8/7/2019 Module 4 Health Gov. Self Determination
1/21
Health Governance
and SelfDetermination:
How is health caredelivered to
Aboriginal peoples in
Canada?
8/7/2019 Module 4 Health Gov. Self Determination
2/21
A quick note on taxes
Many people have the misconception that Aboriginalpeople do not pay taxes
Only status Indians whose incomes are earned on reserve
are exempt from personal income tax.
Only a small number of people live and work on reserves.Furthermore, the income of people who work on reservesis quite low, and often do not earn enough to be subject to
personal income tax.
Purchases made on reserve by a status Indian is alsoexempt from HST/GST.
Joseph & Joseph, Working Effectively
with Aboriginal Peoples, 2007
8/7/2019 Module 4 Health Gov. Self Determination
3/21
First
Nations
and InuitHealth
Status Indians and Registered Inuit
account for less than 60% ofAboriginal peoples in Canada.
Medical services and special
health benefits for Status Indians
and Registered Inuit through First
Nations and Inuit Health (Federal)
Broken into two components: Non-Insured Health Benefits Program
(NIHB)
First Nations and Inuit Health Program
(FNIHP)
8/7/2019 Module 4 Health Gov. Self Determination
4/21
Non Insured Health Benefits
Pharmaceuticals, medical supplies, andequipment, dental services, vision care,medical transportation, individual mentalhealth counselling.
Only when not available through anyother federal, provincial, territorial, orprivate health or social program
Crisis counseling O
nly short-term crisis Benefits are provided for the initial
assessment, development of treatment plan.intervention is covered.
8/7/2019 Module 4 Health Gov. Self Determination
5/21
First Nations and Inuit Health
Programs Community Based
Primary care in northern and isolated communities
Often nurse or community health rep with physician
back up by phone or radio
Community Programs such as:
National Native Alcohol and Drug Abuse Program
Brighter Futures Program HIV/Aids Program
Canadian Prenatal Nutrition Program
8/7/2019 Module 4 Health Gov. Self Determination
6/21
Mtis
But unique health care issues that may be
different than Canadian population.
8/7/2019 Module 4 Health Gov. Self Determination
7/21
Broader Determinants of Health
Income and social status Social support network
Education
Employment and workingconditions
Social environment
Physical environment Personal health practices and
coping skills
Healthy child development
Genetic endowment
Access to health services
Gender
Culture
Determinants of health in an
Aboriginal context
Colonization
Globalization Migration
Cultural continuity
Territory
Poverty
Access Self determination
Naho, 2006
8/7/2019 Module 4 Health Gov. Self Determination
8/21
Access to care and health
information One-third of Aboriginal communities are remote, isolated, or semi-isolated. Barriers exist to basic and specialized services.
Travelling to receive care alienates people from familial, community, and culturalsupports.
Communication barriers exist, both linguistically and in health literacy.
There are capacity, human resources, and infrastructure issues related to tele-health/e-health.
Discuss possible outcomes when you combine the above factors with theseother determinants of health:
Income and social status
Social support network
Education
Employment and working conditions
How would you address this inequity of access to care and health information?
Naho, 2006
8/7/2019 Module 4 Health Gov. Self Determination
9/21
Self Determination and Health Care
Self Determination-Free choice of one's own actsor states without external compulsion.
Many Indigenous communities seek selfdetermination of social services (welfare),education, land, economics, political structure.
1979 Indian Health Policy stated that to betterimprove the health of Aboriginal Canadians theirinput is needed and that spiritual health is asimportant as physical health
8/7/2019 Module 4 Health Gov. Self Determination
10/21
1986 Indian Health Transfer Policy
First Nations could develop, through stages, tothe point where they ultimately obtained controlover the delivery of health services.
90s: Program changed to Integrated Community-Based Health Services, then to Inherent Right toSelf Government Policy.
By 2002 81% of eligible communities wereactively involved in the health transfer in somemanner.
