Structural Profile of Public Health in Canada: Indigenous Health

The information presented in the profile was collected by studying publicly available information from websites and official government publications from each jurisdiction. Online data collection was conducted between January and March 2019. 

For each jurisdiction, information contained in the previous version of the Indigenous Health section of the structural profile was reviewed and used as a starting point. The research team accessed the Department of Health’s website to explore programs and services specifically designed to address First Nation, Métis and Inuit health, and note them in terms of their relevance to public health. Other relevant Departments’ websites with Indigenous policy mandates were also accessed. Finally, they searched for key reports, using “Canada”, “public health” and a number of keywords such as “Aboriginal, First Nation(s)”, “Inuit”, “Metis or Métis”, “Indian”, “Amérindiens”, “Reserve”. In all cases, their investigation took on a snowball process, where one document or webpage led us to the next.

The researchers also explored First Nations, Métis and Inuit health system innovations, albeit at the regional level only. They recognize that the reports provided underrepresent First Nation, Métis and Inuit public health innovations, primarily because these innovations remain under-recognized and often undocumented. They also indicated that their lack of documentation on these innovations is simply related to access to information, and wanted to acknowledge the tireless work of First Nations, Métis and Inuit communities and organizations in the pursuit of health equity.

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

Alberta Health Services has a dedicated Indigenous Health Program. The Indigenous Health Program works throughout the province in partnership with Indigenous people and organizations to provide high-quality, “accessible, culturally appropriate health services for all First Nations, Métis and Inuit people” (Alberta Health Services, n.d.).

The Indigenous Health Program has the following objectives:

• “providing an effective, patient-centered approach for improving care to First Nations, Métis and Inuit peoples and communities through specific services
• working with health zones to facilitate the development and delivery of health services for First Nations, Métis and Inuit peoples
• facilitating accessible, culturally safe, equitable health service delivery for all First Nations, Métis and Inuit communities and peoples” (Alberta Health Services, n.d.).

It also provides:

• cultural and spiritual support for Indigenous families in collaboration with health care providers to ensure “culturally-safe and family-centred care” with a focus onspecialized mental health and addiction support
• diabetes education
• advocacy for support of Indigenous patients and their families across the continuum of care
• help for Indigenous patients navigating the cancer care system (Alberta Health Services, n.d.).

Regional

“The 1989 Métis Settlements Accord, which replaced the 1938 Métis Betterment Act, includes a number of health-specific provisions, including a) the right to make bylaws to promote the health, safety and welfare of the residents of the settlement area; b) the right to invest money in hospital districts or health regions under the Regional Health Authorities; and c) make bylaws respecting and controlling the health of the residents of the settlement area and against the spread of diseases. Since then, the Métis of Alberta have focused on securing increased control over issues such as housing, child welfare, health and legal institutions” (National Collaborating Centre for Aboriginal Health, 2011, p. 30).

References

1. Alberta Health Services. (n.d.). Indigenous Health Program. Retrieved from: https://www.albertahealthservices.ca/findhealth/service.aspx?id=1009563
2. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year transformative plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
3. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
4. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
5. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
6. National Collaborating Centre for Aboriginal Health. (2011). Looking for Aboriginal health in legislation and policies, 1970 to 2008: The Policy synthesis project. Prince George, BC. Retrieved from: http://www.nccah-ccnsa.ca/en/publications.aspx?sortcode=2.8.10&publication=28

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

Within the Ministry of Health, the Office of Indigenous Health “provides an Indigenous lens to strategic priorities, legislation, policy and program development in the Ministry of Health, as well as other ministries where appropriate. The Office works collaboratively with the First Nations Health Authority [FNHA], the regional health authorities, and the Provincial Health Services Authority [PHSA] to address the needs of Indigenous peoples during service planning, policy development and to promote culturally safe and appropriate service delivery. The Office also collaborates with key Indigenous partners and organizations such as Métis Nation BC and the BC Association of Aboriginal Friendship Centres” (B.C. – Ministry of Health, n.d.).

In turn, “[t]he PHSA must develop and maintain effective and efficient working relationships with the Regional Health Authorities, the First Nations Health Authority, and other key service partners to ensure an effective, integrated and well-coordinated system of health care for the citizens of BC. In partnership with First Nations Health Authority PHSA must support the Indigenous Health approach, services and wellness objectives” (Provincial Health Services Authority, 2018).

Many accords have been signed over the past years that have important transformative impact for public health in British Columbia.

In 2005, the “Transformative Change Accord and the First Nations Health Plan form[ed] the Tripartite First Nations policy that aims to close the disparities that exist between First Nations and other British Columbians in the areas of health, education and housing. The policy document also intends to clarify issues surrounding Aboriginal title and jurisdiction. It explicitly applies to First Nations, and does not address the needs of other Aboriginal groups in British Columbia” (First Nations Leadership Council, Government of Canada, & Government of British Columbia, 2006; National Collaborating Centre for Aboriginal Health, 2011, p. 29).

In 2007, the Tripartite First Nations Health Plan was signed. “The Health Plan provides for a new governance structure for First Nations health services in B.C. consisting of a First Nations Health Governing Body (to design and oversee implementation of a new governance structure), a First Nations Health Council (serving as an advocacy voice for First Nations in health-related matters), a tripartite First Nations Health Advisory committee (to review and monitor health plans and health outcomes, and recommend actions on closing health gaps), and an association of health directors and other professionals to create and implement a First Nations capacity development plan” (First Nations Leadership Council, Government of Canada, & Government of British Columbia, 2007; National Collaborating Centre for Aboriginal Health, 2011, p. 31).

“In 2011, BC First Nations Chiefs and leaders came together to take a historic decision – to adopt the BC Tripartite Framework Agreement on First Nation Health Governance and.” (First Nations Health Council & First Nations Health Authority, 2013). “The signing of the, changed the course of First Nations health in BC with the creation of a new First Nations Health Governance Structure that will enable First Nations in BC to participate fully in the design and delivery of these services.” (First Nations Health Authority, n.d. b).

As a result, the First Nations Health Authority (FNHA) was implemented in 2013. “The FNHA is the first province-wide health authority of its kind in Canada. In 2013, the FNHA assumed the programs, services, and responsibilities formerly handled by Health Canada’s First Nations Inuit Health Branch – Pacific Region. The FNHA is responsible for planning, management, service delivery and funding of health programs, in partnership with First Nations communities in BC.” (First Nations Health Authority, n.d. a). Given the federal restructuration highlighted above, Indigenous Services Canada now provides the funding formerly provided by Health Canada, while the FNHA aims towards a better integrated health system (First Nations Health Authority, n.d. b).

The B.C. Centre for Disease Control (BCCDC) also administers Indigenous health programs, notably:

• the Chee Mamuk Program which “provides innovative and culturally appropriate training, educational resources and wise practice models in STIs, hepatitis and HIV” (B.C. Centre for Disease Control, n.d.-a)
• the TB Services for Aboriginal Communities program which provides TB consulting services for healthcare professionals, the management of the majority of active TB cases, and “testing, diagnosis and treatment to marginalized individuals exposed to TB in urban and rural or remote areas” (B.C. Centre for Disease Control, n.d.-b)
• as well as “low-barrier, culturally safe services for diverse communities around the prevention, testing, diagnosis and treatment of sexually transmitted infections” (B.C. Centre for Disease Control, n.d.-c).

Regional

Indigenous health programs are developed and delivered by the five regional health authorities. “Each of the health authorities in British Columbia has an Indigenous health team that leads the work for the health authority in developing and implementing its Indigenous Health Plan” (B. C. Ministry of Health, n.d.).

The five regional health authorities have each signed partnership accords with First Nations Health Council Regional Caucuses to facilitate greater collaboration with the First Nations Health Council, the First Nations Health Authority and the local regional health authority. The First Nations Health Authority (FNHA) has given notice to cancel its service agreement with the Inter-Tribal Health Authority (ITHA) on Vancouver Island. The notice the agreement was to end on March 31, 2019. (First Nations Health Authority, 2019).

