We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long-term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.

Indigenous Watchdog Status Update

Current StatusJan. 10, 2022STALLED
Previous StatusDec. 5, 2021STALLED

Why “Stalled”?

Yellowhead Institute Policy Brief “Colonialism of the Curve: Indigenous Communities and Bad Covid Data” identifies significant gaps in health data gathered by governments versus that gathered by Indigenous researchers. Gaps are further reinforced by “Our Health Counts” the largest urban indigenous population health study in Canada conducted by St. Michael’s Hospital’s Well Living House in Toronto, Hamilton, Kenora and Ottawa and the First Nations Information Governance Centre’s Regional Health Survey Volumes 1 and 2. (See also Problems and Issues in Indigenous Health on Health Calls to Action Home Page).

Measurable goals to identify and close the gaps in health outcomes have not yet been identified although the Federal government is working with First Nations Information Governance Centre to “develop an information strategy to determine appropriate indicators through the First Nations Regional Health Survey and the Inuit on the development of an Inuit Health Strategy”. The Inuit Tuberculosis Elimination Framework has developed regional action plans to eliminate TB. The government is also working with the Métis National Council in gathering health data and developing a health strategy.

No progress on publishing annual progress reports and assessing long-term trends in any jurisdiction.

First Nations Information Governance Centre “Regional Health Survey (RHS): Volumes 1 and 2”

The First Nations Information Governance Centre is an independent, apolitical, and technical non-profit organization operating with a special mandate from the Assembly of First Nations’ Chiefs-in-Assembly (Resolution #48, December 2009)

Mission

With First Nations, we assert data sovereignty and support the development of information governance and management at the community level through regional and national partnerships. We adhere to free, prior and informed consent, respect nation-to-nation relationships, and recognize the distinct customs of nations.

Core Strategic Objectives

Our Vision and Mission are guided by our Core Strategic Objectives

  1. Our approach is Community-driven and Nation-based
  2. Our data are inclusive, meaningful, and relevant to First Nations
  3. Our tools are effective, adaptable, and accessible
  4. Our partnerships connect regions to strengthen data sovereignty

Regional Health Survey, July 2018

The RHS has earned its place as the reliable source of information about life in First Nations communities, with its data being used to support policy and programming at community, regional, and federal levels. And it is still the only First Nations survey of its kind, with its social, cultural, and political impact now widely acknowledged. The RHS National Team is located at the First Nations Information Governance Centre in Ottawa and coordinates the RHS on a national level. Our activities include preparing reports, serving as the data steward, and engaging in partnerships. In addition, ten independent, RHS Regional Partners coordinate the RHS in their respective regions. The National Team and Regional Partners collaborate on collective issues as well as share ideas and knowledge.

The RHS is the only national First Nations health survey in Canada. It has produced important innovations in data sharing, research ethics, computer-assisted interviewing, sampling, field methods, training and culturally appropriate questionnaire content. Most significantly, the RHS process has invested in individual and organizational First Nations capacity at the community, regional and national levels. The RHS is a unique collaborative initiative of First Nations regional organizations across Canada.

Before the RHS, First Nations populations living on reserve and in northern communities had been excluded from national health surveys resulting in an information gap for many key socio-economic indicators to improve the lives of First Nations. The challenges First Nations face are multi-dimensional and require a collective response to promote well-being and to understand and reduce health disparities. The RHS is one such response that is filling this information void by generating regional and national evidence to improve the health care system and the determinants of health for First Nations.

Regional Health Survey: Volume 1

Conclusions

Socioeconomic Conditions

  • Due to a lack of funding and access to services, there is a disparity when comparing the social determinants of health for First Nations people to the general population. Factors such as education, employment, income and housing are a part of this.
  • Income and employment disparities between First Nations adults and the general population in Canada also persist
  • In terms of issues surrounding safe drinking water access, the current Canadian government has pledged to end boil-water advisories on First Nations reserves by 2021 (The Canadian Press, 2015), and future research should evaluate the degree to which these current efforts are implemented and, if they are, how successful they have been in increasing access to safe drinking water
  • Finally, the migration patterns of First Nations people are an avenue where there is potential for further research, especially when it comes to the economic and social impacts (positive and negative) of migration on households. Furthermore, those who live outside of their communities, especially  for economical or educational reasons, may face additional challenges, which government policy or community efforts might support but currently lie outside the scope of the RHS.

