We call upon the federal, provincial, territorial and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.

Indigenous Watchdog Status Update

Current StatusAug. 17, 2020STALLED
Previous StatusJune 15, 2020STALLED

Why ‘Stalled”?

Of the two parts of Call to Action # 14, the federal government and some provinces have “acknowledged that the current state of Aboriginal health is a direct result of previous government policies”. Only BC, Alberta, Manitoba and Ontario have explicitly made an official policy statement to that effect.

With respects to “recognizing and implementing the healthcare rights of Aboriginal people as identified in international law, constitutional law and under the Treaties” no jurisdiction other than BC has formally made any legislative commitment i.e. implementing the United Nations Declaration on the Rights of Indigenous Peoples. BC has formally announced their intention to implement UNDRIP.

The federal government addresses fundamental Indigenous rights – including Treaty rights – through the “Principles respecting the Government of Canada’s relationship with Indigenous peoples“.

“If you want to measure the effect of Canada’s racist and colonial policies toward Indigenous Peoples you only have to look at the fact that while Canada was recently number one in the international quality of life indicator, Indigenous Peoples within its borders languished at number seventy-eight.” 

Manuel, A. (2017). The Reconciliation Manifesto Recovering the Land and Rebuilding the Economy. James Lorimer & Co. Publishers. Toronto:ON, p. 78. 

Federal Health Budgets

Budget 2016

  • $270M over 5 years for the construction, renovation and repair of nursing stations, residences for health care workers, and health offices that provide health information on reserve.
  • $69 million over 3 years for mental wellness teams and crisis stabilization

Budget 2017 = $828.2M over 5 years

  • Chronic and infectious diseases: $50.2M
  • Maternal and Child Health: $83.2M
  • Primary care: $72.1M
  • Mental wellness: $118.2M
  • Home and palliative care: $184.6M
  • Non-Insured Health Benefits Program: $305.0
  • Drug strategy—harm reduction measures: $15.0
  • (all above amounts over 5 years)

Budget 2018 = $1.497B (5 year totals)

  • Access to critical medical care and services: $498M
  • Addictions treatment and prevention: $200M ($40M ongoing)
  • Capacity-building in First Nations communities: $235M
  • Non-Insured Health Benefits Program: $490M
  • Supporting Inuit health priorities: $68M
    • Includes $27million over 5 years for eliminating tuberculosis in Inuit Nunangat
  • Métis health data and health strategy: $6M
Federal/Provincial/Territory Recognition of Indigenous Rights to Health

Federal Government

Feb. 14, 2018 – Going forward, recognition of rights will guide all government relations with Indigenous peoples,” Prime Minister Justin Trudeau told the House of Commons… The new legislation and policy will be developed, he said, in consultations with the First Nations, Inuit and Métis as well as the provinces and territories and non-Indigenous Canadians that will be led by Carolyn Bennett, the Minister for Crown-Indigenous Relations and supported by Jody Wilson-Raybould, the Justice Minister…Or if a group of First Nations wanted to take control of their health-care system, the government would start from the premise that they have the right to do so.”

April 7, 2018 – “The health outcome gaps are a direct result of previous Canadian government policies… but many of those discriminatory policies that have caused the health outcome gaps remain in place… have their roots in the laws, the policies and the operational practices of this country… They were denied the right to self-determination and subjected to laws, policies and practices that were based on domination and assimilation… Where does the TRC say those rights are laid out? In international law, in constitutional law and in treaties. The path to health, safety and healing starts with the recognition and implementation of inherent treaty rights. Dr. Jane Philpott, Minister of Indigenous Services. Closing the Gap Conference – The Next 150: Reconciliation and Health

British Columbia

2003 – The B.C. government expressed its deep regret for the mistakes of past governments in their treatment of Aboriginal people. The Province acknowledged that no words can undo the damage done for past actions and that it is the responsibility of people today to heal these wounds.

