Interior Regional Health and Wellness Plan

Interim Plan June 4, 2014 Acknowledgements The development of the interim Interior Regional Health and Wellness Plan was possible thanks to the wisdom, support and hard work of many:

Thank you to the many Elders, Chiefs, Council Members, Health Directors/Leads, community health staff and community members who participated in the Nation Assemblies, meetings and other engagement sessions that contributed to the information and priorities included in this plan.

Community Engagement Hub Coordinators Kevin Skinner – Dãkelh Dené Nation Shannon Girling-Hebert – Ktunaxa Nation Diane Whitehead – Ktunaxa Nation AJ Aspinall – Nlaka’pamux Nation Ursula Drynock, Virginia Peters & Theresa McIntyre – Nlaka’pamux Nation Cathy Speth – Nlaka’pamux Nation Vicki Manuel – Secwepemc Nation Ryan Day – Secwepemc Nation Sue Wilson Cheechoo – St’át’imc Nation Fabian Alexis – Syilx Nation Connie Jasper – Tsilhqot’in Nation

Interior Region Nation Executive Chief Zach Parker – Dãkelh Dené Nation Gwen Phillips – Ktunaxa Nation Ko’waintco Michel – Nlaka’pamux Nation Kukpi7 Wayne Christian – Secwepemc Nation Chief Arthur Adolph – St’át’imc Nation Mic Werstuik – Syilx Nation Chief Bernie Mack – Tsilhqot’in Nation

Interior First Nations Health Directors Association Representatives Jacki McPherson Teresa Johnny Colleen LeBourdais

Interior Health Authority Bradley Anderson, Director, Aboriginal Health Danielle Wilson, Practice Lead Judy Sturm, Practice Lead Renee Hetu, Practice Lead Shawna Nevdoff, Practice Lead Amanda Parks, Health System Planning

First Nations Health Authority Lisa Montgomery-Reid, Interior Regional Director Mary McCullough, Regional Health Liaison Mark Matthew, Strategic Advisor, Policy, Planning & Strategic Services Matthew Kinch, Senior Policy Analyst, First Nations Health Council Secretariat Trevor Kehoe, John Pantherbone and Davis McKenzie, Communications Unit Isabel Budke, Senior Advisor, Policy, Planning & Strategic Services Harmony Johnson, Director, Policy & Planning Unit Trish Osterberg, Policy Analyst, Policy & Planning Unit Adrienne Peltonen, Planner, Policy & Planning Unit

Executive Summary

The interim Interior Regional Health and Wellness Plan is a joint plan developed through collaboration among the 7 Nations of the Interior - the Dãkelh Dené, Ktunaxa, Nlaka’pamux, Secwepemc, St’át’imc, Syilx and Tsilhqot’in - Interior Health Authority and the First Nations Health Authority. It establishes a common voice and perspective on health and wellness. It describes the Nations’ overall direction regarding their vision and guiding principles; who the Nations are; and their Regional and Nation health and wellness priorities. This plan describes how the Nations and their partners will work together based on the 7 Directives , the guiding principles outlined in the Indigenous Nations of the Interior Declaration of Unity (2010), the Interior Partnership Accord (2012) and the Nation Letters of Understanding with Interior Health Authority.

The Interior Nations’ priorities focus on improving health programs and services, bringing financial resources and decision-making closer to home and strengthening, maintaining and aligning capacity with communities and Nations through a system that is deeply rooted in the values, principles and cultures of the 7 Nations of the Interior. Governance structures and processes continue to evolve to support implementation of this vision and the iRHWP describes the various entities that the 7 Nations will establish, in partnership with Interior Health Authority and the First Nations Health Authority, to support technical work and decision-making. The iRHWP also sets the intention to further refine communication and engagement processes to ensure that everyone receives the information they need and have opportunities for engagement and to provide input and direction to the work moving forward.

Each of the 7 Nations have identified emerging health priorities and remain committed to developing Nation Health and Wellness Plans over the next year. Regional priorities, summarized below, have been identified based on the 7 Directives and the priorities shared among multiple Nations. In future planning cycles, Nation plans, which have been informed by community priorities, will be the basis of the Regional Health and Wellness Plan.

This interim plan is a living document that will be revisited and revised to reflect the structures and processes being developed and the further planning work that will be done throughout the year by the 7 Nations. This work will lay the foundation for the 7 Nations to continue to operationalize the 7 Directives and Unity Principles, and to transform the health system serving their people to one that is based in their values, principles and cultures and best supports the health and wellness of the people of the 7 Interior Nations.

Summary of Regional Priorities

1. Community-Driven, Nation-Based 1.1. Support each Interior community to have an up-to-date Community Health and Wellness Plan 1.2. Develop Nation Health and Wellness Plans in each of the 7 Nations 1.3. Conduct asset and service mapping and complete the Interior Region expenditure analysis to support planning processes

2. Increased First Nations Decision-Making and Control 2.1. Establish governance and technical structures and processes enabling regional and Nation-based decision-making 2.2. Identify and develop strategies and policies for topics that require a regional approach 2.3. Enhance regional data governance and processes ensuring data and research activities are conducted in accordance with Nation priorities, policies and protocols.

3. Improve Services 3.1. Improve the First Nations Health Benefits Program to better meet the needs of First Nations people 3.2. Promote mental wellness and reduce harmful substance use 3.3. Promote Elder wellness and increase supports enabling Elders to remain at home or close to home 3.4. Promote child and family wellness and improve services in collaboration with social service partners

Additional service improvement goals related to holistic wellness, improving access to high quality health services and infrastructure are included in the full document.

4. Foster Meaningful Collaboration and Partnership 4.1. Build a collaborative relationship with Interior Health Authority based on the Partnership Accord and Nation Letters of Understanding 4.2. Align Interior Health Authority First Nations and Aboriginal planning and investment with the Interior Regional Health and Wellness Plan 4.3. Explore mechanisms to resolve the issues of Nations whose territories encompass more than one Regional Health Authority

5. Develop Human and Economic Capacity 5.1. Increase the number of First Nations health professionals and staff working in each of the Interior Nations 5.2. Improve recruitment and retention of health service providers in First Nations communities 5.3. Explore economic opportunities that will support sustainability and build First Nation health sector capacity

6. Be Without Prejudice to First Nations Interests 6.1. Establish processes for engaging Métis and urban Aboriginal groups that respect and reflect the inherent rights and interests of First Nations peoples 6.2. The Interior Caucus will consider avenues for supporting self-determination and jurisdiction interests of the Interior Nations

7. Function at a High Operational Standard 7.1. Establish clear, consistent communication and information-sharing among partners within the Interior Region 7.2. Strengthen Interior Region processes for reciprocal accountability 7.3. Develop indicators enabling Nations to report from the perspective of their values, principles and understandings of wellness 7.4. Explore the potential for more effective and efficient use of existing resources

iii

Table of Contents

Acknowledgements ...... i Executive Summary ...... ii Table of Contents ...... iv Message from the Interior Region Nation Executive ...... 1 Introduction ...... 2 Vision and Guiding Principles ...... 4 Declaration of Unity ...... 5 Social and Cultural Context ...... 6 Interior Nations ...... 7 Governance Structures and Processes...... 8 Communication and Engagement...... 10 Strategic Challenges and Opportunities ...... 11 interim Interior Regional Health and Wellness Plan Goals ...... 12 Regional Priorities ...... 12 Nation Priorities ...... 20 Dãkelh Dené ...... 21 Ktunaxa ...... 23 Nlaka’pamux ...... 25 Secwepemc ...... 29 Northern St'át'imc ...... 31 Syilx ...... 32 Tsilhqot’in ...... 34 Next Steps ...... 35 Conclusion ...... 35 References ...... 36

Appendices Appendix A: Interior Region Profile Appendix B: First Nations Health Transfer History and Context Appendix C: Interior Nations Declaration of Unity Appendix D: Interior Partnership Accord Appendix E. Nation Letters of Understanding – Ktunaxa, Nlaka’pamux, Secwepemc, Northern St’at’imc, Syilx, Tsilhqot’in Appendix F: Interior Health Authority Context and Aboriginal Programs and Services Appendix G: Interior Health Authority Aboriginal Strategy 2010-2014 Appendix H: Interior Team Charter

Message from the Interior Region Nation Executive

When the 7 Nations of the Interior signed a Unity Declaration in 2010 we called our ancestors to be present, to bless the work and set the stage for the work ahead. Four years on from the signing, the Nations of the Interior Region remain committed to the Nation model of working together “for the betterment of the health, safety, survival, dignity and well-being of all of our peoples.” It is in this spirit of unity and cooperation that we celebrate the completion of a Community- Driven and Nation-Based interim Interior Regional Health and Wellness Plan (iRHWP).

In developing this plan we are guided by the directives provided by First Nations leadership in British Columbia through Consensus Papers 2011 and 2012. Consensus Paper 2012 mandated the development of regional teams and supports, regional planning (iRHWP) and the phase-in of regional funding envelopes. This interim plan provides a foundation, for in addition to identifying key emerging priorities for health service improvements, the iRHWP highlights the ongoing development of our regional governance structures and processes and the further planning that will be conducted by each of the 7 Nations to develop Nation Health and Wellness Plans over the next year. The iRHWP further builds on the Interior Partnership Accord and defines how we will begin to transform the relationship between our Nations and Interior Health Authority, leading to greater collaboration and joint efforts to ensure high quality and equitable services for our people.

Implementation of the priorities in the iRHWP will lay the groundwork for putting our Unity Declaration and the 7 Directives into practice and sets the stage for the transformative work we will be doing to establish a health system that is embedded in our values and principles and supports the health and wellness of our Nations.

Chief Zach Parker Chief Arthur Adolph Dãkelh Dené Nation St’át’imc Nation

Gwen Phillips Mic Werstuik Ktunaxa Nation Syilx Nation

Ko’waintco Michel Chief Bernie Mack Nlaka’pamux Nation Tsilhqot’in Nation

Kukpi7 Wayne Christian Secwepemc Nation

Introduction

At Gathering Wisdom for a Shared Journey IV (May 2011), BC First Nations leadership provided direction for each of the five health regions to develop a “Regional Health and Wellness Plan” that establishes a shared voice and priorities for health and wellness1. This interim Interior Regional Health and Wellness Plan (iRHWP) is the product of this direction. It builds on a significant amount of work accomplished to date by First Nations, federal and provincial government partners, and partners within the region. It establishes a common voice and perspective on health and wellness among the 7 Nations of the Interior Region, the Dãkelh Dené, Ktunaxa, Nlaka’pamux, Secwepemc, St’át’imc, Syilx and Tsilhqot’in. The iRHWP describes the Nations’ overall direction regarding their vision and guiding principles; who the Nations are; and their Regional and Nation health and wellness priorities. This plan describes how the Nations and their partners will work together based on the 7 Directives, the guiding principles outlined in the Indigenous Nations of the Interior Declaration of Unity (2010), the Interior Partnership Accord (2012) and the Nation Letters of Understanding with the Interior Health Authority.

The iRHWP is an important milestone for the 7 Interior Nations in putting the Community-Driven, Nation-Based approach into practice and identifying the emerging priorities of the Nations. Additionally, stemming from the signing of the Partnership Accord between the 7 Nations and Interior Health Authority, this is the first time a planning process has been conducted jointly among the 7 Nations, the First Nations Health Authority (FNHA) and Interior Health Authority. This development of a joint plan will enable increased alignment and coordination of the work of the two Health Authorities with the priorities that have been identified by the Nations. The iRHWP will guide regional envelope decision- making and guide FNHA work in partnership with the Interior region and other population health and provincial scale initiatives. It will also inform the provincial work and planning processes of the First Nations Health Council (FNHC) and First Nations Health Directors Association (FNHDA). Overall, the iRHWP will support the delivery and transformation of high-quality health and wellness programs and services for First Nations in the Interior region.

This interim plan is a living document that will be revisited and revised to reflect the structures and processes being developed and the further planning work that will be conducted throughout the year. The Nations of the Interior remain committed to creating Nation Health and Wellness Plans2 and, over the coming year, the foundations will be laid for a planning cycle whereby Community Health and Wellness Plans will inform Nation Health and Wellness Plans and these Nation Plans will be the basis of future Regional Health and Wellness Plans (see figure 1).

1 See Consensus Paper: British Columbia First Nations Perspectives on a New Health Governance Arrangement (2011). Additional information on the history and context of the First Nations Health Transfer, foundational documents and governance structure are provided in Appendix B. 2 See Interior Partnership Accord (2012).

Methodology to develop the interim Regional Health and Wellness Plan The iRHWP was developed through a process of reviewing existing planning work already completed by the Nations3 and holding discussions about the iRHWP and Nation priorities at Nation Assembly meetings conducted throughout February and March, 2014. Based on the discussions at the Nation Assemblies and further engagement within their respective Nations, the Community Engagement Hubs took the lead in gathering and refining the priorities and profiles of their respective Nations to be included in this iRHWP. In the Nation Assemblies and documents, common priorities among the 7 Nations emerged and these were identified as Regional priorities.

Figure 1: Health and wellness planning framework

“We need to move out of crisis mode and into proactive mode” Chief Zach Parker

3 See References for list of documents consulted.

Vision and Guiding Principles

Collective efforts of First Nations in BC are united and guided by a vision of “Healthy, Self-Determining and Vibrant BC First Nations Children, Families and Communities.” The work toward achieving this overall vision is guided by the following shared values: Respect, Discipline, Relationships, Culture, Excellence, and Fairness4. First Nations in BC also set and agreed on the following 7 Directives:

 Directive #1: Community-Driven, Nation-Based  Directive #2: Increase First Nations Decision-Making and Control  Directive #3: Improve Services  Directive #4: Foster Meaningful Collaboration and Partnership  Directive #5: Develop Human and Economic Capacity  Directive #6: Be without Prejudice to First Nations Interests  Directive #7: Function at a High Operational Standard

“We need to incorporate our values and principles into this health initiative, that includes traditional foods and medicines” Chief Art Adolph

4 FNHA vision and values.

Declaration of Unity The 7 Interior Nations’ vision and guiding principles are based upon the Declaration of Unity (2010). This declaration confirmed the commitment of the 7 Nations of the Interior Region to work together in implementing the Tripartite First Nations Health Plan through a Nation to Nation model. In the Declaration, the Nations of the Interior committed to “respectfully work together, collaborating for the betterment of the health, safety, survival, dignity and well-being of all of our peoples”. The Unity Declaration includes the following principles shared by the Interior Nations:

 Health and wellness outcomes and indicators will be defined by each Nation  Partnerships will be defined by each Nation  Agreements will be negotiated and ratified by the Nations  No Nation will be left behind; needs are addressed collectively  The federal fiduciary obligation must be strengthened, not eroded  Services will be provided to all of our people regardless of residency/status  Adequate funding will be provided for our corporate structure(s)  Socio-economic indices will be incorporated into planning and projections – plan for 7 generations  Negotiations will be interest based - not position based (Nations define)  Community hubs will be linked to the health governance process  Documents will be kept simple and understandable  The Interior Leadership caucus will meet regularly  Liability will be minimized; the Nations will inherit no liability from other entities  Celebration will be included in all activities  The speed at which development occurs will be determined by the Nations  The authority to govern rests with each Nation, as does the responsibility for decision-making

Social and Cultural Context

Action on the Social Determinants of Health The 7 Nations recognize that improving the health of their people will take more than the implementation of the Regional Health and “We are a land based Wellness Plan. Within a First Nations holistic perspective there is recognition of the significant impact that the social determinants have culture. In order for us on health and wellness. Factors such as housing, employment to have healthy opportunities, income and wealth, working conditions, education and Nations and experiences of colonization, residential schools and institutional racism communities we need all contribute to people’s health and wellness. Addressing these complex issues challenges those working in health to reach out and to look at ways to heal build partnerships with other sectors to create and advocate for the the land, in turn we supportive environments and public policy that will enable First Nations will heal our people” people to achieve the quality of life they are entitled to as an inherent Chief Art Adolph right. This requires an approach that is collaborative and recognizes and builds upon the integral strengths and assets of the 7 Nations.

First Nations Perspective on Wellness The First Nations Perspective on Wellness is a holistic health and wellness approach that provides a guide for health and wellness planning, program and service delivery throughout British Columbia. It builds on the recognition that health and wellness are intimately connected, and that they encompass emotional, mental, spiritual and physical health and well-being. It also recognizes how health and wellness is interwoven with the health and wellness of families, communities, Nations, Land, and other aspects of the contexts we live in. The First Nations Perspective on Wellness has been derived from a holistic perspective and concepts from traditional knowledge.

Figure 2. First Nations Perspective on Wellness

Interior Nations

The territorial land base of the Interior Region, as defined by BC Regional Health Authority boundaries, covers almost 216,000 square kilometres. For health planning purposes, there are First Nations communities included in the Interior Region that may lie outside this geographic boundary, creating unique jurisdictional complexities. It is also essential that planning take into consideration the diversity of the geography and climate in the region, the travel distances required and the effects of weather conditions.

According to Aboriginal Affairs and Northern Development Canada data (AANDC 2011), the First Nations population in the Interior Region is close to 30,000, representing 22% of the First Nations population in BC. The 54 Interior First Nations communities vary in size and include a number of small and isolated communities.

Figure 3. First Nations Communities in the Interior Region

Governance Structures and Processes

The First Nations of the Interior have formed the Interior Region Health Caucus, which serves as an engagement forum for the political (i.e. Chiefs) and technical leaders (i.e. Health Directors or Health Leads) relating to the implementation of the resolutions and consensus papers passed at Gathering Wisdom for a Shared Journey forums and the Tripartite Framework Agreement on First Nations Health Governance. The Caucus represents 54 First Nations of the 7 Nations: Dãkelh Dené, Ktunaxa, Nlaka’pamux, Secwepemc, St’át’imc, Syilx, and Tsilhqot’in.

The Interior Region Caucus Terms of Reference outlines the roles and responsibilities of the governance entities and technical advisory bodies that are being established to create the space for Nations to provide guidance and make decisions. The diagram and descriptions below outline the governance structures and processes involving the Interior Nations.

Figure 4. Interior First Nations Health Governance Pathways Model

Interior Regional Caucus The Interior Region First Nations Community Health Caucus table provides a forum for the 54 First Nations of the Interior Region to engage with each other for purposes of planning, priority setting and decision-making related to regional health matters. The Health Caucus provides guidance to the Interior Region Nation Executive, Partnership Accord Leadership Table and provides advice and recommendations to the FNHC, FNHA and FNHDA along with approval of region specific documents.

7 Interior Nations The province is broken down into five geographic regions for the purposes of health care service delivery. The Interior Region coincides with the boundaries of the Interior Health Authority and is comprised of 7 distinct Nations: Dãkelh Dené, Ktunaxa, Secwepemc, Syilx, St’át'imc, Tsilhqot’in and Nlaka’pamux. Each of the 7 Nations will develop a Nation Health Plan and negotiate a Letter of Understanding, or other agreement, independently with Interior Health. Issues or interests that are common to the Nations will be addressed in a collaborative manner.

Interior Region Nation Executive The Interior Region Nation Executive Table is comprised of one representative from each of the 7 Nations of the Interior Region, and acts as an Executive body to the Interior Region Caucus, carrying out directions in between Caucus sessions. The Executive Table offers a more equitable decision-making capacity for Interior First Nations and gives regional direction to the First Nations Health Council.

First Nations Health Council Interior Representatives The FNHC is comprised of 15 members, with 3 members appointed by the First Nations resident in each of the 5 geographic Health Authority regions of the province. The 54 First Nation Communities of the Interior Region, through the Caucus, appoint their 3 representatives to the Health Council from amongst the 7 Nation representatives who form the Interior Region Nation Executive.

Interior Region Nation Technicians Table The Interior Region Nation Technicians Table is comprised of one representative from each of the 7 Nations of the Interior Region and acts as an advisory body to the Interior Region Nation Executive providing recommendations to the Interior Region Nation Executive Table on concerns common to the region.

Partnership Accord Leadership Table The Partnership Accord Leadership Table is comprised of Senior Officials from Interior Health Authority along with the 7 Nation representatives of the Interior Region Nation Executive. The Partnership Accord Leadership Table is a decision-making body that provides direction and oversees the implementation of the Partnership Accord. The Table serves as a senior and influential forum for partnership, collaboration, and joint efforts on First Nation and Aboriginal priorities, policies, budgets, programs and services in the Interior Region.

Interior First Nations Health & Wellness Committee The Interior First Nations Health & Wellness Committee is comprised of Senior Management from Interior Health Authority and First Nations Technicians appointed by the 7 Nations of the Interior Region. The Committee is an advisory body that provides recommendations to the Partnership Accord Leadership Table. Upon agreement from the Nations, space may be created for one Urban and one Métis representative.