Self-government agreements have been signed in British Columbia and have included health services (National Collaborating Centre for Aboriginal Health, 2011, p. 6). For example, the Sechelt Indian Band Self-Government Act (1986) “granted authority to the Sechelt band to exercise delegated powers and negotiate agreements about specific issues” (National Collaborating Centre for Aboriginal Health, 2011, p. 46). “Article 14 states that the Council has, to the extent that it is authorized by the constitution of the Band to do so, the power to make laws in relation to health services on Sechelt lands” (Sechelt Indian Band Self-Government Act, 1986; National Collaborating Centre for Aboriginal Health, 2011, p. 46).

Of note, the Nisga’a Health Council is an independent health authority. The Nisga’a Final Agreement (1999) “granted authority to the Nisga’a Nation to exercise delegated powers and negotiate agreements about specific issues” (National Collaborating Centre for Aboriginal Health, 2011, p. 49). “Sections 82 to 86 of the Agreement pertain specifically to health services, and provide the Nisga’a Lisims Government the authority to make laws in respect of health services on Nisga’a Lands. At the request of any Party, the Parties will negotiate and attempt to reach agreements for Nisga’a Lisims Government delivery and administration of federal and provincial health services and programs for all individuals residing within Nisga’a Lands” (Nisga’a Nation, Government of Canada, & Government of British Columbia, 1999, p. 49; National Collaborating Centre for Aboriginal Health, 2011).

References

1. C. Centre for Disease Control. (n.d.-a). Chee Mamuk. Retrieved from: http://www.bccdc.ca/our-services/programs/chee-mamuk
2. C. Centre for Disease Control. (n.d.-b). TB Services. Retrieved from: http://www.bccdc.ca/our-services/programs/tb-services
3. C. Centre for Disease Control. (n.d.-c). STI/HIV Services. Retrieved from: http://www.bccdc.ca/our-services/programs/sti-hiv-services
4. C. Ministry of Health. (n.d.). Office of Indigenous Health. Retrieved from: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/aboriginal-health
5. First Nations Health Authority. (n.d. a). About the FNHA. Retrieved from: http://www.fnha.ca/about/fnha-overview
6. First Nations Health Authority. (n.d. b). Governance and Accountability. Retrieved from: http://www.fnha.ca/about/governance-and-accountability
7. First Nations Health Authority. (2019). FNHA Cancels Service Agreement with Inter-Tribal Health Authority. Retrieved from: http://www.fnha.ca/about/news-and-events/news/fnha-cancels-service-agreement-with-inter-tribal-health-authority
8. First Nations Health Council & First Nations Health Authority. (2013). A joint First Nations health Council and First Nations Health Authority newsletter. Transition update 01(03). Retrieved from: http://www.fnhc.ca/pdf/Transition_update-April_08.2013-FIN_.pdf
9. First Nations Leadership Council, Government of Canada & Government of British Columbia. (2006). First Nations health plan. Memorandum of understanding. Retrieved from: http://www.health.gov.bc.ca/library/publications/year/2006/first_nations_mou.pdf
10. First Nations Leadership Council, Government of Canada & Government of British Columbia. (2007). Tripartite First Nations health plan. Retrieved from: http://www.gov.bc.ca/arr/social/health/down/tripartite_health_plan_signed.pdf
11. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
12. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
13. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
14. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
15. National Collaborating Centre for Aboriginal Health. (2011). Looking for Aboriginal health in legislation and policies, 1970 to2008: The policy synthesis project. Prince George, B.C. Retrieved from: http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/28/Looking%20for%20Aboriginal%20Health%20in%20Legislation%20and%20Polcies%20(English%20-%20Web).pdf
16. Nisga’a Nation, Government of Canada & Government of British Columbia. (1999). Nisga’a Final Agreement. Retrieved from: http://www.nnkn.ca/files/u28/nis-eng.pdf
17. Provincial Health Services Authority. (n.d.). Our Unique Role. Retrieved from: http://www.phsa.ca/about/who-we-are/our-unique-role
18. Provincial Health Services Authority. (2018). Foundational Mandate. Retrieved from: http://www.phsa.ca/about-site/Documents/PHSA%20Foundational%20%20Mandate.pdf
19. Sechelt Indian Band Self-Government Act, S.C. 1986. Retrieved from: https://laws-lois.justice.gc.ca/eng/acts/S-6.6/

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

At the provincial level, “Manitoba Indigenous and Northern Relations is focused on supporting healthy, safe and sustainable Indigenous communities” (Government of Manitoba, n.d.-a). Furthermore, within Manitoba Health, Seniors and Active Living, a newly formed section is dedicated to Intergovernmental Strategic Relations, which includes relations with Indigenous nations.

In 2018, the Government of Manitoba created Shared Health Manitoba with a mandate focused on service delivery. Shared Health envisions a healthcare system that “respect[s] the cultural practices and care needs of Manitoba’s Indigenous populations” (Shared Health Manitoba, 2019).

In addition, three Indigenous organizations are in place in Manitoba.

Firstly, the Assembly of Manitoba Chiefs (AMC) was formed in 1987 to act as an advocate on issues that commonly affected all of the First Nations of Manitoba (Assembly of Manitoba Chiefs, 2018a).

The AMC approved the creation of the First Nations Health and Social Secretariat of Manitoba (FNHSSM) in 2013, to focus on health and social development functions previously under the leadership of AMC. FNHSSM works “to address and prioritize First Nation health issues, discussion of potential governance structures, unification of First Nations in Manitoba and networking opportunities” (FNHSSM, 2019a).

“The Assembly of Manitoba Chiefs (AMC)/Winnipeg Regional Health Authority (WRHA) Patient Advocate Unit supports [First Nations] people by advocating, developing partnerships and bridging services through effective service coordination to ensure quality services for all First Nations people. This partnership with AMC and WRHA is imperative to ensure the medical needs of First Nation people are met and their medical issues are addressed in a timely and meaningful way as each year the number of clients continues to grow” (Assembly of Manitoba Chiefs, 2018b).

“The Intergovernmental Committee on Manitoba First Nations Health (ICMFNH) is the first step for federal, provincial and First Nation governments to work collaboratively to address First Nation health priorities. The goal of the ICMFNH is to address key issues affecting the health and well-being of First Nations citizens. The ICMFNH works to achieve this goal through developing innovative and sustainable strategies and solutions to ensure equity of health outcomes comparable to that of other Canadians” (FNHSSM, 2019b).

Secondly, the Manitoba Metis Federation “is the official democratic and self-governing political representative for the Metis Nation’s Manitoba Metis Community. The MMF promotes the political, social, cultural, and economic interests and rights of the Metis in Manitoba. In addition, the MMF delivers programs and services to [the] community including: child and family services, justice, housing, youth, education, human resources, economic development and natural resources” (Manitoba Metis Federation, 2019).

Finally, the Manitoba Inuit Association was created to enhance “the lives of Inuit in Manitoba by promoting Inuit values, community and culture while connecting to services that meet [Inuit] evolving needs” (Manitoba Inuit Association, 2019).

Regional

Manitoba has five regional health authorities: Winnipeg, Interlake-Eastern, Prairie Mountain, Southern and Northern (Government of Manitoba, n.d.-b).

Indian Bands (First Nations) are recognized in a legal sense in the Regional Health Authorities Act where it is indicated that health authorities can reach agreements with Indian Bands. “The minister may enter into agreements for … (c) an Indian Band, with the approval of the Lieutenant Governor in Council” (Regional Health Authorities Act, 1996, Section 5.1). Indian Bands are also called on to help develop regional health plans, as established in the Regional Health Authorities Act: “In the course of preparing a proposed regional health plan, the regional health authority shall consult with such persons, including municipalities, Indian Bands, and government departments and agencies, as the regional health authority considers appropriate” (Regional Health Authorities Act, 1996, Section 24.2).

A federally-funded First Nation Health Authority also exists (Four Arrows Regional Health Authority). This Authority is not subject to the Regional Health Authorities Act. Programs provided, which focus on public health, “were previously under the direction of the First Nations & Inuit Health Branch” (Four Arrows Regional Health Authority, 2011).

