Ruth Mwaura

Title: Federal Reform of Indigenous Health Policy framework  Issue This briefing note seeks to ask the federal government to resolve jurisdictional issues that render healthcare policies for Indigenous people complex. Aboriginal health inequity is greatly influenced by a less straightforward health care jurisdiction for Indigenous people.1 Background The health needs of Aboriginal people are fulfilled through a coordinated framework between all levels of governments. Jurisdictional ambiguity is a key issue that results from this collaborative approach since there exists uncertainty about the level of government in charge of funding and delivering services to Indigenous people.2 This implies that there lacks an Indigenous health policy that The consequence of jurisdictional ambiguity is health disparities between aboriginal and non-aboriginal communities.3 Therefore, there is a loop hole for an Indigenous health policy with well-established principles and as a result, there is need for a more rigid legislative framework to provide a well-defined structure. Current Status The access of quality and affordable health care for Indigenous people continues being an ongoing challenge. Until today, there is no enactment of Indigenous health care legislation in Canada.4 From 2016 all through to 2020 and 2021, efforts to push for the development of Indigenous healthcare legislation have been made by Indigenous healthcare leaders and other stakeholders.5 Discussion/Analysis In Canada, the level of Indigenous health inequity has increased, which demonstrates that the current public health policy is at a critical state. The historic relationship between Canada and Indigenous people has been questionable owing to the former’s persistent failure to fulfill the contemporary health problems of Aboriginal peoples.6 Partly, this failure is attributed to a lack of shared understanding and the existence of blurred roles of various levels government as far as the healthcare needs of Indigenous communities is concerned. Contemporary Indigenous health policy is characterized by persistent neglect and a lack of political will to make healthcare for the Indigenous communities more accessible.7 Various legislation and policy documents have been used to outline the roles that different governments in facilitating the Indigenous health system. According to the 1979 Indian Health Policy, all forms of governments, which include federal, provincial, municipal and Indian bands play a role. The federal government facilitates activities of public health on reserve areas, promotes health, and detects as well as mitigates environmental hazards that threaten health.8 On the other hand, provincial government’s role is diagnosing and treating acute and chronic disease.9 Recent policy documents include “Jordan Principle”, which was passed in 2007 and demonstrates that either the federal or provincial governments can pay for home care services for Aboriginal children.10 Another one is the 2016 “Daniels Decision” that demonstrated that Métis fall under the Indian category hence are under federal jurisdiction.11 The decision, however, did not provide clarity as to whether the federal government should provide health services to Métis people although they are eligible for funding and programs offered by federal government. The decision proposed by this document is that the federal government urgently creates and confirms a Ministry of Indigenous Health Services, as part of a public health policy by the federal government and that should be solely under federal jurisdiction. The central role of the department should be providing culturally-appropriate health services tailored to all Aboriginal people in Canada. This action has been realized in Australia where there exists a national health policy that seeks to deliver equitable and accessible health services to Aboriginal and Torres Strait Islander people. There is a clear Health Plan Policy instituted by the Australian government, which takes charge of monitoring and evaluation of progress targets made through the health plan.12 In Brazil as well, there exists a legislation based within the Ministry of Indigenous Health. It sees to minimize cultural barriers for Indigenous people. This ministry has been instrumental in devising a National Indigenous Healthcare Policy (PNASPI) that identifies the cultural specific health needs of Indigenous communities.13 This policy has been effective in operationalizing respect for Indigenous health needs and systems and in ensuring that Indigenous people are included appropriately in primary health care services.14 New Zealand too has a number of legislative statues and policies that recognize and embrace specific health values and needs of Māori. There exists a Maori Health Strategy known as He Korowai Oranga, which is a central part of New Zealand’s primary legislation and health policy.15 It monitors whether the primary health care system is compliant with Indigenous healthcare policy. It also seeks to address health inequities that Māori experience.16 The creation of a national policy framework through the development of a Ministry of Indigenous Health will be beneficial to Indigenous people because it will expand their right to participate in the development of health legislation and programs. This will translate to a holistic development of healthcare services for indigenous people and lead to the closing of health disparities for them. Options A major option for consideration when making this decision is the development of a new federal ministry that is fully committed to health service delivery in Indigenous communities.17 Another option entails the development of an Indigenous healthcare legislation by the federal government, whereby the jurisdiction of health service delivery is clearly outlined.18 Recommendation My recommendation is that Canada should develop a national public policy on Aboriginal health that will address inequitable Indigenous-specific health issues. This step will also help resolve jurisdictional ambiguity related to the role of governments in Indigenous healthcare delivery. This can be done through the creation of a Ministry of Indigenous Health services