19 th Annual Conference First Nations Technical Services Advisory Group Inc. Theme: Building Connections

Transcription

1 19 th Annual Conference First Nations Technical Services Advisory Group Inc. Theme: Building Connections Bonnie Healy, RN AFNIGC Operations Manager October 19 th, 2016

2 Our Organization Incorporation Governance Mandate First Nations Owned Servers Protecting Our Knowledge, Telling Our Stories, Strengthening Our Communities

3 Partnerships & Research First Nations Health Surveillance Partners: Alberta First Nations, AFNIGC, Alberta Health, Health Canada, INAC Community Profiles Partners: Alberta First Nations, AFNIGC, Alberta Health, Health Canada, INAC First Nation Cancer Prevention and Screening Partners: Alberta First Nations, AFNIGC, and Alberta Health Services First Nation Cancer Pathways Project Partners: Alberta First Nations, AFNIGC, CPAC, Alberta Health Services, Indigenous Physicians Assoc. of Canada, Aboriginal Nurses Assoc. of Canada First Nations & Inuit Health Branch Food Security/Injury Prevention Partners: Health Canada and AFNIGC Health Co-management Partnerships

4 Current Publications The Lancet Oncology Journal In partnership with the World Health Organization Rheumatology Journal Alberta First Nations Regional Health Survey Report Alberta Baseline Assessment Report In partnership with the First Nation Cancer Pathways Project Team First Nations Health Trends Alberta one-page reports In partnership with Alberta Health

5 Alberta OCAP Resolution The Centre will promote, protect and advance the First Nations Ownership, Control, Access, Possession (OCAP ) principles. The Inherent Right to selfdetermination and jurisdiction in research and information management.

6 Implementing OCAP Supporting community protocol Addressing information poverty Enabling cultural brokers Community Data Profiles: data repatriation First Nations Health Information Governance Agreement

7 OCAP and Protection of Privacy Federal and Provincial legislation operate from the concept of transparency to the Canadian public, thus they are required to release community information Current legislation protects individual information only and deals in the protection of individual rights OCAP operates as a higher level/standard of protection because it not only protects individual information but also community level information

8 Implementing UNDRIP Article 19: States shall consult and cooperate in good faith with the indigenous peoples concerned through their own representative institutions in order to obtain their free, prior, and informed consent before adopting and implementing legislative or administrative measures that may affect them. Article 31: 1. Indigenous peoples have the right to maintain, control, protect and develop their cultural heritage, traditional knowledge, and traditional cultural expressions...they also have the right to maintain, control, protect, and develop their intellectual property over such cultural heritage, traditional knowledge, and traditional cultural expressions. Article 37: 1. Indigenous peoples have the right to the recognition, observance, and enforcement of treaties, agreements, and other constructive arrangements concluded with States or their successors and to have States honour and respect such treaties, agreements, and other constructive arrangements.

9 OBJECTIVES Understanding Health Jurisdictional landscape and First Nations Health Services Contextualize 2015 Truth & Reconciliation Commission of Canada (TRC) health-related calls to action Identify what Truth & Reconciliation means for First Nations Health Service Delivery Propose strategies for First Nations Health to respond to the health related calls to action

10 Overview Background to the TRC Health-related calls Alberta First Nations strategies for responding to the calls Mobilizing for change

11 Terminology Reconciliation is a process of healing of relationships that requires public truth sharing, apology, and commemoration that acknowledge and redress past harms. TRCC, What we have learned: Principles of Truth and Reconciliation, pg. 125 Reconciliation Process of finding how to make 2 different perspectives exist or be true at same time Act of restoring good relationships after discord Indigenous Peoples In Canada this includes First Nations, Métis and Inuit peoples, including onreserve, settlement, rural and urban populations Descendants of original peoples of this land 4.3% of Canadians according to 2011 census, growing faster than non-indigenous populations

12 Truth & Reconciliation Commission of Canada Background

13 TRCC Established by Indian Residential Schools Settlement Agreement to settle class action lawsuit For 6 years, 3 commissioners travelled Canada listening to Indigenous people taken from their families as children and placed in residential schools 6,000 witnesses, most survivors of the schools Published 527 page report in June 2015 Getting to the truth was hard, but getting to reconciliation will be harder Reconciliation requires that a new vision, based on a commitment to mutual respect, be developed Reconciliation is not an Aboriginal problem; it is a Canadian one. Virtually all aspects of Canadian society may need to be reconsidered. (VI: sites/trcinstitution/file/reports/exe cutive_summary_english_web.pdf) 94 calls to action

14 Illness Legacy of Residential Schools TB and other infectious diseases Malnutrition Mental health conditions Mental, physical and sexual abuse Inter-generational trauma Chronic disease burden Systemic neglect, unequal treatment Denied access to traditional and western healthcare; jurisdictional barriers to care

15 Reconciliation Indian Act, s.88: All provincial laws [which are otherwise within the constitutional jurisdiction of the province] which might impact upon traditional healing will apply to Aboriginal people defined as Indians under the Indian Act unless they: (1) specifically legislate in respect of Indians or lands reserved for Indians; (2) are inconsistent with the Indian Act or any other federal legislation; (3) are inconsistent with any regulation or band bylaw enacted under the Indian Act; (4) are inconsistent with treaty rights.

