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 StatusSept. 5, 2021STALLED
Previous StatusJune 14, 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.

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.

Federal Health Budget 2018

Announced $1.5 billion over 5 years, starting in fiscal year 2018 to 2019, and $149 million per year ongoing, as follows:

  1. $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. 
  2. $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. 
  3. $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. 
  4. $490 million over two 2 years to preserve access to medically necessary health benefits and services through the Non-Insured Health Benefits Program. 
  5. $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. $6 million over five years to support the Métis Nation in gathering health data and developing a health strategy.
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

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