First Nations Health: The Landscape

1. First Nations Health: The Landscape Valerie Gideon, PhD AFN Health & Social May 10, 2005

2. Discussion Points • Report Card on First Nations Health • The Direction Forward • FPT/First Nations Relations • Commitment to Transformative Change • National Chief’s Commitments • Getting Results • First Nations Health Action Plan • First Ministers Meeting 2004 • Blueprint on Aboriginal Health • $700M Federal Commitments • National Engagement

3. “Shameful Conditions” • Compared to the Canadian public, First Nations face higher rates of disease and are exposed to greater, unnecessary health risks • Prime Minister acknowledged the “shameful conditions” of First Nations • 5-7 years difference in life expectancy • 1.5 times infant mortality rate • 2.5 times suicide rate • Disproportionate burden of infectious diseases • 8 X tuberculosis rates; 5 X hepatitis A; 7 X chlamydia • 3 times unemployment rate • Housing and water and sewage are inadequate • 29% of water systems labeled “high risk”

4. Poorer Perceived Health • First Nations perceive their personal health as poorer than the Canadian public (40% vs. 61%)

5. First Nations are more likely to not receive needed care. Most common reasons are: waiting time (22%) lack of quality care (21%) no service available at required location (14%) and time (13%) Poorer Access to Services

6. The Direction Forward: Recognizing the Significance of First Nations Health • First Nations population is larger than that of four provinces in Canada • Historical relationship with Canada • Treaty and Inherent Rights • Constitution, section 35 • Fiduciary Duty • First Nations governments have responsibility in a majority of cases for the delivery of health services in their communities • First Nations have the power to exercise jurisdiction and by-law making authority in the area of maintaining public health and safety

7. The Direction Forward:F/P/T/First Nations Relations • RCAP and Romanow • Consolidated and targeted funding for First Nations health • Health Partnership model: focus on meaningful and ongoing input, and capacity-building • Canada-Aboriginal Peoples Roundtable • New Principle of Collaboration • First Ministers Special Meeting on Aboriginal Health, Sept. 04

8. The Direction Forward:Real Engagement • Governments’ commitment to transformative change • underlying social and economic framework that perpetuates inequities (UN Human Development Report) • Recognition of First Nations Governments • Potential for new collaborative models implemented by First Nations authorities with targeted and consolidated funding • No longer will we in Ottawa develop policies first and discuss them with you later.  This principle of collaboration will be the cornerstone of our new partnership.” • Prime Minister Paul Martin, Canada-Aboriginal Peoples Roundtable, April 19, 2004

9. National Chief’s Getting Results Strategy • Recognizing and Implementing First Nations Government • Securing the Place of First Nations in Canada and the World • Strengthening First Nations Communities • First Nations Health Action Plan

10. GRS Policy Development • Building collaborative relationships with F/P/T jurisdictions that move beyond consultation to joint policy development; • Key steps: • Engage First Nations leaders; • Host National Dialogues; • Seek Independent First Nations expertise; • Secure government mandate for change; • Undertake joint national policy processes.

11. First Nations Health Action Plan First Nations controlled and sustainable health system that adopts a holistic, culturally appropriate approach GETTING RESULTS Sustainability Integration Sustainable Financial Base Integrated Primary & Continuing Care Health Human Resources Public Health Infra-structure Healing and Wellness Information and Research Capacity

12. Follow-up to FMM: Blueprint on Aboriginal Health • Goals: • Access through integration and adaptation • Equitable access to Canadian health care improvements in Ten-Year Plan • Upstream investments • Clarify Roles and Responsibilities • First Nations Specific Framework • Recognized role of First Nations governments in delivering health services • To be presented at Fall 2005 First Ministers Meeting on Aboriginal Issues

13. Follow-up to FMM: $700 Million in Federal Investments • Federal government announcements: • $200M Aboriginal Health Transition Fund • Integration and adaptation of services (national/ regional/ local initiatives) • $100M Aboriginal Health Human Resources Initiative • $400M Upstream Investments • Suicide prevention • Diabetes • Maternal and child health • Aboriginal Head Start

14. National Engagement Processes • National FN Health Policy Summit, Oct. 28-29 • Health Sectoral Session, Nov. 4-5 • Initiation of Blueprint Development • Resolution at December 04 Assembly • Mandated CCOH and National Chief to negotiate a FN specific stream and resources for national/regional First Nations leadership organizations • Other related activities: • May Cabinet Retreat • FMM on Aboriginal Issues preparations • First Nations Governments Special Assembly, March 29-31 • AFN Policy Summit on Housing, Education, Environmental Stewardship, April 19-21

15. Health Policy Summit/Sectoral Session Outcomes • Vision: • Effective, efficient, sustainable, responsive, culturally sensitive and accountable First Nations health systems • Key areas of discussion: • Jurisdiction • Integration and access: • Service Integration Framework • Capacity and Sustainability • Coordinated funding arrangements based on real costs • Health Human Resources Framework

16. Health Policy Summit/Sectoral Session Outcomes (ctd) • Short-term: • Meaningful engagement of FN governments • Creation of a health system framework to focus on community-driven models • Changes in funding approach to foster sustainability and universality • Service delivery protocols to include services for on and off –reserve citizens • First Nation owned and controlled information systems

17. Health Policy Summit/Sectoral Session Outcomes (ctd) • Medium term: • Health human resources: • access programs for FN students • enhancement of ‘pre’ and laddering programs • First Nations professional institutions • Legislated authorities with appropriate funding • Development of supportive services in public health • Long-term: • Government-to-Government relationships • Recognition and Inclusion of elders and traditional healers to balance scientific and traditional approaches in curriculum and treatment

18. Federal Budget 2005 • Aboriginal Diabetes Initiative renewed as part of the $400M • $100M FN set-aside of $5B Early Learning and Child Care Initiative • Cuts to NIHB ($27M) and FNIHIS ($36M) over 3 years starting in 2007 • Some cuts to FNIHB Operations starting 2005 • No escalator secured

19. Next Critical Points • First Nations Specific Blueprint • Support for First Nations Health System Escalator • Equitable to escalator received by P/Ts • FMM on Aboriginal Issues