16 Reconciliation (continued) As either an Aboriginal right or a treaty right, the practice of traditional healing and the use of traditional medicines is recognized and affirmed by section 35 of the Constitution Act, This changes the structure and scope of legislative power. These rights are given the highest protection by law in the country. To the extent that any legislation or regulation limits the practice of traditional Aboriginal medicine, the limitation must be justified by the Crown according to the tests set out by the Supreme Court of Canada.

17 OUTCOMES OF THE TRCC Calls to Action (in total 94) to redress the legacy of residential schools and advance the process of Canadian reconciliation. Many institutions, levels of government and organizations are determining how to respond to the Calls to Action Written reports and permanent documentation National Centre for Truth and Reconciliation hosted by the University of Manitoba Adoption of United Nations Declaration on Rights of Indigenous Peoples (UNDRIP) Education initiatives

18 TRC Principles: Reconciliation as Relationship a process of healing of relationships that requires public truth sharing, apology, and commemoration that acknowledge and redress past harms. requires constructive action on addressing the ongoing legacies of colonialism that have had destructive impacts on Aboriginal peoples education, cultures and languages, health, child welfare, the administration of justice, and economic opportunities and prosperity. must create a more equitable and inclusive society by closing the gaps in social, health, and economic outcomes that exist between Aboriginal and non-aboriginal Canadians. %20Reconciliation.pdf (pgs. 3, 125)

19 To go from a largely unaware public to a place of understanding (and widespread commitment to "healthy relationships) is not so easily conceived. If the residential school system is powerfully symbolic of the flawed relationship[s] (Castellano et al., 2008, p. 404) between settlers and Indigenous peoples, and the work of truth and reconciliation has at its core human relationships, (Erasmus, 2009, p. ix) then the TRC must conceptualize its role in relation to the necessity of transforming these relationships Czyzewski, K. (2011). The Truth and Reconciliation Commission of Canada: Insights into the Goal oftransformative Education. The International Indigenous Policy Journal, 2(3).

20 Health Equity health equity concerns those differences in population health that can be traced to unequal economic and social conditions and are systemic and avoidable and thus inherently unjust and unfair.

21 Health Legacy Calls to Action Calls of 94 Calls_to_Action_English2.pdf

22 Call 18 We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.

23 First Nations Health Policy and Legislation in Canada

24 Hierarchy 24

25 First Nations Health Delivery Timeline 1877 (11 Treaties) 1904 (General Medical Superintend ent hired 1922 (Mobile Nurse Visitor Program) 1930 (1st on-reserve nursing station) 1944 (Indian Health/Nati onal Dept of Health and Welfare) 1970 (Canada Health Act) 1979 (Indian Health Policy)

26 Jurisdictional Framework for First Nations Health within Canada is a patchwork of laws 26

27 Laws to Regulate First Nation Jurisdiction/ Inherent Right and Aboriginal/Treaty Rights Federal Jurisdiction Peace order and good government, Criminal Law, Intellectual Property, Spending, Indians and Lands Reserved for Indians Food and Drug Act and Regulations Natural Health Products Regulations Criminal Code Controlled Drugs and Substances Act Hazardous Products Act Indian Act Tobacco Act Provincial Jurisdiction - Health Institutions, Property and Civil Rights, Natural Resources, Local or Private Matters, Taxation and Spending Smoking legislation Collection of medicines (flora and fauna) Regulation of health professionals Privacy and health information

28 Call 19 We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non- Aboriginal communities, and to publish annual progress reports and assess long-term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.

29 Life expectancy for First Alberta Nations Health First Trends Alberta October 7, 2015 Life Expectancy at Birth (years) Japan Singapore Israel Austria Ireland Lebanon Cyprus United States Dominica Croatia Poland Tunisia Libya Malaysia Venezuela Thailand Iran Romania Jamaica Grenada Paraguay Vanuatu Indonesia Fiji Philippines Uzbekistan Mongolia India Madagascar Gabon Papua New Guinea Tanzania Zimbabwe Niger Guinea Burundi Côte d'ivoire Swaziland 1 This is the first in a series of First Nations-specific Health Trends compiled in collaboration by Alberta Health and the Alberta First Nations Information Governance Centre (AFNIGC). To suggest future topics, please contact the AFNIGC (communications@afnigc.ca; ). 2 United Nations Development Programme. Human Development Report, Accessed online October 2015 ( 3 Statistics Canada, CANSIM, table Accessed online October 2015 ( Life expectancy for First Nations in Alberta Life expectancy at birth by country and First Nations status (Alberta, Canada), 2013 Life expectancy at birth is the average number of years a newborn baby is expected to live if current death trends apply. In this first edition of First Nations Health Trends Alberta, 1 life expectancy at birth is presented for 187 countries (not all labeled in figure) and for non-first Nations and First Nations in Alberta separately. Country-specific life expectancies were reported by the United Nations Development Programme. 2 In 2013, life expectancies ranged from 83.6 in Japan to 45.6 in Sierra Leone. For almost all countries, life expectancies were higher for females than males (average 5 year difference). Amongst the 187 countries, Canada was ranked 9th in 2013 with a life expectancy of 81.5 years (79.3 for males and 83.6 for females). This is a substantial improvement from life expectancies reported by Statistics Canada a century ago: in , Canadian males were expected to live to 59 year of age (61 years for females) Alberta, Canada: non-first Nations (82.1 years) First Nations (72.5 years) Life expectancy for First Nations in Alberta is 10 years shorter than non-first Nations 40.0 In Alberta, life expectancy at birth for non-first Nations in 2013 was 82.1 years (80.0 in males and 84.1 in females). This life expectancy was comparable to countries such as Australia, Singapore, and Sweden which all had life expectancies around 80 years of age. For First Nations in the province, however, life expectancy was 10 years shorter: 72.5 years. This was true for both males and females with life expectancies of 70.5 and 74.8 years, respectively. Countries with life expectancies similar to First Nations in Alberta included Guatemala, Paraguay, and Cambodia.

