Blueprint on Aboriginal Health: Approach for a First Nations Specific Framework

1. Blueprint on Aboriginal Health:Approach for a First Nations Specific Framework CSSSPNQL June 2005

2. Discussion Points • FPT Landscape • National Chief’s Commitments • Getting Results • First Nations Health Action Plan • Follow-Up to FMM • Federal Investments • Blueprint • Engagement of First Nations • National • Regional • National First Nations Blueprint Framework

3. F/P/T Landscape in Health • Council of the Federation • Restructuring federalism with implications for First Nations governments • Addressing health and other issues within a population health approach • First Ministers Health Accords • Ten-Year Plan for Canada: Focus on Quality, Accessibility and Sustainability

4. Significance of First Nations for F/P/T Landscape • 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

5. 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 • First Ministers Special Meeting on Aboriginal Health, Sept. 04 • Cabinet-Aboriginal Leadership Policy Retreat

6. Real Engagement • Governments’ commitment to transformative change • underlying social and economic framework that perpetuates inequities • Recognition of First Nations Governments • Key for May Cabinet Retreat – Political Accord • Treaty Relationship and Inherent Right to Self-Government affirm First Nations Jurisdiction • Potential for new collaborative models implemented by First Nations authorities with targeted and consolidated funding

7. Real Engagement (ctd.) • 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

8. 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

9. 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.

10. Dec/03, Minister of Health invites AFN to submit a proposal re. seat at FPT Advisory Committees on Health Feb/04, National Chief requests involvement in the Council of the Federation Apr/04, first Canada-Aboriginal Peoples Roundtable Minister Pettigrew recognizes the federal government’s fiduciary obligation in First Nations health May/04, Premiers Campbell and McGuinty meet with AFN June/04 Premier Campbell and National Chief agreed to seek approval for a joint presentation to the Council in July Regional Chief Erasmus presents to the Western Premiers Meeting, July 2004 National Chief meetings with Romanow National Chief participates at September 13, 2004, First Ministers Meeting First Nations Health Action Plan:Sowing the Seeds

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. First Nations Health Action Plan: Sustainability • New Federal Investments up to $182M/year Required • Cost drivers show an annual potential average growth rate of 10-12%. • Key Elements of Sustainability Required: • Funding matched to population growth, health needs and cost drivers • Multiyear funding arrangements for long-term planning • Flexible and consolidated funding • Adequate funding for core community health programming, health human resources (e.g. wage parity) & administration

13. First Nations Health Action Plan: Non-Insured Health Benefits • First Nations Action Plan on Non-Insured Health Benefits for June 2005 Program Renewal: • Estimated 10.9% annual escalator required; • Key Concepts of Renewal: • Meeting the Health Needs of First Nations with more timely and higher quality of care; • Fostering Reciprocal Accountability to improve the overall management of the Program; • Adopting a Community Health Approach to draw linkages with community health programs for the advancement of First Nations health and well-being.

14. First Nations Health Action Plan: Non-Insured Health Benefits (ctd) • Building Blocks: • Clear mandate and policies; • Reasonable rate of annual growth; • Ensuring needs-based eligibility criteria; • Transparency in Federal Corporate Administration Expenses; • Tri-partite service agreements; • First Nations Charter of Rights and Responsibilities; • Linkages with community-based programming; • First Nations Health Reporting Framework.

15. First Nations Health Action Plan: Health Reporting Framework • Built on reciprocal accountability & OCAP principles • Response to pan-Aboriginal HRF initiative of FPT governments • Health Determinants approach • Released for discussion June 2005

16. First Nations Health Action Plan: Public Health Framework • FPT Advisory Committee on Public Health and Naylor Report recognized that greater public health risks are in First Nations communities. • Naylor recognized that First Nations are not simply “stakeholders” but have aspirations of self-determination that factors into the effectiveness of public health intervention. • Support for First Nations Public Health Infrastructure required with Inter-jurisdictional partnerships: • AFN Advisory Committee on Public Health; • First Nations Public Health Framework released for regional dialogues in Summer 2005.

17. Follow-Up to FMM: Federal Investments of $700M • 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

18. Follow-up to FMM:Blueprint • 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

19. Follow-up to FMM:Blueprint (ctd) • National Approach • FTPA Planning Group • ADM/NAO Core Group (Ont/FNIHB Co-Chair) • Ministers/NAO Leaders • National Framework • Blueprint Approach • Blueprint Outline • Glossary • Submission Template

20. Follow-up to FMM:Blueprint (ctd) • Action Agendas: • Delivery and Access • Sharing in Improvements to Canadian Health Care • Promoting Health and Well-Being • Monitoring Progress and Learning as we go • Clarifying Roles and Responsibilities between F/P/T/First Nations governments and organizations • Developing Ongoing Collaborative Working Relationships

21. 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 • Other related activities: • May Cabinet Retreat • FMM on Aboriginal Issues preparations • First Nations Governments Special Assembly • AFN Policy Summit on Housing, Education, Environmental Stewardship

22. Regional Engagement Processes First Nations Regional Processes (each receiving $200K) • Regional Coordination/Partnership Team • Community meetings • Chiefs Task Force/Working Group/Policy Table • Meeting with NGOs • Tri-partite discussions • Chiefs Assemblies • Participation in national events • Long-term planning for mutually beneficial linkages with P/Ts and FNIHB in Strategy development

23. Critical Steps for Success of First Nations Specific Blueprint • National: • May Cabinet Retreat • National Engagement Session with FNIHB, June 16-17 • CCOH Special Meeting on First Nations Jurisdiction • Clarifying the federal relationship will be key to assuring First Nations that this is not an offloading strategy • Submission of Regional Blueprints in June/July • Presentation of National Update at July AGA in Yellowknife • Presentation of Final Blueprint to First Nations at pre-FMM National FN Health Policy Summit (September)

24. Critical Steps for Success of First Nations Specific Blueprint (ctd) • Regional: • CCOH motion to support regional First Nations funding proposals • P/Ts cannot be expected to take a lead role in creating a FNs specific framework • Integrity of Regional First Nations Blueprints maintained in National Roll-Up

25. Critical Success Factors for National First Nations Blueprint • Strengthen the role of First Nations governments in improving the health and well-being of their peoples, living in and outside their communities • Working Nation-to-Nation with federal, provincial and territorial governments to establish collaboration/coordination • Adequate access to health human resources and infrastructure

26. Critical Success Factors for National First Nations Blueprint 2. Securing equitable opportunities for health • Areas within Ten-Year Plan for Canada where there is no equivalent investment for First Nations, such as: • Escalator - Sustainability • Health Infostructure (research and technology) • Primary and Continuing Care • Healthy Living (Healthy Schools) • Catastrophic Drug Coverage

27. Critical Success Factors for National First Nations Blueprint 3. Obtaining support for a holistic approach to community health, including addressing determinants • Housing, Education, Economic Development • Mental Health 4. Fostering Reciprocal Accountability to measure improvements • Based on Government-to-Government relations • First Nations Health Reporting Framework

28. Conclusion • A First Nations specific framework and process must result in: • Alignment with Historical Foundation of First Nations-Canada Relationship • An Ongoing Commitment Towards Transformative Agenda • An Action-Oriented Agenda • A Needs Based and Holistic Approach