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LOOKING for ABORIGINAL HEALTH in LEGISLATION and POLICIES, 1970 to 2008 the Policy Synthesis Project

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LOOKING for ABORIGINAL HEALTH in LEGISLATION and POLICIES, 1970 to 2008 the Policy Synthesis Project LOOKING FOR ABORIGINAL HEALTH IN LEGISLATION AND POLICIES, 1970 to 2008 The Policy Synthesis Project NATIONAL COLLABORATING CENTRE CENTRE DE COLLABORATION NATIONALE FOR ABORIGINAL HEALTH DE LA SANTÉ AUTOCHTONE Acknowledgements This report is the culmination of work Laverne Gervais, UNBC; Jessica Toner, © 2011 National Collaborating Centre undertaken at the National Collaborating UNBC; Odile Bergeron, Unité de santé for Aboriginal Health, (NCCAH). The Centre for Aboriginal Health (NCCAH) publique des Autochtones of the Institut National Collaborating Centre for as part of its strategic priority on Aboriginal national de santé publique du Québec, Aboriginal Health supports a renewed health policy. and Ginette Thomas, NCCAH. public health system in Canada that is inclusive and respectful of diverse First TheNCCAH would like to recognize The NCCAH uses an external blind Nations, Inuit and Métis peoples. The Dr. Josée Lavoie, Associate Professor, review process for documents that are NCCAH is funded through the Public School of Health Sciences at the University research based, involve literature reviews Health Agency of Canada and hosted at of Northern British Columbia (UNBC) or knowledge synthesis, or undertake an the University of Northern British who provided the scientific direction and assessment of knowledge gaps. We would Columbia, in Prince George, BC. leadership on this project. like to acknowledge our reviewers for the Production of this report has been made generous contributions of their time and possible through a financial contribution The NCCAH would also like to thank expertise to this manuscript. The authors from the Public Health Agency of Canada. the members of the team who collected would also like to thank all of those who The views expressed herein do not necessarily and reviewed information on the health contributed insights and comments along represent the views of the Public Health policies that have an impact on the health the way. Agency of Canada or of the NCCAH. of First Nations, Inuit and Métis peoples at the federal, provincial and territorial This publication is available for download levels, and who supported this project: at: www.nccah.ca CONTENTS Acknowledgements 2 Executive Summary 5 Acronyms & Abbreviations 9 1. Introduction 11 1.1 Why focus on legislation and policies? 12 1.2 Scope 13 1.3 Intended use 13 2. Methodology 14 2.1 Socio-demographic profile of the Aboriginal population 14 2.2 A word on terminology 14 2.3 Treaties and self-government activities 16 2.4 Aboriginal organizations with a health policy mandate in the provinces, territories and Canada 16 2.5 Legislation, policies and Aboriginal health 17 2.6 Decentralization – Regionalization of health services 18 3. Aboriginal Peoples in Canada, the Territories and the Provinces 18 3.1 Socio-demographic profile 18 3.2 Aboriginal organizations with a health policy mandate in the provinces, territories and Canada 18 3.3 Summary 20 4. Aboriginal Peoples and the Federal Government 20 4.1 Foundational documents 20 4.2 The Indian Act 21 4.3 Federal, territorial/provincial and Aboriginal jurisdiction 22 4.4 Strengthening relationships and closing the gap (the Kelowna Accord) 22 4.5 Current federal departments and mandates 22 4.6 Summary 25 5. The Treaties, Self-government Activities and Health 26 5.1 Historic treaties 26 5.2 Self-government activities in the territories and the provinces 27 5.3 Summary 27 6. The Legislative and Policy Environment for Aboriginal Health in the Territories and the Provinces 27 6.1 Aboriginal-specific mandates, legislation and policies 27 6.2 Decentralization 30 6.3 Summary 30 7. Emerging Mechanisms 31 7.1 Emergence of cross-jurisdictional coordination forums 31 7.2 Intergovernmental health authorities 31 7.3 Summary 32 8. Conclusions 32 References 33 Appendices 39 3 EXECUTIVE SUMMARY The objectives of the Policy Synthesis available, and because the internet can be Project were to develop a comparative an important tool of policy research and inventory of federal, provincial and information for policy makers, researchers, territorial health policies and legislation users and many government departments. that make specific mention of Aboriginal, First Nations, Inuit and/or the Métis Overall, this report provides evidence peoples living in Canada. This project that the Aboriginal health policy in aims to close an important information Canada remains very much a patchwork. gap. Despite renewed commitments Considerable diversity exists in all by governments to the principle of provinces and territories. At the federal health equity and to making efforts to level, the policy environment