

Canada’s Constitution embeds discrimination

Policy Options – Canada’s history of colonization has laid the foundation for the implementation of racist health policy and the delivery of culturally unsafe health care, resulting in health disparities that are disproportionately experienced by Indigenous Peoples. Since the establishment of the Indian Act in 1867, Canada’s Constitution has continued to support and maintain discriminatory and inequitable practices and policies that negatively impact the health of Indigenous Peoples. The result is that Canada’s current health-care model is in and of itself a determinant of ill health for Indigenous Peoples. The authors recommend specific policy changes to address these issues:

  • Lack of availability and accessibility to culturally safe health care for Indigenous people in Canada
  • Canada’s long history of implementing racist and sexist policies oppress Indigenous Peoples and place them in inequitable spaces.
  • Indigenous women routinely experience systemic racism, institutional racism, a lack of cultural safety and sexism

Recommendations to make substantial changes to its health policies and legislations:

  • a collaborative approach that engages Indigenous Peoples and their communities in generating culturally safe and relevant health policies.
  • adequate distinctions-based programming and reporting mechanisms,
  • additional support of Indigenous-led research,
  • recruitment of Indigenous health-care personnel and
  • the integration of traditional healing practices in Canada’s health care model.
  • the creation of an ombudsman specific to Indigenous health should be established at the national, regional and local levels to ensure Indigenous Peoples feel safe to report inequities and experiences of mistreatment.

The TRC has advocated for cultural safety training and an increase in Indigenous health professionals in Canada’s health-care system, further supporting our health policy recommendations.Many of the health disparities experienced by Indigenous Peoples correlate to social, economic and political factors, suggesting that the foundation of Canada’s systems and thus its health care are inherently discriminatory.

https://policyoptions.irpp.org/magazines/november-2020/excising-racism-from-health-care-requires-indigenous-collaboration/


October 23, 2019


Fed. Govt., ON

Declaration of Public Health Emergency

Nishnawbe Aski Nation (NAN) Resolution 16/04 Call for Declaration of Public Health Emergency.

NAN is a political territorial organization representing 49 First Nation communities within northern Ontario with the total population of membership (on and off reserve) around 45,000 people.

The Sioux Lookout Chiefs Committee on Health and the NAN Executive declared a Health and Public Health Emergency for First Nations across NAN territory. This Declaration was not made lightly. It was forced into existence by decades of perpetual crisis and persistent health care inequities at the NAN community level. The Declaration is an assertion of the inherent Treaty rights of NAN members to equal opportunities for health, including access to appropriate, timely, high-quality health care, regardless of where they live, what they have or who they are.

In order to exercise our self-determination over health we need to bring back accountability, responsibility and resource allocation to our communities. This involves changing the current colonial system to a new system that is based on the needs and priorities of our communities. This led to the execution of a trilateral commitment document: The Charter of Relationship Principles Governing Health System Transformation in NAN Territory (the Charter) which was mandated by NAN Resolution 17/21. The Charter was signed by the Parties (Grand Chief Alvin Fiddler, Minister Jane Philpott and Minister Eric Hoskins) on July 24, 2017.

In order to support the NAN Health Transformation process, the governments agreed to several actions, including:

  • Developing new approaches to improve the health and health access, including access at the community level.
  • Supporting the ability of First Nations communities and organizations to deliver their own services.
  • Proposing policy reform and exploring legislative changes to design a new health system for NAN territory, including sustainable funding models and decision-making structures.
  • Removing barriers caused by jurisdiction, funding, policy, culture and structures so that First Nations can deliver better plan, design and manage their own services

http://www.nan.on.ca/upload/documents/mushkikiw-wiichihiitiiwin-gathering-fina.pdf