References

1. Assembly of Manitoba Chiefs. (2018a). Assembly of Manitoba Chiefs and the MIB Early Beginnings. Retrieved from: https://manitobachiefs.com/about/history/
2. Assembly of Manitoba Chiefs. (2018b). Patient Advocate Unit. Retrieved from: https://manitobachiefs.com/policy-sectors/health/
3. (2019a). Nanaandawewigamig is our Spirit Name. Retrieved from: https://www.fnhssm.com/
4. (2019b). Intergovernmental Committee on Manitoba First Nation Health. Retrieved from: http://www.fnhssm.com/index.php/policy-areas/intergovernmental-commettee-on-manitoba-first-nation-health
5. Four Arrows Regional Health Authority. (2011). Public Health. Retrieved from: https://www.fourarrowsrha.ca/public-health/
6. Government of Manitoba. (n.d.-a). Indigenous and Northern Relations. Retrieved from: https://www.gov.mb.ca/inr/
   
7. Government of Manitoba. (n.d.-b). Regional Health Authorities in Manitoba. Retrieved from: https://www.gov.mb.ca/health/rha/index.html
8. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
9. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
10. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
11. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
12. Manitoba Inuit Association. (2019). About. Retrieved from: https://www.manitobainuit.ca/about
13. Manitoba Metis Federation. (2019). About the MMF. Retrieved from: http://www.mmf.mb.ca/
14. Regional Health Authorities Act. 1996. Retrieved from: http://web2.gov.mb.ca/laws/statutes/ccsm/_pdf.php?cap=r34
15. Shared Health Manitoba. (2019). Vision, Mission and Values. Retrieved from: http://sharedhealthmb.ca/vision-mission-values

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

According to the Public Health Act, the “Minister may, subject to the approval of the Lieutenant-Governor in Council, enter into and amend an agreement with […] (c) a band council as defined in the Indian Act (Canada) […] for the purpose of the organization and delivery of public health programs and services, the prevention of diseases and injuries and the promotion and protection of the health of the people of New Brunswick or any group of them” (Public Health Act, 1998, section 58.1).

The Aboriginal Affairs Secretariat was formed in 1999 as a result of the task force on Aboriginal issues (Government of New Brunswick, 1999). Its role is “to improve the provincial government’s capacity to address the increasing number of complex matters in Aboriginal affairs and to devote greater attention to Aboriginal issues. In November 2003, a Deputy Minister was appointed exclusively for Aboriginal Affairs. Aboriginal affairs involve complex social, economic, and legal issues” (Government of New Brunswick, 2019a).

“The Aboriginal Affairs Secretariat works closely with all provincial departments on issues related to environment, education, health, housing, family and community services, sport and culture, natural resource management, economic development, and strengthening relationships with Aboriginal people. The Secretariat also acts as the liaison with the Mi’kmaq and Maliseet communities and Aboriginal organizations to ensure the development of long-term positive relationships with the Aboriginal leaders within the province” (Government of New Brunswick, 2019a).

The Union of New Brunswick Indians is also an Aboriginal organization with a health policy mandate (Union of New Brunswick Indians, n.d.-a). Within the UNBI, the Commission on Health and Social Programs “is committed to the well-being of all on or off reserve Aboriginal People of N.B. and P.E.I. It’s [sic] mission is to work with Aboriginal People and others to attain the well-being of Aboriginal People by promoting self-sufficiency and personal responsibility. A goal of the Commission is to increase the life expectancy and quality of life of Aboriginal people of First Nations in N.B. and P.E.I. consistent [with] non-Native brothers and sisters in N.B. and P.E.I.” (Union of New Brunswick Indians, n.d.-b). Priorities of the Commission include family health and health policy.

The New Brunswick Aboriginal Peoples Council (NBAPC) represents Metis and non-status Indigenous peoples in the province, providing services and a political voice, especially with regards to health matters. It was previously known as the New Brunswick Association of Metis and Non-Status Indians (New Brunswick Aboriginal Peoples Council, 2018).

Regional

There are currently two regional health authorities, Vitalité Health Network and Horizon Health Network, which are “responsible for managing and delivering a variety of services including Hospital Services, Community Health Centre Services, Extra Mural Services, Addictions and Mental Health Services and most Public Health Services” (Government of New Brunswick, 2019b). The Regional Health Authority Act states that “[a] regional health authority may enter into, and amend, an agreement for the purposes of this Act and the regulations with […] (c) a band council as defined in the Indian Act (Canada)” (Regional Health Authority Act, 2002, Section 37). Again, it appears that New Brunswick considers services delivered on-reserve to be a matter of federal jurisdiction.

Three regional Indigenous organizations have health policy mandates. “Three Tribal Councils (Mawiw Council, North Shore Micmac District Council, Saint John River Valley Tribal Council) represent 14 First Nations. Only one First Nation is considered independent (no Tribal Council Affiliation)” (National Collaborating Centre for Aboriginal Health, 2011, p. 42).

References

1. Government of New Brunswick. (1999). Report of the Task force on Aboriginal Issues. Retrieved from: https://www2.gnb.ca/content/gnb/en/departments/aboriginal_affairs/publications/content/task_force.html
2. Government of New Brunswick. (2019a). Aboriginal Affairs. Retrieved from: https://www2.gnb.ca/content/gnb/en/departments/aboriginal_affairs/contacts/dept_renderer.202233.html#mandates
3. Government of New Brunswick. (2019b). Regional Health Authorities. Retrieved from: https://www2.gnb.ca/content/gnb/en/departments/health/services/services_renderer.9435.Regional_Health_Authorities.html#serviceDescription
4. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
5. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
6. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
7. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
8. National Collaborating Centre for Aboriginal Health. (2011). Looking for Aboriginal health in legislation and policies, 1970 to 2008: The policy synthesis project. Prince George, CB. Retrieved from: http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/28/Looking%20for%20Aboriginal%20Health%20in%20Legislation%20and%20Polcies%20(English%20-%20Web).pdf
9. New Brunswick Aboriginal Peoples Council. (2018). About NBAPC. Retrieved from: https://nbapc.org/about-us/
10. Public Health Act 1998, C-22.4. Retrieved from: https://www.gnb.ca/legis/business/pastsessions/53/53-3/status-e/bills/056-e.asp
11. Regional Health Authority Act. Retrieved from: http://laws.gnb.ca/en/showfulldoc/cs/2011-c.217/#anchorga:l_3.
12. Union of New Brunswick Indians. (n.d.-a). Welcome. Retrieved from: http://www.unbi.org/
13. Union of New Brunswick Indians. (n.d.-b). First Nations Health. Retrieved from: http://www.unbi.org/first-nations-health

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

In Newfoundland and Labrador, the Department of Health and Community Services “provides a lead role in policy, planning, program development, and support to the four regional health authorities and other mandated health and community service agencies. The department also monitors and provides feedback as appropriate to the regional health authorities and agencies with respect to program implementation, accountability issues and health and community outcomes” (Government of Newfoundland and Labrador, 2018a). The Department lists Aboriginal health topics (Government of Newfoundland and Labrador, 2019a).
Service delivery, including public health, is provided by the four regional health authorities (Eastern, Southern, Western and Northern Health). Of these, only Eastern Health lists an Indigenous-specific program, the Aboriginal Patient Navigator (APN) Program, in existence since 2009 (Eastern Health, 2017). 

Since February 2017, “[t]he Intergovernmental and Indigenous Affairs Secretariat has been established …, to build intergovernmental relations with efforts to advance relationships with Indigenous Governments and Organizations” (Government of Newfoundland and Labrador, 2019b). In addition, the Secretariat oversees the application of the Aboriginal Consultation Policy which applies to decisions on land and resources (Government of Newfoundland and Labrador, 2013). 

Regional

Three regional Indigenous organizations exist in Newfoundland and Labrador.

The Mi’kmaq First Nation Assembly of Newfoundland was created “to be a single voice to promote and develop the awareness of the Mi’Kmaq of Newfoundland” (Mi’kmaq First Nation Assembly of Newfoundland, n.d.).

 The First Nations of Quebec and Labrador Health and Social Services Commission (FNQLHSSC) is a Quebec-based non-profit organization created “[t]o ensure that the First Nations of Quebec and Labrador freely exercise their inherent right to control health and social services program delivery to the citizens of their respective nations;… [and to] be a technical advisor and consultant for First Nations communities and the Assembly of the First Nations of Quebec and Labrador in the area of health and social services (AFNQL)”  (First Nations of Quebec and Labrador Health and Social Services, 2015).

