June 2011 - Canada's health system is varied, complex and inconsistent when it comes to serving Aboriginal peoples.

A new NCCAH report tracks Aboriginal-specific policies and legislation to 2008 and notes, for instance, that the only jurisdiction with a Métis health policy is the Northwest Territories; the most comprehensive Aboriginal-specific policy framework in Canada is the Ontario Aboriginal Healing and Wellness Strategy, and the one jurisdiction in the country recognizing a need to respect traditional healing practices is the Yukon.

The report also highlights new models supporting Aboriginal control of health services and initiatives. Looking for Aboriginal Health in Policies and Legislation, 1970 to 2008 and a related fact sheet provide evidence Aboriginal health policy in Canada remains largely patchwork - and that jurisdictional issues have increased rather than declined.

Led by Dr. Josée Lavoie, Associate Professor, School of Health Sciences at the University of Northern B.C., the report authors note that a national umbrella Aboriginal health policy may be necessary to address significant gaps in service and jurisdictional ambiguities that directly impact the health of Aboriginal peoples.

The policy synthesis project was conducted over a one-year period and involved searches of publicly available information. The goal was to fill an information gap by:

• developing an inventory of federal, provincial and territorial health policies and legislation that make specific mention of First Nations, Inuit and Métis peoples
• documenting health-related provisions embedded in treaties and self-government agreements
• identifying emerging trends in relation to jurisdictional fragmentation and coordination
• noting opportunities for Aboriginal engagement in shaping health policy, programs and services.

The report finds that Canada's health policies are built on a foundation of historically vague legislation that underpins ongoing federal and provincial divisions concerning who provides what health services to which groups of peoples, depending on identity (First Nations, Inuit, Métis); residence (on-reserve, off-reserve); status (registered, non-registered) and service. The development of thirteen different provincial and territorial healthcare systems, a trend toward regionalization, increasing Aboriginal self-government activities, and varying health delivery models compound the difficulty for First Nations, Inuit and Métis in accessing appropriate and responsive health care. 

At the same time, the authors note a transformation in how Aboriginal health services and programs are being delivered. First Nations and Inuit are realizing enhanced control of community-based health services, a trend initiated with the 1979 Indian Health Policy and the Health Transfer Policy framework in 1989. "Today, most First Nations communities design and implement their community health programs and employ the majority of their health service staff," the report notes.

Self-government agreements are also leading to unique models and to legislation defining areas of responsibility in health; for instance, in the Yukon, in Quebec and in Newfoundland and Labrador. 

In addition, Aboriginal healing and ceremonial practices are gaining recognition and affirmation. Health legislation in the Yukon respects traditional healing practices. Ontario and Manitoba recognize that Aboriginal midwives should be exempted from control specified under the Code of Professions, while Ontario extends this exemption to traditional healers. A number of provinces have adopted tobacco control legislation respecting the use of tobacco for ceremonial purposes.

Other highlights:

• Ontario set a precedent with its Aboriginal Healing and Wellness Strategy in 1990; its overarching Aboriginal Health Policy (1994) is considered the most comprehensive policy currently in place in Canada. Aboriginal-specific policies and legislation in Canada, however, continue to be limited.

• The BC Tripartite First Nations policy framework is leading to a new governance structure enhancing First Nations control over health in that province. A similar framework for the Mi'kmaq, "Providing Health Care, Achieving Health," has emerged in Nova Scotia. Both, although both models serve only First Nations populations.

• The health care needs of Nunavik Inuit and James Bay Cree are served through unique structures under the James Bay and Northern Quebec Agreement. These are co-funded by federal and provincial governments, managed by Aboriginal authorities, and linked to the provincial health care system. (See Cree Health).  Similar co-funding arrangements support the Athabasca Health Authority serving several First Nations and Métis communities in Saskatchewan, and the Northern Inter-Tribal Health Authority, serving nearly nearly half of First Nations in Saskatchewan.

• The Manitoba Inter-Governmental Committee on First Nations Health is an example of a cross-jurisdictional forum bringing together federal, provincial and Aboriginal government representatives to identify priorities and coordinate approaches to improving health.

• Alberta's Métis Settlements Accord of 1990 supports the right to make bylaws; for instance, in promoting the health, safety and welfare of residents in the Métis settlement area while enhancing Métis control over issues such as housing, child welfare and health and legal institutions.

Collaborative processes and modern treaties are helping bridge jurisdictional gaps to provide some coherence to Canada's complex health care system. The NCCAH report finds, however, that significant inequities remain in overall health status and health service access, compounded by jurisdictional disputes and ambiguities. Greater coordination and more equitable funding are needed to improve access to health services, and ultimately to support a holistic approach to health that enhances the health of First Nations, Inuit and Métis communities.