Chronic Health Conditions

  • Despite positive trends in terms of reduced prevalence of some chronic health conditions, significant health disparities between First Nations communities and the general population remain an area of concern. Key findings point to the need for timely access to screening, treatment, and monitoring of chronic health conditions. This is particularly evident for First Nations adults with diabetes and CKD.
  • The findings of this study also provide additional evidence that First Nations women tend to carry a higher burden of chronic illness and co-morbidity compared to First Nations men. This speaks to the continued importance of programming that supports timely access to safe, adequate care that addresses the health needs and concerns of First Nations women.
  • The findings also indicate the importance of addressing and supporting the mental, emotional and spiritual well-being of First Nations youth. It was suggested in the RHS Phase 2 report that the mental health experiences of First Nations youth diagnosed with chronic health conditions be considered by health professionals. Arguably, this still remains the case.
  • Access to safe, clean drinking water and homes free of mould and mildew continue to be a pressing priority on First Nations reserves.
  • Although evidence is limited at this stage, the findings suggest that further investigation is warranted into the relationship between sharing traditional foods and how this may serve to support community members experiencing health challenges.

Mental Health and Substance Abuse

  • Too little is known about the mental health of First Nations children, youth and adults. The RHS Phase 3 fills many statistical gaps by tracking self-reported mental health, specific mental health diagnoses (anxiety, mood disorders, ADD/ADHD, ASD) and substance use-related neurocognitive disorders (FASD). But further knowledge needs to be developed for a broader spectrum of diagnoses including PTSD, schizophrenia and intergenerational trauma.
    • Implementing the TRC’s Call to Action to establish measurable goals to identify and close the gaps in health outcomes between Indigenous and non- Indigenous communities, to publish annual progress reports and assess long-term trends including, but not limited to, mental health and addictions would address this gap.
    • Enhanced Indigenous data governance and management, culturally relevant health measurement, clarification of provincial, federal and First Nations jurisdictional responsibilities for health data collection and enhanced dissemination to Indigenous leadership are other possible solutions
  • The medical model driving the broader mental health sector often focuses on deficits and illness which contradicts the wellness focus of most culturally based program
  • The funding base for many of these interventions is too often project-based and time-limited, which makes sustainability a constant challenge. The TRC called for sustained funding for healing lodges devoted to the treatment of IRS trauma. Similarly, funding for promising community- driven initiatives may enhance their sustainability.

Oral Health

  • First Nations on reserve and Northern communities are more likely to report their oral health as being fair or poor and to present higher prevalence estimates of edentulism, dental pain, baby bottle tooth decay (early childhood caries) and perceived dental treatment needs than their counterparts in the general population.
  • Poor oral health among First Nations most often starts in childhood and continues throughout the life course. Thus, it is encouraging that access to dental care has increased among children and seniors.
  • However, for youth and children, the decline in treatment needs started in RHS Phase 2. Gaps still remain, and future research should address the social and cultural determinants of oral health that are fundamental to a First Nations holistic approach to health and well-being.

Indian Residential Schools

  1. The current findings highlight a number of the long-term negative consequences of the IRS legacy on physical and mental health as well as social outcomes, while also highlighting the strengths of the First Nations peoples despite Residential Schools and other aspects of colonization.
  2. Considering the large proportion of the Indigenous population that has been affected by Residential Schools and colonization, combined with insufficient healing and wellness resources and ongoing inequities, it should not be surprising that many of the health inequities faced by Indigenous peoples documented twenty years ago are still present today
  3. Intergenerational exposure has, in some instances, resulted in effects more consequential than the direct effects observed among those who attended themselves. These analyses also emphasize how the effects of Residential School influence First Nations peoples across the lifespan and that prevention and intervention strategies need to be implemented at each stage of life, particularly in early development when environmental exposures can have the most enduring consequences

Strengths inherent in First Nations cultures and communities can act as protective factors and pathways for healing among those whose cultures were attacked by the IRS system and other aspects of historical trauma. There is a clear need for continued healing and wellness services for those directly and intergenerationally affected by Residential Schools, the Sixties Scoop and other aspects of historical trauma that are rooted in local traditional cultures.

Regional Health Survey: Volume 2

The National Report of the First Nations Regional Health Survey Phase 3: Volume Two is intended to provide an overview of the national-level results from the survey, across children, youth and adult First Nations populations.

Health Care Access

  • Inequality of access to health care for First Nations communities compared to the rest of Canada, and especially for remote and special access and rural communities compared to urban First Nations communities, is a significant barrier to First Nations adults receiving the health care that meets their needs. Unavailability of health-care professionals and long wait times are characteristic of the lack of health-care resources available to First Nations communities in Canada.
  • The most commonly reported barrier to accessing traditional medicine was a lack of knowledge, which suggests that some form of educational program aimed at promoting the use of traditional medicine in First Nations communities could be successful in increasing the number of individuals accessing these types of services. This education, in combination with respect and acceptance among those in the health-care profession in Canada, as outlined in the TRC Calls to Action (TRC, 2015), would be a big step towards a health-care system that is culturally appropriate and respectful of First Nations Traditions and Knowledge.
  • Work remains to be done to increase the rate of preventative health screening among First Nations males, especially regarding prostate cancer screening. The TRC Calls to Action could have an impact in this regard, especially if these managed to accomplish the goals of increasing the number of Indigenous health practitioners in First Nations communities as well as trust between health professionals and their First Nations constituents.
  • As identified in the final report of the TRC, there is a need for greater health-care resources in First Nations communities. Perhaps more importantly, though, there is a need for health care which meets the cultural, medical and human needs of First Nations adults, youth and children.