The Labrador Inuit Land Claims Agreement, which was signed by Canada, the province of Newfoundland and Labrador, and Inuit communities in Labrador, sets out details of land ownership, resource sharing and self-government. “The self-government provisions of the Agreement provide for the creation of the Nunatsiavut Government, five Inuit community governments and Inuit community corporations to represent Inuit living outside the Settlement Area” (Canada, 2005). “The Nunatsiavut Government is an Inuit regional government. Although Nunatsiavut remains part of Newfoundland and Labrador, the government has authority over many central governance areas including health, education, culture and language, justice and community matters” (Nunatsiavut Government, 2019).

The Newfoundland and Labrador Health and Community Services Act specifies the responsibilities of the province’s public health actors and indicates how this Act is to be applied in conjunction with Aboriginal self-government agreements. Thus, the Act states that “[this] Act and the regulations made under this Act shall be read and applied in conjunction with the Labrador Inuit Land Claims Agreement Act and, where a provision of this Act or regulations made under this Act is inconsistent or conflicts with a provision, term or condition of the Labrador Inuit Land Claims Agreement Act, the provision, term or condition of the Labrador Inuit Land Claims Agreement Act shall have precedence over the provision of this Act” (Government of Newfoundland and Labrador, 2018b).

References

1. (2005). Labrador Inuit Land Claims Agreement. Retrieved from: http://www.nunatsiavut.com/wp-content/uploads/2014/07/Labrador-Inuit-Land-Claims-Agreement.pdf
2. Eastern Health. (2017). Aboriginal Health. Retrieved from: http://www.easternhealth.ca/OurServices.aspx?d=1&id=2426&p=74
3. First Nations of Quebec and Labrador Health and Social Services Commission. (2015). About the FNQLHSSC. Retrieved from: http://www.cssspnql.com/en/about-us
4. Government of Newfoundland and Labrador. (2013). The Government of Newfoundland and Labrador’s Aboriginal Consultation Policy on Land and Resource Development Decisions (“The Policy”). Available at: http://www.gov.nl.ca/iias/wp-content/uploads/aboriginal_consultation.pdf
5. Government of Newfoundland and Labrador. (2018a). Department of Health and Community Services. Retrieved from: https://www.health.gov.nl.ca/health/department/index.html
6. Government of Newfoundland and Labrador. (2018b). Health and Community Services Act, Government of Newfoundland and Labrador, SNL 1995, Chapter P-37.1. Retrieved from: http://assembly.nl.ca/Legislation/sr/statutes/p37-1.htm
7. Government of Newfoundland and Labrador. (2019a). Aboriginal Health. Retrieved from: https://www.health.gov.nl.ca/health/aboriginalhealth/index.html
8. Government of Newfoundland and Labrador. (2019b). Intergovernmental and Indigenous Affairs Secretariat. Retrieved from: https://www.gov.nl.ca/iias/
9. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
10. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
11. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
12. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
13. Mi’kmaq First Nation Assembly of Newfoundland. (n.d.). Mission & Mandate. Retrieved from: http://www.mfnan.org/?page_id=310
14. Nunatsiavut Government. (2019). About Nunatsiavut Government. Retrieved from: http://www.nunatsiavut.com/government/about-nunatsiavut-government/

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Territorial

The Department of Health and Social Services is responsible for promoting, protecting and providing for the health and well-being of the people of the Northwest Territories (Government of the Northwest Territories, n.d.-a).

Furthermore, the Northwest Territories is the only jurisdiction in Canada that provides a supplementary health benefits program specifically for Métis residents. “The Government of the Northwest Territories (GNWT) sponsors the Métis Health Benefits program to provide registered Indigenous Métis residents of the Northwest Territories access to a range of benefits not covered by hospital and medical care insurance” (Government of the Northwest Territories, n.d.-b).

Regional

The Northwest Territories has been the site of many self-government agreements, which include health provisions:

• The Sahtu Dene & Métis Comprehensive Land Claim Agreement (1993) “includes a provision entrenching the right of signatory First Nations to negotiate individual self-government agreements that include health services …[and are] mindful of public health and public safety” (Sahtu Dene and Metis Land Claim Settlement Act, 1994 in National Collaborating Centre for Aboriginal Health, 2011, p. 48).
• The Tlicho Agreement (2003) “provides certain rights and benefits respecting land and resources for the Tlicho and self-government to Tlicho Citizens as well as governmental powers and authorities (…). Health services are explicitly cited” (Government of Canada, Government of Northwest Territories, & Tlicho, 2003 in National Collaborating Centre for Aboriginal Health, 2011, p. 50).
• The Inuvialuit Final Agreement “provide[s] rights, benefits and compensation in exchange for the interest of the Inuvialuit in the Northwest Territories and Yukon Territory (…) The agreement established the Inuvialuit Social Development Program, mandated to improve health, education, housing and standards of living of the Inuvialuit. Specific areas of concern include housing, health, welfare, mental health education, elders and the maintenance of traditional practices and perspectives within the Inuvialuit Settlement Region. Canada agrees to provide special funding to contribute to the accomplishment of these social goals by the Inuvialuit. Under this agreement, public health remains an area of Territorial jurisdiction” (Indian and Northern Affairs Canada, 1984 in National Collaborating Centre for Aboriginal Health, 2011, p. 46).

The Northwest Territories’ healthcare system was previously managed through regional authorities. These were amalgamated in 2016 through the creation of the Northwest Territories Health and Social Services Authority (NTHSSA). However, as a result of self-government agreements, some health and social services authorities managed by First Nations and Inuvialuit, remain in place. The Hay River Health and Social Services Authority (HRHSSA) remains outside of the NTHSSA, as does the Tłįchǫ Community Services Agency (TCSA) as per the terms of the Tłįchǫ Land Claims and Self-Government Agreement. The NTHSSA, HRHSSA, and TCSA, collectively referred to as the Authorities, are one integrated territorial health and social services system, functioning under a one-system approach and under a single governance structure (Government of the Northwest Territories, n.d.-c, p.7).

References

1. Sahtu Dene and Metis Land Claim Settlement Act. 1994, S.C. 1994, c. 27. Retrieved from: http://laws-lois.justice.gc.ca/PDF/S-1.5.pdf
2. Government of Canada, Government of Northwest Territories & Tłįchǫ. (2003). Tłįchǫ Agreement. Retrieved from: http://www.aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ/STAGING/texte-text/ccl_fagr_nwts_tliagr_tliagr_1302089608774_eng.pdf
3. Government of the Northwest – Health and Social Services. (n.d.-a). About Us. Retrieved from: https://www.hss.gov.nt.ca/en/about-us
4. Government of the Northwest Territories – Health and Social Services. (n.d.-b). Applying for Métis Health Benefits. Retrieved from:  https://www.hss.gov.nt.ca/en/services/supplementary-health-benefits/metis-health-benefits
5. Government of the Northwest Territories. (n.d.-c). Caring for our people. Strategic plan for the NWT health and social services system 2017 to 2020. Retrieved from: https://www.hss.gov.nt.ca/sites/hss/files/resources/caring-our-people-strategic-plan-2017-2020.pdf
6. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
7. Indian and Northern Affairs Canada. (1984). The Western Arctic Claim. The Inuvialuit Final Agreement. Retrieved from: http://www.eco.gov.yk.ca/pdf/wesar_e.pdf
8. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
9. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
10. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
11. National Collaborating Centre for Aboriginal Health. (2011).Looking for Aboriginal health in legislation and policies, 1970 to 2008: The policy synthesis project. Prince George, BC. Retrieved from: http://ccnsa.ca/docs/1833_synthesisproject_V2.pdf

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

The Nova Scotia Department of Health and Wellness provides leadership for programs and services that protect and promote health, and treat illness for families and communities in Nova Scotia (Government of Nova Scotia, 2019).

In addition, the Nova Scotia Health Authority provides a broad range of health and treatment services. In terms of Indigenous-specific programs, mental health and addiction treatment services are delivered in several First Nations communities (Nova Scotia Health Authority, 2018).