8/7/2019 Module 4 Health Gov. Self Determination
11/21
William Charles First Nation
W.C FN at Montreal Lake Saskatchewan was thefirst to obtain control of health care under thetransfer policy.
Built a health center
Programs Developed: Education, prevention, school-based, immunization,
pre-natal, alcohol, chronic disease.
Members felt more secure about their health as theyhad qualified professionals
Emergencies could be handled at the communitylevel
Education program helped people home manageminor illness
More Elders seeking care Use of Cree language and culturally safe care
Immunizations increased
8/7/2019 Module 4 Health Gov. Self Determination
12/21
Self Determination or Cost
Containment? Motivation for policy is questionable, many
scholars belief the underlining goal of selfdetermination by the federal government is costcontrol.
The policy has been marketed as a mechanism forself determination but its formation has beenguided primarily by political economic factors.
Limited benefits in many communities.
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
13/21
Self Determination or Cost
Containment? Prior to the Health Transfer Policy their was a
shift towards devolution of responsibility to theprovinces.
Many attempts at offloading responsibility The final policy did not include training for
transfer.
But it did have a no enrichment clause that
froze budgets at the time of transfer. Given some administrative control but still there
were many structural constraints.
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
14/21
The case ofWikwemikong
The case of Wikwemikong Reserve, Ontario
Despite a long and involved process they signedtheir first Health Transfer Agreement in 1994 to
be negotiated every 5 years. Renewals are subject to appropriation of funds by
parliament.
Lack of any guarantee that a contract will benegotiated.
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
15/21
The case ofWikwemikong
The community had a favourable external evaluation and sothey thought that renegotiation wouldn't be challenging in1999.
They also had growing needs: A growing population,increase rate of disease, and serving many off reserve bandmembers. Aids wasn't even an issue for Wikwemikong when they went
into negations in the 80s.
The community was told it was not a negotiation, only arenewal. Only change was 3% increase in wages
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
16/21
The case ofWikwemikong
One of the community goals was to deliverholistic health services and revitalizetraditional medicine.
Health Transfer will not find traditionalmedicine or mental health programming.
Funds are to deliver mandatory programs andsupport underfunded FNIHB programs.
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
17/21
The case ofWikwemikong
FNIH told Wikwemikong that the reason theycant find traditional healing is for liabilityreasons, even though we believe in it.
Malpractice liability risk
Coverage for traditional medicine liability isavailable in Canada and had been purchasedby the Wikwemikong Reserve.
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
18/21
The case ofWikwemikong
When a Wikwemikong leader asked why their was nomental health policy at the federal level.
The FNIH representative stated Mental Healthremains an issue, but there is no money. There is crisismoney available-this is a proposal driven process.
This patchwork approach to mental health has been
criticized at the national level: Chiefs are placed in a position of watching their children
die before being able to apply pressure to the governmentto provide crisis programming.
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
19/21
The case of WikwemikongConcluding Thoughts
If Health Transfer truly represents amovement toward self-government,funding would need to increase inrelation to community identified
needs.
Poor economic conditions andunhealthy communities mean thatthere is little opportunity todevelop self sustaining resources ora tax base for the foreseeablefuture.
How do Canadians pay
for health care?
Tax
How do you suppose you
get a reserve with no
economic opportunities
to produce taxes?
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
20/21
The case of WikwemikongConcluding Thoughts
Transfer policy simply puts Aboriginal people
in the lowest levels of health care
administration in the Canadian Health Care
system.
In some cases First Nations will be left with
little more than the responsibility to
administer their own poverty.
Jacklin & Warry, 2004
8/7/2019 Module 4 Health Gov. Self Determination
21/21
Discussion
We have seen two different views of self determination from two different
authors (Waldram et al. & Jacklin and Warry). We also now know that
cultural continuity and self determination can increase health in a
community, such as lowering suicide rates (Lalonde and Chandler). Discuss
your thoughts on the government attempting to offload costs andwhether this makes you think differently about Self Determination in
Canada.
Top Related