Language and Culture

  • Results from the RHS Phase 3 show that First Nations children, youth, and adults are connected to their languages and cultures. As noted by the Royal Commission for Aboriginal Peoples (1996),
    by participating in traditional culture through community cultural events, visiting Traditional Healers, using traditional medicines and foods, speaking a First Nations language, and valuing the importance of traditional spirituality, First Nations people are connecting to their language and culture through activities that are part of being with and on the land.
  • The TRC’s Calls to Action (2015a) specifically address the need to reclaim, revitalize and embed First Nations languages in communities and provide opportunities for cultural activities. Ensuring the continued reclamation and strengthening of language and culture in communities means focusing on children and youth. The earlier that First Nations children are provided with language and culture the more likely that they will build a positive sense of their First Nations identity, thereby contributing to the cultural continuity of the community
  • When younger First Nations people learn First Nations languages and cultures, these can act as protective factors and help to instill a positive sense of belonging and identity that can then influence general and mental health and well-being
  • As parents, caregivers, siblings, and extended family are children’s first teachers, it is important to support those people who will be raising the child (Best Start Resource Centre, 2010; 2011). It is also important to provide opportunities for First Nations children and youth to participate in traditional or cultural activities, and this includes support for early childhood programs like Aboriginal Head Start on Reserve, of which language and culture are foundational components.

Nutrition and Food

  • Income-related food insecurity is high within the First Nations population compared to the general population). Traditional foods and the sharing of traditional foods provide a foundation for better nutrition and well-being as well as impacting food security. Although remote geographical locations can increase the cost and availability of healthy traditional and store-bought foods, living in these communities allows First Nations people to remain connected to their land and traditional food systems.
  • The RHS Phase 3 data have confirmed that the rates of food insecurity are high, with half of First Nations adults and more than half of households with children experiencing food insecurity. This is one effect of the ongoing nutrition transition (shift in dietary consumption) that exists today for First Nations people, coupled with high rates of diabetes and other nutrition-related diseases.
  • Food security in the First Nations population is often explored within a deficit-based construct focusing on the needs or problems rather than on solutions. Positioning health and Indigenous food systems within an Indigenous food sovereignty framework provides an opportunity to ground solutions within Indigenous ways of knowing.
  • It is important to draw upon the opportunities for reconnecting with traditional food systems as self- determining and health- and wellness-promoting strategies. When Indigenous people have the skills to practice Indigenous food sovereignty a whole range of positive benefits to their social and economic well- being can unfold
  • Learning from and about the land is an essential aspect of First Nations learning and often entails experiential learning, a mode of learning that is frequently associated with traditional activities that occur outside the classroom (Canadian Council on Learning, 2009) Not only are traditional foods valued from cultural, spiritual and health perspectives, but the activities involved allow for the practice of cultural values such as sharing, reciprocity and cooperation
  • The role of self- determination in health and food sovereignty is an important consideration that should be included in future survey questions to better understand nutrition and food for First Nations people. It is time for action to address food insecurity in First Nations communities.

Physical Activity and Sedentary Behaviours

  • In terms of monitoring and surveillance, several Canadian studies have examined physical activity and sport participation rates among the population; however, similar data for Indigenous populations (especially First Nations living on reserve and in Northern communities) is relatively limited
  • This chapter took a multi-faceted approach by looking at a host of factors at the individual, social and community levels which can influence physical activity and sedentary behaviours. These behaviours were associated with very good health, body mass index, diet, presence of chronic conditions, a sense of belonging, perceptions of being in balance with the four aspects of life (physically, emotionally, mentally, and spiritually) and participation in cultural events
  • Although physical activity and sedentary behaviours can be considered independently, an intervention approach that considers both of these behaviours while also targeting certain common population segments may be useful.
  • The development of guidelines, interventions, programs, initiatives and strategies for increasing physical activity and reducing sedentary behaviours must be culturally valid for First Nations populations

Personal and Community Wellness

  • In light of the methodological and analytical limitations, the current analysis provides a necessary foundation for building future research, rooted in
    a strengths-based approach, that can examine the protective and risk factors, in particular, as they relate to personal and community wellness of First Nations people living on reserve and in Northern communities.
  • More research and work is needed to address modifiable risk factors of personal wellness, particularly at the community level in order to facilitate personal wellness for future generations of First Nations people. In terms of community wellness, improvements in socioeconomic status can foster opportunities for such indicators of personal wellness as mastery, such as through stable and safe housing, food security, and employment and education opportunities in communities. The results also show that sense of belonging in your community is a predictor factor for personal wellness.
  • There are broad implications of these findings that not only provide a fruitful avenue for future research, but also provide opportunities for policy and program development that would foster wellness at the individual, family, community, and environmental level. One implication is that there are sources of resilience that are unique to iving in a First Nations community.