The Health Working Committee of the Mi’kmaq-Nova Scotia-Canada Tripartite Forum plays a key coordinating role. “The Mi’kmaq-Nova Scotia-Canada Tripartite Forum (the Tripartite Forum) was formed in 1997 as a partnership between the Nova Scotia Mi’kmaq, the Province of Nova Scotia, and the Government of Canada. Its purpose is to strengthen relationships and resolve issues of mutual concern affecting the 13 Mi’kmaq communities in the province” (Mi’kmaq-Nova Scotia-Canada Tripartite Forum, 2008, p. VI). The Health Working Committee “works to address various issues in regards to health needs for Nova Scotia Mi’kmaq. Through researching the needs of Mi’kmaq, projects and partnerships are developed with First Nations communities and the government” (Mi’kmaq-Nova Scotia-Canada Tripartite Forum, 2018).

The Native Council of Nova Scotia “is the self-governing authority for the large community of Mi’kmaq/Aboriginal peoples residing off-reserve in Nova Scotia throughout traditional Mi’kmaq territory” (Native Council of Nova Scotia, 2019). Broadly speaking, programs are largely focused on the social determinants of health.

Furthermore, the Atlantic Policy Congress of First Nation Chiefs Secretariat (APC) “is an advocate for speaking with one voice on behalf of First Nations communities. Through research and analysis, [the APC] develop and table policy alternatives for matters affecting First Nations communities in Atlantic Canada, Quebec, and Maine, USA” (Atlantic Policy Congress of First Nation Chiefs Secretariat, 2019).  In terms of health policy, “The APC Health Department works in partnership with First Nations Inuit Health Branch – Atlantic (FNHIB) [now Indigenous Services Canada] to improve Atlantic First Nations’ health and wellbeing” (Atlantic Policy Congress of First Nation Chiefs Secretariat, 2018).

Regional

N/A

References

1. Atlantic Policy Congress of First Nation Chiefs Secretariat. (2018). Health. Retrieved from: https://www.apcfnc.ca/health/
2. Atlantic Policy Congress of First Nation Chiefs Secretariat. (2019). About. Retrieved from: https://www.apcfnc.ca/about-apc/
3. Government of Nova Scotia. (2019). About the Department of Health and Wellness. Retrieved from: https://novascotia.ca/dhw/about/
4. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Available at: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
5. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
6. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
7. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
8. Mi’kmaq-Nova Scotia-Canada Tripartite Forum. (2008). Exploring health priorities in First Nations communities in Nova Scotia. (Health Working Committee). Retrieved from: http://tripartiteforum.pinwheeldesign.ca/wp-content/uploads/2017/12/2TFReportLow.pdf
9. Mi’kmaq-Nova Scotia-Canada Tripartite Forum. (2018). Health Working Committees. Retrieved from: http://tripartiteforum.com/health-working-committee/
10. Native Council of Nova Scotia. (2019). Home. Retrieved from: http://ncns.ca/
11. Nova Scotia Health Authority. (2018). First Nations Services. Retrieved from: http://www.nshealth.ca/service-details/First%20Nations%20Services

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Territorial

The Department of Health is responsible for health services in Nunavut. Its mission is “[t]o promote, protect and enhance the health and well-being of all Nunavummiut, incorporating Inuit Qaujimajatuqangit at all levels of service delivery and design” (Government of Nunavut, n.d.). “Inuit Qaujimajatuqangit (IQ) is the term used to describe Inuit epistemology or the Indigenous knowledge of the Inuit. The term translates directly as ‘that which Inuit have always known to be true.’ Like other Indigenous knowledge systems, Inuit Qaujimajatuqangit is recognized to be a unified system of beliefs and knowledge characteristic of the Inuit culture” (National Collaborating Centre for Aboriginal Health, 2012, p. 1).

Access to care in Nunavut is limited to prevention services and primary care in most communities. Iqaluit has a hospital facility delivering secondary care. Rankin Inlet has a Regional Health Centre with a limited number of overnight beds. A limited number of family physicians and specialists from southern provinces visit Nunavut communities to provide services. Complex out-of and in-hospital care is accessed in Edmonton, Alberta, Winnipeg, Manitoba and Ottawa, Ontario (Office of the Auditor General of Canada, 2017).

The Public Health Branch of the Department of Health “provides direction and leadership throughout Nunavut regarding the core functions of public health, which include population health assessment, health surveillance, health promotion, disease and injury prevention, health protection and management of public health emergencies” (Government of Nunavut, 2017, p. 124)

Regional

N/A

References

1. Government of Nunavut. (n.d.). About us, Welcome to Health. Retrieved from: https://www.gov.nu.ca/health/information/about-us
2. Government of Nunavut. (2017). Business plan 2017-2020. Nunavut. Retrieved from: http://www.gov.nu.ca/sites/default/files/files/Finance/Budgets/business_plan_2017-2020_english.pdf
3. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
4. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
5. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
6. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
7. National Collaborating Centre for Aboriginal Health. (2012). Inuit Qaujimajatuqangit: The role of Indigenous knowledge in supporting wellness in Inuit communities in Nunavut. Prince George, BC. Retrieved from: https://www.nccah-ccnsa.ca/495/_i_Inuit_Qaujimajatuqangit__i___The_role_of_Indigenous_knowledge_in_supporting_wellness_in_Inuit_communities_in_Nunavut_.nccah?id=6
8. Office of the Auditor-General of Canada. (2017). Report—Health Care Services—Nunavut. Retrieved from: http://www.oag-bvg.gc.ca/internet/English/nun_201703_e_41998.html

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

The Ontario Indigenous Healing and Wellness Strategy (previously the Aboriginal Health and Wellness Strategy) was the first of its kind in the country. It was developed in 1990 and supported by an overarching Aboriginal Health Policy put in place in 1994 (Government of Ontario, 1994). These documents remain current today (Ministry of Health and Long-Term Care, 2018, p. 16): “[t]he Indigenous Healing and Wellness Strategy reflects a shared commitment between the Ontario government and First Nations, Métis, Inuit and urban Indigenous partners to reduce family violence and violence against Indigenous women and children, and improve Indigenous healing, health and wellness through culturally appropriate and Indigenous-led programs and services. Three Ontario government ministries fund the strategy:

• Children, Community and Social Services (ministry lead)
• Health and Long-Term Care
• Indigenous Affairs” (Government of Ontario, 2019a).

Furthermore, as a result of the Aboriginal Health and Wellness Strategy and Aboriginal Health Policy, a network of Aboriginal Health Access Centres (AHACs) emerged across the province in 1995. AHACs “are Aboriginal community-led, primary health care organizations. They provide a combination of traditional healing, primary care, cultural programs, health promotion programs, community development initiatives, and social support services to First Nations, Métis and Inuit communities. There are currently ten AHACs in Ontario, providing services both on and off-reserve, in urban, rural and northern locations” (Alliance for Healthier Communities, 2019).

“First announced in 1995, AHACs were closely modelled after Ontario’s Community Health Centres (CHCs), whose wide basket of services and supports had become the preferred mechanism to improve the health and well-being of communities in Ontario facing various barriers in accessing health care. In fact, two CHCs had already been established, one in Toronto and another in Timmins, with a mandate to apply this CHC model as the framework for services to local Aboriginal community members” (Alliance for Healthier Communities, 2019).

“Ontario’s experience with CHCs, including these two Aboriginal CHCs — Anishnawbe Health Toronto CHC and Misiway Milopemahtesewin CHC in Timmins — provided strong evidence that such organizations could play a powerful role in improving the health and wellbeing of Aboriginal communities throughout Ontario. Currently there are three Aboriginal CHCs in Ontario: Anishnawbe Health Toronto, Misiway Milopemahtesewin in Timmins and Chigamik in Midland” (Alliance for Healthier Communities, 2019).

Ontario was also the first to commit substantial resources to Indigenous peoples living in urban environments. The Urban Indigenous Action Plan’s “action areas set a minimum standard for how Ontario ministries engage with and support Indigenous communities, organizations and service providers” in a variety of mutually-agreed upon areas including equitable, accessible and culturally safe public health services delivery (Government of Ontario, 2018a).