“There are going to be growing pains but in the end we are going to have better health services” Chief Percy Guichon

Interior Regional Team The Interior Regional Team of the FNHA includes the Regional Director, the Regional Health Liaison, an Administrative Assistant and a collaborative relationship with the Nation Engagement Coordinators. This team also draws on support from teams throughout FNHA and will be evolving as regional processes continue to develop. This regional and matrix approach will be outlined in the regional team charter that is currently being reviewed and updated based on input gathered through the regional planning process.

Communication and Engagement

For effective health governance, engagement and communication must be community-driven and Nation-based. It must be inclusive and happen at every level. Communities can only give direction if communications are provided in clear and plain language, and they are given sound information upon which to base decisions.

There is currently a robust and dynamic communications and community engagement network to support both political and health service conversations, and specifically to support “We need to make the plan ongoing planning and implementation of plans in the Interior unique to our Nation and region. Leadership has recognized the need for this network to evolve in order to keep pace with the emerging governance unique to our communities. and partnership structure, and the evolving role of the FNHA We need to be working to enhance the delivery of quality health services to BC First together with our partners” Nations. The Regional Team supports regional efforts in Chief Joe Alphonse communication, collaboration, and planning, and serves as a main contact for information within the region. Also, the Regional Team will work in partnership with Interior Health to streamline and integrate community engagement efforts.

Communication has been identified as a key regional priority of the Nations and, as part of addressing this priority, an Interior communication plan will be developed and implemented. This plan will strive to ensure clarity, understanding and consistency around communications among all partners within the region and support communication and engagement on health and wellness issues, including priority areas identified in the iRHWP.

The process used in the development of the iRHWP, which involved engaging with health technicians and Chiefs at Nation Assemblies and other meetings occurring prior to the Regional Caucus will continue to be one of the key processes for communication and engagement. Ongoing, regular communication processes among the FNHA Regional Team, Interior Health Authority, Hub Coordinators, Health Leads and Governance Entities will also continue and be further refined in the communication plan that will be developed in the Region.

Strategic Challenges and Opportunities

In the work moving forward there are a number of opportunities for health service improvements and supporting increased health and wellness; however, there are also challenges that will be encountered, many of which are deeply entrenched and will require time and creativity to address.

Challenges . Persistent health gaps . Inequities facing First Nation communities compared to “The most important priority is the non-First Nation population . Limited resources to get money to our community. . Social determinants of health That’s us doing our job” . Historic and current government policy Chief Jonathan Kruger . Jurisdictional complexities . Cultural safety

Opportunities . Improved planning for, and responding to, regional needs (including socio-geographic factors) . Capacity, decision-making, policy-making and health care design and delivery closer to home . Foster meaningful collaboration and partnerships regionally . Maximize other revenue streams at the regional level . Regional influence over investments . Address region-specific information gaps

interim Interior Regional Health and Wellness Plan Goals

Long term goal Bringing financial resources and decision-making closer to home and strengthening, maintaining and aligning capacity with communities and Nations in a health system that is deeply rooted in the values, principles and cultures of the 7 Nations of the Interior.

Goal 1: Design strong, sustainable health and wellness services that support community capacities

Goal 2: Improve health and wellness programs and services to better meet the needs of the Interior Nations

Goal 3: Align First Nations Health Authority and Interior Health Authority planning and investments with the Interior Regional Health and Wellness Plan

Goal 4: Improve access to high quality health services and infrastructure

Regional Priorities

To support the implementation of the goals of the Nations, and to make early improvements on priority health services, regional priorities have been identified and described below, in alignment with the 7 Directives5. Upon completion of the Nation Health and Wellness Plans that will be developed over the next year, the regional priorities will be revisited and updated to reflect the 7 Nations’ priorities.

5 Regional priorities were identified through analysis and synthesis of the discussions that occurred at Nation Assemblies that took place February through March, 2014, and the documents listed in the Reference section below.

1. Community-Driven, Nation-Based

The framework for planning that the Interior Nations will work towards is Nation Health and Wellness Plans informed by Community Health and Wellness Plans, and a Regional Health and Wellness Plan that is based on the Nation Plans. This planning process will lay the foundation for implementing the Community-Driven, Nation-Based approach and linking investment and supports with community and Nation priorities.

Priorities:

1.1. Support each Interior community to have an up-to-date Community Health and Wellness Plan

1.2. Develop Nation Health and Wellness Plans in each of the 7 Nations

1.3. Conduct asset and service mapping and complete the Interior Region expenditure analysis to support planning processes

“We worked on and signed health transfer so we could have better control and better options for our health care” Kukpi7 Ann Louie

2. Increased First Nations Decision-Making and Control

The 7 Nations are in the process of developing and refining their health governance structures and the processes for how they will work together and make joint decisions. Establishing these structures and processes and strengthening Nations’ policies will lay the foundations that will enable good governance and increased decision-making and control by the 7 Nations. Ensuring all people are included in decision-making and control, regardless of gender, age or status, is also an essential part of conducting this work in alignment with the values and principles of the Interior Nations.

Priorities:

2.1. Establish governance and technical structures and processes enabling regional and Nation-based decision-making

2.2. Identify and develop strategies and policies for topics that require a regional approach

2.3. Enhance regional data governance and processes ensuring data and research activities are conducted in accordance with Nation priorities, policies and protocols

“Data governance is having the information you need to tell the story” Gwen Phillips

3. Improve Services

Systems transformation for service improvements will be a long term process as Nations look at strategies to incorporate holistic wellness perspectives and improve programs and services to ensure they are equal to or better than services provided in the provincial system. The Nation planning that will be taking place will provide an opportunity for Nations to identify their service improvement priorities. Emerging priorities within the region are listed below.

Priorities:

3.1. Improve the First Nations Health Benefits Program to better meet the needs of First

Nations people

3.2. Promote mental wellness and reduce harmful substance use

3.3. Promote Elder wellness and increase supports enabling Elders to remain at home or

close to home

3.4. Promote child and family wellness and improve services in collaboration with social service partners

Additional Goals:

a. Incorporate the First Nations Perspective on Wellness into programs and services promoting health and wellness throughout the life cycle –

Holistic infants, children, youth, mothers, fathers, families, adults and Elders

Wellness b. Strengthen the role of traditional healers and medicines

c. Collaborate with partners across sectors to protect the health of the land and environment and address the social determinants of health

d. Increase access to primary, community and home care service providers and linkages to specialist and acute care e. Increase and improve supports for chronic disease management

Access to High f. Develop health service delivery models for rural and remote contexts

Quality g. Improve first responder services in rural and remote communities

Services h. Improve transitions among service providers and across jurisdictions i. Work with the Provincial health system to increase resources for communities providing services to the off-reserve population j. Increase the cultural safety of health programs and services

k. Develop the facilities, infrastructure and technology required to Infrastructure provide high quality health services l. Enhance health data and information management systems

4. Foster Meaningful Collaboration and Partnership

The signing of the Partnership Accord set the stage for fostering meaningful collaboration and partnership among Interior Health Authority and the 7 Nations. Nations have also been negotiating Letters of Understanding with Interior Health Authority and look to strengthen their relationship with the Health Authority through joint implementation of the work plans developed from these agreements.

Priorities:

4.1. Build a collaborative relationship with Interior Health Authority based on the Partnership Accord and Nation Letters of Understanding

4.2. Align Interior Health Authority First Nations and Aboriginal planning and investment with the Interior Regional Health and Wellness Plan

4.3. Explore mechanisms to resolve the issues of Nations whose territories encompass more than one Regional Health Authority

“We want to be recognized as intelligent, educated and

experienced people and ensure that we have a voice at the

table” Sheila Dick, Health Director for Canim Lake

5. Develop Human and Economic Capacity

Bringing resources closer to home has been an overarching theme of the Interior Nations. As stated in the Unity Declaration, the Nations “desire to establish and maintain a desired level of capacity in the areas of health research, health career development, health service delivery (including traditional practices), information management and governance (health planning, administration, policy/program design and implementation and…), in order to achieve their individual and collective

Nation visions.”

Priorities:

5.1. Increase the number of First Nations health professionals and staff working in each of the Interior Nations

5.2. Improve recruitment and retention of health service providers in First Nations communities

5.3. Explore economic opportunities that will support sustainability and build First Nation health sector capacity

“Equal access to health services by recognizing our community clinics the same as those off reserve” Jackie McPherson, Health Services Coordinator, Osoyoos Indian Band

6. Be Without Prejudice to First Nations Interests

As outlined in the Consensus Paper (2011), it is essential that there be no impact on Aboriginal Title and Rights or the treaty rights of First Nations, no impact on the fiduciary duty of the crown, no impact on existing federal funding agreements with individual First Nations, unless First Nations want the agreements to change, and is without prejudice to any self-government agreements or court proceedings.

Priority:

6.1. Establish processes for engaging Métis and urban Aboriginal groups that respect and reflect the inherent rights and interests of First Nations peoples

6.2. The Interior Caucus will consider avenues for supporting self-determination and

jurisdiction interests of the Interior Nations

7. Function at a High Operational Standard

The newly established structures and processes among the Interior Nations will require processes, procedures and policies to enable them to function at a high operational standard in line with the principles of the Interior Nations. Additionally, data and research can be used to inform best practices.

Priorities:

7.1. Establish clear, consistent communication and information-sharing among partners within the Interior Region

7.2. Strengthen Interior Region processes for reciprocal accountability

7.3. Develop indicators enabling Nations to report from the perspective of their values, principles and understandings of wellness

7.4. Explore the potential for more effective and efficient use of existing resources

Nation Priorities

This section contains a profile and emerging priorities of each of the 7 Nations in the Interior Region. These priorities were drawn from existing plans and community engagement reports provided by the Nations. Based on the discussions at the Nation Assemblies and further engagement within their respective Nations, the Community Engagement Hubs took the lead in gathering and refining the priorities and profiles of their respective Nations to be included in this iRHWP. As the Nations conduct further planning in the development of their Nation Health and Wellness Plans, these priorities will be updated and expanded.

“When we really look at our early teaching with rites of passage and our legends, we focused on the betterment of our communities” Chief Art Adolph

Dãkelh Dené

1. Lhoosk'uz Dené Nation (receives services from Northern Health and at times Interior Health when members are referred) 2. Lhtako Dene Nation (receives services from Northern Health) 3. Ulkatcho (part of Vancouver Coastal Health but receives services from Interior Health through a Memorandum of Understanding)

The Southern Carrier territory is part of the Cariboo-Chilcotin Region in the interior of British Columbia. The Southern Carrier today are represented by the people of Red Bluff (Lhtako Dene Nation), Kluskus (Lhoosk’uz Dené Nation) and Ulkatcho. The Southern Carrier are a semi-nomadic people who migrate with the seasons. They are hunter gatherer people who depend on the land as their way of life. They have been able to maintain an independent, self-sufficient lifestyle based on hunting, trapping and fishing that provides them with the animals, fish, berries and plants for the medicines they may need throughout the seasons. Provisions are taken throughout the summer months to make sure there is enough food dried and stored away for the winter months.

Most Carrier call themselves Dãkelh, meaning "people who travel around by boat". The traditional Carrier way of life was based on a seasonal round, with the greatest activity in the summer when berries were gathered and fish caught and preserved. The mainstay of the economy was fish, especially the several varieties of salmon, which were smoked and stored for the winter in large numbers. Hunting of deer, caribou, moose, elk, black bear, beaver, and rabbit provided meat, fur for clothing, and bone for tools. With the exception of berries and the sap and cambium of the Lodgepole Pine, plants played a relatively minor role as food, though Carrier people are familiar with and occasionally used a variety of edible plants. Plants were used extensively for medicine. Winter activity was more limited, with some hunting, trapping, and fishing under the ice. Fish, game, and berries still constitute a major portion of the Carrier people’s diet.

The Dãkelh Dené have developed a work plan and the priorities identified in this plan are summarized below:

1. Community and Nation Wellness 1.1. Development of the RHWP 1.2. Incorporate Elder and Youth representatives in the Health Committee

2. Land and environmental health 2.1. Mold remediation of affected buildings

3. Social determinants of health 3.1. Economic growth and reduced poverty 3.2. Increase knowledge and educate and empower members

4. Traditional medicine and healers 4.1. Identify and develop opportunities for increased participation and leadership of Elders in community health and wellness

5. Health services and programs 5.1. Achieving equity of service for on- and off- reserve individuals with special needs 5.2. Develop sustainable, ongoing Residential Survivor Programs 5.3. Develop and assess success of current or future men’s, women’s and youth support groups 5.4. Coordinate sharing of medical resources between local nations on and off reserve 5.5. Advocate for mandatory localized cultural competency training for service providers 5.6. Develop a plan to keep educated members in communities, retain staff, and access local expertise 5.7. Raise awareness about available mental wellness programs in community 5.8. Improve the First Nations Health Benefits Program 5.9. Improve and identify available or new options for medical transport to appointments 5.10. Improve first responder services

6. Health Authorities 6.1. Update information on Nation Territory Boundaries 6.2. Increase contact for review and assessment of services from FNHA, Interior Health Authority, Vancouver Coastal Health Authority and Northern Health Authority

7. Health Human Resources 7.1. Address ongoing issues related to retaining primary care staff (RNs) 7.2. Enhance the knowledge of nurses and other health care staff about First Nations health governance structures and processes and the First Nations Health Authority

8. Telehealth and ehealth 8.1. Develop and assess infrastructure for each community 8.2. Consult with FNHA to identify the best option for electronic medical records

9. Capital Projects 9.1. Develop and assess infrastructure for each community

10. Communication and Engagement 10.1. Assess current methods and efficiencies regarding Health Committee communication and relevant technical solutions (Skype / GoTo meetings, etc.) 10.2. Develop a plan for regular ongoing communication and accountability between Interior Health Authority, Vancouver Coastal Health Authority, Northern Health Authority, First Nations Health Authority and communities

11. Planning and Evaluation 11.1. Conduct health service mapping in all communities

12. Data and Research 12.1. Develop Nation wellness indicators

13. Governance Structures and Processes 13.1. Develop processes and procedures for developing a Nation Health Plan

Ktunaxa

1. Akisq'nuk 2. Lower Kootenay 3. St. Mary's 4. Tobacco Plains

Ktunaxa (pronounced ‘k-too-nah-ha’) people have occupied the lands adjacent to the Kootenay and Columbia Rivers and the Arrow Lakes of British Columbia, Canada for more than 10,000 years. The Traditional Territory of the Ktunaxa Nation covers approximately 70,000 square kilometres (27,000 square miles) within the Kootenay region of south-eastern British Columbia and historically included parts of Alberta, Montana, Washington and Idaho.

For thousands of years, the Ktunaxa people enjoyed the natural bounty of the land, seasonally migrating throughout our Traditional Territory to follow vegetation and hunting cycles. We obtained all our food, medicine and material for shelter and clothing from nature - hunting, fishing and gathering throughout our Territory, across the Rocky Mountains and on the Great Plains of both Canada and the United States.

European settlement in the late 1800s, followed by the establishment of Indian Reserves, led to the creation of the present Indian Bands. Ktunaxa citizenship is comprised of Nation members from seven Bands located throughout historic traditional Ktunaxa territory. Five Bands are located in British Columbia, Canada and two are in the United States. Many Ktunaxa citizens also live in urban and rural areas "off reserve".

The Ktunaxa language is unique among Native linguistic groups in North America. Ktunaxa names for landmarks throughout our Traditional Territory and numerous heritage sites confirm this region as traditional Ktunaxa land. Shared lands, a rich cultural heritage, and a language so unique that it is not linked to any other in the world, make the Ktunaxa people unique and distinctive.

Priorities that have been identified by the Ktunaxa Nation are as follows:

1. Relationship building 1.1. Engagement with East Kootenay Aboriginal population and East Kootenay health care providers 1.2. Expand and strengthen activities, relationships, linkages, and understanding through IHA Aboriginal Liaison and Aboriginal Patient Navigator 1.3. Letter of Understanding implementation and Work Plan development

2. Resource and capacity development 2.1. Evaluate and revise educational materials 2.2. Build capacity in communities to train Aboriginal Health Care Providers 2.3. Identify opportunities to increase capacity to provide comprehensive community care 2.4. Increase supports enabling health care providers to provide high quality care

3. Improved access 3.1. Assess the possibility of an Aboriginal community health centre in Cranbrook 3.2. Explore options for rural nursing partnership initiatives 3.3. Ensure the treatment centres address all social determinants of health

3.4. Work with FNHA to identify approved treatment centres that meet the needs of Aboriginal people

4. Health programs and services 4.1. Provide safe places and respectful services, information and supports for immunization and communicable disease control 4.2. Identify early childhood development clients and increase participation in services 4.3. Implement early interventions and prevention processes by increasing knowledge and service capacity 4.4. Expand and improve Aboriginal Health Information and Cultural Awareness 4.5. Develop opportunities for healthy activities and social connections 4.6. Enhance prevention and supports for conflict resolution and lateral violence 4.7. Improve the First Nations Health Benefits Program

5. Mental or emotional health 5.1. Establish an alternative mental health program to support the reconstruction of families and healing of individuals 5.2. Identify resources to re-introduce the CHIP program to address the needs of individuals affected by FAS/E. The loss of this program has significantly impacted communities 5.3. Develop and increase relevant mental health services through planning 5.4. Develop an accountability framework to align and deliver services considering best practices, gaps and barriers and local needs identified in the Mental Wellness Forum

6. Youth and Elder services 6.1. Expand and improve Elder care and needs assessment services 6.2. Expand the Elders Network and the Elders Roster to represent the 5 Nations the Ktunaxa/Kinbasket Child & Family Services Society serves 6.3. Expand and improve youth services and assessment of needs

7. Social determinants of health 7.1. Increase education and skill development activities to enhance employment opportunities for Aboriginal people - especially in health professions 7.2. Develop a plan and standards to address housing, water, mould, radon and other environmental health concerns 7.3. Work with partners and communities to support economic development 7.4. Increase the availability of transportation

8. Community wellness and revitalization of traditional knowledge and language 8.1. Organize family and community cultural activities, knowledge sharing and language learning 8.2. Promote Elder-Youth mentorship 8.3. Develop Permanency Plans for children in care where it is unlikely that they will return to their parents' care 8.4. Reinvigorate traditional food systems 8.5. Promote community participation and increase engagement with men, Elders and youth

9. Aboriginal Urban Services 9.1. Secure Federal Transfer funds to provide services to the Aboriginal Urban population 9.2 Increase access to mental health and substance use services for the Aboriginal Urban population

Nlaka’pamux

1. Ashcroft Indian Band 9. Nicomen Indian Band 2. Boothroyd6 10. Nooaitch 3. Boston Bar First Nation6 11. Oregon Jack Creek 4. Coldwater Indian Band 12. Shackan 5. Cooks Ferry 13. Siska 6. Kanaka Bar Indian Band 14. Skuppah Indian Band 7. Lower Nicola Indian Band 15. Spuzzum6 8. Lytton First Nation

The Nlaka’pamux Nation is an Indigenous Nation with title and rights held communally by the people of the Nation. What defines us is not a line on a map, but a way of life, a shared culture and a communal responsibility to future generations. The Nlaka'pamux Nation is located in the southern interior of British Columbia and extends into the state of Washington. The economic value within the Nation is its richness in natural resources. Water availability is perhaps one of the most significant natural resources available to the Nation. The area is inhabited by numerous species of wildlife, plants, medicines and natural foods. The natural diet of the Nlaka’pamux Nation members consists of fish, wild meats, berries, plants, roots and medicines. The Nations’ people are resilient, strong and generous, sharing and trading their resources with other tribes. The traditions and culture of the Nlaka’pamux Nation members are valued assets transferred from past generations to the present.

Vision for regionalization: 1. Bringing services to community 2. Develop policy and rewrite policy that fits a First Nation perspective and values

Emerging Nlaka’pamux priorities are provided below:

1. Mental wellness and substance use 1.1. Communication at all levels 1.2. Honouring and utilizing cultural roles 1.3. Increase in professional health service providers 1.4. Shared resources and funding access 1.5. Nlaka’pamux cultural positions 1.6. Treatment and healing centres to be built within the community 1.7. Resolve access issues for the community 1.8. Collaboration of community resources 1.9. Rites of passage ceremonies 1.10. Culture and language camps 1.11. Transition out of treatment and aftercare 1.12. Case management and networking 1.13. Resolve access issues for the community by bringing services to the community

6 Boothroyd, Boston Bar First Nation and Spuzzum are part of the Nlaka’pamux Nation but are within the Fraser Health Authority region.