2013 – B.C.’s First Nations assumed the programs, services and responsibilities in B.C. formerly handled by Health Canada’s First Nations Inuit Health Branch. It became the first, and still the only, such provincial First Nations Health Authority in Canada.

April, 3, 2019 – Declaration of Commitment to Advance Cultural Safety and Humility in Health and Wellness Services first launched by the First Nations Health Authority in July, 2015 with signatories of the Government of BC has now been signed by the federal departments of Indigenous Services and Health, as well as the Public Health Agency of Canada

Alberta

Oct. 2, 2018 – Release of “Indigenous Health Transformational Roadmap 2018-2020”. The Introduction states:Any action in Indigenous health begins with knowing: the historical impact of legislation and policies on the health and wellbeing of Indigenous peoples in Canada, the current state of Indigenous health, and the health care rights of Indigenous peoples as laid out in international law, constitutional law, and under the Treaties”.

Strategic Direction # 1 – Align with the TRC Call to Action # 18

  • Establish an organization-wide commitment statement on the TRC calls to action, UN Declaration, Treaties and acknowledgement of Indigenous health-care rights
  • Recognize and shape into policy the health care rights of Indigenous peoples
Saskatchewan

No formal acknowledgement of the negative impacts of previous colonial government policies

June, 2018 – Release of “Indigenous Health in the New Saskatchewan Health Authority: Summary of Findings”. The 2016 Saskatchewan Advisory Panel on Health System Structure Report includes a recommendation to engage with Indigenous people to help inform how best to address First Nations and Métis health needs in a culturally responsive and respectful manner. Both reports clearly identify that health system changes are needed in order to improve the health and well-being of Indigenous peoples in the province.

In accordance with the Advisory Panel’s recommendation, an Indigenous Health Working Group (IHWG) was formed for the months leading up to the transition to a single health authority (May through November 2017). The mandate of the IHWG was recommendation five on the advisory report.

5. Engage with Indigenous people to help inform how best to address First Nations and Métis health needs in a culturally responsive and respectful manner. In particular, the following should be examined:

  • Appropriate representation in the governance of the Provincial Health Authority;
  • Ensuring community advisory networks are reflective of the ethnicity and culture of the community; and
  • Establishing a senior administrative role within the Provincial Health Authority with the responsibility for ensuring health care services respect the Fist Nation and Métis patient experience.
Manitoba

Mar. 15, 2016 – The Path to Reconciliation Act acknowledges that Indigenous people within Canada have been subject to a wide variety of human rights abuses since European contact and that those abuses have caused great harm… that reconciliation is founded on respect for Indigenous nations and Indigenous peoples and their history, languages and cultures, and reconciliation is necessary to address colonization;

June, 2017The Path to Reconciliation Annual Report: Improving Health Outcomes

Manitoba’s commitment to reconciliation has particular focus on addressing the persistent and long-standing negative impacts of residential schools and reconciling relationships between Indigenous and non-Indigenous peoples in Manitoba.

The legacy of colonialism and residential schools led to disruptions in Indigenous child rearing practices and parenting skills among Indigenous families. Manitoba is working to address this by supporting the health of families, mothers and babies through family health and healthy lifestyle programs. Manitoba supports children and adults living with Fetal Alcohol Spectrum Disorder (FASD), addresses jurisdictional disputes to ensure that public service delivery for First Nation children and families are not delayed and provides supports for Indigenous children with disabilities.

The Path to Reconciliation Annual Report: 2018, 2019

Each subsequent report provides more details on progress made in the following areas:

  • Closing the gap in health outcomes between Indigenous and non-Indigenous populations
  • Recognizing and using Indigenous healing practices
  • Improving cultural competencies
  • Increasing the number of Indigenous professionals in the health care system

Sept. 19, 2019 – Release of “The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba” that acknowledges that “The analysis and interpretation of findings in this report acknowledge “that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools” [1].

