Submission to the Standing Committee on Aboriginal Affairs and Northern Development

For the Committee’s Study on the Nishnawbe Aski Nation Declaration of a Health and Public Health Emergency

Grand Chief Alvin Fiddler April 14, 2016

NAN is a political territorial organization representing 49 First Nation communities within northern with the total population of membership (on and off reserve) estimated around 45,000 people. NAN encompasses James Bay Treaty No. 9 and Ontario’s portion of Treaty No. 5, and has a total land-mass covering two-thirds of the province of Ontario spanning 210,000 square miles.

BACKGROUND ON HEALTH CRISIS

May 1973: the National Indian Brotherhood (NIB) pass a resolution calling on the federal government to return control of Indian health to the Department of Indian Affairs, reversing the 1945 transfer to Health and Welfare. The NIB Resolution criticizes the Department of Health and Welfare for refusing to recognize Treaty rights to health care as a matter of departmental policy and for the Department’s history of non-consultation with First Nation people and their imposition of arbitrary decisions onto .

July 1980: Grand Council Treaty #9 Chiefs pass various resolutions related to health matters, including an appeal to the federal government to monitor water quality in the communities and establish potable running water and sewage disposal systems in all homes in Treaty #9 communities as soon as possible.

March 1981: Community Health Representatives (CHRs) present a report to the Chiefs of Grand Council Treaty #9 providing details of the inadequate state of health care services in the area. The Chiefs respond with a Resolution calling on federal Health and Welfare to establish local Health Committees.

August 1981: The Chiefs of Grand Council Treaty #9 pass a resolution expressing concerns about various health issues including the quality and quantity of staff provided by Health Services and the effectiveness of the air ambulance service. The same Resolution authorizes NAN to begin compiling a report on current health problems.

August 1983: NAN Chiefs support a request by James Bay area Chiefs for an inquiry into the operation and administration of the Moose Factory General Hospital because of the Chiefs concerns about the quality of the health and medical care offered at the facility.

July 1987: NAN Chiefs pass a resolution calling on the Sioux Lookout Zone Hospital to re-open one of two wards closed due to cost-cutting measures.

October 1987: NAN Chiefs, Elders and Tribal Council Chairs agree on a joint resolution mandating the NAN Executive to initiate a full-scale inquiry into the delivery of health services in the Nishnawbe- Aski territory.

January 1988: Josias Fiddler, Peter Goodman, Peter Fiddler, Luke Mamakeesic and Allan Meekis hold a fast at the Sioux Lookout Zone Hospital to protest the deplorable health conditions of First Nations in NAN. As a result, the Scott/McKay/Bain Health is established and mandated to investigate health care services and also look into potential models for future health care service delivery in the Sioux Lookout Zone. The report was released in May 1989. Major findings include:

1. The lack of Aboriginal empowerment to develop policies, plan for health care, make decisions, deliver services and accept community and individual responsibility for health. 2. The lack of community infrastructure and economic development required to support and promote health.

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3. The weakening of the traditional extended family due to exposure to western culture and the loss of spiritual values which has resulted in alcohol and substance abuse, family violence, suicide and other serious mental health problems, along with a sense of helplessness and hopelessness. 4. The failure of communication between the two cultures involved in providing and receiving health care which has led to lack of knowledge about health care, unrealistic expectations and a health care delivery system that is not always culturally appropriate. 5. The focus of current health care services is on treating illness rather than promoting health.

March 1988: NAN Chiefs pass a resolution endorsing principles that must be followed in any transfer of services from the federal government. The resolution says that the “Government of Canada is attempting to actually reduce its costs and avoid its fiduciary and treaty obligations under the guise of self-government.”

May 1988: NAN makes a presentation to the Standing Committee on Health and Welfare Canada at the House of Commons in Ottawa indicating the lack of accessibility by First Nations in the NAN area to the same comprehensive health services enjoyed by other Canadians.

May 1991: NAN sends a letter to Federal Minister of Health Benoit Bouchard requesting support for a proposal for community focused healing and suicide prevention strategies. The minister responds “no” to NAN’s request and further states an external review should be completed first on the NODIN mental health program based in Sioux Lookout. This review was completed in 1992 and called on Ottawa to provide the program with an additional $1.7 million per year to be effective.

