1. LECTURE OBJECTIVES Gain awareness and understanding of Aboriginal health legislation and policy framework

2. ABORIGINAL HEALTH POLICY Canadian health system: complex (policies, legislation and relationships) Multiple authorities: federal provincial/territorial, municipal governments Aboriginal authorities Private sector

3. ABORIGINAL HEALTH LEGISLATION CONTEXT 1867 – British North America Act (BNA) –Defined health services as a provincial jurisdiction Indian affairs as federal jurisdiction 1876 – Indian Act –Health related provision (unclear) 1939 – Federal responsibility for Inuit –not health specific

4. FEDERAL ROLE FIRST NATIONS AND INUIT HEALTH BRANCH (FNIHB) Services: –status Indians living on-reserve –Inuit living in their traditional territories NIHB: prescription drugs, dental, vision (all status/registered Indians/Inuit but not Métis)

5. ABORIGINAL LEGISLATION & HEALTH POLICY FRAMEWORK Complex and diverse health service provision across provinces and territories Fails to address the healthcare needs of: –Métis –First Nations, non-registered, not living on-reserve –Inuit, not living on traditional territories Resulted in jurisdictional debating about who should pay for health services 1966: Hawthorne report 2002: Romanow report

6. TRANSFORMATIVE CHANGE 40 – years= transformation in provision of health services and programs Increase involvement of First Nations and Inuit peoples in control and delivery of community –based health services Widely acknowledged: Aboriginal people can identify and manage their own health priorities and healthcare IN their communities

7. HEALTH TRANSFER 1979 – Indian Health Policy: recognition of First Nations and Inuit ability for administering their own health programs 1989 – Health Transfer Policy Framework Benefits of Transfer: –Increased community awareness of health issues –More culturally sensitive health car delivery –Improved employment opportunities for community members –A sense of empowerment and self-determination

8. INTEGRATED AGREEMENTS 1994 – smaller communities: mechanism for community control 176 communities as of 2003

9. POLICIES & LEGISLATION IN P/Ts Provincial/Territorial legislation: specific provisions that clarify the responsibilities of government in Aboriginal health. (Limited & focused on jurisdiction) Self-government agreements: define jurisdiction Embedded provisions related to healing and ceremonial practices (Yukon: respects traditional healing practices)

10. DIVERSITY IN P/T LEGISLATION 1990 – Aboriginal Health and Wellness Strategy Ontario Ministry of Health, Aboriginal Health Policy’ – governing policy –Assist MOH in accessing inequities in programming –Responding to Aboriginal priorities –Adjusting existing programs to be more responsive –Support reallocation of resources –Improving interaction and collaboration between ministry branches to support holistic approaches to health

11. Decentralization/Regionalization Regional Health Authorities: priority setting, planning and delivery of health services Increase public participation - engagement

12. EMERGING MODELS Coordination models: –bridge jurisdictional gaps –Enhance Aboriginal participation Indentify health priorities Designing strategies Coordinating approaches to improve Aboriginal health –Cross-jurisdictional coordination models and –Intergovernmental health authorities

13. CROSS-JURISDICTIONAL Goal is to bride jurisdictional gaps Committee based Include stakeholders in Aboriginal health Most comprehensive: Aboriginal Health and Wellness Strategy (AHWS) BC ‘Tripartite First Nations policy framework’

14. INTERGOVERNMENTAL HEALTH AUTHORITIES Formal organizations –Federal/Provincial partnerships –Self-government agreements Extensions of the provincial health care system but are co-funded by the F/P governments

15. MODERN TREATIES & SELF- GOVERNMENT ACTIVITIES Opportunities for Aboriginal engagement in health policy and service delivery Nunavut Land Claims Settlement Agreement Métis Settlement Agreement

16. The path ahead….national umbrella Aboriginal health policy Significant inequities in health status and access to health services Significant gaps in service and jurisdictional ambiguities Greater coordination needed! Equitable funding for and access to health service Focus on SDOH Inclusive P/T health legislation and policy frameworks