Module 4 Current Array of Aboriginal Health Services

1. Module 4Current Array of Aboriginal Health Services

2. Welcome to Current Array of Aboriginal Health Services. This course takes 45 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. You can either have the volume turned on or off to complete this learning module. Select the arrow keys at the bottom of your screen to move forward and move back, or to stop and start the learning module.

3. Course Learnings By the time you complete this learning module, you will be able to identify: Aboriginal self-determination in healthcare Holistic health, and health status monitoring Federal government programs Provincial government programs Current Array of Aboriginal Health Services

4. Acronyms Used in This Learning Module • ACL: Aboriginal Cancer Lead • ADI: Aboriginal Diabetes Initiative • AHWS: Aboriginal Healing and Wellness Strategy • AHTF: Aboriginal Health Transition Fund • APN: Aboriginal Patient Navigator • CCO: Cancer Care Ontario • CPNP: Canada Prenatal Nutrition Program • DBL: Drug Benefit List • FNIHB: First Nations and Inuit Health Branch • FNIM: First Nations, Inuit, Métis • IHTP: Indian Health Transfer Policy • NCCAH: National Collaborating Centre for Aboriginal Health • NIHB: Non-Insured Health Benefits • RCPs: Regional Cancer Programs • RHA: Regional Health Authority Holistic vs. Wholistic: We have used the more commonly seen spelling of Holistic (for non-Aboriginal Canadians) in this module vs. the Aboriginal spelling which refers to Aboriginal philosophy in which everything is related by virtue of shared origins. This list can be printed if you want to refer to it throughout the module.

5. Insert Pre-Test Quiz Slide True or False Q: The federal government is responsible for covering the health care needs of all Aboriginal people in Canada (First Nations, Inuit and Métis). A:  True  False Move forward to begin Chapter 1

6. Chapter 1: Aboriginal Self-Determination in Healthcare Program Delivery

7. Self-Determination – What does it mean? The International Covenant on Civil and Political Rights, Article 1 states: “All peoples “All peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development.” Essentially this means that a group of people (usually a common ethnicity) living in a territory have the right to determine their own future.

8. What is Aboriginal Self-Determination in health? Being involved in the health services in response to needs the community has identified, including: • creation, • maintenance, and • control. The federal government recognizes that Aboriginal governments and institutions require the authority to make decisions in a number of areas, including health, similar to self-government. We will review a history of the change in Aboriginal government structure that led to the removal of self-government.

9. Traditional governments were characterized by the collective ownership of all lands, waterways, forests and wildlife, full participation and consensus in decision-making and non-coercive leadership. Government policy was usually framed in the context of doing what was best for First Nations, Inuit and Métis people in the long term, but operated in the national interest. An Overview of the Traditional Aboriginal Government Structure

10. The Traditional Aboriginal Government System :

11. Decision Making and Responsibility In Aboriginal culture- all people were considered equal – men, women and youth, and contributed equally to the success of the community. All Leaders had to agree for a decision to pass that affected the whole community. At the micro level, decisions were based on need, survival and family structure. Developments evolved inside of the nation, band, community and the clan structure. All members were expected to contribute to the benefit of the larger group.

12. HealthTraditional medicine and Aboriginal health and wellness are rooted in a holistic approach. The steps to the Aboriginal Path of Well-being include: 1. Health in balance: giving equal importance to all aspects of health 6. Joint and personal responsibility: health and well-being is the responsibility of the individual, family and community 2. Wellness: both emotional and spiritual 3. Active choice: one’s ownership for health decisions 4. Holistic approach: balance the mind, body, and spirit with community and environment 5. Understand root causes: past and present aspects that impact health

13. The Introduction of a New System Post-European contact, a colonial-style government structure was implemented with significant changes to Aboriginal social and government structures. In this new situation, the economies and belief systems of the two groups were increasingly incompatible.

14. Signing of Treaties

15. Differing Views on Treaties

16. Diminishing the Traditional System During the 1800s and mid-1900s, the government exercised extreme measures to assimilate FNIM people into new society. Traditional ceremonies were made illegal: • Sun Dances • Giveaways/Potlatches (honouring births, weddings, or deaths) • Traditional medicines and healing Spiritual leaders and healers were arrested when trying to perform traditional medicines and healing.

