Policy Issue #6: Aboriginal Health

HLTH 405 / Canadian Health PolicyWinter 2012

School of Kinesiology and Health Studies

Course Instructor: Alex Mayer, MPA

Aboriginal Health

Today’s LectureAboriginal Health: Social Determinants of Health and the Import of Ethical Partnerships

• An Abbreviated History of Oppression

• Turning A Cornero Calder case

o Residential Schools Apology

• Self-Determination as Cornerstone for Aboriginal Healtho Promoting Cultural Competency

o Models for Ethical Partnerships

o BC’s Transformative Change Accord

What Canadians See

Attawapiskat Crisis

Attawapiskat Response

The Danger of Stigma

We forget about…o The colonization process (1700-1800s)

o The inauguration of the Indian Reservation System (1830)

o The Indian Act (1867) & Assimilation

o Residential Schools & Sexual Sterilization Acts (1920s)

o The White Paper (1969)

Colonization (1700-1800s)

o Royal Proclamation (1763)

o Treaty of Paris (1783)

Indian Reservation System

o War of 1812

o Loyalist Migration (post-1814)

o Resident Schools are established (1830)

Indian Act (1876)

What did it say?o (S.46) Removal of Indians

o (S.86) Enfranchisement

o (S.138) Unlawful for Indian Agents not to sell land kept ‘in trust’ for Aboriginal peoples

o (S.141) Unlawful to raise or accept money to help Aboriginal peoples pursue a legal claim against the Crown

Assimilation (1920s)

Residential Schools

Kevin Annett's "Unrepentant” A Documentary about Residential School Survivors in Canada

Video:

Post-WWII Policies

Sgt. Thomas George Prince, most decorated Aboriginal soldier (WWII)

o 1951 – Ceremonial bans are lifted

o 1960 – Aboriginal men are eligible to vote

o Nevertheless, “Sixties Scoop” sees upward of 20,000 On-Reserve children adopted into White families, perpetuating the forced assimilation of FN peoples

The White Paper (1969)

Indian Affairs Minister, Jean Chretien (1973)

Based on a desire to promote social equality, and a political ideology bent on removing the special Constitutional status of Quebec and First Nations, for the sake of forming a ‘more perfect union’, Chretien’s White Paper promotes the extinguishment of treaties.

Thoughts?

“However much good a particular health or

social program might do in the narrow

sphere it addresses, it does not shift the

overall picture of Aboriginal disadvantage – the pattern of poverty,

powerlessness and despair – that

determines health and illness.”

- Royal Commission on Aboriginal Peoples (1996)

Ethical Partnerships

2005 Transformative Change Accord

Its Aim

Strengthen government-to-government relationship to achieve 3 key objectives:

o Develop a 10-Year Plan to close gaps in education, health, housing and economic opportunities;

o Reconcile Aboriginal rights and title with those of the Crown;

o Establish a new relationship based on mutual respect and recognition

A BlueprintJuly 2005

First Nations Leadership Council creates the

FN Health Blueprint for British Columbiao Challenges include…

• Expanding health care delivery and access, including dental care

• Need for mental health and addictions services

• Limited access to women’s health

• Clarifying roles and responsibilities between governments and organizations

• Developing collaborative working relationships

• Monitoring progress

Health Gaps

Provincial Medical Officer of Health: 2001 Report

• 49% of young people smoke, more than double provincial avg.

• Aboriginal peoples live 7 years less on avg.

• Diabetes is 40% more prevalent than the BC avg.

• #1 reason for day surgery for children is dental care; aboriginal children are 4 times more likely to require such care than BC avg.