This is not to say that risk factors for decreases in community and personal wellness should not be examined, but that it should be done while also investigating why some communities fare better than others. Such analysis would be useful in informing effective strategies for intervening with risk factors and promoting those factors found in communities that fare better to facilitate wellness

Federal Health Budgets: 2016 – 2021

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

Budget 2019

  • Supporting Inuit children: $220M (over 5 years)
  • Improved Assisted Living and Long-Term Care: $44M (over 2 years)
  • National Inuit Suicide prevention Strategy: $50 over 10 years and #5M ongoing

Budget 2021 = $3,198M

  • COVID-19 response: $1.2B
    • $478.1M to support public health response
    • $760.8M for Indigenous Community Support Fund
  • Maintain essential health services for First Nations and Inuit: $1.4B + $40.6 ongoing
    • $774.6M over 5 years for Non-Insured Health Benefits Program
    • $354M over 5 years to increase number of nurses and medical professionals in remote First Nations communities
    • $107.1M over three years to transform how health care services are delivered ny First Nations communities
    • $125.2M to support First Nations reliable access to clean water and help ensure the safe delivery of health and social services on reserve
    • $22.7M over 5 years to help First Nations and Inuit manage health impacts of climate change
  • Distinctions-based Mental Wellness Strategy
    • $597.6M over three years for First Nations, Métis and Inuit
  • Included in the above figures are $126.7M announced at the Third National Dialogue on Eliminating Racism in the Health Care System after the death of Joyce Echaquan
    • $33.3 million to improve access to culturally safe services, with a focus on services for Indigenous women, 2SLGBTQQIA+ people, persons with disabilities and other marginalized groups who may experience intersecting discrimination. This includes expanding support for Indigenous midwifery and doula initiatives and strengthening funding for national Indigenous women’s organizations, as well as regional and grassroots organizations.
    • $46.9 million to support the changes to health systems through the integration of cultural and patient safety at all levels, as well as through increased Indigenous representation in health professions.This includes $14.9 million, which will be used by Health Canada to establish a program that will provide funding to Indigenous organizations and health partners to support projects that can implement distinctions-based solutions to address anti-Indigenous racism. This funding will also support much-needed capacity for Indigenous partners to undertake meaningful engagement on the development of policy and programs for health priorities.
    • $37.8 million to improve supports and accountability by providing distinctions-based funding to Indigenous organizations for new Indigenous patient advocates that will allow Indigenous patients to more safely navigate federal and provincial health systems.
    • $8.7 million to provide federal leadership, which includes convening national dialogues like this one today to advance concrete actions to address anti-Indigenous racism in Canada’s health systems, and leading by example by evaluating and improving Indigenous Services Canada’s programs and practices to ensure more culturally responsive and safe services.
January 18, 2018 – Ministry of Indigenous Services Priorities

Gaps remain in the overall health outcomes between Indigenous Peoples and non-Indigenous Canadians.

  • Life expectancy for Indigenous People is up to 15 years shorter
  • Infant mortality rates are two to three times higher
  • Diabetes rates are almost four times higher for First Nations on reserve
  • Opioid-related deaths are up to three times higher for First Nations in British Columbia and Alberta
  • Tuberculosis rates are 270 times higher for Inuit

The Path Forward

The Government of Canada will continue to work with First Nations and Inuit, and provincial and territorial partners, to support:

  • First Nations health transformation
  • Improved quality and satisfaction of care
  • Children receiving necessary medical care in a timely manner
  • Sustainable and sufficient health resources in each community
  • The elimination of tuberculosis in Inuit Nunangat

Points of Progress since November 2015

  • The federal government is working with First Nation, Inuit and Métis Nation partners at national and regional levels through bilateral and tri-lateral tables, and the permanent bilateral mechanisms process to advance their health priorities, and other means.
  • In July 2017 the federal government co-signed, with Nishnawbe Aski Nation and the Government of Ontario, a Charter of Relationship Principlesto formalize a partnership to transform the health system in northern Ontario.
  • The Government of Canada continues to work with partners to ensure First Nations children receive the care they need through Jordan’s Principle – A Child-First Initiative. As of December 31, 2017, more than 33,000 services and supports have been approved for First Nations children since 2016.
  • As of December 31, 2017, investments in more than 140 infrastructure projects to build and renovate health facilities such as nursing stations, health centres, acute care facilities and drug and alcohol treatment centres, as well as Aboriginal Head Start on Reserve facilities, in First Nations and Inuit communities.
  • Investments continue to be made in training and education to support the number of Indigenous people entering health careers, and support the hiring and retention of more nurses working in First Nation communities.
  • Together in September 2017, the Government of Canada and Inuit leaders pledged to establish a task force to eliminate tuberculosis in Inuit Nunangat.  The next meeting is scheduled for winter 2018.
  • In July 2016, the Prime Minister announced funding for mental wellness and crises response teams, as well as the First Nations and Inuit Hope for Wellness Help Line, available 24/7 in English, French, and upon request, Cree, Ojibway, and Inuktut.  As of December 31, 2017, there were 43 teams supporting over 300 communities across Canada.
A Common Statement of Principles on Shared Health priorities, August 2017