1.14. Veteran post-traumatic stress disorder support and advocacy for services including defining how many veterans we have and coordinating services 1.15. Provide high quality, culturally safe care for residential school survivors and their families 1.16. Improving housing and reducing overcrowding

2. Healthy living and wellness 2.1. Increase opportunities for physical activity 2.2. Develop groups and programs for all age groups and genders 2.3. Provide programs on parenting and healthy attachment (inclusive of foster children) 2.4. Provide programs to address violence against woman (and by women) 2.5. Elder recreational activities

3. Chronic disease prevention, education and management 3.1. Enhance supports which incorporate the physical, mental, emotional and spiritual components of health in the prevention and management of chronic conditions such as diabetes, arthritis, asthma, heart/circulation and disabilities (e.g. community gardens)

4. Primary care & public health services 4.1. Improve the accessibility and equity of health services for on- and off- reserve members and members of other areas in the territory 4.2. Enhance programs and services supporting the health and wellness of infants and toddlers 4.3. Increased support and programming for Early Childhood Education 4.4. Enhance health promotion, screening and preventive services occurring in schools 4.5. Increase access to physician, nurse practitioner and nursing services 4.6. Improve access to x-ray and lab services 4.7. Enhance the availability of emergency services 4.8. Enhance aftercare and support for discharging and liaison with the Band/Health Centre 4.9. Address the unique issues of small and isolated communities 4.10. Support the development of community health and wellness plans 4.11. Address gaps in services in collaboration with FNHA and Interior Health Authority 4.12. Establish access to basic health services in all communities, including doctors, dentists and eye care

5. Social determinants of health 5.1. Strengthen partnerships with social service agencies to address issues related to the social determinants of health 5.2. Support economic development

6. Elder care 6.1. Assess Elder’s facilities and programs and identify assets and priorities for improvement 6.2. Develop groups and programs for Elders such as healthy eating, safety and recreation

7. First Nations Health Benefits 7.1. Improve the First Nations Health Benefits Program to better meet the needs of First Nations 7.2. Develop and circulate clear descriptions of what Health Benefits coverage allowances are available (i.e. glasses, dental, etc.)

7.3. Programs for pharmaceutical drug misuse that are inclusive of: 7.3.1. Doctor awareness and prevention 7.3.2. Education on side effects of medication 7.3.3. Counselling and prevention

8. Letter of Understanding implementation 8.1. Select a Nlaka’pamux representative for the Joint Committee

9. Housing 9.1. Collaborate with partners in the housing sector to address repairs, renovations and plans for new houses

10. Culture and Spirituality 10.1. Incorporate cultural and spirituality throughout all documents and programs 10.2. Support cultural and spiritual practices and traditional activities such as the gathering of traditional foods and medicines

11. Environment 11.1. Protection of the watersheds 11.2. Quality assurance of water samples within community by ensuring processes and standards of water safety are being adhered to for safe drinking water 11.3. Protection of the pollen bee population

12. Travel 12.1. Address travel issues for remote sites/communities 12.2. Address travel issues for patients with mobility challenges, including establishing a space to rest while waiting for the community bus

13. Policy 13.1. Revise and develop policies from a First Nations perspective

14. Chronic disease prevention, education and management 14.1. Enhance supports which incorporate the physical, mental, emotional and spiritual components of health in the prevention and management of chronic conditions (diabetes, arthritis, asthma, heart/circulation and disabilities) eg. Community gardens

15. Database 15.1. Support communities to obtain a database (eg. Mustimuhw)

16. Communications 16.1. Develop a communication plan that speaks to: 16.1.1. Band Administration and health 16.1.2. Interior Health Authority services and structures 16.1.3. FNHA services and structures 16.1.4. First Nations Health Benefits services, process and appeal of services

17. Infrastructure 17.1. Improve infrastructure in communities, including for for water and internet

18. Health Authority Boundaries 18.1. Address the issues of communities that are at the boundaries of Regional Health Authorities

Secwepemc

1. Sexqeltqín - Adams Lake

2. St’uxwtéws - Bonaparte 10. Simpcw - North Thompson

3. Tsq’éscen - Canim Lake 11. Skítsesten - Skeetchestn 12. Splats’in - Spallumcheen 4. Esk’étemc – Alkali Lake

5. Llenllenéy’ten – High Bar 13. Tk’emlúps - Kamloops

6. Qw7ewt – Little Shuswap Lake 14. Ts'kw'aylaxw - Pavilion 15. Stil’qw/Pelltíq’t – Whispering Pines/Clinton 7. Sk’atsin - Neskonlith 16. T’éxel’c – Williams Lake 8. Stswécem’c/Xgét’tem’ -Canoe/Dog Creek

9. Kenpésq’t - Shuswap 17. Xats’úll – Soda Creek

The Secwepemc, more commonly known as the Shuswap, are comprised of 17 Bands located over approximately 18% of the total area of British Columbia. Their lands, Secwepemcúl’ecw, are geographically located in the South Central Interior of the Province. The Secwepemc, in terms of land base and population, are one of the largest Indigenous people in BC. Their lands cover over 180,000 km2. The traditional Secwepemc were a semi-nomadic people, living during the winter in warm semi- underground "pit-houses" and during the summer in mat lodges made of reeds. The traditional Secwepemc economy was based on fishing, hunting and trading. Secwepemc diet consisted of fish, meat, berries and roots. Many Secwepemc people still depend on these subsistence food gathering activities to meet their basic needs while also participating in the broader economy.

The Secwepemc Health Caucus has identified the following priorities:

1. Relationship with Interior Health Authority  Letter of Understanding and Workplan implementation  Effective discharge planning process developed and implemented  Secwepemc on board of Interior Health Authority  Interior Health Authority financial allocations for 17 communities  Health services same for on- and off- reserve members

2. Mental Wellness and Substance Use  Nation based community driven mental wellness and substance use plan  Re-establish family values  Re-store traditional justice activities  Research and implement healing plan/strategies  Nation-based treatment programs  Youth suicide plan  Drug abuse plan  Assessment of long-term cost of addressing FASD effects

3. Long Term Care – Elder Care  Elders homes in Kamloops and Williams Lake  Host Elders Forum

 Appoint Elder/Youth seats to Secwepemc Health Caucus Table  Assessment of existing programs and services for Elders  Elders coordinator for social functions

4. First Nations Health Benefits/Non-Insured Health Benefits  Nation FNHB/NIHB coordinator  Develop partnerships with FNHA Health Benefits staff  Address FNHB/NIHB issues (FNHDA)

5. Transition to a new Health Authority  Funding arrangements and processes  Capital projects  Communications and technology  Capacity  Ensuring adequate resourcing for services taken over

Additional priorities - To start implementation for April 1st, 2014 – March 31st, 2015 Fiscal Year 6. Social Determinants of Health – Hold 2nd Forum 7. Traditional Medicine & Healers – Hold 2nd Forum 8. Wellness and Lifestyle 9. Nutrition and food security 10. Brain Injury 11. Linkages with physicians 12. Relationships with other health care providers 13. Crisis response planning 14. Metis and Urban Aboriginal health jurisdiction 15. Research and data governance

Northern St'át'imc

The St’át’imc Traditional Territory is 20,500 square kilometres and is home to 11 St’át’imc communities. The six Northern St’át’imc communities are: Tsal’alh (Seton Lake), which is considered remote, and the rural communities of Xwisten (Bridge River), Ts’kw’aylaxw (Pavilion), Xaxli’p (Fountain), T’it’q’et (Lillooet), and Sekw’el’was (Cayoose Creek). Approximately half of our community members live on reserve and half live off reserve, either in Lillooet or in surrounding neighbourhoods and communities, towns, cities, and other First Nations communities.

The St'át'imc are the original inhabitants of the territory which extends north to Churn Creek and to South French Bar; northwest to the headwaters of Bridge River; north and east toward Hat Creek Valley; east to the Big Slide; south to the island on Harrison Lake and west of the Fraser River to the headwaters of Lillooet River, Ryan River and Black Tusk. The St'át'imc way of life is inseparably connected to the land. Our people use different locations throughout our territory of rivers, mountains and lakes, planning our trips with the best times to hunt and fish, harvest food and gather medicines. The lessons of living on the land are a large part of the inheritance passed on from St'át'imc Elders to our children. As holders of one of the richest fisheries along the Fraser River, the St'át'imc defend and control a rich resource that feeds our people throughout the winter and serves as a valued staple for trade with our neighboring nations. The St'át'imc can think of no other better place to live.

The current health priorities of the Northern St’át’imc are: 1. Complete Community Health Plans in all six Northern St’át’imc communities. 2. Carry out an Urban Health Strategy in the Northern St’át’imc Territory. 3. Develop a Northern St’át’imc Health Plan which will contribute towards the Interior Regional Health and Wellness Plan. 4. Strategize on improvements to the First Nations Health Benefits Program.

Syilx

1. Lower Similkameen Indian Band 5. Upper Nicola Band 2. Okanagan Indian Band 6. Upper Similkameen Indian Band 3. Osoyoos Indian Band 7. Westbank First Nation 4. Penticton Indian Band

The Okanagan Nation Alliance (ONA) is a tribal council and was formed in 1981. It is representative of the seven member Bands (noted above) including the Colville Confederated Tribes of Northern Washington State. The ONA’s mandate is to advance, assert, support and preserve Syilx title and rights. The ONA is charged with providing members with a forum to discuss and develop positions on areas of common concern. ONA’s responsibilities include serving the Syilx people as a collective, by addressing common issues and opportunities of the Nation and supporting a shared vision that promotes asset and capacity building for long term sustainable self-sufficiency.

The Syilx Nation represent their citizenry regardless of residency and supports the pursuit of its rights to retain responsibility for the health, safety, survival, dignity and well-being of Syilx children and families, consistent with the UN Convention on the rights of the child and the UN Declaration on the rights of Indigenous Peoples.

Listed below are priorities from the 2010 Syilx Nation Health Plan and emerging priorities that have been identified through more recent community engagement sessions:

1. Addressing current health priorities 1.1. Explore the potential for more effective and efficient use of existing resources among ONA communities 1.2. Develop Nationwide initiatives to address addictions and mental wellness 1.3. Develop a Regional Wellness Program to address chronic disease management 1.4. Build and sustain relationships with regional, provincial and federal partners 1.5. Address issues underlying HIV/AIDS 1.6. Offer violence, abuse and suicide prevention programs to all seven Bands

2. Developing Frameworks 2.1. Work on a reciprocal Accountability Framework with Interior Health to define relationships, communication protocols, operations, and reporting 2.2. Continue to develop a Health Governance Framework 2.3. Develop early childhood development initiatives and strategies

3. Strengthening Partnerships/Linkages 3.1. Letter of Understanding implementation 3.2. Ensure Okanagan Nation representation at all Interior Health policy and program development activities affecting Okanagan Nation populations 3.3. Enhance systems and linkages with partners in Housing, Education, Economic Development, Child and Family Services that address Social Determinants of Health

4. Identifying Future Nation Health Priorities for Action 4.1. Review recommendations from ONA “Pathways to Health and Healing Report” and move forward on identified priorities 4.2. Develop, implement and assess an action plan to address Nation health priorities

5. Strengthening the role of ONA in supporting the health of the Syilx Peoples 5.1. Ensure the ONA health office has sustainable and appropriate resources 5.2. Ensure ONA and member bands are positioned to secure future program funding

Emerging Priorities:

 Develop a mental health strategy  Increase access to nurse practitioner services  Develop a communication and community engagement strategy  Strengthen research partnerships with UBCO (eg. chronic disease, cultural competency)  Prepare for accreditation  Increase and improve programs and services for Elders  Develop regional wellness programs for youth. These programs could encompass nutrition, mental health, self-esteem, healthy activities and supports for parents and guardians  Create improvements in the First Nations Health Benefits Program  Increase the equity of services received on and off reserve  Develop a regional wellness program to address dental health for children in all communities  Obtain the services of a mental health clinician to be shared among the communities, similar to the Nurse Practitioner  Develop the health system to be consistent with the Community-Driven, Nation-Based directive and is based on a strong cultural framework

Tsilhqot’in

1. ?Esdilagh (receives services from both 4. Tsi Del Del Interior Health and Northern Health) 5. Yunesit'in Government 2. Tl’esqox 6. Xeni Gwet'in First Nation Government 3. Tl'etinqox Government

Chilcotin, meaning "people of the river," also refers to the Chilcotin Plateau region in British Columbia. The Chilcotin (Tsilhqot'in) First Nation are a DENE-(Athapaskan) speaking people numbering nearly 3200 who live between the Fraser River and the Coast Mountains in west-central BC. The Chilcotin traditional culture was similar to that of other Northern Athapaskan. Through much of the year, families moved about independently hunting, fishing and gathering roots and berries. In late summer most families gathered along the rivers to fish the salmon runs. In midwinter they moved to sheltered locations, usually near lakes suitable for ice fishing, where they lived in shed-roofed houses or pit houses.

The current health priorities of the Tsilhqot’in are: 1. Mental health and addictions 2. Elder care 3. Patient travel 4. Youth services 5. Promote traditional diet, medicines and Healers 6. Implementation of the Tsilhqot’in Wellness Plan: 6.1. Unify the Tsilhqot’in people by gathering and sharing ideas and resources 6.2. Balance and strengthen the spiritual, language and cultural traditions of the Tsilhqot’in people. Deni gatŝin gwayajelh tīg 6.3. Integrate traditional and contemporary health services in the community wellness centres 6.4. Promote holistic wellness practices 7. Letter of Understanding implementation

Next Steps The next steps for the iRHWP will be the development of a detailed implementation work plan and framework for reporting and evaluation. Implementation of the iRHWP will be a collaborative process by the First Nations Health Authority, Nation health technicians and Leads, and Interior Health Authority. To support implementation, the iRHWP will be linked with human and financial resources from the First Nations Health Authority and Interior Health Authority. Reporting and evaluation are essential components for accountability and establishing a clear, transparent framework will enable tracking of progress in achieving the goals that have been set, identification of lessons learned and celebration of successes.

Conclusion This first interim Regional Health and Wellness Plan lays a strong foundation consisting of the principles, values, structures and processes that will support the 7 Nations, the First Nations Health Authority and Interior Health Authority in the work moving forward in their new partnership. Recognizing that additional planning will be conducted at the Nation level to develop Nation Health and Wellness Plans, the iRHWP is a living document that will be revisited and revised to reflect new information and priorities identified by the Nations.

The 7 Nations, the First Nations Health Authority and Interior Health Authority have a vision to create improvements in the health and well-being of First Nations in the Interior Region by transforming healthcare for the better. The 7 Nations are driven by the common values of their cultures and their holistic perspectives of health and wellness. They look to their traditions to enhance health practices and they look to their current and future health leaders for guidance. This is an historic opportunity to achieve transformative change in First Nations health and wellness, and all of the partners involved are committed to make the most of this opportunity. Through their combined strengths and assets, the 7 Nations, the First Nations Health Authority and Interior Health Authority will strive to make this vision a reality.

References In preparing this iRHWP, the following documents were reviewed and relevant content was incorporated:

1. A Path Forward Dãkelh Dené Mental Health Forum (2013) 2. A Path Forward Ktunaxa Nation Assembly (2013) 3. Aboriginal Affairs and Northern Development Canada: Registered Indian Population by Sex and Residence 2011 http://www.aadnc-aandc.gc.ca/eng/1351001356714/1351001514619 4. Consensus Paper: British Columbia First Nations Perspectives on a New Health Governance Arrangement (2011) http://www.fnha.ca/Documents/FNHC_Consensus_Paper.pdf 5. East Kootenay Region Aboriginal Health and Wellness Community Planning Report (2010) 6. First Nations Health Council Interior Governance Entities Terms of Reference (2011) 7. Indigenous Nations of the Interior Declaration of Unity (2010) 8. Interior Health Authority Aboriginal Health & Wellness Plan (2010-2014) 9. Interior Region Summary Report on the Building Blocks for Transformation (2013) 10. Interior Partnership Accord (2012) http://www.fnha.ca/Documents/Interior_Partnership_Accord.pdf 11. Ktunaxa Nation Community Engagement Hub Community Priorities and Asset Mapping (2013) 12. Letter of Understanding between Ktunaxa Nation and Interior Health Authority (2012) 13. Letter of Understanding between Nlaka’pamux Nation and Interior Health Authority (2013) 14. Letter of Understanding between Okanagan Nation Alliance and Interior Health Authority (2012) 15. Letter of Understanding between Secwepemc Health Caucus and Interior Health Authority (2013) 16. Letter of Understanding between Tsilhqot’in National Government and Interior Health Authority (2013) 17. Lytton Area Health Hub: Results from Community Engagement Sessions (2013) 18. Missing Spokes in the Wheel of Health and Wellness: Exploring Gaps in Health Services for the Northern St’át’imc (2013) 19. Navigating the Currents of Change: Transitioning to a New First Nations Health Governance Structure (2012) http://www.fnha.ca/Documents/iFNHA_Consensus_Paper_2012.pdf 20. Nlaka’pamux Mental Wellness and Substance Use Forum (2014) 21. Nlaka’pamux Nation Health Priorities Collected from Leadership and Health Leads, March 26, 2013 (2013) 22. Northern St’át’imc Mental Wellness & Substance Use Health Forum (2013) 23. Okanagan/Syilx Nation Health Plan (2010) 24. Secwepemc Health Caucus Strategic Plan Up-Date June 19 (2013) 25. St’át’imc Nation Health Priorities: 3rd annual Elder’s gathering, March 13-14, 2013 (2013) 26. Summary of Health Priorities by Nation for the Dãkelh Dené, October 4, 2013 (2013) 27. Tsilhqot’in Wellness Plan (2012)

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Appendix A: Interior Regional Profile

Regional Profile of First Nations Communities in Interior Region

November 2013

DRAFT

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Table of Contents 1. Demographics ...... 3 1.1 Geography ...... 3 1.2 Population ...... 3 1.3 First Nations Communities ...... 4 1.4 Community Engagement Hubs ...... 8 1.5 Tribal Councils ...... 10 1.6 Umbrella Health Organizations ...... 10 2. Health Status Information ...... 11 2.1 Life Expectancy...... 12 2.2 All-cause Mortality ...... 13 2.3 Suicide ...... 14 2.4 Infant Mortality ...... 15 2.5 Diabetes ...... 17 2.6 Cancer ...... 19 2.7 Injury ...... 20 2.8 Mental Health and Wellness ...... 23 2.9 Circulatory System Disease ...... 25 2.10 NIHB Pharmacy Utilization ...... 26 2.11 Healthcare Utilization ...... 28 3. Budget Information ...... 29 4. Aboriginal Health & Wellness Strategy: 2010-2014 ...... 31 5. Appendix ...... 32 5.1 Definition of Potential Years of Life Lost: ...... 32 5.2 First Nations Health Authority Health Services ...... 33

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1. Demographics

Population Data Sources Census: The mandatory long-form Census (2006) contained a field in which Aboriginal peoples could choose to self-identify as First Nations (status or non-status), Metis or Inuit1. However, some First Nations reserve communities did not participate in enumeration. The mandatory long-form Census was cancelled and replaced in the 2011 Census with the non-mandatory National Household Survey (NHS)2. Since participation in NHS is voluntary, Aboriginal data from the NHS are less representative than those from the long-form Census. Note that only on-reserve population data are available from the 2011 Census.

AANDC Indian Registry: The AANDC’s Indian Registry is the definitive registry for all individuals registered under the Indian Act (Status First Nations). The AANDC population for BC captures all First Nations registered to BC bands and is not a BC Resident population. It excludes BC residents who are members of non-BC Bands. Two major limitations of the Indian Registry as a population data source are late reporting of life events (e.g. births and deaths) and the fact that residency code (e.g. on- and off-reserve) is not consistently updated after initial registration.

1.1 Geography The territorial land base of the Interior Region, as defined by BC Regional Health Authority boundaries is 237,692 km squared, 25.7% of the total provincial land base. For the purposes of this profile, the administrative geographic boundaries of the Interior Health Authority (IHA) are used but there are First Nations communities within these geographic boundaries that are included in other health regions for First Nations health planning purposes (see section 1.3). 1.2 Population Table 1 provides estimates of the First Nations population living in Interior Region using different data sources, including the 2011 Aboriginal Affairs and Northern Development Canada (AANDC)’s Indian Registry, the 2006 Census and the 2011 Census (see Sidebar for more information on these data sources). According to AANDC 2011 data, the First Nations population in Interior Region is close to 30,000, representing 22.3% of the First Nations population in BC.

Table 1 Interior Region Status First Nation Population Estimates, 2006 and 2011

Data Source/Year On-Reserve Off-Reserve Total AANDC 2011 15165 14772 30030 Census 2006 11205 11605 22810 NHS 2011 11570 13205 24780 Sources: Aboriginal Affairs and Northern Development Canada (AANDC), Census 2006, Statistics Canada, National Household Survey (replaces long form Census), Statistics Canada

1 Statistics Canada. 2006 Census: Aboriginal Peoples in Canada in 2006: Inuit, Métis and First Nations. Available: http://www12.statcan.gc.ca/census-recensement/2006/as-sa/97-558/note-eng.cfm. Accessed: Apr 24, 2013. 2 Statistics Canada. 2011 Census questionnaire. Available: http://www12.statcan.ca/census- recensement/2011/ref/gazette-eng.cfm. Accessed: Apr 25, 2013. P a g e | 4

1.3 First Nations Communities

The following table illustrates the population estimates and distance to service centre for the 54 communities in the Interior Region.

