The Canada Health Accord between the federal government and the provinces will expire in 2014. This financial transfer arrangement is between Canada and the provinces. First Nations have a special arrangement through Health Canada for programs and services on reserves. However the province has jurisdiction to implement health program and services and therefore First Nations are implicated. This creates uncertainty and no effective funding or health services to First Nations. There is urgency for change and improvement in health policy to address the health crisis of First Nations across Canada. The problem is that provinces also have a limited role in negotiations. Prime Minister Harper has already announced there will only be a 6% increase to federal transfer payments to the provinces. This does not include how First Nations and there health services will be addressed. Canada allocates more than ten percent of its gross domestic product revenues to healthcare, but the numbers aren’t adding up as health performance data indicate a level of services far behind the resources committed[1].
Privatization of health care is on federal government radar and rising drug prices are one of the main drivers of a health-care system said to be headed for in-sustainability. A recommendation by the Canadian Pharmaceutical Association suggests, “The federal government should allow the provinces the maximum amount of flexibility to design, regulate, and provide healthcare to citizens within a universal and portable framework”[2]. First Nations need to be part of the planning process to address their health. Accountability is more than financial statements of the paper trail. First Nation suffering is big business for Health Canada stakeholders like pharmaceutical companies and the bureaucracy controlling the strings. There is a growing health disparity and population growth between First Nations and the rest of Canada. It is time for legislation to control funding levels for health programs. First Nations say health is treaty right, government says that it is policy; the game of hot potato between federal and provincial government over responsibility has had fatal consequences and needs to come to an end.
Health Care is important to all Canadians and Canada is working to find solutions to rejuvenate its universal Health Care system for the long haul. There is a widening gap between the health of First Nations people, and the rest of Canada. Historically, First Nations had three types of healers; herbalists, medicine men and shamans. Largely considered folklore by Europeans, they dismissed their knowledge as basic first aid and witchcraft. Today there are over 170 drugs listed in the pharmacopoeia of the United States of America which owe their origin to Aboriginal usage and a more understood connection between physical health and spiritual health. Studies from anthropologists whom have looked at bones and teeth from remains of prior to contact have concluded Aboriginal people were relatively healthy and disease free. At contact, infectious diseases like tuberculosis and influenza took a significant toll on depopulating Aboriginal nations, estimates running as high as more than 90% of the original inhabitants. In the twentieth century, there have been increases in new infectious diseases such as AIDS and chronic diseases such as cancer and cardiovascular disease. There has also been an increase in deaths from accidents, violence and substance abuse[3].
There are other factors that affect the health of First Nations. Today, hard drugs have made their way into First Nation’s communities. Cocaine cut with other fillers to increase profit, crack cocaine, ecstasy, even marijuana with higher levels of pcp than earlier decades and alcohol abuse, such as drinking at an early age, binge drinking, and during pregnancy have had very adverse effects on communities. This is evident in the school system where children have problems paying attention because of FAS. This is the big difference my parents saw growing up in the community from when they were kids until today. Many of the health problems are self inflicted and the fault of the Aboriginal individual, tobacco abuse is one such example. People starting smoking at an earlier age, and have a higher percentage of smokers than the rest of the population at 58%[4]. In northern communities, this problem in compounded with another factor that is not their fault.
Manitoba Hydro changed the landscape forever and an entire way of life was destroyed and forever altered. Meanwhile government officials, media, and a large part of mainstream society go off lecturing about healthy eating and healthy lifestyle; failing to consider the price of food is much higher and their traditional hunting, fishing and gathering lifestyle, cannot be supported in an environment which can be likened to a 50 year old clogged bath tub.
Two particularly pressing concerns for Aboriginal peoples today are access to adequate housing and their overall health. Of the 1,600 active tuberculosis cases reported in Canada in 2005, 19% of the patients were Aboriginal peoples. HIV/AIDS rates among Aboriginal peoples are an ongoing concern, especially for Aboriginal women and youths. From 1998 to 2005, women made up 47% of all new HIV diagnoses among Aboriginal people, and there are higher rates for diabetes mellitus among Aboriginal peoples. In 2001, 11% of Aboriginal adults on reserves had been diagnosed with diabetes. These problems are linked to income, employment levels, education, social conditions, access to health care; people living in overcrowded conditions with moldy houses not being properly ventilated, malnutrition, and a lack of running water. [5] It will cost the Canadian government more money to look after chronically ill and acutely ill Aboriginal people in the long run which is why prevention and education of illness is key and why health care is important to First Nations and all Canadians.
One of the biggest concerns about the current state of health care is that it is headed for in-sustainability. Rising drug prices are one of the main drivers and further, up to 80 per cent of new drugs are a long way from miracles. They're in fact knockoffs of existing drugs - a molecule changed, a new name, and a marketing campaign in the hundreds of millions[6].