is largely closing the gap that exists between the implicit rather than explicit. Some areas of health of Aboriginal people and that clarity, innovation and gaps have emerged. of their national counterparts, studies These are discussed below. documenting legislative and policy responses are lacking. Treaties and Self-Government For this project, information that is Activities publicly available on the worldwide web was gathered over a one year period (April A variety of arrangements have emerged 2007 – April 2008). The decision to focus as a result of treaties and self-government on internet searches was made because activities in Canada. In some areas, the information is publicly and readily historic treaties signed between 1870 and 5 1929 remain current. In others, modern Legislation and Policies Self-government agreements, where treaties have been signed and have clarified they exist, define areas of jurisdiction for areas of ambiguities embedded in historic This Policy Synthesis Project maps out: the federal, provincial/territorial and treaties. Modern treaties have also been Aboriginal governments. This is reflected signed in areas where historic treaties had · the health legislation in place at the in legislation. Health legislation in the never been negotiated. federal level, in the territories and in the Yukon, Quebec and Newfoundland & provinces, and the Aboriginal-specific Labrador contain provisions related to Modern treaties have resulted in different provisions that are stated in legislation; existing self-government agreements, arrangements. All four Inuit regions have and thereby clarifying these territory/ engaged in self-government activities, · the health policies in place at the provinces’ roles and responsibilities in resulting in increased autonomy in federal level, in the territories and in the health only in the areas included in these key areas. The Nunavut Land Claim provinces, and the Aboriginal-specific self-government agreements. Agreement resulted in the creation of the provisions that are stated in policies. territory of Nunavut. In the Inuvialuit and Finally, some provinces and territories Nunatsiavut regions, Inuit have signed As a result, the following pattern emerges. have embedded provisions related to self-government agreements. In Nunavik, Aboriginal healing and ceremonial the James Bay and Northern Quebec At the national level, there are only two practices. The Yukon is the only Agreement gave rise to a unique model publicly available national Aboriginal jurisdiction where health legislation whereby Inuit-managed structures were health policies: the 1979 Indian Health recognizes the need to respect traditional created as a result of this agreement (the Policy and the 1989 Health Transfer healing practices.1 The legislation does Health Board and School Boards). An Policy. There is ambiguity as to the range not define what is included as traditional agreement signed in 2007 will lead to the of application of the Indian Health Policy healing practices. Quebec, Ontario and creation of the Regional Government of because the text of the policy does not Manitoba recognize that Aboriginal Nunavik, which will have oversight of specify whether it is inclusive of registered midwives should be exempted from all Nunavik structures created as a result and non-registered Indians. It makes no control specified under the Code of the James Bay and Northern Quebec mention of Inuit. The Health Transfer of Professions. Ontario extends this Agreement, including health services. Policy applies to First Nations on-reserve exemption to traditional healers. In This new order of government will answer and to the Inuit of Labrador only. addition, British Columbia, Alberta, directly to the National Assembly of Saskatchewan, Manitoba, Ontario, New Quebec. This model is unique in Canada. At the territorial and provincial levels, Brunswick and Prince Edward Island have some legislation contains specific adopted tobacco control legislation that The Nisga’a Agreement, the James Bay and provisions clarifying the responsibilities clearly states that the use of tobacco for Northern Quebec Agreement, and the of the governments of these territories ceremonial purposes will not be regulated Labrador Inuit Association Agreement and provinces in Aboriginal health. These under the terms of this legislation. are tripartite agreements that include are, however, quite limited and focus provisions for self-administration of on jurisdiction. For example, legislation Findings also showed the existence of a health services. in Alberta are said to apply to Métis limited number of Aboriginal-specific settlements. Alberta, Saskatchewan, legislation and policies. Ontario was the To date, most self-government agreements Ontario and New Brunswick legislation first province to develop an Aboriginal have been signed in the Yukon and in specifically state
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