November 15, 2021


NU

Denial of medicine for Inuit Babies

Nunatsiaq News – Dr. Anna Banerji, an associate professor at the University of Toronto, who works in public health, pediatrics and infectious diseases, said Nunavut’s Health Department is not doing enough to protect Inuit babies from RSV. She said all Inuit babies should be considered high risk since Inuit babies born at full term still have higher rates of hospital admissions with RSV than babies in the south who are born early or are high risk for other reasons.
Both Patterson and Banerji said factors like overcrowded housing and food insecurity make Inuit babies more at risk of contracting or developing severe complications from RSV or other viruses. Banerji said having unequal access to health care in some remote communities, and kids being exposed to second-hand smoke, are also risk factors.
In 2009, the Canadian Pediatric Association recommended all Inuit babies get the antibodies to protect them from RSV. That same year, Banerji published a study that states Nunavut has the highest hospitalization rates for RSV in the world. With cases of a respiratory virus rising across the world, those considered high risk in Nunavut will get antibodies a month ahead of schedule this year. In Nunavut and the rest of Canada only those deemed high risk, like preterm babies, are given the antibodies, called Palivizumab, to reduce the risk of hospitalization.
Banerji said it would be more cost-effective to give all babies the RSV antibodies than paying for hospital admissions and air travel to receive medical care.


September 17, 2019


MB

Health Care Data: 2015-17 vs 2002

University of Manitoba Today – Joint study by the First Nations Health and Social Secretariat of Manitoba (FNHSSM) and the Manitoba Centre for Health Policy (MCHP) in the Rady Faculty of Health Sciences at the University of Manitoba, “The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba” compares health data collected in 2015-2017 with the results of a study the MCHP published in 2002.
“When we look at health status and health-care access, the inequities between First Nation people and all other Manitobans have gotten worse, according to many indicators,” said Leona Star, a Cree woman who is director of research at FNHSSM and co-led the study.

For example, the First Nations life expectancy from birth in 2002 was 7 years lower than for the non-Indigenous population; in 2019 First Nations life expectancy from birth is now 11 years lower.

Other disturbing trends:

  • First Nation people’s rate of premature mortality (death before age 75):
    • 2002 = 2x other Manitobans;
    • 2019 = now 3x
  • Suicide rates for First Nations people = 5 x higher
  • Suicide attempts by First Nations people = 6x higher
  • As we have now documented that health inequities have increased since 2002, we propose the following specific actions:
  • Annual reporting on progress in addressing gaps in health and access to healthcare;
  • Development of strategic initiatives for equitable access to intervention and prevention measures (including addressing racism in the health system through mandatory cultural safety training for all staff, hiring of First Nation providers, new human resource policies for safe reporting of racist incidents);
  • Development of short-and long-term plans for the training and hiring of First Nation healthcare professionals;
  • Further development of research partnerships among MCHP, MHSAL, FNHSSM and Manitoba First Nations;
    Setting First Nations on the path to borderless healthcare delivery by improving access to primary care healthcare that is designed and delivered through First Nations-led partnerships.

http://mchp-appserv.cpe.umanitoba.ca/reference//FN_Report_web.pdf


September 8, 2020


AB, BC, Fed. Govt., MB, NB, NL, NS, NT, NU, ON, PE, QC, SK, YT

Unicef “Innocenti Report Card 16”

NationTalk – Release of Unicef “Innocenti Report Card 16: Worlds of Influence – Understanding What Shapes Child Well-being in Rich Countries” where Canada placed in the bottom 10 of 38 countries. In fact, all four countries with large Indigenous populations – who all initially opposed The United Nations Declaration the Rights of Indigenous People – ALL placed in the bottom 8: (Canada # 30, Australia # 32, New Zealand # 35 and the United States # 36) and experts attribute this to the poor health outcomes of Indigenous kids.

Unicef issued “Top 5 Policies to Defend Childhood in 2020” on Dec. 30, 2019 one of which # 3 “Ensure Fairness for indigenous Children.” The federal government should adopt the Spirit Bear Plan proposed by the First Nations Child and Family Caring Society and endorsed by the Chiefs of the Assembly of First Nations to permanently end funding shortfalls in the services provided to First Nations children. First Nations children and families living on reserve and in the Territories receive public services funded by the federal government. Since Confederation, these services have fallen significantly short of what other Canadians receive. In 2015, the Truth and Reconciliation Commission released its Calls to Action, including a call to achieve parity for First Nations, Inuit and Métis children. Equitable spending on public services for children including clean water, health care, education and protection is their right.