Oct. 9, 2019 – Announced enhanced and expanded mental health and addictions programming for youth with three new initiatives today.  The investments, which total $2.94 million over three years, include:

  • $823,000 to the NorWest Youth Hub, to increase mental health and addictions counselling, Indigenous cultural supports, primary health care, as well as recreation and training opportunities for youth aged 14 to 24;
  • $621,000 to Project 11, which provides virtual and in-person lessons and activities designed to improve mental health awareness and positive coping strategies for students in kindergarten to Grade 8; and
  • $1.5 million to expand the distribution of Thrival Kits to grades 4 to 6 students across the province.

Federal Government and Souther Chiefs MOU

June 18, 2020 – Anishinaabeg and Dakota peoples will assume greater control of their health and wellness, as a result of an historic Memorandum of Understanding (MOU) signed between Canada’s Minister of Indigenous Services and the Southern Chiefs’ Organization. “The path forward to improved health outcomes for First Nations must include high quality, culturally-safe health systems that are designed by and under the leadership of First Nations,” said Minister Miller. “This Memorandum of Understanding, together with significant investment, will not only help the Southern Chiefs’ Organization address gaps in the health care system, but will also assist in bringing much needed health care services closer to Manitoba First Nation communities, and improve health outcomes for Indigenous Peoples living in their home communities.”

In 2019, the SCO Chiefs-in-Summit passed a resolution supporting the health transformation process called “Exercising our Treaty and Inherent Right to Health”. The Southern Chiefs’ Organization represents 34 First Nations in what is now called southern Manitoba. SCO is an independent political organization that protects, preserves, promotes, and enhances First Nations peoples’ inherent rights, languages, customs, and traditions through the application and implementation of the spirit and intent of the Treaty-making process.

http://scoinc.mb.ca/programs/health/

Ontario

Aug, 24, 2015 – The Chiefs of Ontario and the Government of Ontario signed a historic Political Accord to guide the relationship between First Nations and the province. The Accord creates a formal bilateral relationship framed by the recognition of the treaty relationship.

May 25, 2016 – Ontario is investing nearly $222 million over the next three years to ensure Indigenous people have access to more culturally appropriate care and improved outcomes, focusing on the North where there are significant gaps in health services. This investment will be followed by sustained funding of $104.5 million annually to address health inequities and improve access to culturally appropriate health services over the long term.  

July 24, 20117 – Ontario also recently signed a Charter of Relationship Principles with Nishnawbe Aski Nation and Canada, and is working with other Political Territorial Organizations and First Nations partners on similar relationship documents. These will express Ontario’s commitment to collaborate with partners in creating new health systems for First Nations communities that will be led, planned and delivered by First Nations themselves.

Feb. 14, 2018 – Ontario and Indigenous partners are working together to improve access to care and increase the involvement of Indigenous communities in developing and delivering their health services. This includes direct funding for communities to enhance access to care, funding for services as well as training opportunities, and identifying opportunities for greater First Nations control over the design and delivery of health care services in the future, including:

  • Home Care, Primary Care, Palliative Care, Mental Health and Wellness, Healing and Treatment Centres

Feb. 14, 2020 – Ontario is expanding mental health, addictions and well-being services for First Nations and Indigenous organizations, helping to provide culturally-appropriate services closer to home by investing $1.2 million in additional funding to expand community-based mental health and addictions services provided by First Nations and Indigenous organizations.

  • Batchewana First Nation to expand existing mental health and wellness programs to offer a combination of clinical care and traditional healing and operate a new mental health and addictions aftercare program for post-treatment clients.
  • Sioux Lookout First Nations Health Authority to establish a team of specialized mental health professionals including counsellors, an expressive arts therapist and clinical psychologist, to provide care to First Nations youth in northwestern Ontario with acute mental health needs.

The Ontario Federation of Indigenous Friendship Centres to expand mental health and wellness programs that will serve more community members.