In 2008, the Chiefs of Ontario (COO) strongly recommended the adoption of an Ontario-First Nations Health Accord. Following this, “a meeting was held on November 24, 2010, between the Chair of Ontario Chiefs Committee on Health (OCCOH) on behalf of the Chiefs of Ontario (COO), Deputy Ministers (DMs) of the Ontario Ministry of Health and Long-Term Care (MOHLTC), Ministry of Aboriginal Affairs (MAA), and Cabinet Office, Intergovernmental Affairs” (Chiefs of Ontario, 2019). These discussions have led to the establishment of a Trilateral First Nations Health Senior Officials Committee (TFNHSOC) to work collaboratively in identifying and implementing practical measures on specific priority areas including mental health and addictions, public health, chronic disease management, addressing service delivery gaps and service coordination, priority setting, and policy development. It was further agreed that the Federal government be engaged as an active participant given its historical and continuing role with First Nations. Health Canada, representing the Federal government is committed to participate in a trilateral process with Ontario First Nations and the provincial government to improve health outcomes for First Nations, in a manner that is guided by the honour of the Crown (Chiefs of Ontario, 2019).

Regional

Ontario’s healthcare system is divided into fourteen Local Health Integration Networks (LHINs). “Through the Local Health System Integration Act, 2006, LHINs have a mandate to engage with First Nation, Inuit and Metis peoples to provide direction and input on the development and the delivery of health care services” (Ontario Local Health Integration Network, 2014).

In 2018, the Ministry of Health and Long-Term Care issued the Relationship with Indigenous Communities Guideline. “This guideline is intended to assist boards of health in implementing the requirements established in the Health Equity Standard and the requirement for boards of health to engage in multi-sectoral collaboration with municipalities, LHIN(s), and other relevant stakeholders in decreasing health inequities. The requirement further specifies that engagement shall include the fostering and the creation of meaningful relationships, starting with engagement through to collaborative partnerships with Indigenous communities and organizations, as well as with First Nations and Indigenous communities striving to reconcile jurisdictional issues.” (Ministry of Health and Long-Term Care, 2018).

In addition, under Section 50 of the Health Protection and Promotion Act (1990), a board of health for a public health unit and a local band council may enter into an agreement in writing under which the board agrees to provide health programs and services to the band, and the council of the band agrees to accept the responsibilities of a municipality within the public health unit (Health Protection and Promotion Act, 1990). Example of Section 50 agreements facilitating the delivery of public health program and services to First Nations on reserve include the agreement with Peterborough Health Unit and the Curve Lake and Hiawatha First Nations communities and Eastern Ontario Public Health Unit (Peterborough Public Health, 2018; see also Board of Health for Peterborough Public Health, 2018).

References

1. Alliance for Healthier Communities. (2019). Aboriginal Health Centres. Retrieved from: https://www.allianceon.org/aboriginal-health-access-centres
2. Board of Health for Peterborough Public Health. (2018). Peterborough public health board of health response to the report of the Minister’s expert panel on public health. Retrieved from: https://www.peterboroughpublichealth.ca/wp-content/uploads/2018/05/171013-PPH-Board-Response-to-the-Expert-Panel-Report.pdf
3. Chiefs of Ontario. (2019). Background. Retrieved from: http://www.chiefs-of-ontario.org/priorities/health/trilateral-first-nation-health-senior-officials-committee/
4. Government of Ontario. (1994). New directions, Aboriginal Health Policy for Ontario. Retrieved from: https://ics.sanyas.ca/assets/156/Aboriginal_health_policy_for_Ontario_1999_1_.pdf
5. Government of Ontario. (2018a). Urban Indigenous Action Plan. Retrieved from: https://www.ontario.ca/page/urban-indigenous-action-plan
6. Government of Ontario. (2019a). Ministry of Community and Social Services. Goal of the Indigenous Healing and Wellness Strategy. Retrieved from: https://www.mcss.gov.on.ca/en/mcss/programs/community/ihws/goal_strategy.aspx
7. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
8. Health Protection and Promotion Act. 1990. Retrieved from: https://www.ontario.ca/laws/statute/90h07
9. Indigenous Services Canada. (2013). First Nations and Inuit Health
   Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
10. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
11. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
12. Ministry of Health and Long-Term Care. (2018). Relationship with Indigenous communities guideline, 2018. Ontario, Canada: Government of Ontario. Retrieved from: http://health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Relationship_with_Indigenous_Communities_Guideline_en.pdf
13. Ontario Local Health Integration Network. (2014). Aboriginal Community Engagement. Retrieved from: http://www.lhins.on.ca/Pan-LHIN%20Content/Provincial%20Aboriginal%20LHIN%20Network/Aboriginal%20Community%20Engagement.aspx
14. Peterborough Public Health. (2018). Indigenous Public Health. Retrieved from: https://www.peterboroughpublichealth.ca/about-us/indigenous-public-health/

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

Aboriginal programming is the purview of the Aboriginal Affairs Secretariat which “was established in 2009 to coordinate government’s response to Aboriginal matters within the province.  In addition to offering a central point of contact for First Nations and Aboriginal organizations, the Secretariat provides a means by which to promote inter-departmental communication and cooperation on governmental matters related to Aboriginal Affairs. The Secretariat supports work conducted under the Partnership Agreement with the Mi’kmaq and Canada, continues to participate in a contribution agreement with the Native Council of PEI, and provides annual grant funding to the Aboriginal Women’s Associate of PEI. The Secretariat represents PEI at various inter-governmental tables” (Aboriginal Affairs Secretariat, 2019). The Secretariat works with other departments “to reduce any socio-economic gap between Aboriginal and non-Aboriginal Islanders and improve life outcomes for Aboriginal Islanders” (Aboriginal Affairs Secretariat, 2019).

At the provincial level, the Mi’kmaq Confederacy of Prince Edward Island represents PEI’s Mi’kmaq Nation. The health program of the Mi’kmaq Confederacy of Prince Edward Island manages a “wide range of programs and services designed to support the health and wellbeing of Lennox Island and Abegweit First Nation members living on-reserve. They include; Health Policy, Jordan’s Principle program, Indian Residential School program, and Health Promotion” (Mi’kmaq Confederacy of PEI, 2019).

In addition, “The Native Council of Prince Edward Island is a Community of Aboriginal People (NCPEI) residing off-reserve in traditional Mi’kmaq territory. NCPEI is the self-governing authority for all off-reserve Aboriginal people living on Epekwitk (PEI)” (Native Council of Prince Edward Island, 2014a). Funded through the United Way of Canada, the NCPEI offers health programs and services to urban Indigenous people living off-reserve. “The goal of the program is to provide tools, resources, education and to empower participants to make healthy choices to promote their overall wellness” (Native Council of Prince Edward’s Island, 2014b).

Regional

On Lennox Island Mi’Kmaq First Nation, the Lennox Island Health Centre offers health care services, home support and substance abuse counselling, access to fitness and maternal-health coordinators (Lennox Island, 2013).

The Abegweit First Nations Mi’kmaq Wellness Centre also provides a wide range of health and wellness programs (Abegweit Health, 2019).

References

1. Abegweit Health. (2019). Abegweit First Nation Mi’kmaq Wellness Centre Programs and Services. Retrieved from:  http://www.abegweithealth.ca/programs_services_wellness.asp
2. Aboriginal Affairs Secretariat. (2019). Aboriginal Affairs. Retrieved from:  https://www.princeedwardisland.ca/en/information/executive-council-office/aboriginal-affairs-secretariat
3. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
4. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
5. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
6. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
7. Lennox Island (2013). Community Health Care. Retrieved from: http://lennoxisland.com/community/health-care/
8. Mi’kmaq Confederacy of PEI. (2019). Health Programs and Services. Retrieved from: http://mcpei.ca/#programs
9. Native Council of Prince Edward Island. (2014a). Home. Retrieved from: http://www.ncpei.com/home
10. Native Council of Prince Edward Island. (2014b). Family Health and Wellness. Retrieved from: http://www.ncpei.com/programs/family-health-and-wellness

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

At the policy level, “[t]he Secrétariat aux affaires autochtones is the primary agency responsible for ensuring communication and contact between Native peoples and the Gouvernement du Québec” (Secrétariat aux affaires Autochtones Québec, 2018a).

