Summary Of Discussions - First Nations Breakout Group

Jurisdiction and Control

Launch Question:

How will we address the issues of jurisdiction and control that are impacting on the delivery of, and access to, health services?

To facilitate the discussion on the launch question the participants were provided with a more focused question to explore:

What would you do if you had First Nations jurisdiction in health?

• clear First Nations government roles and responsibilities/legislative mandate;
• define the scope of acute care, public health and rehabilitation services;
• require qualified human resources and professionals (capacity);
• require more funding and accountability; and
• support First Nations control of integration of different jurisdictions.

Definition of Success

The First Nations group determined that their definition of success would be best articulated through a vision statement. Participants in the breakout sessions came to a consensus on the following statement:

We would have sufficient resources to provide our clients with integrated, holistic, accessible and universally available services which ensure proper governance structures based on inherent rights and ensures First Nations health is standard with the rest of Canada.

Short-term Recommendations/Actions

Many of the participants in this breakout session identified various strategies, the need for more health authorities and, frameworks, as well as the need for analysis. Specific data collection and community visioning were identified as part of the short term recommendations, which included:

• First Nations require a youth strategy;
• reliable data required on First Nations population;
• First Nations need to articulate a vision of a Ahealthy community@;
• First Nations want to develop Health Authorities;
• a Health System Framework that is not illness based needs to be defined; and
• regular gender-based analysis within First Nations communities needs to be conducted.

Medium-term Recommendations/Actions

Participants discussed issues around traditional knowledge, sharing medical models internationally, and enhancing educational opportunities for First Nations students pursuing careers in health care. Some of the actions include:

• First Nations want to develop an open medical model that will integrate traditional knowledge and practices. This would include the Aboriginal world view and concepts on health while integrating traditional knowledge, ceremonies and medicines into First Nations health practices;
• First Nations want to enhance support to all First Nations students;
• all universities need to have Aboriginal recruitment and retention policies; and
• First Nations need to articulate and develop appropriate governance models for health.

Long-term Recommendations/Actions

Participants identified recommendations that stretch from the implementation of the recommendations on health from the Royal Commission on Aboriginal Peoples (RCAP) to specific legislation to replace the Indian Act. Further drill-down on accreditation and training was identified, as well as ideas of how First Nations can use best practices and performance measurement to inform best concepts within health environments. Other recommendations included:

• Aboriginal peoples are equal partners with governments in all discussions on Aboriginal health care and service delivery (government-to-government relationship);
• removal of jurisdictional barriers to health services (including culturally appropriate) through negotiation with, and among, governments (Aboriginal and non-Aboriginal) and service providers of fully reciprocal agreements for the provision of health services to Aboriginal peoples. Specific details of such agreements to be negotiated at the provincial/regional/local levels as deemed appropriate to meet the needs of communities involved;
• need an ongoing process that engages Aboriginal peoples and governments at the national, provincial, territorial, regional, local levels to work out details of integrated health services;
• set general parameters to guide discussions at the national level. Establish task groups with Elders, leaders and experts to develop proposals and recommendations that outline a general approach;
• develop provincial parameters to guide local discussions through task groups;
• develop service details at the local level;
• achieve accreditation and training of 10,000 professional in five years. Increase the number of First Nations health care professionals (doctors, nurses, dentists, specialists, etc.), health policy, health planners, community practitioners and traditional healers;
• share and document best practices within five years (First Nations best concepts should inform our best practices, one should continuously inform the other);
• implement the RCAP recommendations and consistently do gender-based analysis on the recommendations; and
• replace the Indian Act with a First Nations Recognition Act.

Determining Success

Participants determined that success in health jurisdiction and control will be measured through some very tangible indicators such as better health for First Nations, the involvement of women in decision making, more resources, and a full menu of health services close to the communities that are culturally appropriate. First Nations will have:

• services that are available close to home;
• a full continuum of primary health care;
• improved health status;
• resources that match health needs;
• smoking, drinking, prescription drugs and gambling addictions are gone;
• women involved in health decision making;
• policy makers, academics and community people sitting at the same table for a common purpose; and
• culturally appropriate services available and accessible where people live.