Recognizing the significant disparities in Indigenous health outcomes compared to the Canadian population, the federal, provincial and territorial governments are committed to working with First Nations, Inuit and Métis to improve access to health services and health outcomes of Indigenous peoples and discuss progress. At the national level, the federal government is committed to working with national First Nations, Inuit and Métis leadership in response to their identified health priorities (developed through the First Nations Health Transformation Agenda, an Inuit –Specific Approach to the Canadian Health Accord and the Métis National Health Shared Agenda). At the regional level, federal, provincial and territorial Health Ministers commit to meaningfully engage and to working together with regional Indigenous organizations and governments.

FPT Health Ministers commit to approaching health decisions in their respective jurisdictions through a lens that promotes respect and reconciliation with Indigenous peoples

Objectives

This Common Statement of Principles focuses on two priority areas (home and community care, and mental health and addictions) where federal funding will be provided to Provinces and Territories in response to increased demands.

Principles to Guide Actions

All elements of the Statement of Principles will be interpreted in full respect of each government’s jurisdiction, guided by the following principles:

A. Collaboration: FPT Health Ministers agree to work together to achieve the objectives set out in this Statement of Principles.
B. Innovation: FPT Health Ministers agree to continue the development and evaluation of innovations which deliver better outcomes for Canadians, and to share successes and lessons learned with a view to further stimulating improvement across health systems.
C. Accountability: FPT Health Ministers agree to measure progress on the collective and jurisdiction-specific goals under this Statement of Principles, and to report to Canadians.

Improving Access to Mental Health and Addiction Services

Over the next ten years, FPT Health Ministers will work together to improve access to evidence-supported mental health and addiction services and supports for Canadians and their families by pursuing one or more of the following actions:

  • Expanding access to community-based mental health and addiction service for children and youth (age 10–25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders;
  • Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services; and
  • Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.

To support provinces and territories to improve access to mental health and addiction services through such initiatives, the federal government will provide the provinces and territories with $5.0 billion over ten years starting with $100 million in 2017/18.

Improving Access to Home and Community Care

Over the next ten years, FPT Health Ministers will work together to improve access to appropriate services and supports in home and community, including palliative and end-of-life care, by pursuing one or more of the following actions:

  • Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care;
  • Enhancing access to palliative and end of life care at home or in hospices;
  • Increasing support for caregivers; and
  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community based service delivery

To assist with improving access to appropriate home and community care, the federal government will provide PT governments with $6.0 billion over 10 years, starting with $200 million in 2017/18.

https://www.canada.ca/content/dam/hc-sc/documents/corporate/transparency_229055456/health-agreements/principles-shared-health-priorities.pdf

Inuit Nunangat Declaration: Elimination of TB

Rates of TB among Inuit were more than 290 times higher than in the Canadian-born, non-Indigenous population in 2016 and trending upwards.

Mar. 24, 2021: Indigenous Services Canada and Inuit Tapariit Kanatami – “On World Tuberculosis (TB) Day 2021, we reaffirm our joint commitment to improving the health of Inuit across Inuit Nunangat through our TB reduction and elimination milestones…Persistently high rates of TB across Inuit Nunangat are a symptom of health disparities, which are rooted in colonization. The COVID-19 pandemic has further demonstrated the depth and breadth of inequities faced by Inuit communities that create unjust health outcomes for Inuit.

Adequate, ongoing and targeted actions and investments are needed to develop and support the social and economic conditions necessary for healthy, TB-free Inuit communities. Key areas of focus include:

  1. Acknowledging and honouring the unique history and impacts of the TB epidemic on Inuit through continued support of healing projects such as the Nanilavut Initiative in accordance with the National Inquiry into Missing and Murdered Indigenous Women and Girls’ Calls for Justice, 16.46.
  2. Confronting gaps in social determinants of Inuit health that have perpetuated TB in Inuit communities, including housing, food security and nutrition, mental wellness, equitable and culturally relevant education, and access to culturally safe health services.
  3. Addressing social and economic infrastructure gaps through major new investments in infrastructure, including the creation of an Inuit Nunangat Infrastructure Fund to accelerate the distribution of resources required to close the infrastructure gap, as well as to achieve the goals of the Arctic and Northern Policy Framework and uphold Canada’s human rights obligations.
  4. Poverty reduction through development of a model of basic income in partnership with Inuit that targets those living around or below a poverty line established using regional and community cost of living and income indicators.
  5. Minimizing major data, research and policy gaps throughout Inuit Nunangat, especially those that impact health, and specifically TB, through the support of Inuit-led data partnerships.