Quebec

No formal acknowledgement of the negative impacts of previous colonial government policies

Aug. 30, 2019 – Ghislain Picard, Chief of the Assembly of First Nations of Quebec and Labrador (AFNQL) signed a tripartite Memorandum of Understanding (MOU)as part of the AFNQL health and social services governance process with governments of Canada and Quebec. The MOU paves the way for better access to health and social services and better delivery of those services. It confirms the commitment made by all parties to address the challenges resulting from the multiple levels of jurisdiction. The MOU will also support the search for various governance models tailored to the realities and needs of Quebec First Nations. The chosen model will give First Nations the chance to develop and manage programs and provide health care and services for the benefit of their communities, according to various priorities. These services include services for seniors, children and youth; preventive services; mental health services; addiction services; psychosocial services; and other services. In 2018‒2019, federal funding of $3 million over three years was allocated to Quebec First Nations to support the governance process in health and social services.

New Brunswick

No formal acknowledgement of the negative impacts of previous colonial government policies

Nova Scotia

No formal acknowledgement of the negative impacts of previous colonial government policies

Oct. 12, 2018 – Eskasoni First Nation, District of Unama’ki in the traditional un-ceded territory of the Mi’kmaq people celebrated the grand opening of a new, state-of-the-art health centre more than twice the size of the former space that makes it the largest on-reserve health centre in the Atlantic Region. Indigenous Services Canada provided an investment of $6.6M for this project, and Eskasoni First Nation contributed $3.5M.

The new facility will enable access to quality care in the community by supporting a wide-range of health services and programs under one roof, including a dental clinic and pharmacy. The health centre will provide space for programs and services for people of all ages, including mental wellness, health promotion, disease prevention and primary care. Eskasoni First Nation is the largest Mi’kmaq community in the Atlantic Region. It is located in Cape Breton, Nova Scotia, and has an on-reserve population of approximately 3,867 people

Prince Edward Island

No formal acknowledgement of the negative impacts of previous colonial government policies

Jan. 16, 2019 – The Province of Prince Edward Island is committed to advancing reconciliation with the Mi’kmaq of Prince Edward Island in a manner consistent with Section 35 of the Constitution Act, 1982. Strategic Priorities of the Indigenous Relations Secretariat includes Work with all levels of government, including First Nations, to reduce any socio-economic gap between Aboriginal and non-Aboriginal Islanders and improve life outcomes for Aboriginal Islanders

Newfoundland and Labrador

No formal acknowledgement of the negative impacts of previous colonial government policies

Aboriginal Health Transition Fund: In an effort to improve the health status of Canada’s Aboriginal peoples, the federal government has partnered with the provinces and territories to deliver the Aboriginal Health Transition Fund (AHTF). With three distinct funding envelopes, Integration, Adaptation and Pan-Canadian, the AHTF provides funding for Aboriginal initiatives that 1) improve accessibility of health programs and services for Aboriginal peoples; 2) adapt existing health programs and services to better meet the needs of Aboriginal peoples; 3) increase the participation of Aboriginal peoples in the design, development, implementation and evaluation of programs and services that serve Aboriginal populations.

Yukon

Deputy Ministers’ Report to the Premier on the Truth and Reconciliation Commission of Canada Report

Jan. 12, 2016 – The Government of Yukon acknowledges that Aboriginal people in Yukon, and their descendants, continue to be affected by the devastating impacts of the Indian Residential School system. The Yukon government has also indicated that addressing this legacy is a significant priority. The residential school system is part of our shared history; the work called for by the TRC is part of our shared future.

Key work done to date: Aboriginal healing practices in health care:

  • Health and Social Services is taking measures to ensure that addictions programming and the environment in the new Sarah Steele detox facility supports First Nations peoples.
  • All new Continuing Care facility designs include healing centres and First Nations food preparation areas to ensure access to Aboriginal healing practices.
  • Health and Social Services funds First Nation Health programs through the Hospital Corporation in Whitehorse, Watson Lake and Dawson.
Northwest Territories

Feb. 26, 2019 – The Government of the Northwest Territories has acknowledged the role that residential school policies have played in contributing to health disparities for Indigenous peoples.