Table 2 Population Estimates for Interior Region First Nation Communities, by Nation and Distance to Service Centres

Distance to AANDC Band AANDC Band AANDC Band 2011 Census Service Affiliation 2011 Affiliation 2011 Affiliation 2011 on-reserve Centre7 total on-reserve off-reserve Dãkelh Dene: 1 Lhoosk'uz Dene n/a 209 51 158 44 Government3 2 Lhtako Dene n/a 161 74 87 73 Nation3 3 Ulkatcho4 No year 998 700 298 349 round access Ktunaxa: 4 ?Akisq'nuk First <50 km 268 154 114 114 Nation 5 Lower Kootenay <50 km 214 108 106 113 6 St. Mary's <50 km 364 215 149 109 7 Tobacco Plains <50 km 193 95 98 57 Nlaka’pamux5: 8 Ashcroft <50 km 255 79 176 97 9 Coldwater <50 km 795 404 391 385 10 Cook’s Ferry <50 km 310 79 231 64 11 Kanaka Bar n/a 215 78 137 68 12 Lower Nicola <50 km 1115 549 566 672 13 Lytton <50 km 1892 938 954 686 14 Nicomen <50 km 133 70 63 64 15 Nooaitch <50 km 206 118 88 127 16 Oregon Jack <50 km 63 20 43 15 Creek 17 Shackan < 50km 121 83 38 55 18 Siska <50 km 308 104 204 131 19 Skuppah <50 km 106 67 39 46

3 ?Esdilagh First Nation, Lhoosk’uz Dene and Lhtako Dene Nation are included in the Northern Region but have signed a unity declaration with Interior Region Nations. They are included in both Northern and Interior Regional profiles. 4 Ulkatcho has signed a unity declaration with interior Region Nations. They are included in both Vancouver Coastal and Interior Regional profiles 5 Boothroyd, Boston Bar First Nation and Spuzzum all belong to Nlaka’pamux Nation which has communities in both Fraser and Interior Regions. These First Nations are included in the Fraser Regional Profile. P a g e | 5

Secwepemc: 20 Adams Lake <50 km 742 421 321 356 21 Bonaparte <50 km 852 236 616 221 22 Canim Lake <50 km 585 441 144 229 23 Esketemc 50-350 km 835 466 369 403 24 High Bar n/a 93 n/a n/a 5 25 Little Shuswap <50 km 326 235 91 379 Lake 26 Neskonlith <50 km 621 326 295 327 27 Stswecem’c n/a 712 317 395 207 Xgat’tem First Nation 28 Shuswap <50 km 249 115 134 293 29 Simpcw First <50 km 664 249 415 267 Nation 30 Skeetchestn <50 km 509 246 263 253 31 Splatsin <50 km 813 391 422 435 32 T'kemlups <50 km 1158 641 517 2577 33 Ts'kw'aylaxw First <50 km 543 275 268 119 Nation6 34 Whispering <50 km 148 61 87 60 Pines/Clinton 35 Williams Lake <50 km 688 264 424 227 36 Xatsull <50 km 395 183 212 144 Syilx: 37 Lower <50 km 466 285 181 243 Similkameen 38 Okanagan Indian <50 km 1862 912 950 5193 Band 39 Osoyoos <50 km 490 372 118 628 40 Penticton <50 km 992 609 383 1667 41 Upper Nicola <50 km 891 426 465 302 42 Upper <50 km 77 63 14 76 Similkameen 43 Westbank First <50 km 732 422 310 7068 Nation St'át'imc: 44 Bridge River <50 km 432 218 214 236 (Xwisten) 45 Cayoose Creek <50 km 194 86 108 84 (Sekw’el’was) 46 Tsalahh <50 km 643 348 295 264 47 T'it'q'et <50 km 394 198 196 264 48 Ts'kw'aylaxw First <50 km 543 275 268 119

6 Included in both Secwepemc and St'át'imc. P a g e | 6

Nation 49 Xaxlip First Nation <50 km 981 392 589 Tsilhqot’in: 50 ?Esdilagh <50 km 180 54 126 52 51 Tl’esqox <50 km 312 166 146 118 52 Tl'etinqox-t'in 50-350 km 1503 604 899 475 Government 53 Tsi Del Del 50-350 km 639 347 292 200 54 Yunesit'in 50-350 km 424 277 147 201 Government 55 Xeni Gwet'in First 50-350 km 416 258 158 176 Nation Government Sources: Aboriginal Affairs and Northern Development Canada (AANDC) and Census, Statistics Canada

Figure 1 Percent of Interior Region First Nation communities by community size (number, %), 2011 AANDC

3, 6%

6, 11% <100 people 100-249 12, 22% 250-499 500-999 20, 37% 1000-1999 2000+ 13, 24% n/a

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7 Figure 2 Percent of Interior Region First Nation Communities by Distance to a Service Centre (number, %), 2011 AANDC

5, 9% 1, 2% 0, 0%

5, 9% No year round access <50 km 50-350 km >350 km n/a 43, 80%

Figure 2 above indicates that within Interior Region, a large proportion of communities are within 50 km of a service centre.

7 Service centre is defined as the nearest community to which a First Nation can refer to gain access to government services, banks and suppliers. The nearest service centre would have the following services available: (a) Suppliers, material and equipment (i.e., for construction, office operation, etc.) (b) A pool of skilled and semi-skilled labour, and (c) At least one financial institution (i.e., bank, trust company, credit union, etc.) In addition, the following services would typically be available: (d) Provincial services (such as health services, community and social services, environmental services, etc.), and (e) Federal services (such as Canada Post, Service Canada, etc.) P a g e | 8

1.4 Community Engagement Hubs

Community Engagement Hubs (CeH’s) are groups of First Nations communities who agree to plan, collaborate, and communicate to meet their nation’s health priorities.

Table 3 Community Engagement Hubs in Interior Region

Sub-region Number of Hubs supporting the sub-region 2013-2014 (Nation) Communities (Contribution Holder) Tsilhqot’in 6  Tsilhqot’in Health Hub (Tsilhqot’in National Government) Northern St'at'imc 5  Northern St'at'imc Hub (Lillooet Tribal Council)  Fraser Canyon Hub (Fraser Canyon Tribal Administration)  Merritt area Hub (First Nations Health Authority Direct Nlaka'pamux Contract)  Lytton Area Hub (Lytton FN) Syilx 7  Okanagan Nation Hub (Okanagan Nation Alliance) Secwepemc 17  Health Director’s Hub (Q'wemtsin Health Society) Ktunaxa 4  Ktunaxa Nation Hub (Ktunaxa Tribal Council Society) Southern Dakelh 3  Southern Dakelh Dené Hub (Carrier Chilcotin Tribal Council) Dené Number of Communities not formally involved in the Hub 54 process: 0

**Dakehl Dene hub is based out of Interior Region and includes 3 communities, 2 of which are in the Northern Region Communities (Lhoosku’z Dene Government, Lhtako Dene Nation)

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Figure 3 Interior Community Engagement Investment 2013/2014

Figure 4 Interior Region Hub Budget ($ dollar amount, %), 2012-2013

Human Resources

$167,500, Overhead $102,000, 14% 8% Communications

Administration $87,000, 7% $634,500, 52% $95,500, Travel and Meetings 8% Coordinator Travel & other community meetings $72,500, 6% Regional & Sub-Regional $61,000, 5% Caucus

There are 10.5 FTEs in the Interior Health Authority Hub with a total budget of $1,220,000.

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1.5 Tribal Councils Tribal Councils are defined as institutions established as "a grouping of bands with common interests who voluntarily join together to provide advisory and/or program services to member bands".8

Table 4 Tribal Councils in Interior Region

Tribal Councils 1. Northern Secwepemc Tribal Council 2. Carrier-Chilcotin Tribal Council 3. Ktunaxa Nation Council 4. Lillooet Tribal Council 5. Nicola Tribal Association 6. Nlaka’pamux Nation Tribal Council 7. Okanagan Nation Alliance 8. Shuswap Nation Tribal Council 9. Tsilhqotin National Government 1.6 Umbrella Health Organizations

Umbrella health organizations can be defined as an organization that coordinates the activities of a number of member organisations and hence promotes a common purpose. The organizations in the following table receive funding from the First Nations and Inuit Health BC Region.

Table 5 Umbrella Health Organizations in IHA

Communities Covered Umbrella Health Organizations In the Umbrella Health Organization Siska 1. Heskw’en’scutxe Health Services Society Cook’s Ferry Band Skeetchestn 2. Q’wemtsin Health Society Tk'emlups Whispering Pines Spuzzum Boston Bar 3. Fraser Thompson Indian Services Society Boothroyd Oregon Jack Creek Soda Creek 4. Three Corners Health Services Society Canoe Creek Williams Lake 5. Skeesht Health Services Society Lytton Coldwater 6. Scw’exmx Community Health Services Society Shackan Nooaitch

8 As defined by Aboriginal Affairs and Northern Development Canada’s website: http://www.aadnc- aandc.gc.ca/eng/1100100013812/1100100013813 accessed on: June 27, 2013 P a g e | 11

2. Health Status Information The graphs included in this section pull in data from a number of sources outlined in the “Health Status Data Sources” panel below.

Statistics reported in this section are based on currently available data. These statistics are largely “illness-based” and do not reflect the envisioned Wellness approach to health reporting.

Health Status Data Sources First Nations Client File (FNCF)9: The First Nations Client File is the product of a record linkage between an extract of the Aboriginal Affairs and Northern Development Canada Indian Registry and the BC Ministry of Health Client Registry and subsequent probabilistic matching. The Personal Health Number contained in the FNCF enables linking to other administrative databases. The First Nations Client file is a cohort of BC Resident First Nations people registered under the Indian Act, and their unregistered descendants for whom entitlement-to-register can be determined, linkable on their BC Ministry of Health PHN number. In the 2012 FNCF, approximately 5% of the total FNCF cohort has had their Status inferred. The First Nations Client File is updated on an annual basis using a fresh extract from the BC Client Registry and the AANDC Indian Registry. The data presented in this section are derived from databases held by the British Columbia Vital Statistics Agency linked to the First Nations Client File.

Vital Statistics Agency Database: The Vital Statistics Agency Database registers all births, marriages, deaths, and changes of name that occur in British Columbia.

Medical Services Plan Group 21: The MSP Registration & Premium Billing Group 21 includes individuals who have registered to have their MSP premium funded by the federal government. Eligible recipients are Status First Nations, Inuit recognized by Inuit Land Claim organizations and infants less than one year of age whose parent is an eligible recipient. MSP Group 21 does not include Status First Nations who have not requested their premiums to be paid by the federal government (eg. those who are working and have their MSP premiums covered by their employers).

Blue Matrix: The Blue Matrix is a collection of chronic disease and health service utilization registries held by the BC Ministry of Health. This data source includes physician services, hospital inpatient and day surgeries, PharmaCare, Residential Care, Home and Community Care Services.

Non-insured Health Benefits (NIHB): Data are presented for NIHB pharmacy utilization for status First Nations using pharmacies in British Columbia. The NIHB Program covers claims for pharmacy benefits not covered by private, public or provincial health care plans. The NIHB Program covers prescription drugs listed on the NIHB Drug Benefit List and approved over-the-counter medications.

Provincial Health Officer (PHO) Annual Report 200710: BC Resident Status Indian population in the 2007 PHO report was estimated using Health Canada’s Status Verification File (SVF) with the Ministry of Health’s Client Roster to count persons living in BC. The SVF is an extract of data from the AANDC Indian Registry.

9 BC Ministry of Health. Presentation to the Tripartite Data and Information Planning Committee. August 2012. 10 British Columbia Provincial Health Officer. Pathways to Health and Healing – 2nd Report on the Health and Well-being of Aboriginal People in British Columbia. Provincial Health Officer’s Annual Report 2007. Victoria, BC: Ministry of Healthy Living and Sport.

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2.1 Life Expectancy

Life expectancy is the expected (in the statistical sense) number of years of life remaining at a given age. The following graphs show life expectancy at birth for Status First Nations in Interior Region, as compared to other residents and then life expectancy at birth comparing males and females among Status First Nations in the region.

Figure 5 Life Expectancy in years, Status First Nations and Other BC residents 1993-2010, Interior Region

85.0 Status First Nations Other BC Residents

80.0

75.0

70.0

Life Life Expectancy in Years 65.0

60.0 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10

Source: BC Vital Statistics Agency, data as of April 17, 2012 (First Nations individuals identified through linkage to the First Nations Client File – see description in the Health Status Data Sources panel)

Figure 6 Life Expectancy in years, Status First Nations by Gender 1993-2010, Interior Region

85.0

80.0

75.0

70.0

Male

Life Life Expectancy in Years 65.0 Female

60.0 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10

2.2 All-cause Mortality

Age-standardized mortality rate (ASMR) measures the number of deaths due to all causes, expressed as a rate per 10,000 people. This measure allows for comparison in death rates between Status First Nations and other BC residents by adjusting for differences in population age distribution.

Figure 7 All-cause mortality (age-standardized), Status First Nations and Other Residents, 1993/97- 2006/10, Interior Region

Status First Nations Other BC Residents

100

Rate per10,000 30

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2.3 Suicide

Between the years 1993-1997 to 2006-2010, the suicide mortality rate has decreased for Status First Nations resident in BC. However it is still relatively high compared to other residents of BC and remains an important concern for all communities.

Figure 8 Suicide Mortality Rate, by Age Group, Status First Nations and Other BC residents, Average for 1993-2010 combined

4.50 Status First Nations Other BC Residents 4.00

3.50

3.00

2.50

2.00

Rate per10,000 1.50

1.00

0.50

0.00 10-14 15-24 25-44 45-64 65-84

Figure 9 Suicide Mortality Rate, Youth Aged 15-24, Status First Nations and Other BC residents, 5-year aggregate 1993/97-2006/10

6.00 Status First Nations Other BC residents 5.00

4.00

3.00

2.00 Rate per10,000

1.00

0.00

11 Figure 10 Potential Years of Life Lost (PYLL) due to Suicide (with 95% Confidence Intervals) , Status First Nations in BC, by Gender, 1993/97-2006/10

25.00 Male Female

20.00

15.00

10.00

PYLL PYLL per1000 population 5.00

0.00

Figure 11 Hospitalization rate for Suicide/Attempted Suicide, Status First Nations and Other Residents, by BC Regional Health Authority, 2006

250 Status First Nations Other BC Residents 200

150

100 Rate per100,000

0 Interior Fraser Vancouver Coastal Vancouver Island Northern

Source: Provincial Health Officer’s Annual Report 2007. Victoria, BC

2.4 Infant Mortality

11 A confidence interval is a statistical technique that measures the range of values estimated in the sample of a population. A 95 per cent confidence interval means that 19 times out of 20, the true values lies between the horizontal bars shown as (I) on the charts. Because of the fluctuations in the small numbers of events, the use of confidence intervals helps to determine whether changes from year to year are more likely to be due to chance alone or are reflecting a real change. P a g e | 16

Infant mortality rates for Status First Nations living in Interior Region have improved between the years 1993-1997 to 2006-2010, however it still higher than the rate for all other residents.

Figure 12 Infant Mortality Rate (per 1,000 births), Status First Nations and Other Residents, Interior Region, BC, 1993/97-2006/10

20.00 18.00

16.00 14.00 12.00 10.00 8.00 6.00

Rate per1,000 Births 4.00 2.00 0.00 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10 Status First Nations 8.33 7.97 8.57 7.71 6.00 6.98 7.89 7.12 8.67 8.82 8.70 9.05 8.93 8.10 Other BC Residents 5.51 5.04 4.59 4.08 3.94 3.92 3.90 4.02 4.35 4.19 3.87 3.73 3.43 3.11 # First Nations Infant Deaths 23 22 23 20 15 17 19 17 21 22 22 23 23 21

Figure 13 Infant Mortality Rate (per 1,000 births), Status First Nations and Other Residents, by BC Regional Health Authority, 1993/97-2006/10

14.00 12.00

10.00 8.00 6.00 4.00 2.00

Rate per 1,00 Live Births 0.00 Vancouver Vancouver Interior Fraser Northern Coastal Island Status First Nations 8.08 7.11 9.32 12.44 7.07 Other BC Residents 4.24 3.96 4.04 4.21 4.39 # First Nations Infant Deaths 75 58 67 146 101

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2.5 Diabetes

For the diabetes statistics displayed in this section, a case may be defined as an individual with a physician diagnosis of diabetes or be identified through record of diabetes drug utilization. It is evident from the figures that diabetes is a growing concern for Status First Nations as well as other residents of BC.

Figure 14 Age-standardized Diabetes Prevalence, Status First Nations and Other Residents, Interior Region, BC 1993-2011

1 Rate per100 (with 95% CI) 0 93/9494/9595/9696/9797/9898/9999/0000/0101/0202/0303/0404/0505/0606/0707/0808/0909/1010/11 Status First Nations 2.9 3.3 3.6 4.0 4.2 4.4 4.7 4.9 5.3 5.6 5.8 6.1 6.2 6.5 6.8 7.0 7.1 7.3 Other BC Residents 2.0 2.2 2.4 2.6 2.8 2.9 3.1 3.3 3.5 3.7 3.9 4.0 4.2 4.4 4.6 4.7 4.8 4.9 Year

Source: Population Health Surveillance and Epidemiology, BC Ministry of Health, October 2012.

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Figure 15 Age-standardized Diabetes Prevalence, Status First Nations by Gender, Interior Region, BC 1993-2011

Rate per100 (with 95% CI) 0 93/94 94/95 95/96 96/97 97/98 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 Males 2.1 2.6 3.0 3.5 3.7 4.0 4.4 4.7 5.1 5.4 5.6 5.8 5.9 6.1 6.5 6.9 7.0 7.1 Females 3.5 3.8 4.1 4.4 4.6 4.8 5.0 5.1 5.4 5.7 6.0 6.3 6.5 6.9 7.0 7.1 7.3 7.5 Year Source: Population Health Surveillance and Epidemiology, BC Ministry of Health, October 2012. Figure 16 Hospitalization for Endocrine, Nutritional and Metabolic Disorder, First Nations and Other Residents, BC, 2004-2007

30 Status First Nations Other BC Residents

Rate 000 per10 10

0 Diabetes Mellitus Metabolic Disorders

Source: Pathways to Health and Healing – 2nd Report on the Health and Well-being of Aboriginal People in British Columbia. Provincial Health Officer’s Annual Report 2007. Victoria, BC: Ministry of Healthy Living and Sport

The figure above indicates that Status First Nations people resident in BC have a higher rate of hospitalization due to diabetes and metabolic disorders than other BC residents.

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2.6 Cancer

Figure 17 Cancer Mortality (age-standardized), Status First Nations and Other Residents, Interior Region, BC 1993/97-2006/10

8 Status First Nations Other BC Residents 6 Rate per10,000

Figure 18 Number of Deaths due to Cancer, Status First Nations, Interior Region, BC, 1993/97-2006/10

140

120

100

20 Numberof Deaths DueCancer to

0 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10

The age-standardized mortality rate due to cancer for Status First Nations people resident in Interior Region has decreased between 1993-1997 to 2006-2010. However the absolute numbers of deaths due to cancer has increased during this same time period.

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2.7 Injury

Potential Years Life Lost (PYLL) was used as a unit of measurement in presenting death by external causes. This measure integrates information on both the mortality event and the years of life lost, from the referent age of 75. For a more detailed description of PYLL see Appendix 6.1. An external cause of death, defined by the WHO’s ICD-10 codes12, is a death due to accidents, violence, poisoning, other adverse events, including environmental events.

Figure 19 Potential Years of Life Lost (PYLL), External Causes, Status First Nations and Other Residents, Interior Region, BC, 1993/97-2006/10

100.00 Status First Nations Other BC Residents 90.00

80.00

70.00

60.00

50.00

40.00

30.00

20.00 Potential Years Life Lost /1,000 10.00

0.00 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10

11 World Health Organization website: http://www.who.int/classifications/icd/en/ retrieved November 23, 2012 P a g e | 21

Figure 20 Potential Years of Life Lost (PYLL), External Causes, Status First Nations by Gender, Interior Region, BC, 1993/97-2006/10

100.00 Male

90.00 Female 80.00

70.00 Total

60.00

50.00

40.00

30.00

20.00

Potential Years Life Lost / 1,000 10.00

0.00 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10

Accidental poisonings defined by the WHO’s ICD9 codes13, include the following:

 Analgesics antipyretics and antirheumatics  barbiturates  sedatives and hypnotics  tranquilizers  other psychotropic agents  other drugs acting on central and autonomic nervous system  antibiotics  other anti-infectives  other drugs  alcohol not elsewhere classified  cleansing and polishing agents disinfectants paints and varnishes  petroleum products other solvents and their vapors not elsewhere classified  agricultural and horticultural chemical and pharmaceutical preparations other than plant foods and fertilizers  corrosives and caustics not elsewhere classified  foodstuffs and poisonous plants  other and unspecified solid and liquid substances  gas distributed by pipeline  other utility gas and other carbon monoxide  other gases and vapors

13 World Health Organization website:http://www.icd9data.com/2012/Volume1/E000-E999/E860- E869/default.htm accessed on June 20, 2013 P a g e | 22

Figure 21 Potential Years of Life Lost, by External Cause, Status First Nations - Male, Interior Region, BC, 1993/97-2006/10

80.00 Fire and flames

70.00 Homicide

Suicide 60.00 Accidental Falls 50.00 Accidental Poisoning

40.00 Motor Vehicle Accidents

30.00

20.00 Potential Years Life Years Life Potential Lost /1,000 10.00

0.00 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10

Figure 22 Potential Years of Life Lost (PYLL), by External Cause, Status First Nations - Female, Interior Region, BC, 1993/97-2006/10 80.00 Fire and flames

70.00 Homicide

60.00 Suicide

50.00 Accidental Falls

Accidental Poisoning 40.00 Motor Vehicle Accidents 30.00

20.00 Potential Years Life Lost /1,000 10.00

0.00 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10

As you can see in Figure 20, the proportion of PYLL/1,000 due to suicide and motor vehicle accidents has decreased over time for Status First Nation males in Interior Region.