17. The displacement of the traditional system contributed greatly to the impoverishment of Aboriginal societies. Poverty was non-existent during these times. Removed was collective ownership and decision-making. Impoverishment of Aboriginal Societies These needs included health, work, and food. The traditional government system ensured that the needs of the people were met.

18. Signing of Treaties

19. 1969 - The White Paper

20. First Nations leaders were nearly unanimous in their rejection. One main reason was that they were not consulted during the creation of the paper, and it had major impacts to their lives. In addition, special rights deriving from their unique and historical relationship with the government. FNIM Response: Citizens Plus. More commonly known as the Red Paper. Leaders maintained that their people were entitled to all the benefits of Canadian citizenship. Leaders based their response on early legislation from 1763 and the intent of their treaties.

21. Some Key Developments Transfer of Control over Community Health Programs The Government’s Re-evaluation of Aboriginal Self-Determination in Canada Over the last few decades, governments recognized that the losses as a result of the policies and practices governments have placed on Aboriginal communities (i.e. assimilation, move to reserves, and removal of self-determination) had a detrimental impact to their well-being. This recognition has resulted in a concerted effort to increase the transfer of health accountability in some form back to Aboriginal communities.

22. Some Key Developments Transfer of Control over Community Health Programs: 1970s and 1980s 1979: Federal Indian Health Policy recognizes that FNIM people may assume responsibility for administering any or all aspects of their community health programs. 1988: Final Transfer Agreement transfers responsibility for Universal Health Programs to the Government of the Northwest Territories (NWT). NWT would continue to have access to any new federal programs for FNIM people 1988-1989: Cabinet and Treasury Board approves the health Transfer south of the Territories: policy framework, financial authorities and resources for transferring control of community-based health programs to FNIM communities.

23. Some Key Developments Transfer of Control over Community Health Programs: 1990s 1995: Inherent Right to Self-Government Policy recognizes that the inherent right to self-government is an existing Aboriginal right under section 35 of the Constitution substantive information with respect to FNIM control of health services. April 1999: Nunavut Territory is created with the conditions of the 1988 Northwest Territories Final Transfer Agreement applying to the Government of Nunavut.

24. Some Key Developments Transfer of Control over Community Health Programs: 2000s onward Oct. 2013: The Government of Canada hands over full health care services control to the newly formed First Nations Health Authority (100% First Nations community-run) in British Columbia, a first for a province in Canada. 2013: Health Canada's Health Services Integration Fund is a five-year, $80 million initiative supporting collaborative planning and multi-year projects aimed at better meeting the health care needs of FNIM Canadians. 2014: Canada Health Transfer (CHT) is the largest major transfer to provinces and territories. It provides long-term predictable funding for health care.

25. The Federal Indian Health Policy is based on four pillars of public health from which the federal government and FNIM communities can build upon to increase the level of health in FNIM communities:

26. Pillars 1 & 2

27. Pillars 3 & 4

28. Why Self-Determination is Important to Aboriginal Health The removal of Aboriginal self-determination had detrimental effects to the health and well-being of FNIM people.

29. Following the release of the 1979 Indian Health Policy:

30. In 2010: The Health Council of Canada (HCOC) Project

31. Current Statistical Inequalities in FNIM Health in Canada:FNIM people: Are much more likely to have poor health and die prematurely. Have a higher burden of chronic conditions and infectious disease. Are more likely to live in poverty affecting aspects of their lives. Children are more likely to die in the first year of life. For example: go hungry, or suffer from poor nutrition and obesity.

32. Lessons from Aboriginal Self-DeterminationIt is well documented that when initiatives are developed, led, and managed by First Nations and Inuit, there is the greatest potential for success in improving health care for their people. • They have the flexibility to tailor care to meet community-specific needs within the: • local • social, • cultural, and • geographic context. • The government’s transfer of health ownership has been proven to yield positive results as studies have demonstrated. Pictured: MnaamodzawinHealth Services in Little Current, Ontario

33. Two examples include:

34. Two Case Studies: Merits of Aboriginal Self-Determination 1. Community Crisis Teams in Northern Ontario In response to a rising suicide rate amongst First Nations youth in Northern Ontario, the NishnawbeAski Nation (NAN) reached out and received funding to create crisis teams in the communities. First Nations communities have considerable flexibility on crisis team spending decisions. The program is administered by a First Nations organization (the NAN), which is accountable to Aboriginal Healing and Wellness Strategy. This is an almost pure example of Aboriginal self-determination.