June 1991: NAN Chiefs pass a resolution calling for a Commission of Inquiry into Youth Issues. Chiefs cite completed suicides and suicide attempts among young people as the rationale. The NAN Executive is also mandated to assist First Nations who have suffered losses from suicide, suicide attempts and emotional trauma by negotiating for funding for the implementation of community- focused healing and suicide prevention programs.

September 1992: NAN Chiefs pass a resolution declaring state of emergency due to high number of suicides; a copy of the resolution is sent to Health Minister Bouchard.

February 1996: NAN Chiefs pass a resolution calling for a Non-Insured Health Benefits (NIHB) mental health moratorium to be imposed on program changes and funding reductions to the Medical Services Branch of the NIHB Program, specifically on mental health, as suicide rates escalate in NAN.

March 2006: NAN Chiefs pass a resolution opposing Ontario’s unilateral establishment of the Local Health Integration Networks (LHINs) and its failure to consult with First Nations before changing the health planning system. 2006: Council declares a State of Emergency on prescription drug abuse/misuse in their communities.

August 2008: NAN Chiefs pass a resolution calling on Health Canada to develop a policy on prescription drug abuse (PDA) and establish treatment programs and services including aftercare programming.

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November 2009: NAN Chiefs pass a resolution declaring a prescription drug abuse state of emergency and call on both levels of government to respond immediately. In 2010, the NAN PDA Framework is created for which NAN receives no funding from either level of government for implementation.

April 2015: The Auditor General of Canada releases a report entitled Access to Health Services for Remote First Nations Communities which finds that Health Canada “did not have reasonable assurance that eligible First Nations individuals living in remote communities in Manitoba and Ontario had access to clinical and client care services and medical transportation benefits” and “did not take into account the health needs of remote First Nations communities when allocating its support.” NAN and Manitoba Keewatinowi Okimakanak (MKO) request a meeting with the Federal Minister of Health to discuss the implementation of report recommendations. The minister defers the matter to the ADM level and no concrete process established.

Other findings by the Auditor General of Canada include that Health Canada:

1. Did not ensure that nurses had completed mandatory training courses. 2. Had not put in place supporting mechanisms for nurses who performed some activities beyond their legislated scope of practice. 3. Could not demonstrate whether it had addressed nursing station deficiencies related to health and safety requirements or building codes. 4. Had not assessed the capacity of nursing stations to provide essential health services. 5. Did not sufficiently document the administration of medical transportation benefits. 6. Has a practice that First Nation individuals who had not registered are ineligible for Health Canada’s medical transportation benefits. 7. Committees designed to resolve inter-jurisdictional challenges have generally not been effective.

January 2016: NAN chiefs pass a resolution NAN Suicide Crisis Response and Need for Comprehensive Mental Health and Addictions Funding calling on Health Canada and Ontario for increased funding for community-based PDA programs.

January 2016: releases the report Nobody Wants to Die: They Want to Stop the Pain – The People’s Inquiry into our Suicide Pandemic. The NAN chiefs pass a resolution Special Emergency Task Force on Suicide and call on Ontario and Canada to help establish the task force to address the growing suicide epidemic.

February 2016: NAN declares a State of Public Health and Health Emergency. This is subsequent to a meeting on February 19, 2016, whereby Federal and Provincial representatives declined to declare a state of health and public health emergency on behalf of the NAN communities.

March 2016: NAN meets with the Ministers of Health Canada and the Ontario Ministry of Health & Long Term Care. Both levels of government commit to reviewing immediate and intermediate needs and a long term process on a transformation of the health system within NAN territory.

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PRESENT STATE OF HEALTH IN NAN TERRITORY

Effects of Levels of Education on Health and Wellbeing in NAN

Within NAN First Nations, a major barrier to employment and adequate wages is level of education. Lower levels of federal education funding for NAN children, compared to mainstream levels, has created challenges for the communities in the delivery of the same standard levels of education. The resulting low levels of income and education have a compounding effect on the health of a community. In order to further educational aspirations, many youth in NAN are forced to disconnect from their familiar surroundings of family, friends, home and community and find themselves displaced and alienated within an urban setting for which they are not prepared. A large proportion of First Nation youth (23.4%) aspired to complete high school while just over 10% of First Nation youth wanted to complete graduate or professional degrees (First Nations Information Governance Centre, Preliminary report of RHS Phase 2, 2011).