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2.8 Mental Health and Wellness

Figure 22, below, illustrates the rates of hospitalizations for Mental and Behavioural Disorders for Status First Nations people compared to other residents in BC for the years 2004 to 2007 combined. The category “Mental disorders due to psychoactive substance use” are defined by the WHO’s ICD 1014 as those mental disorders due to the use of:  alcohol  opioids  cannabinoids  sedative hypnotics  cocaine  other stimulants, including caffeine  hallucinogens  tobacco  volatile solvents  multiple drug use and use of other psychoactive substances

“Mood disorders” include various types of depression, bipolar, and mania.

Figure 23 Rate of hospitalizations for Mental and Behavioural Disorder, Status First Nations and Other Residents, BC, 2004-2007 Combined 60.00 Status First Nations Other BC Residents 50.00

40.00

30.00

20.00

10.00 Age Age Adjusted Rateper10 000 0.00 Mental Disorders Mood disorders Schizophrenia Neurotic stress- Organic, due to psychoactive disorders related disorders symptomatic mental substance use Disorders

14 World Health Organization website: http://www.who.int/substance_abuse/terminology/ICD10ResearchDiagnosis.pdf accessed on June 20, 2013 P a g e | 24

Figure 24 Percentage of Mental Health Hospital Admissions with Community Follow-up within 30 days after Discharge, Status First Nations and Other Residents, by BC Regional Health Authority, 2006

90 Status First Nations Other BC Residents

80 70 60 50 40 up within 30 days - 30 20

% follow % 10 0 Interior Fraser Vancouver Coastal Vancouver Island Northern

From the data summarized in Figure 23, above, it is evident that a lower proportion of First Nations people who had been admitted to hospital due to mental health reasons received community follow-up within 30 days after discharge than other residents for all Regional Health Authorities.

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2.9 Circulatory System Disease

Mortality due to circulatory system disease captures deaths attributed to stroke and/or heart disease.

Figure 25 Age-standardized mortality due to Circulatory System Disease, Status First Nations and Other Residents, Interior Region, BC, 1993/97-2006/10

35 Status First Nations Other BC Residents 30

15 Rate per10,000 10

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2.10 NIHB Pharmacy Utilization

The Non-Insured Health Benefits Program is Health Canada's national, medically necessary health benefit program that provides coverage for benefit claims for a specified range of drugs, dental care, vision care, medical supplies and equipment, short-term crisis intervention mental health counselling and medical transportation for eligible First Nations people and Inuit.

An eligible recipient is someone who is entitled to receive benefits such as vision care, prescription drugs or other benefits or services from the NIHB Program. An eligible recipient must be identified as a resident of Canada and one of the following:  A registered Indian according to the Indian Act;  An Inuk recognized by one of the Inuit Land Claim organizations; or  An infant less than one year of age, whose parent is an eligible recipient.15

Table 6 Remoteness and percentage of clients who filled out prescriptions in BC First Nations Communities (2011)

Remoteness and % of clients who filled out prescriptions in BC First Nations Communities (2011)

Proximity to Service # Communities % of eligible clients who filled 95% Confidence Center 7 out prescriptions using NIHB Interval

< 50 km to service 75 63.1% 63.5 – 69.6 center

Between 50 and 350 73 63.5% 60.2 – 69.1 km to service center

> 350 km from 11 64.7% 61.9 – 65.2 nearest service center

No year round access 28 66.6% 61.1 – 65.1 to service center

The above table illustrates that proximity to a service centre had no effect on the % of eligible clients who filled out prescriptions using NIHB. All clients were approximately equally likely to fill out a prescription regardless of their proximity to a service centre.

15 As defined by Health Canada on: http://www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/index-eng.php accessed on June 27, 2013 P a g e | 27

Table 7 NIHB Pharmacy Utilization by Region, 2011

NIHB Pharmacy Utilization by Region

NHA IHA FHA VCHA VIHA Number of clients eligible for 47 173 29 487 8 946 15 959 30 888 NIHB (2011) % of population who filled a 62.5 62.3 58.9 69.1 66.1 prescription with NIHB (2011) Average Cost / Claimant in 622 660 748 736 674 2011 ($) Average Cost / Claimant in 322 330 435 428 384 2000 ($) Amount Paid in 2011 19 087 006 12 356 184 4 337 775 8 188 050 13 695 873

Source: Non-insured Health Benefits Pharmacy Data Cube

Table 7 illustrates that for that for Interior Region, there was in increase in the average cost per claimant between the years 2000 and 2011 from $330 to $660. This may be due to factors such as an increase in professional fees charges by pharmacists and the addition of new medications being covered under the NIHB plan.

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2.11 Healthcare Utilization

Figure 26 Number and Percentage of Status First Nations Population by Chronic Condition and Percentage of Interior Region Total Costs attributed by Chronic Condition (number, %)

Source: MSP Group 21 denominator file linked to the Ministry of Health’s Blue Matrix, (see the Health Status Data Sources panel)

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3. Budget Information

First Nations Inuit Health- BC Region Program Funding data

This report includes regional summaries on the status of First Nations and Inuit Health’s (FNIH) Health Transfer Program, which began in 1989. In 2005, FNIH introduced new Health Funding Arrangements entitled the Contribution Funding Framework (CFF) to the Health Transfer Program. According to FNIH, the new CFF is designed to be more responsive to communities and have increased flexibilities across sectors, as well as allowing the possibility of greater community-control.16 Under the new CFF, a recipient can enter into a longer term contribution agreement (up to ten years in the flexible transfer funding model) compared to the old maximum of five years associated with previous model Transfer agreements. Significantly, a recipient does not need to go through each of the four models in the new CFF to apply for the highest level of self-control. Rather, following a capacity assessment done collaboratively between the recipient and FNIH, a recipient can apply for the most appropriate model based on their capacity and abilities.

The previous funding arrangements consisted of three defined funding agreement models (General, Integrated, and Transfer). Associated with these funding models were additional elements, such as community size that determined whether a community may reach the final phase. In 2007, updated funding models were introduced (Set, Transitional, Flexible, and Flexible Transfer). One or more of these funding models could be accommodated in a single funding agreement, with flexible transfer allowing for the most community-control.

In 2011, new funding models were introduced (Set, Flexible and Block) in an effort to harmonize federal government funding mechanisms. These funding models are similar to the funding models introduced in 2007, with the exception of the Block funding model, which combines the characteristics of the previous Flexible and Flexible Transfer funding models17. The funding models vary in the amount of participation of FNIHB in program management and administration; flexibility in reallocating funds within and between programs; the ability to carry forward unspent funds from fiscal year to fiscal year and to use a surplus; as well as reporting and evaluation requirements.

At the time of publication, updated funding arrangement and program funding data from FNIH BC Region were not available so the 2008/2009 funding amounts and funding arrangement details published in the previous version of this Profile report are repeated.

16 First Nations and Inuit Health, BC Region (2007). Contribution Funding Framework and Health Planning Process, May 2007. Retrieved May 6, 2009 from http://74.125.155.132/search?q=cache:dmiEXtBgTEUJ:www.bcfnhs.org/downloads/admin/national/Natl_Funding_Changes_2008.ppt+FNIHB+ Health+funding+arrangements&cd=6&hl=en&ct=clnk . 17 For more information on types of FNIHB contribution agreements, please see: http://www.hc-sc.gc.ca/fniah-spnia/finance/agree- accord/index-eng.php#type. Accessed: September 26, 2011. P a g e | 30

Table 8 Funding Arrangements between First Nations communities in the Interior Health Region with FNIHB (as of January 29, 2013)

Type of Funding Arrangement Number % Total number of Bands with a Block Flexible Transfer Agreement 11 20.00% Total number of Bands with a Flexible Transfer Agreement 36 65.45% Total number of Bands who receive Set Funding 7 12.73% Total number of Bands with no funding agreement 1 1.82% TOTAL 55 100%

Table 9 Interior Health Region Summary of FNIHB Clusters funded by Contribution Agreements, 2012/1318

FNIHB Cluster Funding amount Childhood and Youth $3,443,173 Chronic Disease and Injury Prevention $1,056,206 Communicable Disease Program $122,358 Environmental Health and Research Program $765,666 Mental Health and Addictions $2,082,682 Primary Health Care Program $4,158,068 Total $11,628,153

Figure 27 Interior Health Region Summary of FNIHB Clusters funded by Contribution Agreements, 2012/13

18 For a description of programs in each cluster, please see Appendix. P a g e | 31

4. Aboriginal Health & Wellness Strategy: 2010-201419 The IHA Aboriginal Health & Wellness Strategy presents five key strategies that define their approach to Aboriginal health. They are: 1. Develop a sustainable Aboriginal health program 2. Ensure Aboriginal Peoples’ access to integrated services 3. Deliver culturally safe services across the care & service continuum 4. Develop an information, monitoring and evaluation approach for Aboriginal health 5. Ensure ongoing meaningful Aboriginal participation in healthcare planning

19 IHA. Aboriginal Health and Wellness Strategy (2010-2014). Available: http://www.interiorhealth.ca/YourHealth/AboriginalHealth/Documents/AboriginalHealthStrategy2010-14.pdf. Accessed: Apr 24, 2013 P a g e | 32

5. Appendix 5.1 Definition of Potential Years of Life Lost20: Potential years of life lost (PYLL) is the number of years of life "lost" when a person dies "prematurely" from any cause – before age 75. A person dying at age 25, for example, has lost 50 years of life. Potential years of life lost are calculated by taking the median age in each age group, subtracting from 75, and multiplying by the number of deaths in that age group disaggregated by sex and cause of death. These data are presented as a standardized rate per 100,000 population. (However, in this report, the data are presented as a rate per 1,000 population.) Causes of death are classified according to the International Classification of Disease (ICD–9) from 1979 to 1999. The year 2000 and subsequent years available are classified according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD–10).

20 Statistics Canada website: http://www.statcan.gc.ca/pub/82-221-x/2011002/def/def1-eng.htm#de1pyo retrieved November 23, 2012

P a g e | 33

5.2 First Nations Health Authority Health Services

Health Promotion & Health Protection Dental Health Surveillance Prevention Children and Youth  Communicable Disease  Children's Oral  Epidemiology Control Unit Health Initiative  Health Reporting  Maternal Child  TB Control  Therapy and  e-Health Solutions Health  Pandemic/Emergency Treatment  Regional Pharmacist  Canada Prenatal Planning  Prevention and  Consultation for Nutrition  HIV/AIDS Promotion Nursing, Non-Insured Program  STI/BBI Health Benefits and  Fetal Alcohol  Immunization Tripartite First Nations Spectrum  Consultation for Health Plan Disorder Environmental Public  Aboriginal Head Health Start

Mental Health and Environmental Public Health Non-Insured Health Health Transfer & Addictions Services Benefits Benefits  Drinking Water  Pharmacy  Manage Post Transfer  Indian  Waste Water  Dental Care  Manage Transfer Residential  Waste Management  Vision Care Development Schools  Food Safety  Medical Supplies &  Community  National Native  Facilities Health Inspection Equipment Development and Alcohol & Drug  Emergency Response  Short-term Crisis Capacity Building Abuse Program  Housing Intervention  Quality Improvement  National  Zoonotic Diseases  Medical and Accreditation Aboriginal Youth  Communicable Disease Transportation  Contracts & Suicide Control  Administration of Contributions Prevention  Environmental Contaminant Provincial Care Card Strategy Nursing Services Policy and Strategic Capital Chronic Disease and Planning Injury Prevention  Transfer Nursing  Planning with FNHA  Health Facility  Recruitment and in year of transition Development  Aboriginal Retention  Health Services  Health Facility Diabetes  Nursing Education Integration Fund Replacement Initiative  Nursing Practice and  Supporting Transition  Health Facility  Nutrition Research Engagement and operations and  Injury Prevention  Northern Operations change management maintenance  Home and Community  Best Practices for Care construction/tender process  Residences - use and management

Appendix B: First Nations Health Transfer History and Context

The Transformative Change Accord (2005) was the starting point of a shared journey of BC First Nations and the federal and provincial governments to improve the quality of life of First Nations people. In health, incremental progress has been made since then through a series of health plans and agreements, including the Transformative Change Accord: First Nations Health Plan (2006); the First Nations Health Plan Memorandum of Understanding (2006); the Tripartite First Nations Health Plan (2007); the BC Tripartite Framework Agreement on First Nations Health Governance (2011); and the Health Partnership Accord (2012). These are illustrated in figure 1, and key agreements are summarized below.

Figure 1. Health Plans and Agreements

The Transformative Change Accord: First Nations Health Plan (TCA: FNHP; 2006) was signed by the First Nations Leadership Council1 and the Province of BC. The 10-year plan includes 29 action items in four areas: Governance, Relationships and Accountability; Health Promotion/Disease and Injury Prevention; Health Services and Performance Tracking.

Subsequently, a tripartite process was established to develop a Tripartite First Nations Health Plan (TFNHP, 2007) to build on the commitments in the TCA: FNHP. The BC Tripartite Framework Agreement on First Nation Health Governance (the “Framework Agreement”) provided for the creation of a new health governance structure and the transfer the federal programs and operations to First Nations control. This new health governance structure includes the First Nations Health Council (FNHC), First Nations Health Authority (FNHA), First Nations Health Directors Association (FNHDA) and the Tripartite

1 First Nations Leadership Council – Collective body of First Nations organizations in BC (BC Assembly of First Nations, First Nations Summit, and Union of BC Indian Chiefs) who came together to push for improvements to policies and programs and a new relationship with BC, and later with Canada.

Committee on First Nations Health (TCFNH) (see figure 2). It holds responsibility for health planning and administration as well as health design, delivery and accountability to better support the health care and service delivery needs of BC First Nations.

Figure 2. Overview of the First Nations Health Governance Structure

The Health Partnership Accord describes the parties’ common vision for the tripartite partnership, including the scope of possibilities for health innovation enabled by a committed, resourced and supportive relationship. It sets context for the tripartite efforts in implementing the Framework Agreement and the other tripartite commitments regarding First Nations health.

As part of this new health governance structure, BC First Nations have, through engagement and consensus-building processes, collectively established a new First Nations health governance structure and standards. The structure and standards build from the ground-up and include a strong regional emphasis, recognizing the value of making decisions at the appropriate levels (e.g., community decisions made in communities, regional decisions made in the region).

A key part of this new structure are regional caucuses in each of the health regions. The Interior Region Caucus is represented by 54 communities and seven Nations: Dakelh Dené, Ktunaxa, Secwepemc, Syilx, St’at’imc, Tsilhqot’in and Nlaka’pamux.

The Interior Region Nation Executive2 and the Interior Health Authority signed the Interior Partnership Accord on November 14, 2012 with the overall goal to improve the health and wellness outcomes for First Nations people in the Interior by establishing a coordinated and integrated First Nations health and wellness system. A Partnership Accord Leadership Table has been developed to oversee the implementation of the Partnership Accord.

At Gathering Wisdom for a Shared Journey V (2012), BC First Nations Chiefs and leaders provided direction to establish Regional Offices (now referred to as regional teams and supports) in order to support the implementation of these agreements and improve health programs and service delivery and health outcomes for First Nations in the regions. To date, the FNHA has supported the development and implementation of extensive community engagement in each region to facilitate dialogue and participation through the regional structures and Community Engagement Hubs. Activities have taken place to build regional teams and supports, including the hiring of Regional Directors in each Region in 2013. The iRHWP will further support the planning, collaboration and implementation of the evolving regional work, including regional health and wellness priorities and regional envelopes

2 Acts as an executive body to the Interior Region First Nations Community Health Caucus and carries out the directions of the Caucus.

Appendix C: Interior Nations Declaration of Unity

FNHC

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Signatories for the Interior Region First Nations:

Mic Werstuik Secwepemc Syilx

Kevin Skinner Chief~cJr Bernie Elkins DakelhDene Tsilhqot'in

Chief Arthur Adolph St'at'imc Nlaka'pamux

Ktunaxa

Signatories for the Interior Health Authority:

Witness Signatories for the First Nations Health Authority:

Lydia Hwitsum, Board Chair First Nations Health Authority

FNHC: Interior Region Nation Executive & Interior Health Authority: Partnership Accord 2012 10

APPENDIX APPENDIX

health health

Framework Framework

implementation implementation

Health Health

Nations Nations

Health Health

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administrative administrative

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of of

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natural natural

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FNHC: FNHC:

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collaborations collaborations

a a

in in

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communities. communities.

beliefs. beliefs.

local local

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informed informed

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health health

people" people"

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amongst amongst

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resolution resolution

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BC BC

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DEFINITIONS DEFINITIONS

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26,2011. 26,2011.

to to

peoples peoples

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member member

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Inuit Inuit

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11 11

level level

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The The of of

based based

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development development

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assist assist

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54 54

Nations Nations

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7 7

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the the

by by

their their

residents residents

undertaken undertaken

actions actions

Regional Regional

Plan Plan

on on

13 13

and and

Community Community

the the

Provides Provides

political political

as as

September September

and and

BC BC

Under Under

shared shared

outcomes, outcomes,

Health Health

needs, needs,

discrimination discrimination

includes includes

Canada, Canada,

Province Province

United United

their their

the the

on on

to to

First First

on on

history, history,

off off

of of

Health Health

health health

Health Health

be be

development development

outlined outlined

November November

entities. entities.

rights rights

reserve. reserve.

executive executive

with with

the the

by by

British British

priorities, priorities,

a a

vision vision

Nations Nations

addressed addressed

Nations Nations

roadmap roadmap

twenty-nine twenty-nine

where where

2007. 2007.

a a

Health Health

of of

language, language,

partners, partners,

new new

potential potential

to to

BC BC

and and

a a

against against

staged staged

The The

13 13

First First

work work

and and

of of

27, 27,

and and

by by

of of

the the a a

development, development,

the the

Indigenous Indigenous

their their

Declaration Declaration

FNHC: FNHC:

right right

Interior Interior

to to

peoples, peoples,

remain remain

multicultural multicultural

is is

Region Region

to to

encourage encourage

and and

distinct distinct

Nation Nation

it it

promotes promotes

democracy democracy

Executive Executive

and and

countries countries

to to

pursue pursue

their their

& &

Interior Interior

and and

to to

full full

their their

work work

decentralization. decentralization.