Canada’s universal health care system is consuming a comparatively high share of national resources but fails to deliver results comparable to other industrialized countries. In 2009, Canada allocated 11.4 percent of its national economy (GDP) to healthcare and none of the health performance data indicate a level of services adequate with the resources devoted to healthcare[7]. On the United Nations index, Canada ranks in the top ten, while First Nations sit closer to 100. This is appalling given most of these resources are taken right out of First Nations backyards and they are the ones left to live with the health hazards associated to environment degradation and pollution. There are also no hospitals in remote communities despite billions coming out of the north in resources.
The growing Aboriginal population and their overall health situation is another area of financial concern in the long term. However, the federal government believes that, with certain exceptions, it does not have any legal or fiduciary obligations with regard to health care for Aboriginal people. The federal government is adamant that health care for Aboriginal people is not a treaty right but rather a discretionary policy for programs and services. The issue of jurisdiction for effective health services for First Nations creates the underlying problem for effective health delivery for First Nations. The funding problem because of the division of powers between the federal government and provincial government is to adequately address health issue for First Nations. The last Health Accord in 1994 also excluded First Nations input in the negotiations and so too will the 2014 health accord have little or no Aboriginal input.
There are some fundamental disputes between First Nations and the federal government about health services. First is the conflict in the definition of health, second is how health policy is implemented for Aboriginal people, and third is the funding of First Nation health services, including the statutory, constitutional, or fiduciary obligations of the federal government regarding the provision of health services of Aboriginal people. The underlying problem of health is the fiduciary obligation by federal or provincial governments. This conflict provides a lack of appropriate funding arrangements[8].
Canada does have an Indian health transfer policy dealing with First Nation’s health services. However because of jurisdiction provinces have some role in health delivery including to First Nations. First Nations say health is treaty right, government says that it is policy. The game of hot potato between the federal government and provincial over responsibility has had fatal consequences that may have been avoided. Jordan’s Principle was the result of federal and provincial government disagreement on who should pay for government services to status Native children on reserves. This is just a prime example of how FN’s, especially our most vulnerable, fall through jurisdictional cracks and received treatment less than anyone else in this country[9].
It’s time for legislation, not policy to address the funding for health on First Nations. The province receives funding for health and social transfer payments from federal government based on population data including the population of First Nation’s. Policies can and are changed unilaterally by Government to suit their needs and do so often. Often the bottom line comes down to dollars. With legislation there would be enhanced safeguards against this in that it would harder to change legislation versus policy. Andrew Webster emphasizes,” Canada has avoided any Indian-specific legislation which suggests federal responsibility for Indian programs and services. Every year, Aboriginal Affairs and Northern Development Canada and other departments request from parliament the moneys they need to be appropriated”[10]. Doctors and specialists should be more sharing more test results with one another. In one of my family members’ case, they have seen numerous specialists all taking x-rays and running their own tests. I imagine this also goes on at a larger scale with more people and contributes to the swelling cost.
There is little to no arrangements for First Nations to be at the table and participate in health strategies for the future. It is importantly to remember that First Nations health is operating in a system that for the last 150 years, has been trying to rid its self of its fiduciary obligation. The cost is increasing while First Nations are getting sicker. Health Canada does not have public health legislation that applies to reserves and therefore works with provincial governments to address regulatory issues[11].
Canadians need to be on guard for privatization of health care, Harper has openly supported this move. His position is that health care is the responsibility of the provinces. The last time First Nations were involved in discussions was in 1995 when the Liberals tabled the Kelowna accord. This had a 5 billon dollar plan with prevention strategies that included health services. This Kelowna Accord would have addressed the health crisis of First Nations to a level that can be manageable and improved[12]. The Canadian Pharmacists Association recommends that the federal government establish a consultation process involving all key stakeholders to discuss the future of health care in Canada post-2014[13]. “The federal government should allow the provinces the maximum amount of flexibility to design, regulate, and provide healthcare to citizens within a universal and portable framework”[14]. First Nations want control of their health programs; this would include holistic approach, a blended medicine model.
If Aboriginal self-government is supposed to be based on tradition, then ASG would also have to include using traditional medicine. It is not possible to put labels on traditional medicine or to divide into boxes like western medicine. Traditional medicine is primary. It exists in a person’s entire life and deals with all as aspects of wellness. Western system focuses on physical and mental, but not as much emotional and spiritual, so not as holistic.[15] Western system requires scientific evidence before it can be used for public health. For example, Oxycotin was a scientific approach for public consumption that went terribly wrong for people to be addicted to it rather than manage pain to heal. First Nations need minimum standards for care; Legislative standards of care. This would include a minimum number of doctors/nurses per number of population. No more providing generic and cheaper drugs in place of what is actually prescribed. There should standards for screening in cancer care[16].