Alienation is made even more apparent where English is a second language to First Nation youth; over 20% of First Nation youth use a First Nation language most of the time in their daily lives, and more than half (56.3%) can understand or speak a First Nation language (FNIGC, 2011). In addition, practicing traditional knowledge and values is not recognized nor encouraged by the non-Aboriginal dominant society. Health Canada’s report Acting on What We Know: Preventing Youth Suicides in First Nations – the report of the advisory group on suicide prevention, May 2010, maintains that any breakdown in the transfer of cultural knowledge and traditions appears to contribute substantially to widespread demoralization and hopelessness of First Nation youth. While in pursuit of post- secondary education, students have lost their lives in city centres as demonstrated by the current Inquiry into the seven youth that lost their lives while attending high school in .

Housing

The current housing situation in many NAN communities is unacceptable by Canadian standards. The situation is not uniform in all NAN communities; rather a continuum of social deprivation and poverty exists. Some communities, such as Attawapiskat, have a majority of houses needing major repairs. Other communities, such as Pikangikum, face even more serious issues. For example, overcrowding is of grave concern, with as many as 18 individuals reported to be living in one house (Inspection report on the Pikangikum water and sewage systems. Northwestern Health Unit. 2006).

There are 22 communities in NAN with Boil Water or Do Not Consume advisories. According to a 2006 protocol designed to ensure safe drinking water for First Nation communities, it is the responsibility of Indian and Northern Affairs Canada (INAC) to provide funding to adequately maintain and operate water facilities (INAC, 2006). Pikangikum is one community but presented here as an illustration of all NAN communities: Pikangikum has a water distribution system built in 1995 and only 5% of the community’s 387 households are connected (ibid). The situation requires many residents to travel to the water station every day to pick up water. Those who are unable to travel to the water station are often left to consume untreated water from the lake, which exposes them to a number of potential health risks. Even the band office lacks sewage and water service (ibid). After their inspection of Pikangikum’s water and sewage situation in 2005, the Northwestern Health

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Unit recommended immediate action by the appropriate government agency to ensure that all residents of Pikangikum had access of to clean water in their home, at no expense to residents. The lack of a proper water distribution system in the community does not the meet the need for fire suppression measures and therefore cannot offer protection for the community members. That is sadly demonstrated by a house fire that occurred this month that took the lives of nine people, including that of three children.

Canada Health Policy Barriers and Challenges

More than half of NAN First Nations are remote and/or isolated, only accessible by air year round, creating unique challenges that affect accessibility to health services, infrastructure materials and affordable healthy food contributing to overall health disparities. Health Canada’s Non-Insured Health Benefit (NIHB) Medical Transportation Program has caused significant barriers to the access of quality health care through significant numbers of denials for travel for patients to their medical appointments in southern centers. NIHB clerks routinely deny and overrule physician referrals and a double standard exists in terms of how this program is delivered in comparison with the mainstream Northern Travel Grant Program that assists northern patients’ travel costs. While there is presently a national NIHB program review, it is much too early for NAN to identify any benefits but past participation in other national reviews have demonstrated that NAN’s recommendations are not identified in the final reports.

Suicides in NAN

Suicide rates continue to escalate at an alarming rate within NAN territory. Statistics show that suicide among Aboriginal people is two to three times higher than that of the general population in Canada (Health Canada. Acting on what we know: Preventing youth suicides in First Nations – The report of the advisory group on suicide prevention. May 2010). Many First Nation youth experience isolation, poverty, lack of basic amenities, and lack of family relationships that are nurturing or supportive (Health Canada, May 2010). The effects of colonization, marginalization and rapid cultural change have left youth in the wake of foreign values and beliefs and deep conflicts surrounding their identity, resilience and culture.