Health Health

and and

own own

alongside alongside

effective effective

Authority: Authority:

visions visions

participation participation

Indigenous Indigenous

Partnership Partnership

of of

economic economic

Accord Accord

peoples peoples

in in

and and

all all

2012 2012

social social

matters matters

to to

solve solve

development. development.

that that

global global

concern concern

issues, issues,

The The

them them

like like

goal goal

14 14

and and of of

APPENDIX APPENDIX

FNHC: FNHC:

Interior Interior

TWO: TWO:

Region Region

i i

Nation Nation

INFORMATION INFORMATION

Executive Executive

& &

Interior Interior

Health Health

AND AND

issues issues

Executive Executive

Regional Regional

Authority

and and

collaboration collaboration

and and

MoH MoH

REPORTING REPORTING

Planning Planning

works works

: :

needs needs

Partnership Partnership

to to

address address

at at

with with

through through

Table Table

the the

IHA IHA

Accord Accord

2012 2012

FLOW FLOW

information information

Collaboration Collaboration

local local

unresolved/ongoing unresolved/ongoing

Executive Executive

needs needs

level level

issues issues

and and

on on

to to

with with

gathers gathers

issues issues

needs needs

address address

l l

IHA IHA

and and

at at 15 15 APPENDIX THREE: INTERIOR HEALTH MAP OF NATIONS

.. 1H wes\ \'WJiamslalce

e EskelftnC

~noeCteek

Cool

~""-'' ..~~ t-.tom.ch·~~ICOia

Montana Idaho .. \o\eshtngton L_.._25_.__._.J50_J._._....__.~oo 11m A

FNHC: Interior Region Nation Executive & Interior Health Authority: Partnership Accord 2012 16

Tsilhqot'in: Tsilhqot'in:

**Part **Part

*Part *Part

Nlaka'pamux: Nlaka'pamux:

St'at'imc: St'at'imc:

Syilx: Syilx:

Secwepemc: Secwepemc:

Ktunaxa: Ktunaxa:

Dakelh Dakelh

FNHC: FNHC:

APPENDIX APPENDIX

COMMUNITIES COMMUNITIES

of of

Interior Interior

of of

Dene: Dene:

Fraser Fraser

Northern Northern

Region Region

FOUR: FOUR:

Nation Nation

Region Region

Spuzzum Spuzzum

Ashcroft Ashcroft

Government, Government,

lower lower

Nation*, Nation*,

Xwisten, Xwisten, Nooaitch, Nooaitch,

Nation) Nation)

Indian Indian

?Esdilagh, ?Esdilagh,

Band, Band,

Adams Adams

lower lower

Executive Executive

Akisq'nuk Akisq'nuk

Nation, Nation,

Band, Band,

Nation Nation

Pines/Clinton Pines/Clinton

Band, Band,

Indian Indian

lhoosk'uz lhoosk'uz

INTERIOR INTERIOR

Simpcw Simpcw

Penticton Penticton

Tobacco Tobacco

Neskonlith Neskonlith

Esketemc Esketemc

Nicola Nicola

Similkameen Similkameen

Band, Band,

Band Band

lake lake

& &

T'kemlups T'kemlups

Indian Indian

Coldwater Coldwater

Interior Interior

First First

Sekw'el'was, Sekw'el'was,

** **

Oregon Oregon

First First

Dene Dene

Indian Indian

Tl'esqox, Tl'esqox,

and and

Indian Indian

and and

First First

Nation* Nation*

First First

Nation, Nation,

Plains Plains

Health Health

Band, Band,

Government**, Government**,

Indian Indian

First First

Westbank Westbank

Indian Indian

Xeni Xeni

Jack Jack

Indian Indian

Nations, Nations,

NATIONS NATIONS

Band, Band,

Nation, Nation,

Indian Indian

Band, Band,

Authority: Authority:

Nation, Nation,

Indian Indian

Boothroyd Boothroyd

Tl'etinqox-t'in Tl'etinqox-t'in

Tsalahh, Tsalahh,

Creek, Creek,

Gwet'in Gwet'in

lower lower

Band, Band,

Bonaparte Bonaparte

lytton lytton

Band, Band,

Skeetchestn Skeetchestn

Williams Williams

First First

Band Band

Partnership Partnership

High High

Upper Upper

Shackan, Shackan,

Kootenay Kootenay

Stswecem'c Stswecem'c

First First

Ts'kw'aylaxw Ts'kw'aylaxw

T'it'q'et, T'it'q'et,

lhtako lhtako

Nation Nation

Cooks Cooks

Okanagan Okanagan

AND AND

Indian Indian

First First

Bar Bar

Nation Nation

Nicola Nicola

Indian Indian

Government, Government,

lake lake

Accord Accord

Band, Band,

Nation, Nation,

Siska, Siska,

Ferry, Ferry,

Dene Dene

Indian Indian

Band*, Band*,

Indian Indian

MEMBER MEMBER

Xaxli'p, Xaxli'p,

Indian Indian

Xgat'tem, Xgat'tem,

Band, Band,

Government Government

2012 2012

Indian Indian

little little

First First

and and

Nation** Nation**

Kanaka Kanaka

Nicomen Nicomen

Band, Band,

Boston Boston

and and

Band, Band,

Upper Upper

Skuppah Skuppah

Canim Canim

Shuswap Shuswap

Nation, Nation,

lsi lsi

Band, Band,

St. St.

Shuswap Shuswap

Splatsin Splatsin

(Ts'kw'aylaxw (Ts'kw'aylaxw

Bar Bar

Del Del

Bar Bar and and

and and

Indian Indian

Mary's Mary's

Similkameen Similkameen

lake lake

Osoyoos Osoyoos

Indian Indian

Del, Del,

Whispering Whispering

Indian Indian

First First

Xatsull Xatsull

lake lake

Ulkatcho Ulkatcho

First First

Indian Indian

Yunesit'in Yunesit'in

Indian Indian

Band, Band,

Indian Indian

Band, Band,

Indian Indian

Band, Band,

Indian Indian

First First

First First 17 17

FNHC: FNHC:

Interior Interior

APPENDIX APPENDIX

Wba,..u

Whereu, Whereu,

Wbereu, Wbereu,

Wbereu

Wbereao, Wbereao,

Nation-to-Nation Nation-to-Nation

reopeaol reopeaol

government-to-government government-to-government

.,.._ .,.._

for for

Columbiai Columbiai

to to

Wbereu, Wbereu,

environ environ interference, interference,

...... the the

and and

Our Our

Columbia, Columbia,

having having

and and righto; righto;

IDclla-u IDclla-u

a a

acknowledged acknowledged

people people

governmentc governmentc

and and

government government

oolf-dotermlnati

atatuo atatuo

By By Iodlgenouo Iodlgenouo

if if

inotitutiono, inotitutiono,

Columbia Columbia

or or Iodigenouo Iodigenouo

their their

they they

cultural cultural

have have

cultural cultural

Columbia Columbia

rw.u rw.u

Stll:.-

latter latter

they they

govern govern

acquired; acquired;

virtue virtue

Region Region

their their

•overeignty •overeignty

build build

Relations Relations

their their

remain remain

havo havo

the the

dittinct dittinct {5§~f6lhuf/ {5§~f6lhuf/

and and INDIGENOUS INDIGENOUS

rribal rribal

to to

and and

oo oo

mental mental

, ,

life life

f f

citizenry, citizenry,

"' "'

development; development;

right right

o..a, o..a,

the the

tho tho

the the

blotoricolly, blotoricolly,

of of

Sir Sir

the the

upon upon

traditionally traditionally

Indigonouo Indigonouo

oach oach

over over

atlnd atlnd

choooo

peoploo peoploo

and and

ondoroo ondoroo

poop poop

......

thdr thdr

have have

P.opJ. P.opJ.

of of

poopleo poopleo

that that

in in

while while

Netioac Netioac

frooly frooly

Indigonouo Indigonouo

Nation• Nation•

and and

intac.t, intac.t,

Wilfred Wilfred

Nation Nation

boundorioa boundorioa

from from

politic.al, politic.al,

to to

title title

...... ,_ ...... ,_

to to

accord accord

tho tho

~ ~

real

matterc matterc

of of

these these

both both

1.1¥• 1.1¥•

loa loa

igenouaNationl, igenouaNationl,

right right

diu•gard. diu•gard.

tho tho

that that

h h

n, n,

, ,

oped&c oped&c

be be

bee bee

==-~

which which

Stuo

each each

with with

ouuideaourua

retaining retaining

aod aod

bovo bovo

wlolcJ. wlolcJ.

othoro' othoro'

in in

(peroonal (peroonal

tiec tiec

tho tho

purcuo purcuo

•.t •.t

de1pite de1pite

have have

lando, lando,

havo havo

oupreme oupreme

l.&Urior l.&Urior

of of

blotori

their their

of of

CDl.CJos:"thao CDl.CJos:"thao

Iodlrnouo Iodlrnouo

Nation• Nation•

tho tho

the

Executive Executive

owned, owned,

ltgal, ltgal,

and and

; ;

r.lating r.lating

with with

rlghto rlghto

tho tho

UN UN

the the

Nation Nation

tho tho

the the

~007

Nations Nations

inta~;t inta~;t

and and

includoo includoo

known known

NW-',..-,s,..,s-,

FIVE: FIVE:

y y

dd. dd......

tho tho

-w. -w.

tho tho

autonomy, autonomy,

political, political,

right right

lando lando

frooly frooly

terri terri

or or

Irlterior Irlterior

Interior Interior

c c

al'tlocl-.fartdohta....SU.. al'tlocl-.fartdohta....SU..

their their

Declaration Declaration

their their

with with

numerous numerous

government government

at.Onomie, at.Onomie,

aupport aupport

.. ..

further further

in in

agroemento; agroemento;

; ;

jUriadictlon) jUriadictlon)

right right

opldt opldt

of of

In In

right right

otherwile otherwile

occupied occupied

n n

and and

of of

1910 1910

tori•• tori••

and and

to to

Iince Iince

to to

and and

of of

u.chauerttheirauthority u.chauerttheirauthority

ezercloing ezercloing

Firat Firat

dotennine dotennine

alaarU, alaarU,

their their

&!oat &!oat

(terri (terri

tha tha

the the

: :

right right

Notion• Notion•

mal mal

K~t•r

tho tho

their their

economic, economic,

and and

to to

the the

eontinue eontinue

& &

economic, economic,

...a ...a

to to

their their

that that

,..

that that

f f

collectively collectively

and and

right right

government government

and and

ntei ntei

r...lla-o r...lla-o

oelf-determination. oelf-determination.

Britiah Britiah

Iot.rior Iot.rior

eo Nations Nations

tori tori

Interior Interior

own own

INDIGENOUS INDIGENOUS

tirnt tirnt

Interior Interior

to to

autonomy autonomy

aoc.ial aoc.ial

attemptl attemptl

internal internal

or or

illl.limt illl.limt

on on

extinguith extinguith

of of

nand nand

invt~atrnent

and and

participate participate

J,;ii.. J,;ii..

...,ourcoo ...,ourcoo

NATIONS NATIONS

Inherent Inherent

a a I

. .

to to

--.k --.k

of of

otherwisa otherwisa

tboy tboy

and and

UNIIY UNIIY

territ

their their

ted ted

their their

tho tho

jurlodiction) jurlodiction) Canada Canada

plan plan

immemorial immemorial

to to

end end

the the

Columbia

oocial oocial

otrongthen otrongthen

•oclal •oclal

m m

of of

found found

recognize recognize

by by

' '

otating otating

Righto Righto

to to

and and

by by

politleoi politleoi

, ,

Hea

Interior Interior

right right

JICIDP1et JICIDP1et

., .,

cultural cultural

for for

or or

t1oc t1oc

Britiah Britiah

Britioh Britioh

Brilloh Brilloh

Britioh Britioh

aU aU

which which

righto righto

relate relate

other other

, ,

the,. the,.

. .

local local

fully, fully,

uoed uoed

oolf

and and

ond ond

not not

All All

tho tho

th th

of of

to to

in in

: :

· ·

Authority: Authority:

DECLARATION DECLARATION

Wborou, Wborou,

THAT THAT

THEREFORE, THEREFORE,

boing boing

that that bettannent bettannent

(including (including

program program

rooeorch, rooeorch,

achieve achieve

aod aod

rking rking

wa wa

maintain maintain

OF OF

govamanee govamanee

.AJlequate .AJlequate

Apeement8 Apeement8

The The

bued bued

ofaU ofaU

atrengthened, atrengthened,

Liability Liability

governance governance

Documentr Documentr

.:.orporote .:.orporote

determined determined

be be

u u planning planning

inheriL inheriL

addreaoed addreaoed

regard~ regard~

Por

No No

Health Health

Celebration Celebration

Negot.iationo·wlll Negot.iationo·wlll

Communit'/ Communit'/

Socio

the the

Senicec Senicec

we we

will will

their their

together

does does

defined defined

deoign deoign

health health

tho tho

Nation Nation

Nationr Nationr

will will

ner.ohipo ner.ohipo

Partnership Partnership

traditional traditional

tpeed tpeed

fiduciary fiduciary federal

Interior Interior

NATIONS NATIONS

authority authority

respe

of of

THE THE

(Nationo (Nationo

individual individual

economic economic

a a

N'otiono N'otiono

and and

no no

the the

tho tho

be be

.. ..

deoired deoired

will will

ur ur

the the

wlu wlu

eeroer eeroer

and and

: :

(health (health

funding funding

otructure(~) otructure(~)

collectively collectively

tfully tfully

at at

guided guided

liability liability

will will

by by

health, health,

pooplu; pooplu;

responsibilit.y responsibilit.y

Wellnerr Wellnerr

proces.t proces.t

f f

will will

Nat!

by by

will will

hubs hubs

be be

which which

be be

will will

reddency

Jjeaderahip Jjeaderahip

Implementation Implementation

e•ch e•ch

projection•-

proeticeo), proeticeo),

to to

not not

have have

development, development,

love! love!

the the

be be

defme) defme)

provided provided

work work

minimized

be be

and and

be be

govern govern

indicu indicu

planning, planning,

be be be be

INTERIOR INTERIOR

no no

by by

will will

ufety, ufety,

left left

will will

Nation.ll Nation.ll

Accord Accord

from from

keptaimple1

Nation Nation

and and

negotiated negotiated

of of

otated otated

included included

development development

of of

collective collective

the the

defmed defmed

intel'elt intel'elt

torther, torther,

Ou Ou

obligllti

ded ded

capacity capacity

behind, behind,

be be

tho tho

be be

further further

atotur atotur

foll

teo teo

ourvival, ourvival,

information information

rutl rutl

will will

other other

linked linked

a~ucut a~ucut

t.o t.o

for for

tholr tholr

provided provided

Interior Interior

adrniniotratlon, adrniniotratlon,

; ;

mer mer

OF OF

plan plan

health health

all all

2012 2012

the the

bared bared

by by

be be

Nation Nation

in in

deei$ion-malting deei$ion-malting

and and

in in

with with

ing ing

n n

and and

needa needa

entiti4o entiti4o

doolre doolre

of of

llaborating llaborating

each each

tho tho

and and

incorporated incorporated

allaetiviuer allaetiviuer

Na Na

will will

nd nd

t.o t.o

muot muot

dignity dignity

for for

principle• principle•

occur1 occur1

o"r o"r

oervica oervica

. .

h.,..by h.,..by

each each

), ),

the the

aroos aroos

tionJI tionJI

ht!Aed ht!Aed THE THE

vision•. vision•.

management management

lnd lnd

' '

meet meet

N~tion N~tion

not not

nde:ratondable nde:ratondable

in in

are are

to to

r r

people people

be be

genen genen

health health

Nation, Nation,

and and

establloh establloh

order order

ica ica

will will u

will will

del del

polition polition

declare declare

fhoalth fhoalth

r r f

regularly regularly

t.oro t.oro

while while

ivory ivory

r r

woll

y y

be be

the the

tion

INTERIOR: INTERIOR:

ey/ ey/

to to

int

will will

o o

a a 18 18 APPENDIX SIX: INTERIOR GOVERNANCE ENTITIES FUNCTIONAL RELATIONSHIP DIAGRAM

Adopt Regional Health Plan

Provide guidance in Regional Health Authority Relationships

- - - - - Interior First Nation Community Councils participate in Nation Assemblies and send a representative to the Community Caucus meetings. ~------~--- --. ------·- --·------~__..-::

FNHC: Interior Region Nation Executive & Interior Health Authority: Partnership Accord 2012 19

FNHC: FNHC:

APPENDIX APPENDIX

REFERENCE REFERENCE

Interior Interior

Region Region

Nation Nation

SEVEN: SEVEN:

Approved Approved

Interior Interior

Executive Executive

First First

& &

INTERIOR INTERIOR

Interior Interior

Terms Terms

Nations Nations

Health Health

Governance Governance

Authority: Authority:

December December

FNHC FNHC

of of

Partnership Partnership

Health Health

GOVERNANCE GOVERNANCE

Reference Reference

Accord Accord

2012 2012

16, 16,

Council Council

Entities Entities

ENTITlES ENTITlES

2011 2011

TERMS TERMS

20 20 OF OF

FNHC: FNHC:

Table Table

4. 4.

5. 5.

3. 3.

2. 2.

1. 1.

Interior Interior

C. C.

A. A.

D. D.

B. B.

Amendments Amendments

Parties, Parties,

Purpose: Purpose:

Interior Interior

Preamble: Preamble:

of of

Interior Interior

First First

Region Region

Contents Contents

Nations Nations

Roles Roles

Region Region

Nation Nation

Region Region

Nation Nation

Region Region

and and

Health Health

Values: Values:

Executive Executive

22 22

23 23

Health Health

Nation Nation

First First

Relationships Relationships

Review Review

Society Society

Nations Nations

& &

23 23

Assemblies Assemblies

Executive Executive

Interior Interior

of of

......

Terms Terms

Community Community

of of

Health Health

Table Table

First First

(7 (7

of of

Authority: Authority:

Nations Nations

Reference: Reference:

(Executive): (Executive):

Health Health

Assemb/ies): Assemb/ies):

Partnership Partnership

Health Health

Caucus Caucus

......

Governance Governance

29 29

Accord Accord

(54 (54

......

Communities Communities

2012 2012

Structure: Structure:

Caucus): Caucus):

24 24

......

21 21

......

27 27

26 26

25 25 24 24

DRAFT DRAFT

1. 1.

H. H.

C. C.

A. A.

Preamble: Preamble:

B. B.

G. G.

F. F.

E. E.

D. D.

iv. iv.

vi. vi.

iii. iii.

v. v.

The The

system system

ii. ii. own own

Framework Framework

The The

to to

Council Council

separate separate

wellness wellness

take-over take-over

Tripartite Tripartite

The The including including

decision-making decision-making

planned, planned,

Under Under

resources, resources,

i. i.

ii. ii.

The The

and and

The The

and and

The The

FNHC Communities Communities

their their

Health Health

arrangements arrangements

i. i.

achieving achieving

the the

specifically specifically

and and

the the

minimum, minimum,

First First

respects respects

embraces embraces

Provides Provides

will will

is is

reflects reflects

health health

First First

Framework Framework

based based

local local

Caucus Caucus

First First

Society Society

Tripartite Tripartite

First First

First First on on

act act

in in

and and

: :

support support

design design

this this

engagement, engagement,

result result Interior Interior

to to

that: that:

role role

parties parties

and and

Nations, Nations,

First First

Plan Plan

Nations Nations

system system

research, research,

Nations Nations and and

designed, designed,

a a

care care

as as

shape shape

Framework Framework

managers managers

to to

Nations Nations

the the

health health

the the

yet yet

Nation Nation

Nations Nations

on on

Tripartite Tripartite

that that

Agreement; Agreement;

is is

the the

First First

the the

an an

knowledge knowledge

tables, tables,

Nation Nation

in in

comparable comparable

be be

MOU MOU

Region Region

paraliel paraliel

of of

at at

the the

to to

respecting respecting

programs, programs,

education, education,

to to

cultures cultures

to: to:

that that

advisory advisory

administration administration

improved improved

First First

Committee Committee

the the

First First

including including

desired desired

that that

administered administered

the the

on on

with with

Agreement Agreement

regarding regarding

engage engage

of of

Nations Nations

be be

Interior Interior

governance governance

Health Health

policy, policy,

(2006), (2006),

Nation Nation

Health Health

a a

B.C. B.C.

managed managed

British British

Nations Nations

at at

research, research,

final final

communities. communities.

of of

defined defined

are are

Nations Nations

Nation Nation

level. level.

Committee Committee

First First

regional/tribal regional/tribal

stronger stronger

Agreement Agreement

the the

First First

and and

health health

defining defining

are are

body body

and and

working working

in in

and and

Executive Executive

form form

to to Directors Directors

Authority Authority

First First

the the

in in

program program

quality, quality,

knowledge knowledge

Nation Nation

the the

Regional Regional

Directors Directors

Columbia, Columbia,

the the

discussion discussion

on on

Individual Individual

Nation Nation

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7 7

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as as 31 31

Aboriginal Aboriginal

fiduciary fiduciary

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2. 2.

May May

Council Council

or or

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May May

APPENDIX APPENDIX

November November

1. 1.

required. required.

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update update

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32 32 in in APPENDIX TEN: INTERIOR HEALTH STRATEGY MAP (201213-2014/15) Interior Health Strate 2012/13-2014/15

VISION: To set new standards of excellence In the delivery of health services In the Province of British Columbia. MISSION: Promote healthy lifestyles and provide needed health services In a timely. caring and eflicient manner to the highest professional and quality standards T•--·{ SYSTEM OUTCOMES: Improve population health, enhance patient and provider experience of care, reduce the costs of providing health care.