“Caring for Our People – Cultural Safety Action Plan”

As part of the Department of Health and Social Services’ official release of the “Caring for Our People: Cultural Safety Action Plan 2018-2020” today, a Declaration of Commitment was signed to embed cultural safety within the Northwest Territories’ health and social services system. Through the implementation of the Cultural Safety Action Plan, the Government of the Northwest Territories aims to improve the health outcomes Indigenous residents and all Northerners.

An engagement process with Indigenous and northern residents, including health and social services clients, the NTHSSA Leadership Council, Regional Wellness Councils, and non-government organizations, four objectives were identified for the Action Plan.

  1. Creating an organizational culture of cultural safety.
  2. Strengthening staff capacity for cultural safety.
  3. Honouring traditional knowledge and healing approaches in care.
  4. Improving client and community experience.
Nunavut

May 30, 2018 – The lack of health services offered in Indigenous languages is impeding the delivery of care to Indigenous populations, according to Aluki Kotierk, president of Nunavut Tunngavik Incorporated, which administers treaty rights for the 49 000 Inuit inhabitants of Nunavut. The first language of 75% of the Inuit population in Nunavut is Inuktituk, yet patients are unlikely to hear it spoken by health care providers.

Jan. 7, 2020 – Nunavut’s new Public Health Act came into force January 1, replacing the version carried over from the Northwest Territories. This new and improved legislation works to modernize the territory’s health system and recognizes the unique needs of Nunavummiut.

Minister of Health George Hickes aid, “The new Act modernizes our public health legislation to ensure processes in place to keep Nunavummiut safe and healthy, ensuring Inuit Qaujimajatuqangit are the legislation’s guiding principles.” Nunavut’s Public Health Act establishes measures relating to health protection and promotion, population health assessment, public health surveillance, disease and injury prevention, and public health emergency preparedness and response. It also outlines requirements in food and water safety, sanitation, and reporting and responding to communicable diseases to strengthen health protection.

Prime Minster Trudeau’s Apology to the Inuit for Governments lack of response to TB Epidemic

The apology and the Nanilavut Initiative are the result of a collaborative effort between the Government of Canada, Inuit Tapiriit Kanatami, Inuvialuit Regional Corporation, Makivik Corporation, Nunatsiavut Government and Nunavut Tunngavik Incorporated. Reconciliation initiatives like this are a key priority for these partners, and part of the work of the Inuit-Crown Partnership Committee. They also reflect the Government of Canada’s firm commitment to renewing the Inuit-Crown relationship based on recognition of rights, respect, cooperation, and partnership.

Mar. 8, 2019 – “To Inuit, and the families and communities of Inuit Nunangat who were wronged by the federal government’s management of the tuberculosis epidemic – we are sorry. We apologize to those who were forced to leave, those left behind, the families without knowledge of the fate of their loved ones, and the communities that continue to feel the impacts today. We cannot undo the shameful actions of the past, but we can work together to create a better future, one built on respect and partnership. Every step we take on this journey of reconciliation, we will take together.”

https://pm.gc.ca/en/news/speeches/2019/03/08/statement-apology-behalf-government-canada-inuit-management-tuberculosis

—The Rt. Hon. Justin Trudeau, Prime Minister of Canada

“This apology is a necessary first step toward closing this dark chapter in Canada’s history and remedying the ongoing challenges that are connected to it. It allows families to seek the closure and healing they have sought for more than half a century. I am pleased that the Prime Minister’s words are also accompanied by actions. The launch of the Nanilavut Initiative will help many families gather tangible information to help them find the final resting place of their loved ones. Through the Inuit-Crown Partnership Committee, Inuit leaders and federal ministers must continue to work together to achieve our shared commitment of eliminating TB in Inuit Nunangat by 2030. These are all critical elements on our shared path towards reconciliation.”
—Natan Obed, President, Inuit Tapiriit Kanatami