The report, Horizons of Hope: An Empowering Journey: Nishnawbe Aski Nation Youth Forum on Suicide. April 2011, states there were 130 suicides in NAN territory at the time this report was released. Of the 427, 57 completed suicides occurred in children 10-14 years of age and 174 completed suicides for youth 15-20 years of age (ibid). Out of the 427, 322 completed suicides were as a result of hanging, 30 from gunshot, and 13 from overdose. Males accounted for more completed suicides at 262 than females at 145. Disclaimers to these statistics are influenced by: i) jurisdiction where not all suicides within the NAN territory are within the same jurisdiction or reported to the same agency, e.g., police, counselling services, children and youth services, or medical services; ii) confidentiality policies from so many different sources vary and do not allow for easy collection of data; iii) coroner reporting where overdoses are often reported as accidents although many are ‘suspected’ suicides; and iv) reported suicides for NAN members living off-reserve may not be reported back to the respective First Nation or to NAN (Nishnawbe Aski Nation, April 2011). As of March 2016, there have been a total of 509 people lost to suicide. As a response to this epidemic, we are calling on Canada to help create and participate in a Special Emergency Task Force to address the growing suicide epidemic.

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Mental Health

In 1996, NAN hosted a Youth Forum on Suicide to bridge the generation gap, address the suicide crisis, and allow NAN youth to identify potential long term solutions and conduct an inquiry into the lives and deaths of the young people. In the NAN Youth Suicide Forum 1996 report, it states that the youth were killing themselves because of deep psychological pain and their fear of breaking the silence of abuse and violence (NAN, 1996). The youth identified that one of these goals would be to find adequate financial and human resources to provide adequate mental health services and support across the continuum of care (NAN, 1996). The youth were also quick to point out that there was no single cause, no single solution to the problem of suicide but it was a complex interplay of social, economic, community, spiritual and political factors (NAN, 1996). Health Canada provides some funds to NAN communities for suicide prevention/life promotion but they are severely underfunded. Significant investments are required to deliver effective prevention and life promotion programs.

Prescription Drug Abuse (PDA)

In 2009, NAN declared a State of Emergency in relation to the PDA epidemic within the NAN territory. The opiate addiction rate within NAN’s member communities reached a magnitude not perceived anywhere else in Canada’s First Nations. Addiction rates reached up to 80% of some of the communities and children as young as 10 years old were identified as misusing prescription drugs. While Health Canada has recently started to provide limited funding for community-based PDA programming, programs are severely underfunded and focused mainly on the detoxification component. In addition, most of these programs are delivered in makeshift buildings. Health Canada has to significantly increase funding for aftercare and infrastructure.

Diabetes

The prevalence of diabetes among First Nation people in Ontario is three times higher than among non-First Nation (Yuan, L. Nishnawbe Aski Nation community and health profile, 2006). Of those afflicted with diabetes, mortality rates are higher among First Nation people than among non- First Nations (ibid). While individual data for NAN communities is not always available, nearly half of the First Nation communities surveyed in Ontario were NAN communities (ibid). One example from a NAN community is Eabematoong (Fort Hope), where 1 in 5 adults has diabetes (ibid). The statistics confirm the notion that Diabetes is a real problem within NAN territory. It is easy to identify the major factors that contribute to diabetes in NAN communities, particularly among communities that are considered remote or isolated. Following a food survey in Fort Severn, NAN and Ontario’s most northern community, it was determined that a family food basket cost nearly two times more than in Ottawa or Winnipeg (, 2006). Without access to affordable, nutritious food, NAN communities will continue to be plagued by high rates of diabetes. Other challenges include inadequate screening systems and prevention programs from Health Canada. It should be noted that Thunder Bay was recently identified by the media as the amputation capital of Canada due to First Nation people’s diabetes rates.