• Higher rates of pneumonia, MVAs, HIV/AIDS, child mortality

Jurisdictional Context• Currently, provincial and federal programs and

funding creates a patchwork of services that are prone to gaps, discontinuities and inadequacies in service delivery

• Programs developed in silos create duplication and overlap, create different levels of accessibility for services based on different eligibility criteria (e.g. Metis versus First Nations versus non-status FN)

• Data-sharing between providers is compromised or non-existent, creating difficulties in assessing overall picture of Aboriginal health in BC

Transformative Change Accord’s

10-Year Action Plan

1. Establish effective mental health programs to address substance abuse and youth suicide

Transformative Change Accord’s

10-Year Action Plan

2. Integrate the ActNow BC Strategy with First Nation health programs to avoid preventable chronic diseases (e.g. diabetes)

Transformative Change Accord’s

10-Year Action Plan

3. Establish tripartite pilot programs in Northern Health Authority and build the Lytton Health Centre to improve acute care and community health services under the direction of First Nations stakeholders

Transformative Change Accord’s

10-Year Action Plan

4. Increase the number of trained FN health professionals

Transformative Change Accord’s

10-Year Action Plan

Governance, Relationships and Accountability

Transformative Change Accord –

Governance, Relationships and

Accountability

1. Establish a First Nations Health Council that supports FN regional health planning; participates in prov/fed health policy and program planning; and provides leadership in the implementation of a Health Plan

2. Hire an Aboriginal physician to work with the Provincial Health Officer on Aboriginal health issues, with a specific responsibility for tracking health progress of Aboriginal people in British Columbia

3. Each Health Authority and FN will develop Aboriginal Health Plans and engage in collaborative decision-making

Transformative Change Accord –

Governance, Relationships and

Accountability

4. Create a high-level Health Partners Group (FNHC, prov and fed govt, colleges and universities, professional health groups, etc.) to close the gaps in health

5. Develop a reciprocal accountability framework between FN and provincial government to clarify accountabilities for health service delivery

Transformative Change Accord’s

10-Year Action Plan

Health Promotion and Disease/Injury Prevention

Transformative Change Accord –

Health Promotion and Disease/Injury

Prevention

1. Minister of State for ActNow BC will collaborate with FN groups to create an Aboriginal-specific ActNow BC program. Increase number of FN community workers trained in chronic disease prevention from 140 to 300 over 3 years.

2. Aboriginal Mental Health and Addictions Plan targeting high-risk areas for youth suicide through community-based programs (e.g. healing circles, cultural camps, counseling programs)

3. Provide health screenings (hearing, dental, vision) for all Aboriginal children under 6 years of age

Transformative Change Accord –

Health Promotion and Disease/Injury

Prevention

4. Match non-FN communities in terms of accessibility of primary health care services on-reserves

5. Work with federal government to improve First Responder programs for remote communities

6. Work with police on an information campaign regarding the use of seatbelts and safe driving

7. Develop culturally appropriate detox beds in the community

Transformative Change Accord’s

10-Year Action Plan

Health Services

Transformative Change Accord –

Health Services

1. Build a FN-run acute care hospital centre in Lytton, BC.

2. Build on success of chronic disease prevention and management community collaboratives, by instituting a diabetes prevention pilot program in North Health Authority

3. Dedicate post-secondary seats to Aboriginal health professions to increase the number of FN health professionals working in BC

4. Develop a curriculum for cultural competency that will be mandatory for all Ministry of Health and BC Health Authority staff

Transformative Change Accord –

Health Services

5. Develop a Maternity Access Project to train midwives and bring women’s health care closer to the homes of expecting mothers

6. Introduce self-management programs for diabetes, HIV/AIDS and Hepatitis C patients

7. Develop a fully-integrated clinical telehealth network for on-reserve health care providers

8. Expand role of Nurse Practitioners in primary health care clinics and healing centres to promote accessibility

9. Recruit more Hospital Liaison staff to help FN patients better navigate the health care system

Transformative Change Accord’s

10-Year Action Plan

Performance Tracking

Transformative Change Accord –

Performance Tracking

1. Provincial Health Officer will issue Aboriginal Health Reports every 5 years to monitor progress towards achieving goals, with interim reports published every 2 years

2. Renew tripartite agreement between fed, prov and FN governments to ensure that all health data is shared to facilitate research

3. Provincial Health Services Authority will expand its community health survey to include First Nations in its assessment of risk factors (e.g. nutrition, obesity, physical activity) in order to share this data with FN communities and Aboriginal health providers

Conclusion

Have a great week!