• Gain awareness and understanding of
Aboriginal health legislation and policy framework

• Canadian health system: complex (policies, legislation and relationships)
• Multiple authorities: federal provincial/territorial, municipal governments
• Aboriginal authorities
• Private sector

• 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

• 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)

• 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

• 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

• 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

• 1994 – smaller communities: mechanism for community control
• 176 communities as of 2003

• 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)

• 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

• Regional Health Authorities: priority setting, planning and delivery of health services
• Increase public participation - engagement

• 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

• 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’

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

• Opportunities for Aboriginal engagement in health policy and service delivery
• Nunavut Land Claims Settlement Agreement
• Métis Settlement Agreement

• 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