Québec does not have an Indigenous-specific health policy. However, “[i]n its Politique gouvernementale de prévention en santé (government preventive health policy), launched in October 2016, the Government du Québec undertook to ‘improve the living conditions of Aboriginal populations’ (measure 3.6). On the basis of this policy, a 2017-2021 interministerial action plan was developed. It includes actions designed to benefit the entire population of Québec, including the First Nations and Inuit” (Secrétariat aux affaires Autochtones Québec, 2018b).

With regard to public health protection, Aboriginal communities are covered by the Public Health Act (Ministère de la Santé et des Services sociaux du Québec, 2016).

Established in 1994, the “First Nations of Quebec and Labrador Health and Social Services Commission (FNQLHSSC) is a non-profit organisation that is responsible for supporting the efforts of the First Nations of Quebec in order to, among other things, plan and deliver culturally-appropriate and preventive health and social services programs.” Its mission is to “accompany Quebec First Nations in achieving their health, wellness, culture and self-determination goals” (First Nations of Québec and Labrador Health and Social Services Commission, 2015). One of the Commission’s key roles is “to act as a technical advisor and consultant among the First Nations communities and the Assembly of First Nations of Quebec and Labrador in the areas of health and social services” (First Nations of Québec and Labrador Health and Social Services Commission, 2015).

The Indigenous health sector of the Institut national de santé publique du Québec (INSPQ) supports the development of public health expertise and knowledge among its partners in Indigenous communities. “Since the end of the 90s, the INSPQ has been working with the regional health authorities of Nunavik and the territory of Eeyou Istchee. In order to respond adequately to an increased demand for this type of collaboration, the offer of expertise and skills development is now available to partners in non-convention territories in Quebec through close collaboration with the First Nations of Quebec and Labrador Health and Social Services Commission” (Institut national de santé publique, 2019 [translation]).

Regional

The 1978 Northeastern Quebec Agreement provides a mechanism for defining the rights of the Naskapi with regard to land and resources (National Collaborating Centre for Aboriginal Health, 2011, p. 46). As a result of the Northeastern Quebec Agreement, a health and social services advisory committee was set up to represent the interests of the Naskapi. According to the Agreement, services are provided by the Québec health care system (Indian and Northern Affairs Canada, 1984; National Collaborating Centre for Aboriginal Health, 2011, p. 46).

Prior to this, the James Bay and Northern Quebec Agreement (JBNQA) was signed in 1975. It defined the rights of the Cree and Inuit in relation to land and resources (1975; National Collaborating Centre for Aboriginal Health, 2011, p. 46). The Cree Board of Health and Social Services of James Bay (CBHSSJB) and the Nunavik Regional Board of Health and Social Services (NRBHSS, initially known as the Kativik Regional Council of Health and Social Services) were created in 1978 as a result of this agreement.

The CBHSSJB “is responsible for the administration of health and social services for all persons residing either permanently or temporarily in Region 18, the administrative region of the Ministry of Health and Social Services of Quebec corresponding to the Cree territory of James Bay. [Their] mandate is defined in Chapter S-5 An Act respecting health services and social services for Cree Native Persons” (Cree Board of Health and Social Services of James Bay, 2012a). “In partnership with the Government of Québec, the Cree Health Board provides health and social services to the 9 communities of the Cree Territory of James Bay.” This includes public health functions (Cree Board of Health and Social Services of James Bay, 2012b).

The primary mandate of the NRBHSS is “to organize health and social service programs in the region (14 villages of Nunavik), evaluate those programs’ effectiveness and ensure the users receive services of good quality appropriate to their needs. Further, it ensures the organization and efficient use of financial resources granted to the Nunavik region. The NRBHSS is an organization dedicated to improving the health and well-being of the populations of the 14 communities on its territory. Its overall mission is to adapt the health and social service programs to the population’s needs and to the region’s realities” (Nunavik Regional Board of Health and Social Services, 2018).

In addition, regional public health directors are responsible for communicating all information regarding public health protection to all Aboriginal communities on their territory, particularly with regard to epidemics and risk situations that may affect these communities (Ministère de la Santé et des Services sociaux du Québec, 2007, p. 15 [translation]).

References

1. (1975). The James Bay and Northern Quebec Agreement (JBNQA). Available at: http://www.naskapi.ca/documents/documents/JBNQA.pdf
2. Cree Board of Health and Social Services of James Bay. (2012a). About us. Available at: http://www.creehealth.org/about-us
3. Cree Board of Health and Social Services of James Bay. (2012b). Cree health. Available at: http://www.creehealth.org/
4. First Nations of Quebec and Labrador Health and Social Services Commission. (2015). About the FNQLHSSC. Available at: http://www.cssspnql.com/en/about-us
5. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Available at: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
6. Indian and Northern Affairs Canada. (1984). La Convention du Nord-Est québécois, The Northeastern Quebec Agreement. Available at: http://caid.ca/AgrNorEasQueA1974.pdf
7. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Available at: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
8. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Available at: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
9. Indigenous Services Canada. (2019). Indigenous Services Canada. Available at: https://www.canada.ca/en/indigenous-services-canada.html
10. Institut national de santé publique (2019). Santé des autochtones. Available at: https://www.inspq.qc.ca/sante-des-autochtones
11. Ministère de la Santé et des Services sociaux du Québec. (2007). Prestation et financement des services de santé et des services sociaux destinés aux Autochtones (Première Nations et Inuits) – Cadre de référence. Available at: https://www.cerp.gouv.qc.ca/fileadmin/Fichiers_clients/Documents_deposes_a_la_Commission/P-086.pdf
12. Ministère de la Santé et des Services sociaux du Québec. (2016). Particularités des services aux Premières Nations et aux Inuits, Santé Publique. Available at: http://www.msss.gouv.qc.ca/professionnels/soins-et-services/particularites-des-services-aux-communautes-autochtones/sante-publique/
13. National Collaborating Centre for Aboriginal Health. (2011). Looking for Aboriginal Health in Legislation and Policies, 1970 to 2008. The Policy Synthesis Project. Canada. Available at: http://www.nccah-ccnsa.ca/docs/Looking%20for%20Aboriginal%20Health%20in%20Legislation%20and%20Policies%20-%20June%202011.pdf
14. Nunavik Regional Board of Health and Social Services. (2018). About us. Available at: https://nrbhss.ca/en/nrbhss/about-us
15. Secrétariat aux affaires Autochtones Québec. (2018a). Ministère du Conseil exécutif. Available at: https://www.autochtones.gouv.qc.ca/index_en.asp
16. Secrétariat aux affaires Autochtones Québec. (2018b). Do more, do better: Government Action Plan for the Social and Cultural Development of the First Nations and Inuit 2017-2022. Available at: https://www.autochtones.gouv.qc.ca/plan-action-social-culturel/prevenir-sante-autochtones-en.asp

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Provincial

Responsibilities for Indigenous health are delegated to the Saskatchewan Health Authority which was created in December 2017 and consolidates 12 former regional health authorities (with the exceptions of Indigenous-led health authorities such as the Northern Intertribal Health Authority and the Athabasca Health Authority) (SK Health Authority, 2019).

The Saskatchewan Health Authority formed the Indigenous Health Working Group whose mandate is “to engage with the First Nations and Métis communities to develop recommendations for improvement” (SK Health Authority, 2018a, p. 14).  The Indigenous Health Working Group worked in close collaboration with the regional health authorities on the strength of the recommendations of the 2016 Saskatchewan Advisory Panel on Health System Structure Report. The 2009 Saskatchewan Patient First Review had previously recommended more equitable, respectful, and culturally safe care for Indigenous peoples (SK Health Authority, 2018b, p. 4).

Indigenous authorities are recognized under The Public Health Act of 1994 which states that health authorities can reach agreements with a Band council. “For the purpose of carrying out this Act according to its intent, the minister may enter into agreements with a local authority, the Government of Canada or its agencies, the government of another province or territory of Canada or its agencies, an Indian band or any other person” (The Public Health Act, Section 4). This is reiterated in the Provincial Health Authority Act (2017, Section 4.3(h)).