“On behalf of Beneficiaries of the Labrador Inuit Land Claims Agreement, we acknowledge and accept the Prime Minister’s apology. We also appreciate the federal government’s efforts to help Inuit find closure in relation to this important issue. We are proud to be working with our partners across Inuit Nunangat and in Ottawa to help Inuit find out what happened to lost loved ones who were sent south for medical treatment between the 1940s and 1960s. The work we are doing together is extremely important, and there is still so much to do to create the better future that the Prime Minister spoke so eloquently about.”
—Johannes Lampe, President, Nunatsiavut

“We acknowledge the apology, which is long overdue. While we look at the wrongs of the past, we also look at problems of today, among them overcrowding from the lack of housing and the spread of tuberculosis that is endangering our people as the disease slowly spreads in Arctic communities.”
—Adamie D Alaku, Vice President, Makivik Corporation of Nunavik

Principles respecting the Government of Canada’s relationship with Indigenous peoples

These Principles are rooted in section 35, guided by the UN Declaration, and informed by the Report of the Royal Commission on Aboriginal Peoples (RCAP) and the Truth and Reconciliation Commission (TRC)’s Calls to Action. In addition, they reflect a commitment to good faith, the rule of law, democracy, equality, non-discrimination, and respect for human rights. They will guide the work required to fulfill the Government’s commitment to renewed nation-to-nation, government-to-government, and Inuit-Crown relationships.  

These Principles are a starting point to support efforts to end the denial of Indigenous rights that led to disempowerment and assimilationist policies and practices. They seek to turn the page in an often troubled relationship by advancing fundamental change whereby Indigenous peoples increasingly live in strong and healthy communities with thriving cultures.

The Government of Canada recognizes that:

  1. All relations with Indigenous peoples need to be based on the recognition and implementation of their right to self-determination, including the inherent right of self-government.
  2. Reconciliation is a fundamental purpose of section 35 of the Constitution Act, 1982.
  3. The honour of the Crown guides the conduct of the Crown in all of its dealings with Indigenous peoples. 
  4. Indigenous self-government is part of Canada’s evolving system of cooperative federalism and distinct orders of government.
  5. Treaties, agreements, and other constructive arrangements between Indigenous peoples and the Crown have been and are intended to be acts of reconciliation based on mutual recognition and respect.
  6. Meaningful engagement with Indigenous peoples aims to secure their free, prior, and informed consent when Canada proposes to take actions which impact them and their rights on their lands, territories, and resources.
  7. Respecting and implementing rights is essential and that any infringement of section 35 rights must by law meet a high threshold of justification which includes Indigenous perspectives and satisfies the Crown’s fiduciary obligations.
  8. Reconciliation and self-government require a renewed fiscal relationship, developed in collaboration with Indigenous nations, that promotes a mutually supportive climate for economic partnership and resource development.
  9. Reconciliation is an ongoing process that occurs in the context of evolving Indigenous-Crown relationships.
  10. A distinctions-based approach is needed to ensure that the unique rights, interests and circumstances of the First Nations, the Métis Nation and Inuit are acknowledged,  affirmed, and implemented.
Official Federal Government Response: Sept., 2019

The Government of Canada recognizes that the current state of Indigenous health is a direct result of the shameful historical legacy of colonialist policies and interventions against the well-being of Indigenous peoples and communities, including Indian residential schools, the Sixties Scoop and other harmful practices. The intergenerational impacts of Indian residential schools are well documented in international and national evidence cited in Government of Canada publications and specifically recognized in partnership agreements with Indigenous governments and representatives.