Mar. 25, 2019 – The regional action plans have been developed in consultation with communities, Inuit organizations, partners in health service delivery, provincial and territorial governments, experts in TB programming, care and research, and local health care providers. While each region has specific needs and challenges with regards to TB elimination, all regional action plans commit to:

  • Establishing regional TB committees/advisory groups,
  • Enhanced/community wide TB screening campaigns,
  • Improving preventative treatment completion of latent TB infection by introducing or expanding the use of shorter course treatment regimens,
  • Reviewing access to new diagnostic technologies,
  • Strengthening the foundation of TB programs in all regions with high incidence of TB by:
  • Enhancing TB teams based on regional needs,
  • Developing and strengthening community partnerships,
  • Strengthening community engagement and education,
  • Enhancing local human resource capacity; and, Identifying areas of collaboration within and between organizations for action towards improving social determinants of Inuit health directly related to TB

Dec. 10, 2018 – The Inuit Tuberculosis Elimination Framework was released by Inuit Tapiriit Kanatami as a next step in ongoing efforts to address staggeringly high rates of tuberculosis (TB) among Inuit living in Inuit Nunangat. The Framework describes six priority areas for action and investment:

  1. Enhance TB care and prevention programming
  2. Reduce poverty, improve social determinants of health and create social equity
  3. Empower and mobilize communities
  4. Strengthen TB care and prevention capacity
  5. Develop and implement Inuit specific solutions
  6. Ensure accountability for TB elimination

These priority actions will be used by the four Inuit regions to design and implement TB elimination action plans that are customized to reflect each region’s priorities, needs and strengths. Using this approach will also ensure the interventions and activities described within each action plan are informed by local TB epidemiology and health systems. The regional TB elimination action plans are expected to be released by March 2019.

Mar. 23, 2018 – To mark World Tuberculosis Day, Honourable Jane Philpott, Minister of Indigenous Services, together with Natan Obed, President of Inuit Tapiriit Kanatami (ITK), commit to eliminating TB across Inuit Nunangat by 2030, and reduce active TB by at least 50% by 2025.

This will be achieved through an Elimination Action Framework led by the previously announced TB Task Force. Among the first priorities are to prevent deaths related to delays in diagnosis and to eliminate TB disease in young children. Elimination plans in each of the four Inuit regions that make up Inuit Nunangat will be developed and tailored to regional strengths and requirements. Regional plans will include enhanced public health programs and capacity-building within communities to enable earlier diagnosis, leading to earlier treatment of active TB disease and latent TB infection. Awareness efforts will also be undertaken to increase understanding of TB in order to help reduce transmission and address stigmatization.

In order to meet these aggressive target dates, special emphasis will be placed on work to address social inequities and improve Inuit social determinants of health that are closely linked to TB; such as housing, food security and nutrition, access to health services and mental wellness. Budget 2018 announced $27.5 million over five years to support an Inuit-specific approach to tuberculosis elimination. This is in addition to the $640 million over 10 years announced in Budgets 2017 and 2018 to address Inuit Nunangat housing needs.

Office of the Auditor General Spring Report – 2018

Report 5: Socio-economic Gaps on First Nations Reserves—Indigenous Services Canada

Measuring Well-Being on First Nations Reserves – April 2015 – December 2017

The Department did not have a comprehensive picture of the well-being of on-reserve First Nations people compared with other Canadians

Over-all Message

5.17     Overall, we found that Indigenous Services Canada’s main measure of socio-economic well-being on reserves, the Community Well-Being index, was not comprehensive. While the index included Statistics Canada data on education, employment, income, and housing, it omitted several aspects of well-being that are also important to First Nations people—such as health, environment, language, and culture.     

5.18     We also found that the Department did not adequately use the large amount of program data provided by First Nations, nor did it adequately use other available data and information. The Department also did not meaningfully engage with First Nations to satisfactorily measure and report on whether the lives of people on First Nations reserves were improving. For example, the Department did not adequately measure and report on the education gap. In fact, our calculations showed that this gap had widened in the past 15 years.