GOAL 1: Improve Health and Wellness GOAL 1: Deliver High Quality Care

* 1.1 Redirect healttl promotion and prewntion Initiatives tc 2.1 Work with partnen to shift care to the community l * 1.2 Meet the needs of First Nations and Aboricinal where possible and appropriate to best meet population communities by collaboratin1 with them to plan and 1111d Individual health care needs deliwr culturally sensitive health care services * 2.2 Dewlap and Implement chronic dlse•e prevention and manqement stratesies 1.3 Assess, recommend and Implement actions to Improve the health Health care * 2.3 Promote a coordinated network d efficient, effective of Interior Health's population delivery. .. acute care services 1.4 Partner with patients, clients, residents and their families to * 2.4 Implement evidence lnfonnecl clinical care culdellnes as participate, as they choose, In the delivery of their health care -11 as quality and safety initiatiws and in the planning. design. and evaluation of health services 2.5 Meet the health care needs of seniors

GOAL l : Ensure Sustainable Health Care by Improving GOAL 4: Cultivate an Engaged Workforce and a Healthy Innovation, Productivity, and Efficiency Workplace

*3.1 Implement Innovative approaches 1111d service delivery tc 4.1 Create a healthy and safe work environment models * 4.2 Improve employee, physician, 1111d volunteer encacement * 3.1 Dewlop priority plans and implement transparent Service decision maldnc and accountability processes to achiew 4.3 Enhance leadership capacity enablers objectives and miticate risks that support. .. *3.3 Dewlop healttl human resource business CDntinuityand succession plans 3.4 Enhance IMIT solutions 3.5 Engage in community consultations and partner with community stakeholders 3.6 Enhance research and education capacity

VALUES: Quality, Integrity, Respect, Trust GUIDING PRINCIPLES: Innovative, Clear and Respectful Communication, Continual Growth and Learning. Teamwork, Equitable Access, Evidence-based Practice

*Indicates organizational priorities ±J Interior He.lth April lOll

DRAFT 8 - FNHC: Interior Region Nation Executive & Interior Health Authority: Partnership Accord 2012 33 Appendix E: Nation Letters of Understanding

Included in this section are the following Letters of Understanding between Nations and Interior Health Authority:

1. Letter of Understanding between Ktunaxa Nation and Interior Health Authority

2. Letter of Understanding between Nlaka’pamux Nation and Interior Health Authority

3. Letter of Understanding between Okanagan Nation Alliance and Interior Health Authority

4. Letter of Understanding between Secwepemc Health Caucus and Interior Health Authority

5. Letter of Understanding between Northern St’át’imc and Interior Health Authority

6. Letter of Understanding between Tsilhqot’in National Government and Interior Health Authority

LETTER OF UNDERSTANDING

between Ktunaxa Nation Council

and Interior Health Authority

(each a “Party” and collectively “the Parties”)

1.0 PURPOSE 1.1 The Ktunaxa Nation Council and the Interior Health Authority are working together to increase the influence of the Ktunaxa Nation Council in decisions related to health services that impact its members and other Aboriginal peoples residing within Ktunaxa Traditional Territory.

1.2 The Parties understand that the Ktunaxa Nation is working towards full authority in all affairs related to its citizenry.

1.3 The Parties seek to improve the health outcomes for Aboriginal people by achieving effective shared decision making that will reduce the barriers for Aboriginal people to access better health services.

2.0 PREAMBLE 2.1 The Parties agree to enter into a mutually beneficial relationship that will work toward, in a quantifiable manner, shared responsibility and shared decision making as it impacts the provision of Health Services to Aboriginal people.

2.2 The Parties agree to use a cooperative, collaborative approach to improving the health status of Aboriginal individuals, families and communities through the design, delivery and evaluation of health programs and services for Aboriginal individuals, families and communities.

Page 1 of 7

2.3 Interior Health acknowledges the inherent rights of the Ktunaxa Nation Council for its citizenry regardless of residency and supports the Ktunaxa Nation‟s pursuit of its rights to retain responsibility for the health, safety, survival, dignity and well-being of Ktunaxa children and families consistent with the UN Convention on the Rights of the Child and the UN Declaration on the Rights of Indigenous people.

2.4 The Parties agree and understand that this Letter of Understanding, herein referred to as the „LOU‟, pertains to the Interior Health Authority‟s roles and responsibilities according to the purpose and description under the Health Authorities Act, Section 5 (1) and Section 5 (2), which states that:

“(1) The purposes of a board are as follows:

(a) To develop and implement a regional health plan that includes (i) the health services provided in the region, or in a part of the region, (ii) the type, size and location of facilities in the region, (iii) the programs for the delivery of health services provided in the region, (iv) the human resource requirements under the regional health plan, and (v) the making of reports to the minister on the activities of the board in carrying out its purposes.

(b) To develop policies, set priorities, prepare and submit budgets to the minister and allocate resources for the delivery of health services, in the region, under the regional health plan.

(d) To deliver regional services through its employees or to enter into agreements with the government or other public or private bodies for the delivery of those services by those bodies.

(e) [Repealed 2002-61-4] therefore not applicable.

(f) To develop and implement regional standards for the delivery of health services in the region.

(g) To monitor, evaluate and comply with Provincial and regional standards and ensure delivery of specified services applicable to the region.

(2) In Carrying out its purposes, a board must give due regard to the Provincial standards and specified services.”

Page 2 of 7

3.0 GEOGRAPHIC AREA 3.1 The activities referred to in this LOU will be carried within that portion of the Ktunaxa Traditional Territory within British Columbia as shown in Appendix A.

4.0 SERVICE PROVISION 4.1 The Parties agree that: 4.1.1 the planning for and the provision of health services will be inclusive of all Aboriginal people, 4.1.2 the Ktunaxa Nation Council may represent other organized groups of Aboriginal people provided that there are formal written agreements to that effect, 4.1.3 mutual respect, trust, openness, accountability and transparency will be the basis of the understanding and foundation of the relationship established under this LOU, 4.1.4 every effort will be made where possible to harmonize and integrate programs and services including potential expansion to include social determinants of health, 4.1.5 activities will be carried out with a view to sustainability, efficiency, and effectiveness without limiting innovation, equitable access or quality and by building on existing best practices, 4.1.6 a strengths-based approach will be used to measure outcomes, 4.1.7 mutually agreed upon indicators of health will be followed as a baseline for measurement, and 4.1.8 there will be a balance of qualitative and quantitative outcomes.

5.0 IMPLEMENTATION 5.1 Coordination 5.1.1 The Parties will establish a Joint Committee that will be tasked with the following actions, which may include, but are not limited to: a. development of annual work plans; b. evaluate outcomes related to annual work plans; c. overseeing research projects involving Aboriginal people or communities; d. reviewing all activities of the working groups to ensure that their work builds upon existing processes, explores and incorporates best practices and maximizes the value added to planning processes and service delivery;

Page 3 of 7

e. drafting an Interior Health/Ktunaxa Health Plan; f. ensuring that the Interior Health/Ktunaxa Health Plan is coordinated with the Health Plans developed by the First Nations Health Council, Provincial and Federal governments and others; and g. reporting out to the respective Parties on activities of the Joint Committee.

5.2 Activities 5.2.1 To improve the health outcomes for Aboriginal people, the Parties will carry out specific actions including but not limited to the following: a. improve on processes; b. review of the existing standards; c. develop service delivery systems to better reflect the needs of Aboriginal people; d. develop a Planning Framework; e. develop a consistent and harmonized planning process; f. establish common indicators, targets, milestones, benchmarks; g. develop Health Plans, including setting standards, targets, outcomes and measurements; h. engage in dialogue, identify linkages and establish networks with other Aboriginal and non-Aboriginal stakeholders; i. identify those matters including policy issues that will address gaps and eliminate overlaps; and j. establish at the program level communications with the First Nations and Inuit Health branch of Health Canada.

5.2.2 The Parties will establish working groups to carry out the activities set out in paragraph 5.2.1.

5.3 Resource Requirements 5.3.1 The Parties will identify the human, financial and capital resources required to achieve the goals of the LOU. 5.3.2 The Parties will work cooperatively to secure resources identified under paragraph 5.3.1, both internally and externally.

6.0 COMMUNICATION AND INFORMATION SHARING 6.1 Communication between the Parties will be open, regularized and reciprocal.

Page 4 of 7

6.2 The Parties will work together to coordinate and determine the most effective and efficient means of data exchange, system integration, and information–sharing, to the fullest extent possible.

7.0 EVALUATION OF LOU 7.1 The Parties will review the Letter of Understanding annually. 7.2 Upon successful attainment of agreed upon outcomes or unless otherwise agreed by the Parties, the Parties will assess the potential for heightened forms of agreement leading to gradual increased authority for Ktunaxa Nation Council.

8.0 OTHER AGREEMENTS 8.1 The Parties acknowledge and agree that this Letter of Understanding is between the Parties identified and should not be interpreted to have any influence, bearing or impact on other agreements including, but not limited to: 8.1.1 Enabling Agreements; 8.1.2 Federal Health Transfer Agreement; 8.1.3 Protocols or Agreements between Ktunaxa Nation Council and other Aboriginal or non-Aboriginal entities; and 8.1.4 Relationship to Treaty Process Stage IV.

9.0 PROCESSES 9.1 This Letter of Understanding does not extend to the following processes: 9.1.1 Interior Health Authority Corporate planning; and 9.1.2 Ktunaxa Nation Council National planning.

9.2 The Parties agree to use a consensus-building model.

10.0 TERM 10.1 Duration 10.1.1 The term of the LOU will be in perpetuity with review every 3 years from the date of signing. 10.2 Termination 10.2.1 The Parties agree that either Party may terminate this agreement by providing sixty (60) days written notice, including the cause for termination.

Page 5 of 7

11.0 AMENDMENT 11.1 The LOU may be amended by the Parties at any time by mutual consent of both Parties in writing.

Dated on the 26th day of July, 2012

Signed by:

______Kathryn Teneese, Dr. Robert Halpenny Ktunaxa Nation Chair President and Chief Executive Officer Interior Health

Witnessed by:

______Chief Cheryl Casimer, Norman Embree, St. Mary’s Indian Band Board Chair Interior Health

Page 6 of 7

APPENDIX A: Geographic Map

Page 7 of 7 LETTER OF UNDERSTANDING

Between

Nlaka’pamux Nation

As represented by the Nlaka’pamux Nation Bands

and

Interior Health Authority

FINAL-October 2013

Nlaka’pamux Nation

APPENDIX 1 LETTER OF UNDERSTANDING

Between

Nlaka’pamux Nation

As represented by the Nlaka’pamux Nation Bands

and

Interior Health Authority (each a “Party” and collectively “the Parties”)

1.0 PURPOSE

1.1 The Parties commit to working together through meaningful participation and collaboration, to increase the influence of the Nlaka’pamux communities in decisions related to health services that impact their members and other Aboriginal peoples residing within the Nlaka’pamux Territory.

1.2 The Parties seek to improve the health outcomes for Aboriginal people by achieving effective shared decision making that will reduce the barriers for Aboriginal people to access better health services.

2.0 PREAMBLE

2.1 The Parties agree to enter into a mutually beneficial relationship that will work toward, in a quantifiable and qualitative manner, shared responsibility and shared decision-making as it impacts the provision of health services to Aboriginal people.

2.2 The Parties agree that cultural and spiritual aspects should be respected, where possible, in all areas of health services.

2.3 The Parties agree to use a cooperative, collaborative approach to improving the health status of Aboriginal individuals, families and communities through the design, delivery and evaluation of health programs and services.

2.4 Interior Health Authority acknowledges the inherent rights of the Nlaka’pamux people. Further, Interior Health Authority recognizes that the established Nlaka’pamux Bands represent their citizenry regardless of residency. Furthermore, Interior Health authority supports the Nlaka’pamux pursuit of its rights to retain responsibility for the health, safety, survival, dignity and

FINAL-October 2013 1

Nlaka’pamux Nation

APPENDIX 1 well-being of Nlaka’pamux children and families, consistent with the United Nations (UN) Convention on the Rights of the Child and the UN Declaration on the Rights of Indigenous people.

2.5 The Parties agree and understand that the Letter of Understanding pertains to the Interior Health Authority’s roles and responsibilities according to the purpose and description under the Health Authorities Act, Section 5(1) and Section 5(2), which states that: 2.5.1 The purposes of a board (IHA) are as follows: (a) To develop and implement a regional health plan that includes (i) the health services provided in the region, or in a part of the region, (ii) the type, size and location of facilities in the region, (iii) the programs for the delivery of health services provided in the region, (iv) the human resource requirements under the regional health plan, and (v) the making of reports to the minister on the activities of the board in carrying out its purposes. (b) To develop policies, set priorities, prepare and submit budgets to the minister and allocate resources for the delivery of health services, in the region, under the regional health plan. (c) To administer and allocate grants made by the government for the provision of health services in the region. (d) To deliver regional services through its employees or to enter into agreements with the government or other public or private bodies for the delivery of those services by those bodies. (e) [Repealed 2002-61-4] therefore not applicable. (f) To develop and implement regional standards for the delivery of health services in the region. (g) To monitor, evaluate and comply with Provincial and regional standards and ensure delivery of specified services applicable to the region. 2.5.2 In Carrying out its purposes, a board must give due regard to the Provincial standards and specified services.

3.0 PRINCIPLES

3.1 The Parties acknowledge and respect established and evolving jurisdictional and fiduciary relationships and responsibilities, and will seek to remove impediments to progress by establishing cooperative working relationships.

3.2 The Letter of Understanding is a living document that will transcend changes within the Parties and will represent an integrated approach to the enhancement of relationships and development of services.

3.3 The Parties acknowledge and respect the need for transparency and reciprocal accountability.

FINAL-October 2013 2

Nlaka’pamux Nation

APPENDIX 1 4.0 GEOGRAPHIC AREA

4.1 The activities referred to in the Letter of Understanding will be applicable within that portion of the Nlaka’pamux Territory which lies within the Interior Health Authority Service area (see attached IHA Map).

5.0 SERVICE PROVISION

The parties agree that:

5.1 Mutual respect, shared responsibility, shared decision-making, trust, openness, accountability and transparency will be the basis of the understanding and the foundation of the relationship established under this Letter of Understanding.

5.2 The planning for and the provision of health services will be inclusive of all Aboriginal people.

5.3 The Nlaka’pamux Nation may represent other organized groups of Aboriginal people, provided there are formal written agreements to that effect.

5.4 Every effort will be made to harmonize and integrate health programs and services including potential expansion to include social determinants of health.

5.5 Activities will be carried out with a view to maintaining principles of equitability, sustainability, efficiency and effectiveness without limiting innovation, improving access or quality and by building on existing best practices.

5.6 Appropriate qualitative and quantitative methods will be used to measure outcomes, including participatory action oriented and strengths-based approaches (e.g. client focused, holistic or “wrap-around”).

5.7 Mutually agreed upon indicators of health will be followed as a baseline for measurement.

5.8 There will be a balance of qualitative and quantitative data collection tools used to measure changes in the health status of Aboriginal people.

6.0 IMPLEMENTATION

6.1 Coordination 6.1.1 The parties will establish a Joint Committee that will be tasked with the following actions, including but not limited to: a) Developing annual work plans. b) Evaluating outcomes related to annual work plans. c) Overseeing research projects involving Aboriginal people or communities.

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APPENDIX 1 d) Reviewing all activities of the working groups to ensure that their work builds upon existing processes, explores and incorporates best practises and maximizes the value added to planning processes and service delivery. e) Drafting an Interior Health/Nlaka’pamux Health Plan. f) Ensuring that the Interior Health/Nlaka’pamux Health Plan is coordinated with the Health Plans developed by the First Nations Health Authority, Provincial and Federal governments and others. g) Reporting out to the respective Parties on activities of the Joint Committee.

6.2 Activities 6.2.1 To improve the health outcomes for Aboriginal people, the Parties will carry out specific actions including but not limited to the following: a) Improve on processes. b) Review of the existing standards. c) Develop service delivery systems to better reflect the needs of Aboriginal people. d) Develop a Planning Framework. e) Develop a consistent and harmonized planning process. f) Establish common indicators, targets, milestones, benchmarks. g) Develop Health Plans, including setting standards, targets, outcomes and measurements. h) Engage in dialogue, identify linkages and establish networks with other Aboriginal and non- Aboriginal stakeholders. i) Identify those matters including policy issues that will address gaps and eliminate overlaps. j) Establish at the program level communications with the First Nations, First Nations Service providers and First Nations Health Authority.

6.2.2 The Parties will establish working groups to carry out the activities set out in paragraph 6.2.1

7.0 RESOURCE REQUIREMENTS

7.1 The parties acknowledge that Interior Health Authority is responsible for the provision of health services to all citizens residing in its service delivery area.

7.2 The parties will identify the human, financial and capital resources required to achieving the goals of the Letter of Understanding.

7.3 The Parties will work cooperatively to secure resources, both internally and externally.

8.0 COMMUNICATION AND INFORMATION SHARING

8.1 Communication between the Parties will be respectful, transparent, regular and reciprocal.

8.2 The Parties will work together to coordinate and determine the most effective and efficient means of data exchange, system integration and information-sharing, to the fullest extent possible.

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APPENDIX 1 8.3 The principles of Ownership, Control, Access and Possession (OCAP) will be consistently applied wherever applicable.

9.0 EVALUATION OF LETTER OF UNDERSTANDING

9.1 The Parties will review the Letter of Understanding annually or as otherwise agreed by all Parties.

9.2 The Joint Committee will determine and agree upon the process and procedures for the evaluation and implementation of recommendations.

10.0 OTHER AGREEMENTS

10.1 The Parties acknowledge and agree that this Letter of Understanding is between the Parties identified and should not be interpreted as having any influence, bearing or impact on other agreements including, but not limited to: 10.1.1 Enabling Agreements (i.e. contracts). 10.1.2 Federal Health Transfer Agreement including the Tri-partite Agreement. 10.1.3 Protocols or Agreements between Nlaka’pamux communities and other Aboriginal or non- Aboriginal entities.

10.2 The Parties agree and understand that this Letter of Understanding is not prejudicial to the implementation of any inherent right of self-government or any other agreements that may be negotiated with respect to self-government.

11.0 PROCESSES

11.1 This Letter of Understanding does not extend to the following processes: 11.1.1 Interior Health Authority Corporate planning. 11.1.2 Nlaka’pamux Nation planning. 11.1.3 Planning processes conducted by the Nlaka’pamux communities (for example, strategic plans and community plans).

12.0 TERM

12.1 Duration: The term of the Letter of Understanding will be in effect for five (5) years from the date of signing and will be reviewed by both parties annually. 12.2 Extension: The term of the Letter of Understanding may be extended by mutual consent of the Parties. 12.3 Termination: If mediation and/or resolution cannot be achieved, the Parties agree that either Party may terminate this agreement by providing sixty (60) days written notice, including the cause for termination.

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APPENDIX 1 13.0 AMENDMENT

13.1 The Letter of Understanding may be amended by the Parties at any time by mutual consent of all parties, in writing.

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APPENDIX 1 Dated this 06 of NOVEMBER, 2013

For Nlaka`pamux Governments For Interior Health Authority 1. Coldwater Band Dr. Robert Halpenny, President and 2. Lower Nicola Band Chief Executive Officer 3. Nooaitch Band 4. Shackan Band Norman Embree, Board Chair, Interior Health 5. Cooks Ferry Band Authority 6. Oregon Jack Creek Band 7. Ashcroft Band 8. Nicomen Band 9. Lytton Band 10. Siska Band 11. Boston Bar Band * 12. Boothroyd * 13. Kanaka Bar Band 14. Skuppah Band 15. Spuzzum Band *

*In Fraser Health Region at this time

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APPENDIX 1

FINAL-October 2013 1

LETTER OF UNDERSTANDING

between

Okanagan Nation Alliance and the seven member communities: Upper Nicola Band, Okanagan Indian Band, Westbank First Nation, Penticton Indian Band, Osoyoos Indian Band, Lower Similkameen Indian Band and Upper Similkameen Indian Band

and

Interior Health Authority

(each a “Party” and collectively “the Parties”)

1.0 PURPOSE 1.1 The Parties wish to define a collaboratively developed engagement process for the planning of Aboriginal services and operations across their respective territories.

1.2 The Parties seek to improve the health outcomes for Aboriginal people by achieving effective shared decision making that will reduce the barriers for Aboriginal people1 to access better health services.

1.3 The Parties commit to working together through meaningful participation and collaboration, to increase the influence of the Okanagan Nation Alliance and the seven member communities in decisions related to health services that impact their members and other Aboriginal peoples residing within Okanagan Territory.

1.4 The Parties agree that health outcomes should be comparable for all residents of British Columbia.

2.0 PREAMBLE 2.1 The Parties agree to enter into a mutually beneficial relationship that will work toward, in a quantifiable and qualitative manner, shared responsibility and shared decision making as it impacts the provision of Health Services to Aboriginal people.

2.3 Interior Health Authority acknowledges the inherent rights of the Syilx people. Further, Interior Health Authority recognizes that the Okanagan Nation Alliance and the seven

1 See Glossary for definition.

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member communities represent their citizenry regardless of residency and supports the Syilx pursuit of its rights to retain responsibility for the health, safety, survival, dignity and well-being of Syilx children and families, consistent with the UN Convention on the Rights of the Child and the UN Declaration on the Rights of Indigenous people2.

2.4 The Parties agree and understand that this Letter of Understanding pertains to the Interior Health Authority’s roles and responsibilities according to the purpose and description under the Health Authorities Act, Section 5(1) and Section 5(2), which states that:

“(1) The purposes of a board are as follows:

(b) To develop policies, set priorities, prepare and submit budgets to the minister and allocate resources for the delivery of health services, in the region, under the regional health plan.

(d) To deliver regional services through its employees or to enter into agreements with the government or other public or private bodies for the delivery of those services by those bodies.

(e) [Repealed 2002-61-4] therefore not applicable.