Other Recommendations

Participants provided two specific recommendations related to issues around Aboriginal health status reporting and data needs:

• a requirement for the development of data collection methodology and Aboriginal-specific indicators that allow for consistent reporting across the country on the health status of all Aboriginal peoples; and
• such data collection methodology to include the implementation of a blind identifier attached to provincial health cards. Such an identifier would be private, not accessible by service providers or insurance companies, but only accessible in data runs when it is tied only to a number, not a name.

Access and Integration

To facilitate discussion of the launch question, the following question was put forward to the group:

Launch Question:

What are the key issues and adaptive approaches that would contribute to improved levels of access to, and integration of health programming and services?

Definition of Success

Participants at this stage of the workshop organized their discussions by defining approaches at the local, regional and national levels for the topic of integration of health programming and services. Principles and processes were defined and dictated to include:

• respect for the distinct culture and identity between and among specific Aboriginal peoples (First Nations, Métis and Inuit). Avoid the Aone size fits all@ pan-Aboriginal approaches;
• health approach needs to emphasize promotion and prevention, building on existing successful models of health prevention; and
• sustainability should not drive integration; good health outcomes should be the driver.

At the local level, the recommendations focused on community-driven solutions with greater access to health programming and a menu of services, including public health, primary care, women's health and advocacy for clients. It was suggested that community needs assessments with community health plans include health policies and protocols. Participants also recommended that Health Canada define integration from a government standpoint.

At the regional level, participants focused on specialized services such as physiotherapy, occupational therapy, and mental health service availability. It was repeatedly recommended that regional networking and partnering is imperative. Clustering communities (while respecting political affiliation) to share resources is a logical recommendation. Portable rights must be acknowledged and supported for First Nations living off-reserve.

Participants recommended at the national level and federal/provincial/territorial tables that the voices of women and people with disabilities must be present and included in all decision-making processes. When the National Health Action Plan is reviewed, women and people with disabilities must be included in the consultation processes. Nationally, best practices helping to set standards need to be shared.

Short-term Recommendations/Actions

• Regionally clustered communities need to respect political jurisdiction, agencies and organizations that deliver services and map all services.
• Changes in federal funding approaches are needed to ensure monies are targeted to all First Nations through one funding source.

Medium-term Recommendations/Actions

• Establish public health professional organizations where community health workers, alcohol and drug workers, health professionals, etc. receive standardized training and credentials.
• Build on successful health promotion strategies.
• Make provinces accountable for the monies they receive on behalf of First Nations.

Long-term Recommendations/Actions

• First Nations communities must develop strategic plans in health.
• The community development process must be flexible and issue-driven so communities can take ownership of their health.
• Educational reform is needed
  • in the development of a framework and business plan to promote lifelong learning to ensure the cultural competencies of educators and health providers (future and current); and
  • to encourage youth to enter health programs and health professional career paths.
  • Elders and traditional healers must be included to ensure a complementary balance of western scientific approaches and traditional knowledge.
  • Adequate resources need to be provided.

Determining Success

Participants reported the following keys to determining success:

• the establishment of new health models that exist across the country;
• the establishment of educational programs;
• First Nations pride and ownership of their health agenda, programs and services;
• accommodation of First Nations community timetables;
• more First Nations graduates in all sectors who return to their communities to live and work; and
• full implementation of RCAP recommendations.

Capacity and Sustainability

Capacity

To facilitate discussion of the launch question the following question was put forward to the group:

Launch Question:

What and how should capacity need be built? How do we know we have achieved success?

Professionals:

• A vast selection of health professionals, para-professionals and associated professions are needed in First Nations communities to support health positions, including primary care givers, specialists, health administrators, researchers, counsellors, educators, traditional caregivers, recreational workers and environmental health officers.

What and how to build capacity:

• internships for traditional practitioners;
• implementation of the approach in health programs and policies such as the Aboriginal Healing and Wellness Strategy in Ontario;
• more healing and birthing lodges;
• Accreditation Centre of Excellence for Aboriginal peoples;
• include mentorship programs;
• local training and support;
• post-secondary recruitment strategies that target First Nations youth;
• encourage more women to enter health science programs;
• establish internship programs for Aboriginal health professions;
• develop and provide summer science programs;
• accessible and available funding to provide extensive cultural awareness; and
• create targeted funding and investments to support Aboriginal post-secondary institutions.