5.19     These findings matter because measuring and reporting on progress in closing socio-economic gaps would help everyone involved—including Parliament, First Nations, the federal government, other departments, and other partners—to understand whether their efforts to improve lives are working. If the gaps are not smaller in future years, this would mean that the federal approach needs to change.

http://www.oag-bvg.gc.ca/internet/English/parl_oag_201805_05_e_43037.html – hd2e

The Challenges of Delivering Quality Care in First Nations Communities

Report of the Standing Committee on Indigenous and Northern Affairs, December, 2018

Recommendations:

  1. That Indigenous Services Canada provide increased funding to the First Nations and Inuit Home and Community Care Program to include palliative care as a service eligible for funding under the program.
  2. That Indigenous Services Canada evaluate the current needs regarding in-home respite care under the First Nations and Inuit Home and Community Care Program and report publicly on it; and that Indigenous Services Canada review the funding allocated for the First Nations and Inuit Home and Community Care Program to ensure that in-home respite care on reserve is accessible and adequate.
  3. That Indigenous Services Canada: establish a funding formula that provides stable, predictable and long-term funding to projects to build or maintain long-term care facilities on reserves and that the new formula take into account factors such as First Nation population growth, inflation and the remoteness of communities; facilitate and support partnership initiatives to build long-term care facilities; and work with First Nations and the provinces and territories, in accordance with the priorities that First Nations set for long-term care on reserves, to develop and implement pilot projects in various regions of Canada to build and maintain long-term care facilities on reserves.
  4. That Indigenous Services Canada work with First Nations and the provinces and territories to take immediate measures to encourage the implementation of culturally appropriate programming and service delivery including traditional foods in long-term care facilities and as part of home care and community-based care on reserves.
  5. That Indigenous Services Canada work with First Nations and provincial and territorial partners to develop and implement a mandatory training program for Indigenous and non-Indigenous health professionals providing continuing care on reserve about the values, culture and history of Indigenous peoples.
  6. That, in implementing Call to Action 22 of the Truth and Reconciliation Commission of Canada, Indigenous Services Canada work with First Nations, provinces and territories and health authorities to recognize, fund and provide access to First Nation traditional healing practices in the delivery of continuing care.
  7. That Indigenous Services Canada, in partnership with First Nations and other relevant federal departments, improve access to post-secondary health education and occupational training for First Nations learners to provide more opportunities for First Nations people to deliver health care on reserve.
  8. That Indigenous Services Canada co-ordinate with First Nations and the provinces and territories to clarify their respective roles and responsibilities for continuing care on reserves.
  9. That the Minister of Indigenous Services Canada facilitate tripartite meetings between the federal government, provinces and territories and First Nations representatives to address the jurisdictional challenges that exist regarding the delivery of home and community care, palliative care and long-term care services on reserves.
  10. Based on the principles of OCAP® (ownership, control, access and possession) of the First Nations Information and Governance Centre, that Indigenous Services Canada work with First Nations and provinces and territories to develop and implement an integrated data collection protocol specific to the health and well-being of First Nations; and that this data be used to inform the provision of evidence-based health services on reserves.

http://www.ourcommons.ca/Content/Committee/421/INAN/Reports/RP10260656/inanrp17/inanrp17-e.pdf

Official Federal Government Response: Sept. 5, 2019

Indigenous Services Canada (ISC) is working with Indigenous organizations including 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 to advance shared priorities focused on improving and closing the gaps in health outcomes for Indigenous peoples.

ISC has engaged with First Nations and Inuit partners in all regions to strategically allocate health funding announced in Budget 2017. These additional resources are aligned with health priorities identified by Indigenous partners. These new investments will help improve access to needed services in the area of maternal and child health, mental wellness, clinical care, home care and communicable diseases controls.

ISC, in collaboration with the First Nations Information Governance Centre, will explore the development of an information strategy to determine appropriate indicators through the First Nations Regional Health Survey. Furthermore, ISC will also work with the Inuit Tapiriit Kanatami towards the development of an Inuit Health Survey.

At the regional level, First Nations and Inuit partners, along with officials from ISC, are working within their respective jurisdictions to explore opportunities to access First Nations and Inuit specific health data.

To keep Indigenous families healthy, Budget 2018 announced $1.5 billion over 5 years, starting in fiscal year 2018 to 2019, and $149 million per year ongoing, as follows:

  • $498 million, with $97.6 million per year ongoing, to sustain access to critical medical care and services, including 24/7 nursing services in 79 remote and isolated First Nations communities
  • $200 million, with $40 million per year ongoing, to enhance the delivery of culturally appropriate addictions treatment and prevention services in First Nations communities with high needs
  • $235 million to work with First Nations partners to transform First Nations health systems by expanding successful models of self-determination so that health programs and services are developed, delivered and controlled by and for First Nations. This investment will also support access to quality and First Nations-controlled health care in remote and isolated James Bay communities, as part of the Weeneebayko Area Health Integration Framework Agreement
  • $490 million over 2 years to preserve access to medically necessary health benefits and services through the Non-Insured Health Benefits Program
  • $109 million over 10 years, with $6 million per year ongoing, to respond to high rates of tuberculosis in Inuit communities and develop a better understanding of the unique health needs of Inuit peoples through the co-creation of a distinct Inuit Health Survey
  • $6 million over 5 years to support the Métis Nation in gathering health data and developing a health strategy
Canadian Federation of Medical Students

The Canadian Federation of Medical Students (CFMS) is the national organization representing over 8,000 medical students at 15 medical schools across Canada.