35. 2. British Columbia Tripartite First Nations Health Plan Oct.1, 2013, the federal government transferred its role in the design, management, and delivery of First Nations health programming in British Columbia to the new First Nations Health Authority. Under the system, First Nations work closely with government and health agencies for better coordination of health programs and services. The government funds the program and acts as a governance partner, but do not deliver or define services.

36. Insert Quiz slide: Quiz for Chapter 1 There is one question for this chapter. Q: Name two reasons that self-determination is important to Aboriginal health as defined in the chapter. A: _______________________________________

37. Chapter 2: Commitment to Holistic Health, and Health Status Monitoring

38. Emerging ModelsFNIM leaders and federal and provincial governments collaborate to improve relationships to develop new models in Aboriginal health programming and service delivery.

39. Charting a new course: Protocol agreements and what they mean What are protocol agreements?Protocol agreements establish and formalize relationships with FNIM people. They provide a framework for collaboration and outline processes for engagement with the FNIM nations regarding a contemplated project or activity that may have adverse effects on established rights.

40. The Ministry of Aboriginal Affairs recognizes protocol agreements as an agreement that: While protecting and promoting the distinct culture, identity and heritage of FNIM people. Fosters partnership opportunities that respect FNIM traditions. Recognizes the unique history and ways of life of FNIM communities in Ontario. Is intended to improve the well-being of FNIM people and communities. Sets a collaborative relationship with the government and FNIM people. Protocol agreements establish and formalize relationships with FNIM people. They provide a framework for collaboration and outline processes for consultation with an FNIMgroup regarding a contemplated project or activity that may have adverse effects on established rights.

41. Federal and Provincial DirectivesIn 2005, the Blueprint to Aboriginal Health was created as the result of collaborative efforts by federal, provincial and territorial governments and representatives of FNIM people.

42. The Blueprint charted a 10 year course of action. • We will first review Federal Directives: Consultation and then Provincial Directives Federal consultation directives are specific to First Nations people and Inuit. There are no federal level provisions for Métis people.

43. Consultation Directive #1During the planning or implementation of a federal proposed activity: If information becomes available about potential adverse impacts on rights exercised by a First Nations or Inuit group, officials must undertake the appropriate consultations. • For example, decisions with respect to: • a pipeline that may affect wildlife, movement, supply and access; • decisions with respect to pollution from construction; or • use that may affect flora or animal populations.

44. Consultation Directive #2Departments and agencies must assess their activities, policies and programs that may adversely impact potential or established Aboriginal or Treaty rights and related interests. Based on this review, federal officials will ensure that appropriate consultation activities with FNIM groups are carried out.

45. Consultation Directive #3Federal officials must be able to demonstrate in decision making processes that FNIM concerns have been addressed or incorporated into the planning of proposed federal activities. As such, early discussions with the FNIM groups who may be adversely impacted by a federal activity are crucial.

46. Consultation Directive #4The Government of Canada and its officials are required to carry out a fair and reasonable process for consultations. A meaningful consultation process is characterized by good faith and an attempt by parties to understand each other’s concerns, and move to address them.

47. Consultation Directive #5To manage FNIM consultation and accommodation, the Government of Canada will facilitate efficient and effective cooperation among and within federal departments and agencies via senior federal official governance structures which will assign a lead in a consultation process where the lead is not clear. Consultation Directive #6The Government of Canada, in carrying out consultation processes, must act in accordance with its existing commitments and processes (e.g. Treaties, Treaty land entitlement agreements, settlements and consultation agreements).

48. Consultation Directive #7The Government of Canada and its officials can rely on FNIM groups, industry and provinces and territories, to carry out procedural aspects of a consultation process (e.g. information sessions or consultations with FNIM groups). The information collected during can be used by the Government of Canada and its officials in meeting its consultation obligations. Consultation Directive #8A whole of government approach for FNIM consultation will be used in the regulatory review process for major natural resource projects. Consultation will be integrated into environmental assessment and regulatory approval processes.

49. Insert pop up quiz box • [Add in a pop-up: This is a non-scoring quiz: True or False Consultation directives were developed to identify potentially adverse impacts of federal activities on Aboriginal or Treaty rights and interests and find ways to avoid or minimize them. • Answer: True False

50. Provincial DirectivesIn 2004, the provincial government collaborated with FNIM leaders and communities to determine a new approach for FNIM health care.