Regional

In the most northern part of Saskatchewan, the population is served by the Athabasca Health Authority. The Authority opened its Athabasca Health facility in 2003. The Athabasca Health Authority is not a regional health authority pursuant to The Regional Health Services Act (2017). “Saskatchewan Health and the federal government annually enter into a funding agreement with the Athabasca Health Authority for the provision of health services to be provided to those residing in the Athabasca Basin” (Government of Saskatchewan, 1999).

The Athabasca Health Authority “provides health care services to five main communities in the north … the 2 First Nations Communities of Black Lake and Fond Du Lac, as well as Stony Rapids, Uranium City, and Camsell Portage” (Athabasca Health Authority, n.d.).

In addition, the Northern Saskatchewan Population Health Unit (PHU) is responsible for health surveillance and health status reporting. “It is a major collaborative initiative of the Athabasca Health Authority (AHA) and the former Keewatin Yatthé and Mamawetan Churchill River Regional Health Authorities, formalized through a Co-Management Partnership Committee Memorandum of Understanding” (Athabasca Health Authority, 2018, p. 51). Other partners include: First Nations and Inuit Health Branch, Northern Medical Services, and the Northern Inter-Tribal Health Authority.

The Northern Inter-Tribal Health Authority (NITHA) was created in 1998, comprised of four Indigenous organizations in Northern Saskatchewan, to deliver health services, including public health programs (population health assessment, disease surveillance, health promotion, health protection, and disease and injury prevention) (Northern Inter-Tribal Health Authority, 2019a, 2019b).

The NITHA is a partnership of the Meadow Lake Tribal Council, the Lac LaRonge First Nations, the Peter Ballantyne Cree Nation, and the Prince Albert Grand Council. These Tribal Councils and First Nations collectively represent nearly half of First Nations in Saskatchewan. The NITHA provides education and technical support to its partners in the area of communicable disease control, epidemiology and health status monitoring. (National Collaborating Centre for Aboriginal Health, 2011, p.8). “NITHA is funded through a contribution agreement with FNIHB [Health Canada’s First Nations and Inuit Health Branch]” (National Collaborating Centre for Aboriginal Health, 2011, p.32).

References

1. Athabasca Health Authority. (n.d.). Welcome to the Athabasca Health Authority. Retrieved from: http://www.athabascahealth.ca/
2. Athabasca Health Authority. (2018). Healthy people healthy land. Annual report 2018. Retrieved from: https://www.athabascahealth.ca/Documents/2018%20Annual%20Report.pdf
3. Government of Saskatchewan. (1999). Athabasca Health Authority to Serve Residents of Far North. Retrieved from: https://www.saskatchewan.ca/government/news-and-media/1999/january/28/athabasca-health-authority-to-serve-residents-of-far-north
4. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
5. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
6. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
7. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
8. National Collaborating Centre for Aboriginal Health. (2011). Looking for Aboriginal health in legislation and policies, 1970 to 2008: The policy synthesis project. Prince George, BC. Retrieved from: http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/28/Looking%20for%20Aboriginal%20Health%20in%20Legislation%20and%20Polcies%20(English%20-%20Web).pdf
9. Northern Inter-Tribal Health Authority. (2019a). Our History. Retrieved from http://www.nitha.com/our-history/
10. Northern Inter-Tribal Health Authority. (2019b). Public Health Unit. Retrieved from: http://www.nitha.com/public-health-unit/
11. Saskatchewan Health Authority. (2018a). Annual report to the community. Retrieved from: https://www.saskhealthauthority.ca/about/Documents/SHA-Community-Report-Dec-2018.pdf
12. Saskatchewan Health Authority. (2018b). Indigenous health in the new Saskatchewan health Authority: Summary of findings. Retrieved from: https://www.saskhealthauthority.ca/about/Documents/Indigenous-Health-Summary-Report.pdf
13. Saskatchewan Health Authority. (2019). Our organization. Retrieved from:  https://www.saskhealthauthority.ca/about/Pages/default.aspx
14. The Provincial Health Authority Act.  Retrieved from: http://www.publications.gov.sk.ca/freelaw/documents/english/Statutes/Statutes/P30-3.pdf
15. The Public Health Act.1994. Retrieved from: http://www.qp.gov.sk.ca/documents/English/Statutes/Statutes/P37-1.pdf
16. The Regional Health Services Act. 2017. Retrieved from: http://www.publications.gov.sk.ca/redirect.cfm?p=836&i=1309

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

Territorial

The Yukon Department of Health and Social Services’ programs and services are available to both First Nations and non-First Nations residents of Yukon (Government of Yukon, 2018).

The First Nations Health Programs (FNHP) at Whitehorse General Hospital “provide and support compassionate care for First Nations, Inuit and Metis people based on First Nations culture and values” (Yukon Hospital Corporation, 2019). When recipients self-identify, they are linked with available patient support services that include in-hospital patient support, mental health services and complex care discharge plans (Yukon Hospital Corporation, 2018).

The Inuvialuit Final Agreement (1984) was signed by the Inuvialuit and the federal and territorial governments and “provides rights, benefits and compensation in exchange for the interest of the Inuvialuit in the Northwest Territories and Yukon Territory” (National Collaborating Centre for Aboriginal Health, 2011, p. 46). “The agreement established the Inuvialuit Social Development Program, mandated to improve health, education, housing and standards of living of the Inuvialuit. Specific areas of concern include housing, health, welfare, mental health education, elders and the maintenance of traditional practices and perspectives within the Inuvialuit Settlement Region. Canada agrees to provide special funding to contribute to the accomplishment of these social goals by the Inuvialuit. Under this agreement, public health remains an area of territorial jurisdiction” (Indian and Northern Affairs Canada, 1984; National Collaborating Centre for Aboriginal Health, 2011, p. 46).

In addition, the Government of Yukon and Yukon First Nations Chiefs signed an intergovernmental declaration in January 2017 that commits to a renewed relationship based on reconciliation and collaboration. The declaration resulted from the first Yukon Forum in 2005 that brought together political leaders of the Government of Yukon, Yukon First Nations governments and the Council of Yukon First Nations under the Cooperation of Governance Act. There will be four Yukon Forums held a year to explore how to work together and develop an approved Joint Priority Action Plan focusing on such items as procurement, resource royalties, infrastructure funding, education, and health and wellness  (Government of Yukon, 2017).

Health legislation in the Yukon contains provisions related to existing self-government agreements and modern treaties, thereby clarifying responsibilities of the territorial government in health only in those areas articulated in these agreements. For example, the Yukon Health Act “stipulates the importance of partnerships with Aboriginal groups and the respect of traditional Aboriginal healing. [However, it] also stipulates that the Yukon Land Claim Agreement or the Yukon First Nation Self-Government Agreement shall prevail in a conflict” (Health Act, 2002, in National Collaborating Centre for Aboriginal Health, 2011, p.29).

Regional

N/A

References

1. Government of Yukon. (2017). Government of Yukon and First Nations sign intergovernmental declaration. Retrieved from: http://www.gov.yk.ca/news/17-005.html#.WIAC_FMrKUk
2. Government of Yukon. (2018). Yukon Health and Social Services. Retrieved from:  http://www.hss.gov.yk.ca/
3. Health Act. 2002. Retrieved from: http://www.gov.yk.ca/legislation/acts/health_c.pdf
4. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html
5. Indian and Northern Affairs Canada. (1984). The Western Arctic Claim the Inuvialuit Final Agreement. Retrieved from: http://www.eco.gov.yk.ca/pdf/wesar_e.pdf
6. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html
7. Indigenous Services Canada. (2018). Indigenous Services Canada – Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460
8. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html
9. National Collaborating Centre for Aboriginal Health. (2011). Looking for Aboriginal health in legislation and policies, 1970 to 2008: The policy synthesis project. Prince George, BC. Retrieved from: http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/28/Looking%20for%20Aboriginal%20Health%20in%20Legislation%20and%20Polcies%20(English%20-%20Web).pdf
10. Yukon Hospital Corporation. (2019). First Nations Health Programs (FNHP). Retrieved from: https://yukonhospitals.ca/whitehorse-general-hospital/programs-and-services/first-nations-health-programs
11. Yukon Hospital Corporation. (2018). First Nations Patient Support Services. Retrieved from: https://yukonhospitals.ca/whitehorse-general-hospital/first-nations-patient-support-services