Challenges Canadians and First Nations are facing are finding solutions to curb the rising cost of health care. First Nations are having a difficult time having their input to address their health problems heard and considered. In northern Manitoba, it’s time for a hospital to accommodate the health issues. Nurses are dealing with health issues beyond their scope. Many nursing stations don't even have defibrillators."They're being distributed in libraries in southern Manitoba, and there are no defibrillators in nursing stations," said MKO Grand Chief David Harper. "It's totally unacceptable.[17]" During the H1N1 scare, body bags were sent to communities. A few years later, Slop pails were sent to deal with water crisis. There is just a lack of Aboriginal consultation that isn’t looking like it will improve soon. There are too many profiteers in the Aboriginal industry, too many drug companies that are profit driven. An incredible amount of money is spent to keep the bureaucracy alive while money meant to reach communities – never does.
First Nations are disappointed at the way the media portray their issues for a couple reasons. First, the way they are constantly portrayed as taxpayers burdens, which are always complaining, and a drain on public resources. Secondly, that more attention is paid to mismanagement of funds, even if they are just accusations. The public opinion is important because if no one is concerned about the living conditions and underfunding of First Nations communities, then nothing will be done. In Attawapiskat, it was only the anger of public opinion that made the federal government act in the way they did and send Ready-to-Move houses to the community. Public opinion matters because that’s the way elected politicians survive. Furthermore, the term taxpayers burden is a misdemeanor because all Canadians are entitled to universal health care through the health accord transfer arrangements, it is not only First Nations that receive federal funding.
This negative public opinion affects the way that Aboriginal people are treated when they go to emergency rooms. Underfunding problems create situations that when Aboriginal elders who need to go into home-care situations, there's none available. With more projects ahead like the proposed pipeline through British Columbia, these projects have health impacts because Indigenous peoples live downstream. Leaders are wondering if they should continue to try to sit outside looking in as these discussions take place, or do we take a progressive move and set up thier own forums, which would cost money that government or the companies profiting from resources in First Nations territories are not likely to provide, leaving leadership to consider looking for international funding to make it happen[18].
The Romanow Report (2002) suggested funding for Aboriginal health should come from all levels of government – include Aboriginal traditional approaches to health in mainstream healthcare – make health care more accessible, stable, and predictable. The report identified a need for an increase in the number of aboriginal health care professionals. What is happening is First Nations end up with lots of nurses, community health representatives, but not doctors. Creating a sub-culture with a lot of healthcare aids, instead of professionals like nurses and doctors[19].
Canada with the advice of the department of justice will not discuss health as a treaty right, but rather as a policy discretionary for services. Health Minister, Leona Aglukkaq has already indicated to the Manitoba chiefs that the topic of treaty is not on the table for discussion for the 2014 Health Accord. The federal position has always been that the provinces need to be involved in First Nation’s programs and services. The dilemma for First Nations is about fiduciary obligation and jurisdiction. This conflict is one of the basic reasons for the crisis of First Nations health. Second, is what this paper has outlined about health issues in First Nations. This 2014 health accord the federal government has already capped it at a 6 % increase per year for the next 5 years[20]. Federal government has also indicated there will be no negotiations either with the provinces or First Nations. It may be understood this step is necessary for the overwhelming increase of health costs for all Canadians. This was the issue in 1990 when Paul Martin addressed the federal debt crisis. The rising cost of health arises from the cost off drugs, professional care and internal matters in the health system. Canada position is the provinces and First Nations should manage their own existing funding from the federal government. Health care will continue to be a crisis if all three levels of government will not work as a team as what federalism was meant to be.
Bibliography
1. Andrew Webster. “Perspective- First Nations- Fed and Economic Update,” accessed 24 January 2012: available from: http://www.turtleisland.org/discussion/viewtopic.php?f=19&t=5052
2. Cindy Blackstock. “Jordan’s principle”: Editorial update Accessed 27 December 2011 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603509/
3. David Harper. “Parents want answers”. Accessed at http://www.winnipegfreepress.com/local/parents-want-answers-after-infant-dies-134736083.html
4. David P. Ball. On the outside looking in: Indigenous peoples excluded from premiers' health talks. Accessed 28 February 2012 at: http://rabble.ca/blogs/bloggers/david-p-ball/2012/01/outside-looking-indigenous-peoples-excluded-premiers-health-talk
5. Government of Canada. “Aboriginal Health and Well Being” Accessed 6 March 2012 at: http://www41.statcan.gc.ca/2007/10000/ceb10000_004-eng.htm
6. James S. Frideres, Rene R. Gadacz. “Aboriginal Peoples in Canada”: Eighth Edition. (Toronto: Pearson, 2008).
7. James B Waldram, D. Ann Herring, T. Kue Young. “Aboriginal Health in Canada”: Historical, Cultural, and Epidemiological Perspectives. (Toronto: University of Toronto Press, 1995).