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Primary Care and Nursing Stations in the First Nations

The Auditor General of Canada’s Spring 2015 report found that nursing stations did not have the capacity to deliver essential services in First Nations, that nurses were not properly trained, and that they operated beyond their legislated scope of service. Nursing stations are often not properly equipped or stocked even with basic medications. Four year-old Brody Meekis of is one of two children who died in 2014 from a treatable strep throat infection after the local nursing stations failed to admit them and treat them accordingly. In the fall of 2015, the oxygen bottle supply ran out at the nursing station while Laura Shewaybick was waiting to be medevaced. During her wait for transport, she received dangerous lowered levels of oxygen (than the level as prescribed by the physician) to conserve remaining oxygen. She later died as a result of complications in Thunder Bay. Waiting lists are long to see physicians that come only for several days each month at best, resulting in many people not being admitted and/or treated. A significant transformation is required in the way Health Canada operates and funds nursing and physician services, and stocks medical supplies and equipment.

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NAN’S RECOMMENDATIONS TO THE STANDING COMMITTEE

1. Health Canada, NAN and MKO jointly develop a course of action to fully implement the recommendations made by The Auditor General of Canada outlined in the 2015 Spring report Access to Health Services for Remote First Nations Communities. This work will consider the relationship to any process arising from the NAN and Health Canada and MOHLTC ministers meeting in March 31, 2016.

2. Health Canada to acknowledge that the present policies, services delivery and funding models is failing First Nations. The Auditor General of Canada supports that Health Canada does not consider the health needs of the community. An overall health system transformation is required. As per the March 31 2016 meeting, Health Canada and MOHLTC must work collaboratively with NAN on a long term process towards solutions beginning with urgent priorities that need expedient solutions, and intermediate and long term health and infrastructure needs in a framework to be designed and implemented along NAN and various First Nation health organizations within NAN territory. This collaborative framework will include a health transformation system component and will consider models envisioned by Weeneebayko Area Health Authority, Sioux Lookout First Nations Health Authority and other First Nation health entities.

3. The Minister of Indian Affairs Canada participates along with NAN and Health Canada in an ongoing political oversight body to the process as proposed by NAN at the March 31, 2016 meeting. It is imperative that INAC be part of this process as water and housing situations in the NAN communities are detrimental to the health of our people.

4. NAN and Mushkegowuk Council leadership work in collaboration with Health Canada, INAC and other departments to establish a Special Emergency Suicide Task Force to address the growing suicide epidemic in NAN territory. Health Canada and INAC must provide the resources to support this process.

5. NAN leads a collaborative process with Health Canada and Ontario that will redefine Jordan’s Principle. The result of this work will form a basis for which Canada will create legislation that will compel other jurisdictions to a uniform implementation process. Health Canada and MOHLTC must provide the resources to support this process.

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ABOUT NAN: Nishnawbe Aski Nation (known as Grand Council Treaty No. 9 until 1983) was established in 1973. It represents the legitimate, socioeconomic, and political aspirations of its First Nation members of Northern Ontario to all levels of government in order to allow local self-determination while establishing spiritual, cultural, social, and economic independence. In 1977, Grand Council Treaty No. 9 made a public declaration of the rights and principles of Nishnawbe Aski. NAN’s objectives are:

• Implementing advocacy and policy directives from NAN Chiefs-in-Assembly • Advocating to improve the quality of life for the people in areas of education, lands and resources, health, governance, and justice • Improving the awareness and sustainability of traditions, culture, and language of the people through unity and nationhood • Developing and implementing policies which reflect the aspirations and betterment of the people • Developing strong partnerships with other organizations NAN is a political territorial organization representing 49 First Nation communities within northern Ontario with the total population of membership (on and off reserve) estimated around 45,000 people. These communities are grouped by Tribal Council (Windigo First Nations Council, , Shibogama First Nations Council, Mushkegowuk Council, Matawa First Nations, Keewaytinook Okimakanak, and Independent First Nations Alliance) according to region. Six of the 49 communities are not affiliated with a specific Tribal Council. NAN encompasses James Bay Treaty No. 9 and Ontario’s portion of Treaty No. 5, and has a total land- mass covering two-thirds of the province of Ontario spanning 210,000 square miles. The people traditionally speak four languages: OjiCree in the west, Ojibway in the central-south area, and and Algonquin in the east. NAN continues to work to improve the quality of life for the Nishnawbe Aski territory. Through existing partnerships and agreements with Treaty partners (governments of Canada and Ontario), NAN continues to advocate on behalf of the communities it represents for self-determination with functioning self-government.

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