The Government of Canada has committed significant new investments in Budgets 2016, 2017 and 2018 to increase the capacity of Indigenous communities to address both risk factors and impacts of health inequities resulting from the intergenerational effects of colonization. These investments include:

  • $69 million over 3 years for mental wellness teams and crisis stabilization
  • $828.2 million over 5 years for communicable diseases, primary care transformation, mental wellness, children’s oral health and home and community care
  • $200 million over 5 years with $40 million ongoing to address the needs of high risk communities in the area of addictions
  • $27.5 million over 5 years for eliminating tuberculosis in Inuit Nunangat
  • $86 million for Non-Insured Health Benefits to expand access to mental health professionals, including access to traditional healers
  • making accessible to all First Nations and Inuit women who must leave their home community during their pregnancy, an escort such as a family member

These investments will result in meaningful change in Indigenous communities in terms of levels of access to services, number of community-based workers, partnerships with provincial and territorial health systems, and better linkages with the Indigenous social determinants of health. For example, the number of multidisciplinary and culturally grounded mental wellness teams will quadruple. This model is based on the First Nations Mental Wellness Continuum Framework endorsed by First Nations chiefs in assembly in 2015. The National Inuit Suicide Prevention Strategy developed by and for Inuit will be implemented. The Know Your Status First Nations community-designed and driven initiative will be replicated across all First Nations communities in Saskatchewan, an initiative that has demonstrated capacity of First Nations to exceed the 90-90-90 HIV elimination target of the World Health Organization.

In addition to these significant investments in Indigenous designed and implemented health and wellness initiatives, the Government of Canada is actively supporting Indigenous peoples to take control over health services in recognition of their rights to self-governance and self-determination. Building on the success of the British Columbia First Nations Health Authority who took over federal British Columbia operations in First Nations health in 2013, it has committed to Mental Wellness Transformation partnership with the British Columbia First Nations Health Council and the provincial government. An initial investment of $10 million over 3 years has been committed by the Government of Canada to support the aspirations of British Columbia First Nations leaders and representatives to support community-driven, nation-based plans in the area of mental health and wellness.

Budget 2018 announced $235 million to advance targeted health systems transformation initiatives launched by First Nations in several provinces. The Government of Canada has signed partnership agreements with Northern Manitoba First Nations (MKO), Northern Ontario First Nations (Nishnawbe Aski Nation and Treaty 3) and is expecting to shortly sign protocol agreements with non-self-governing First Nations of Quebec and Labrador. A Memorandum of Understanding with the Onion Lake Cree Nation was signed to establish the first treaty-relationship based funding agreement related to health, reflecting the importance of Treaty 6 and the Medicine Chest clause.

The Government of Canada will continue to pursue collaboration, both bilateral and tripartite, with First Nations across the country. In 2016, funding was provided to National Indigenous Organizations to develop distinctions-based plans for health transformation, presented to federal, provincial and territorial Health Ministers by Indigenous leaders in October 2017.

As well, the permanent bilateral mechanism process is instrumental in advancing priorities identified in these health transformation plans and joint health and wellness work plans with the Assembly of First Nations, Inuit Tapiriit Kanatami and the 4 Land Claim Organizations as well as the Métis National Council and its governing members. A Memorandum of Understanding to develop a 10-year Métis Health Accord with the Métis National Council has been signed as an outcome of this process.

In addition to investing in capacity building and actively supporting the devolution of health services, the Government of Canada recognizes that to make improvements to health outcomes for Indigenous individuals, families and communities, cultural safety and humility must be embedded in the health system and in health service delivery. Again, building on the accomplishments realized by the British Columbia First Nations Health Authority in making the health system in British Columbia more culturally safe for First Nations, the federal departments of Indigenous Services and Health, as well as the Public Health Agency of Canada, signed a Declaration of Commitment to Advance Cultural Safety and Humility in Health and Wellness Services in British Columbia on April 3, 2019.