30 Closing the Gap In Alberta Life Expectancy for: Non-First Nations same as Sweden, Singapore and Australia First Nations same as Cambodia, Guatemala and Paraguay

31 Closing the Gap

32 Co-Management The experiences of co-management and decentralization provide for a number of policy implications to be drawn concerning the role of government. Pomeroy and Berkes suggest that co-management in Canada works on a devolution model between government and First Nations, primarily because land claims and treaties provide legally defined relationships between the two parties. Co-management assumes an equal access to information, with community having traditional knowledge and government having access to academic knowledge. For a co-management regime to be successful, government must have a legal regime in place for support. In Canada, true comanagement can only exist between government and First Nations because land claim agreements provide legally defined rights.

33 Royal Commission on Aboriginal Peoples (1997) Co-management has come to mean institutional arrangements whereby governments and Aboriginal entities (and sometimes other parties) enter into formal agreements specifying their respective rights, powers and obligations with reference to the management and allocation of resources in a particular area of crown lands and waters.

34 Manitoba s Projections and cost analysis to close the gap Clatworthy (2001; 2005) Population Figures The population figures used for the Manitoba case study came from two studies completed by Clatworthy (2001; 2005). These projections were based on the department of Indians and Northern Affairs Status Verification system, and were developed to assess the long-term impact of Bill C-31. They take into consideration a number of key factors, including: (a) trends in population size by location (on and off reserve), including migration; (b) annual rates of population growth by locations (on and off reserve); (c) annual additions to the population through Bill C-31 registrations; (d) trends in the composition of the population by section 6 registry category and location (on and off reserve); and (e) the rate of exogamous parenting, or parenting between someone who is (or is entitled to be) legally registered under the Indian Act and someone who is not entitled to be registered. Per capita costs were calculated over the whole relevant population, rather than just the people who used a particular program. This allowed us to add together expenditures on different programs to estimate total expenditure per person.

35 Call 20 In order to address the jurisdictional disputes concerning Aboriginal people who do not reside on reserves, we call upon the federal government to recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples. Call 21 We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.

36 Source: Alberta Health Interactive Health Data Application (Retrieved May 11, 2016) Non-First Nations Male Non-First Nations Female 21,619 26,402 36,893 53, ,517 34,366 44,067 58,062 82, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,000 50, , , , ,000

37 Source: Alberta Health Interactive Health Data Application (Retrieved May 11, 2016) First Nations Male First Nations Female 4,547 5,209 5,415 5,596 6,141 6,735 8,058 7,608 7,322 8,221 7,888 3, ,418 2, ,017 1,700 2,415 3,546 4,582 5,253 5,636 5,820 6,556 6,815 7,508 7,268 7,138 8,028 7,689 10,000 8,000 6,000 4,000 2, ,000 4,000 6,000 8,000 10,000

38 Source: INAC Indian Registry System First Nations Male First Nations female 5,507 6,285 6,103 6,209 6,831 3,086 3,439 3,535 3,893 4,675 4,346 2, ,005 1, ,000 6,000 4,000 2, ,000 4,000 6,000 8,000

39 Source: INAC Indian Registry System On Reserve Nations Male On Reserve Nations Female , ,740 1,952 1,975 2, , , ,258 4,130 3,956 4, , ,000 4,000 3,000 2,000 1, ,000 2,000 3,000 4,000 5,000

40 Source: INAC Indian Registry System Off Reserve First Nations Male Off Reserve First Nations Female ,346 1,487 1,560 1,665 1,827 1,900 2,027 1,973 2, , , ,000 2,000 1, ,000 2,000 3,000

41 Call 22 Call 23 We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients. We call upon all levels of government to: i. Increase the number of Aboriginal professionals working in the health-care field. ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities. iii. Provide cultural competency training for all health-care professionals.

42 Call 24 We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skillsbased training in intercultural competency, conflict resolution, human rights, and anti-racism.

43 Equality vs Equity

44 Health Equity Framework Mãori Uphold Treaty Right to Health

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