1. Policy Issue #6:
Aboriginal Health
HLTH 405 / Canadian Health Policy
Winter 2012
School of Kinesiology and Health Studies
Course Instructor:
Alex Mayer, MPA

2. Aboriginal Health

3. Today’s Lecture
Aboriginal Health: Social Determinants of Health
and the Import of Ethical Partnerships
• An Abbreviated History of Oppression
• Turning A Corner
o Calder case
o Residential Schools Apology
• Self-Determination as Cornerstone for Aboriginal Health
o Promoting Cultural Competency
o Models for Ethical Partnerships
o BC’s Transformative Change Accord

4. What Canadians See
Attawapiskat Crisis
Attawapiskat Response

5. 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)

6. Colonization (1700-1800s)
o Royal Proclamation (1763)
o Treaty of Paris (1783)

7. Indian Reservation System
o War of 1812
o Loyalist Migration (post-1814)
o Resident Schools are established (1830)

9. 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

10. Assimilation (1920s)

11. Residential Schools
Video:
Kevin Annett's "Unrepentant‛
A Documentary about Residential
School Survivors in Canada

12. Post-WWII Policies
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
Sgt. Thomas George Prince, peoples
most decorated Aboriginal soldier (WWII)

13. The White Paper (1969)
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
Indian Affairs Minister, Jean Chretien (1973)
Paper promotes the
extinguishment of treaties.

14. Thoughts?

15. ‚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)

16. Ethical Partnerships

17. 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

18. A Blueprint
July 2005
First Nations Leadership Council creates the
FN Health Blueprint for British Columbia
o 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

19. 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

20. 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

21. Transformative Change Accord’s
10-Year Action Plan
1. Establish effective mental health programs to address
substance abuse and youth suicide

22. 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)

23. 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

24. Transformative Change Accord’s
10-Year Action Plan
4. Increase the number of trained FN health professionals

25. Transformative Change Accord’s
10-Year Action Plan
Governance, Relationships and Accountability

26. 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

27. 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

28. Transformative Change Accord’s
10-Year Action Plan
Health Promotion and Disease/Injury Prevention

29. 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

30. 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

31. Transformative Change Accord’s
10-Year Action Plan
Health Services

32. 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

33. 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

34. Transformative Change Accord’s
10-Year Action Plan
Performance Tracking

35. 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

36. Conclusion

37. Have a great week!