Feb. 12, 2018 – The Canadian Federation of Medical Students (CFMS) urges the Government of Canada to:

The CFMS looks forward to working with the Government of Canada towards building a strong Indigenous mental health and wellness strategy that is responsive to community needs. This strategy should have culture as its foundation; foster community development, ownership, and capacity building; promote Indigenous self-determination; provide quality care and competent service delivery; encourage partnerships and collaboration; and ensure effective and efficient allocation of resources.

  • Adopt the frameworks and strategies put forward by Indigenous communities and peoples in Canada to guide the federal response to the Indigenous mental health and suicide crisis:
  • Adopt the First Nations Mental Wellness Continuum Framework as a framework to address First Nations peoples’ mental health and suicide
  • Adopt the National Inuit Suicide Prevention Strategy as a framework to address Inuit peoples’ mental health and suicide.
  • Undertake a comprehensive review of the current distribution of funding through the National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) in collaboration with Indigenous communities, to ensure that every Indigenous community receives funding that is both sustainable and provided in accordance with need.
  • Direct Health Canada and Indigenous Services Canada to re-evaluate what programs and services are funded under the Non-Insured Health Benefits Program (NIHB), and:
  • Increase funding for preventative and land-based mental wellness programs that create opportunities within the community.
  • Support and expand the list of approved service providers to include Indigenous traditional knowledge keepers.

The CFMS looks forward to working with the Government of Canada towards building a strong Indigenous mental health and wellness strategy that is responsive to community needs. This strategy should have culture as its foundation; foster community development, ownership, and capacity building; promote Indigenous self-determination; provide quality care and competent service delivery; encourage partnerships and collaboration; and ensure effective and efficient allocation of resources.

Research Investments in Indigenous Health

Federal Government

Budget 2019 – To ensure that First Nations have the information they need to serve their members well, Budget 2019 proposes to provide $78.9 million over seven years, starting in 2019–20, with $13.7 million per year ongoing, to permanently fund the Surveys on Indigenous Peoples and the First Nations Regional Health Survey. These surveys provide important information on education, health, employment and language proficiency—information that is needed for decision-making in First Nations communities and for designing programs and services tailored to community needs. These surveys are conducted under the leadership of the First Nations Information Governance Centre, in collaboration with Statistics Canada.

Aug. 24, 2020 Mental Health Supports

Funding of $82.5 million in mental health and wellness supports to help Indigenous communities adapt and expand mental wellness services, improving access and addressing growing demand, in the context of the COVID-19 pandemic. The funding will help partners and communities to adapt mental wellness services to the current COVID-19 context, including:

  • expanding access to culturally appropriate services such as on the land activities, community-based health supports and mental wellness teams;
  • adapting mental health services, such as virtual counselling, to meet increased demand; and
  • supporting Indigenous partners in developing innovative strategies to address substance use and to improve access to treatment services.

From January to April 2019, the Hope for Wellness Help Line received 3,602 calls and chats from individuals seeking crisis intervention services. For this same period in 2020, there have been just over 10,000 calls and chats, representing a 178% increase in demand.

Manitoba

Sept. 17, 2019 – “The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba“, a 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 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.

The research project is the first in Canada to compare data from a study designed and implemented by First Nation researchers across Canada – the First Nations Regional Health Survey (2015-16) – with data that reports on the health of a representative sample of all First Nation communities in Manitoba, stored in a repository at MCHP.

Dec. 21, 2020The Path to Reconciliation Annual Progress Report 2020 – An Advisory Committee was established for the development of the draft Indigenous Partnership Strategy Framework (IPSF) that included seventeen Indigenous members with extensive knowledge in the Indigenous health field. The framework was developed to enable culturally relevant and appropriate engagement with First Nations, Métis and Inuit organizations and communities in Manitoba’s Health System Transformation. Four key guiding principles were used:

  • Indigenous History
  • Traditional Knowledge and Wellness
  • Indigenous and Human Rights
  • Systems and Structures

Planning for the implementation of a number of Rapid Access to Addictions Medicine (RAAM) Clinics in locations throughout Manitoba, including one in the north. This new model will serve all Manitobans including Indigenous persons both on and off reserve. Services are to be delivered by the Addictions Foundation of Manitoba, Regional Health Authorities and other regional resources such as Indigenous communities. Developed the Mental Health and Addictions (MHA) Strategy. The mental wellness of Indigenous peoples of Manitoba is one of seven priority areas included in the Virgo report.

Atlantic Canada Funding CIHR – Institute of Aboriginal People’s Health

Eight Atlantic Canadian universities: Guided by spirit, ceremony and storytelling, the AIM Network will expand and augment research capacity, skills, and career trajectories of Indigenous early career researchers and trainees at all post-secondary levels. Through their programming, they hope to start a shift towards meaningful, impactful health research that resonates with communities and indigenous scholars.