8. Jason Clemens. “Turning point 2014”:Reforming Canada Health Transfer. Accessed 20 February 2012 at: http://www.ipolitics.ca/2011/10/27/jason-clemens-turning-point-2014-reforming-the-canada-health-transfer/
9. Maude Barlow. “Canadians need to be on guard for upcoming renegotiation of the Canada Health Accord”: ACCESSED 23 FEBRUARY 2012 AT: http://rabble.ca/blogs/bloggers/maude-barlow/2011/06/canadians-need-be-guard-upcoming-renegotiation-canada-health-acc
10. Melanie McKinnon. “A first nations voice in the present creates healing in the future”. Accessed February 2012 at: http://www.medicinecreek.ca/files/A%20First%20Nations%20Voice.pdf
11. Micheal McBane. “Harper's abandonment of federal responsibility in health care”. Accessed 3 February 2012 at: http://rabble.ca/news/2012/01/harper-governments-abandonment-federal-responsibility-health-care
12. “Protecting Public Health Care in the 2014 Health Care Accord”. Accessed 25 February 2012 at: http://www.canadians.org/healthcare/issues/accord/index.html
13. “Pre-Budget Consultation”. Accessed 6 March 12 at: http://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/PreBudgetConsultation2011.pdf
14. Roy Romanow. “Commission on the Future of Health Care in Canada”. Accessed 19 February 2012 at: http://aupe.nucleus.com/Romanow0402.pdf
[1] “Protecting Public Health Care in the 2014 Health Care Accord”. Accessed 25 February 2012 at: http://www.canadians.org/healthcare/issues/accord/index.html
[2] “Pre-Budget Consultation”. Accessed 6 March 12 at: http://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/PreBudgetConsultation2011.pdf
[3] James B Waldram, D. Ann Herring, T. Kue Young. “Aboriginal Health in Canada”: Historical, Cultural, and Epidemiological Perspectives. (Toronto: University of Toronto Press, 1995).
[4] James B Waldram, D. Ann Herring, T. Kue Young. “Aboriginal Health in Canada”: Historical, Cultural, and Epidemiological Perspectives. (Toronto: University of Toronto Press, 1995).
[5] Government of Canada. “Aboriginal Health and Well Being” Accessed 6 March 2012 at: http://www41.statcan.gc.ca/2007/10000/ceb10000_004-eng.htm
[6] Micheal McBane. “Harper's abandonment of federal responsibility in health care”. Accessed 3 February 2012 at: http://rabble.ca/news/2012/01/harper-governments-abandonment-federal-responsibility-health-care
[7] Jason Clemens. “Turning point 2014”:Reforming Canada Health Transfer. Accessed 20 February 2012 at: http://www.ipolitics.ca/2011/10/27/jason-clemens-turning-point-2014-reforming-the-canada-health-transfer/
[8] James S. Frideres, Rene R. Gadacz. “Aboriginal Peoples in Canada”: Eighth Edition. (Toronto: Pearson, 2008).
[9]Cindy Blackstock. “Jordan’s principle”: Editorial update Accessed 27 December 2011 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603509/
[10] Andrew Webster. “Perspective- First Nations- Fed and Economic Update,” accessed 24 January 2012: available from: http://www.turtleisland.org/discussion/viewtopic.php?f=19&t=5052
[11] Melanie McKinnon. “A first nations voice in the present creates healing in the future”. Accessed February 2012 at: http://www.medicinecreek.ca/files/A%20First%20Nations%20Voice.pdf
[12] James S. Frideres, Rene R. Gadacz. “Aboriginal Peoples in Canada”: Eighth Edition. (Toronto: Pearson, 2008
[13] “Pre-Budget Consultation”. Accessed 6 March 12 at: http://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/PreBudgetConsultation2011.pdf
[14] “Pre-Budget Consultation”. Accessed 6 March 12 at: http://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/PreBudgetConsultation2011.pdf
[15] James S. Frideres, Rene R. Gadacz. “Aboriginal Peoples in Canada”: Eighth Edition. (Toronto: Pearson, 2008).
[16] Melanie McKinnon. “A first nations voice in the present creates healing in the future”. Accessed February 2012 at: http://www.medicinecreek.ca/files/A%20First%20Nations%20Voice.pdf
[17] David Harper. “Parents want answers”. Accessed at http://www.winnipegfreepress.com/local/parents-want-answers-after-infant-dies-134736083.html
[18] David P. Ball. On the outside looking in: Indigenous peoples excluded from premiers' health talks. Accessed 28 February 2012 at: http://rabble.ca/blogs/bloggers/david-p-ball/2012/01/outside-looking-indigenous-peoples-excluded-premiers-health-talk
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