Success for building capacity would include:

• a collaborative effort by/from all players;
• First Nations leadership at all decision-making tables;
• creating support systems that will help students in returning to communities;
• greater support for technology in communities;
• early education as a tool for improving health outcomes;
• the establishment of a First Nations Educational Advisory Group for Indian and Northern Affairs Canada;
• addressing the determinants of health;
• breaking away from the Aright to welfare@; and
• secure agreements with all partners, status, non-status and women's groups.

Making progress would mean:

• 10,000 more Aboriginal health care workers;
• Aboriginal control over reproductive and mental health;
• lower statistics of teenage births;
• more Aboriginal people with disabilities participating in health activities;
• improved health indicators;
• funding would no longer be an issue;
• less unknowns;
• First Nations jurisdiction and control over health; and
• all First Nations people, on and off reserve having access to NIHB.

Sustainability

Launch Question:

What and how sustainability needs be built? And how do we know we have achieved success?

Participants addressed the questions in various sections. The summaries are as follows:

Definition of sustainability

• continued progress, existence and evolution in meeting needs, as well as a commitment to resources, monitoring, evaluation, quality control, accountability, and systems and supports; and
• in the short term, building processes to achieve long-term goals, such as establishing long-term agreements for self-sufficiency (without impacting on fiduciary obligation).

Environmental scan

• all areas need to be sustainable;
• external influences include governments and other organizations; and
• weakness includes lack of resources.

What needs to be done?

• First Nations needs, role modelling and mentorship should be defined;
• current investments to support business and strategic planning need to be reviewed;
• First Nations human resources and organizational development need to be increased; and
• strong commitments with provinces and territories must be established.

Who is going to do it?

• all stakeholders and players in government and First Nations communities.

How do we sustain First Nations health care?

• continue making agreements and partnerships with non-governmental organizations (NGOs), and private/public sectors; and
• improve infrastructure and adequate financial and human resources.

Broad Determinants of Health

Launch Question:

What needs to happen to address health determinants? What role can I/we play?

Participants identified a vast number of determinants that can be summarized as follows :

• better education from kindergarten to post-secondary for First Nations and Aboriginal peoples on health;
• better living and disease prevention teachings;
• more housing that is better built and available to all Aboriginal peoples (with emphasis on single parents);
• environmental safeguards and greater clean-up of water, air and land;
• access to technology;
• First Nations health legislation, laws and a framework for Aboriginal health policy;
• greater communication to, and education of, all stakeholders on health issues;
• balanced attention to health issues, including mental health, traditional approaches and tools, and access to country and traditional foods;
• establish gender-specific issues, reproductive health, maternal health and data collection;
• establish more services for working with persons with disabilities; and
• reduce duplication by implementing interdepartmental discussions at the community level.

Application of the Crosscutting lens

Clear references were made to health issues and recommended actions as they relate to women, people living off-reserve, non-status Indians and the additional lens of First Nations people living with disabilities. A review of the flip chart notes also suggests that the references to provinces in some cases reflect an application of the urban lens.

The geographic lens (urban, rural, remote) was addressed in terms of “portable rights” to “… fair, accessible equal services…recognizing gender and disabilities issues”; First Nations control of service delivery protocols/partnerships; establishment of community development models that include off-reserve; and funding and changes to the Canada Health Act to ensure urban/off-reserve service delivery.

The gender lens was applied through the provision of health programming of particular concern to women (e.g. maternal and reproductive health, community care supports); improved access to other health services; and the inclusion of gender issues and gender-based analysis in a variety of areas such as off-reserve access to services; equity within health professions/salaries; strategic planning; involvement in consultations, decision making and leadership; a National Health Action Plan/Strategy and the report of the Royal Commission on Aboriginal Peoples; and as a means of developing trust among partners at all levels.

A disabilities lens was applied in terms of on and off-reserve service access; increased participation in health activities and decision making processes; recognition of special needs in a national housing strategy; increased efforts to inform people with disabilities; and implementation of existing recommendations.

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The documentation contained on this website does not necessarily represent the views of any government or National Aboriginal Organization. The purpose of this website is to share information related to the Canada-Aboriginal Peoples Roundtable: background papers, Facilitator's sectoral and final reports, agendas and media announcements.

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