(f) To develop and implement regional standards for the delivery of health services in the region.

(g) To monitor, evaluate and comply with Provincial and regional standards and ensure delivery of specified services applicable to the region.

(2) In Carrying out its purposes, a board must give due regard to the Provincial standards and specified services.”

3.0 PRINCIPLES The development of this Letter of Understanding was based upon the following principles:

2 See the ONA Declaration in Appendix 1.

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3.2 The planning and coordination of Interior Health Authority services for Okanagan Nation Alliance members will be more effective if there is increased participation of the Okanagan Nation Alliance and the seven member communities in the planning of services.

3.3 The Letter of Understanding is a living document that will transcend changes within the Parties and will represent an integrated approach to the enhancement of relationships and development of services.

3.4 The Parties acknowledge and respect the need for transparency and reciprocal accountability.

4.0 GEOGRAPHIC AREA The activities referred to in this Letter of Understanding will be applicable within that portion of the Syilx (Okanagan) Territory which lies within British Columbia as shown in Appendix 2.

5.0 SERVICE PROVISION The Parties agree that:

5.1 Mutual respect, trust, openness, accountability and transparency will be the basis of the understanding and foundation of the relationship established under this Letter of Understanding; the Four Food Chiefs as defined in the Syilx Health Plan3 are to be utilized as guiding principles.

5.2 The planning for and the provision of health services will be inclusive of all Aboriginal people, and services will be culturally safe.

5.3 The Okanagan Nation Alliance may represent other organized groups of Aboriginal people provided that there are formal written agreements to that effect.

5.4 Every effort will be made where possible to create culturally safe services, and to harmonize and integrate programs and services.

5.5 Activities will be carried out with a view to maintaining principles of sustainability, efficiency and effectiveness without limiting innovation, improved access or quality and by building on existing best practices.

5.6 Appropriate methods will be used to measure outcomes, including a strengths-based approach (e.g. client focused, holistic or “wrap-around”).

5.7 Mutually agreed upon indicators of health will be followed as a baseline for measurement, and there will be a balance of qualitative and quantitative outcomes.

3 See Appendix 3

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6.0 ACTIVITIES 6.1 To improve the health outcomes for Aboriginal people, the Parties will carry out specific actions including but not limited to the following: 6.1.1 Review of the existing standards. 6.1.2 Development of service delivery systems to better reflect the cultural context of Aboriginal people. 6.1.3 Development of a consistent and harmonized planning process. 6.1.4 Establishment of common indicators, targets, milestones and benchmarks. 6.1.5 Review alignment within health plans, including setting standards, targets, outcomes and measurements. 6.1.6 Engagement in dialogue, identification of linkages and establishment of networks with other Aboriginal and non-Aboriginal stakeholders. 6.1.7 Identification of those matters including policy issues that will address gaps and eliminate duplication.

6.2 The Parties will establish a Joint Committee and working groups (with specific terms of reference and deliverables) to carry out the activities set out in paragraph 6.1.

7.0 IMPLEMENTATION As per 6.2 above, the Parties will establish a “Joint Committee” comprising representatives from all Parties that will be tasked with responsibilities which may include, but are not limited to:

7.1 Development of a strategy for building relationships between the Parties, including an engagement strategy and communication and consultation processes.

7.2 Development of protocols between the Parties including the sharing of information on initiatives that are of interest or are shared between the Parties.

7.3 Prioritization of services.

7.4 Laying the foundation for relationship documents (e.g. Letters of Understanding, Memorandum of Understanding, etc.) between the Parties on specific service-related issues.

7.5 Overseeing research projects involving Aboriginal people or communities, applying the principles of Ownership, Control, Access and Possession (OCAP).

7.6 Where appropriate, establishment and implementation of a process for establishing and reviewing the activities of specific working groups to ensure that their work builds upon existing processes, explores and incorporates best practices and maximizes the value added to planning processes and service delivery (including Terms of Reference and deliverables).

7.7 Reviewing the Parties’ Health Plans to ensure alignment with each other and with the Tri- Partite First Nations Health Plan.

7.8 Development, agreement and implementation of a Data Sharing Agreement.

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7.9 Determination of and agreement upon the process and procedures for the evaluation of this Letter of Understanding and the implementation of subsequent recommendations.

7.10 The Joint Committee representatives will report through their respective organizations.

8.0 RESOURCE REQUIREMENTS 8.1 It is acknowledged that through the Ministry of Health, Interior Health Authority is responsible for the provision of health services to all citizens.

8.2 The Parties will identify the human, financial and capital resources and potential sources of funding required to achieve the goals of the Letter of Understanding.

8.3 The Parties will work cooperatively to secure resources, both internally and externally.

9.0 COMMUNICATION AND INFORMATION SHARING 9.1 Communication between the Parties will be transparent, regular and reciprocal.

9.2 The Parties will work together within the legislative framework, e.g. Freedom of Information and Protection of Privacy Act (FOIPPA) etc., to coordinate and determine the most effective and efficient means of data exchange, system integration and information-sharing to the fullest extent possible.

9.3 The principles of Ownership, Control, Access and Possession (OCAP) will be consistently applied wherever applicable.

10. 0 EVALUATION OF LETTER OF UNDERSTANDING The Parties will review the Letter of Understanding annually or as otherwise agreed by all Parties. As per paragraph 7.9 above, the Joint Committee will determine and agree the process and procedures for the evaluation and implementation of subsequent recommendations.

11.0 OTHER AGREEMENTS 11.1 The Parties acknowledge and agree that this Letter of Understanding is between the Parties identified and should not be interpreted as having any influence, bearing or impact on other agreements including, but not limited to: 11.1.1 Enabling Agreements (i.e. contracts). 11.1.2 Federal Health Transfer Agreement including the Tri-Partite Agreement. 11.1.3 Protocols or Agreements between Okanagan Nation Alliance and other Aboriginal or non-Aboriginal entities.

11.2 The Parties agree that this Letter of Understanding is not prejudicial to the implementation of any inherent right of self-government or any agreements that may be negotiated with respect to self-government.

12.0 PROCESSES 12.1 This Letter of Understanding does not extend to the following processes: 12.1.1 Interior Health Authority Corporate planning. 12.1.2 Okanagan Nation Alliance organizational/business planning.

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12.1.3 Planning processes conducted by the seven member bands (for example, strategic plans and community plans).

12.2 The Parties agree to use a consensus-building model.

13.0 TERM 13.1 Duration: The term of the Letter of Understanding will be four years from the date of the signing.

13.2 Extension: The term of the Letter of Understanding may be extended by mutual consent of the Parties.

13.3 Resolution of Issues: The Parties will work towards remedy of any issues pertaining to this Letter of Understanding through a mutually agreed-upon process (such as mediation).

13.4 Termination: If mediation and/or resolution cannot be achieved, the Parties agree that either Party may terminate this agreement by providing sixty (60) days written notice, including the cause for termination.

14.0 AMENDMENT The Letter of Understanding may be amended by the Parties at any time by mutual consent of all Parties, in writing.

Dated this 13th day of June, 2012

Signed by:

Okanagan Nation Alliance Interior Health Authority

Grand Chief Stewart Phillip, Dr. Robert Halpenny, Okanagan Nation Alliance Chair President and Chief Executive Officer

Pauline Terbasket, Norman Embree, Okanagan Nation Alliance Board Chair, Interior Health Executive Director Authority

Witnessed by:

Jacki McPherson, ONA Wellness Committee Member

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Appendix 1 The Declaration

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Appendix 2 The ONA Territory

The Okanagan Nation territory includes an area that extends over approximately 69,000 km. The northern area of this territory is close to the area of Mica Creek, just north of modern-day Revelstoke, B.C., the eastern boundary lies between Kaslo and Kootenay Lakes. The southern boundary extends to the vicinity of Wilbur, Washington, and the western border extends into the Nicola Valley. The map below is the IHA region, showing our communities.

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Appendix 3 Syilx Health Plan 2010

Extract: The Four Food Chiefs

Chief Siya (Saskatoon Berry) – Vision & Innovation Perspective For Syilx people, health is multifaceted, holistic and interconnected. The health of the Syilx people is reflected in the health of the individual, family, community and land. These elements are inseparable and cannot be looked at in isolation. The survival of the Nation as a whole is dependent on the well-being of the individuals, the families, and the community. The reverse is also true. We know that cultural pride, cultural identity and traditional knowledge are important to our individual health and to the health of our families, the community and the land. The long history of colonization has therefore played a major role in the current health of individuals, families and the Nation. This was very evident in the environmental scan.

We have therefore applied our Indigenous “way of knowing” as the framework for this Health Plan.

“COMMUNITY” in Nsyilxcәn (Okanagan) is a word that has the meaning that we

are ‘OF ONE SKIN’. The one skin is not referring so much to the idea that we’re

biologically related as to the idea that we share something which gives us a

covering, a security, a protection – in the same way that our skin, stretched over

our blood and bones protects us from dissipating back into our larger selves which is the external world. Your skin holds you together.”

(Sharing One Skin, by Dr. Jeannette Armstrong, 1998) Syilx Cultural Framework The Syilx people have passed down their cultural way of knowing from one generation to the next, orally through storytelling. When we tell Chaptikwl, “our stories”, we breathe life into the ember that is waiting to come alive again. When we talk about how we are going to reclaim and restore the well-being of our communities, we are breathing life into our words and into our actions and into the people. This is a regenerating experience that creates fluid dynamic movement and begins to address the years of oppression when the colonial governments attempted to silence our stories, literally to strip us of the knowledge of our ancestors.

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The Syilx (Okanagan) cultural framework is built on the foundation of Syilx cultural ways of knowing and of being and is drawn from a Chaptikwl called “How Food was Given.” In this story, Kul’nchut’n (creator) visited the Tmixw (including but not limited to the people, animal plants, air and water). Kul’nchut’n (creator) sent Senklip (coyote) to prepare for the future of the Stelsqilxw (people-to-be). Kul’nchut’n told the Tmixw that people were coming. The four (4) Chiefs: Skemxist (Black Bear) Siya (Saskatoon Berry), Spitlem (Bitter Root), Ntyxtix (King Salmon) then came together and made a plan for how to feed Stelsqilxw (people to be). The story then tells how the differing perspectives of the four chiefs were brought together to inform the discussion, the problem solving, the decision making and the action plan.

The Chaptikwl illustrates the Enowkinwixw process, the cultural practice or discipline that describes how to plan, solve problems, make decisions, resolve conflicts and/or develop an action plan. It brings people together to dialogue on specific issues. The practice welcomes, encourages and supports the expression of differing perspectives that, at times, may be in opposition to each other. The practice of Enowkinwixw embraces the dynamic tension that emerges and uses it to develop a collective understanding or to shape a shared approach to an issue or concern. This process has been described as a “mind meld” (Okanagan Nation Response Team 2007 Booster Training Session).

Enowkinwixw is a consensus based practice developed on the principles of respect, trust and inclusion. The following principles/actions are embedded within the process.

Consensus Establishment of Common Ground Protocols for discussion Full participation Commitment to see the process to its end, regardless of the time involved Differing perspectives (Siya, Spitlem, Skemxist, Ntyxtix) that have a defined place: Innovators, Traditional, Action, and Relationships The process is complete when an action and implementation plan incorporating all views is in place.

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Skem xist

issue Ntyxtix Spitlem

Siya

Differing Perspectives “How Food was Given” is a teaching that illustrates how the Okanagan/Syilx community can come together and make decisions about how to take care of future generations, especially in relation to their well being. It lends itself very well to providing a framework for, and an understanding of, the four main components of our health plan.

The Four Food Chiefs are described as having the following attributes (please note this list is not meant to be exhaustive.)

Siya Chief of all things Youth We CAN do it (Saskatoon Berry) growing above Land Innovation/Creative No Barriers Think BIG Creative Spitlem Chief of all Roots Female Interconnectedness (Bitterroot) Relationships Nurturing Skemxist Chief of all 4 legged Elder Protocols (Black Bear) Animals Tradition Culture Contemplation/Thinking Ntyxtix Chief of all that is in the Male Get it done (King Salmon) Water Action Timely Efficient Planning

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1 Chief Siya (Saskatoon Berry) embodies the spirit of creative energy, vision and innovation that can be associated with Youth. In this section of our health plan we provide those components that relate to the Nation’s vision and the innovation associated with the use of the Syilx Cultural Framework to assist in the understanding of the health plan.

2 Chief Spitlem (Bitter Root) describes relationships, and the interconnectedness among Tmixw including but not limited to the people, the animals, the plants, the land, the air and the water. This provides the “context” in which individuals, families and communities endeavor to live in harmony with each other, and with their relatives - the animals, the plants and the land. This section of our plan provides a description of the Okanagan Nation Alliance (ONA) including its structure, capacity and existing programs, and profiles of the seven Okanagan member Bands and the Wellness Committee. The need for the health plan and the phases of the health plan are also described.

3 Chief Skemxist (Black Bear) represents the traditions and cultural practices, the concept of reflection and contemplation on “what is” informed by an understanding of the past and how that is connected to the future. It is this understanding that then shapes development of protocols. In this section of the health plan, the environmental context, the analysis of data, research, key findings and the establishment of priorities are the focus.

4 Chief Ntyxtix (King Salmon) exemplifies the process of preparing (readiness), determining the objective (aim), and then taking action (act). In this section, the Findings, Action Plan and the Conclusions are presented.

The concepts of individual, family, community, land (Armstrong, J. 2000-Let us begin with courage) are defined thus: “Each individual person is singularly gifted, each person actualizes full human potential only as a result of physical, emotional, intellectual and spiritual well-being – those four aspects of existence are always contingent on external things. Each individual is a single facet of a trans- generational organism known as family.”

“Through this organism flows the powerful lifeblood of cultural transference designed to secure the best probability of well-being for each of the generations. Family systems are the foundation of a long-term living network called community.” “In its various configurations this network spreads its life force over centuries and across physical space; it uses its collective knowledge to secure the well-being of all by the short- and long-term choices made via its collective process. A community is the living process that interacts with the vast and ancient body of intricately connected patterns in perfect unison called the land.”

“Land sustains all life and must be protected from depletion in order to insure its continued good health and ability to provide sustenance over generations.”

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All of these Syilx concepts and framework are integrated in the Wellbeing of the Syilx.

Appendix 4 Glossary of Terms

Aboriginal People Aboriginal People include all Indigenous people of Canada. The Constitution recognizes three groups of Aboriginal people: Status and Non-Status First Nations, Métis and Inuit.

ONA Member Bands Okanagan Indian Band, Westbank First Nation, Penticton Indian Band, Lower Similkameen Indian Band, Upper Similkameen Indian Band, Upper Nicola Indian Band, Osoyoos Indian Band. Cooperate To act or work together with another or others for a common purpose. Collaborate To work with another party towards a shared goal. Consultation A process by which the interested party’s input on matters affecting them is sought. Note: IH will consult (confer) with the ONA on issues that pertain to the Nation as a whole. Specific band issues will be the responsibility of IH and the band. Recognizing that there are some changes that IHA has no control over (e.g. at Ministry level), IH determined service changes that impact bands will be required to include consultation process with the band. Cultural Safety Cultural safety is the effective care of a person/family from another culture by a health-care provider who has undertaken a process of reflection on their own cultural identity and recognizes the impact of the health-care provider’s culture on their practice. Unsafe cultural practice is any action which diminishes, demeans or dis-empowers the cultural identity and well-being of an individual. Client focused, holistic or These terms are used within the respective Parties to reflect similar “wrap-around” principles. Terms that are also used include “recipient of service” (not client) thus the appropriate terminology will be used in each context. Mediation Mediation is a voluntary settlement negotiation facilitated by a neutral third party who has no decision-making power (as defined by the BC Dispute Resolution Office).

Acronyms

FOIPPA Freedom of Information and Protection of Privacy Act IHA Interior Health Authority LSIB Lower Similkameen Indian Band OCAP Ownership, Control, Access and Possession OIB Osoyoos Indian Band OKIB Okanagan Indian Band ONA Okanagan Nation Alliance PIB Penticton Indian Band UNB Upper Nicola Band USIB Upper Similkameen Indian Band WFN Westbank First Nation

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“WORKING IN PARTNERSHIP”

Letter of Understanding Between Secwepemc Health Caucus

and Interior Health Authority (each a “Party” and collectively “the Parties”)

Table of Contents

1.0 Purpose ...... 2 2.0 Preamble ...... 2 3.0 Principles ...... 4 4.0 Service Provisions ...... 4 5.0 Activities ...... 5 6.0 Implementation ...... 6 7.0 Resource Requirements ...... 7 8.0 Communication and Information Sharing ...... 7 9.0 Evaluation of Letter of Understanding ...... 8 10.0 Other Agreements ...... 8 11.0 Process...... 8 12.0 Term ...... 9 13.0 Amendment ...... 9 Appendix A SHC Membership...... 11 Appendix B SHC Principles ...... 12 Appendix C Secwepemc Health Caucus Research Policy ...... 13 Appendix D Secwepemc Health Caucus – Interior Health Authority Workplan 2013 – 2014 ...... 23

1 1.0 Purpose

1.1. The Parties wish to define a collaboratively developed engagment process for the planning of Aboriginal services, programs and operations across Secwepemc Territory for the improvement of services for Secwepemc people.

1.2. The Parties seek to improve the health outcomes for Secwepemc people by achieving effective shared decision making that will reduce the barriers for Secwepemc people to access better health services.

1.3. The Parties commit to working together through meaningful participation and collaboration, to increase the influence of the Secwepemc Health Caucus in decisions related to health services that impact their members and other Aboriginal peoples residing within Secwepemc Territory.

1.4. The Parties agree that health outcomes held in common with all residents of British Columbia should be at least equal for Secwepemc citizens and health outcomes beyond these, as defined by Secwepemc citizens, pursued with equal vigor and diligence.

2.0 Preamble

2.1 The Parties agree to enter into a mutually beneficial relationship that will work towards, in a quantifiable and qualitative manner, shared responsibility and shared decision making as it impacts the provisions of Health Services to Secwepemc people within Secwepemc Territory.

2.2 As capacity grows, planning and provision of health care by The Parties will extend beyond care for Secwepemc citizens to include other groups in Secwepemc Territory.

2.3 The Parties agree to use a cooperative, collaborative approach to improving the health status of Secwepemc individuals, families and communities through the design, delivery and evaluation of culturally safe health programs and services.

2.4 Interior Health Authority acknowledges the inherent and Aboriginal rights (including but not limited to self-determination and freedom from discrimination) of the Secwepemc People. Further, Interior Health Authority recognizes the Secwepemc Health Caucus “Authority” represents their citizenry regardless of residency and supports the Secwepemc pursuit of its rights to retain responsibility for the health, safety, survival, dignity and well-being of the Secwepemc children and families, consistent with the UN Convention on the Rights of the Child and the UN Declaration on the Rights of Indigenous Peoples.

2.5 This letter of understanding does not abrogate nor derogate from Secwepemc Aboriginal Rights as per Section 35(1) Constitution Act. 1982.

2.6 The Parties agree and understand that this Letter of Understanding pertains to the Interior Health Authority’s roles and responsibilities according to the purpose and description under the Health Authorities Act which states that:

5 (1) The purposes of a board are as follows:

(a) To develop and implement a regional health plan that includes (i) The health services provided in the region, or in a part of the region, (ii) The type, size and location of facilities in the region, (iii) The programs for the delivery of health services provided in the region. (iv) The human resource requirements under the regional health plan and, (v) The making of reports to the minister on the activities of the board in carrying out its purposes.

(b) To develop policies, set priorities, prepare and submit budgets to the minister and allocate resources for the delivery of health services, in the region, under the regional health plan.

(d) To deliver regional services through its employees or to enter into agreements with the government or other public or private bodies for the delivery of those services by those bodies.

(e) [Repealed 2002-61-4] therefore not applicable

(f) To develop and implement regional standards for the delivery of health services in the region.

(g) To monitor, evaluate and comply with Provincial and regional standards and ensure delivery of specified services applicable to the region.

5 (2) In Carrying out its purposes, a board must give due regard to the Provincial standards and specified services.”

3 3.0 Principles

This Letter of Understanding is based upon the following principles:

3.1 The Secwepemc Health Caucus will be guided by the following principles adopted from the 7 Nations Unity Declaration. 1 (See Appendix B)

3.2 The Parties acknowledge and respect established and evolving jurisdictional and fiduciary relationships and responsibilities, and will seek to remove impediments to progress by establishing effective working relationships.

3.3 The planning, coordination and implementation of Interior Health Authority services for Aboriginal people in Secwepemc Territory will be more effective with increased participation of the Secwepemc Health Caucus in the planning of services.

3.4 The Letter of Understanding is a living document that will respond to changes within the Parties and will represent an integrated approach to the enhancement of the relationship and development of services.

3.5 The Parties acknowledge and respect the need for transparency, reciprocal accountability, and accountability to the communities affected by decisions made by The Parties.

4.0 Service Provisions

The Parties agree that:

4.1 Mutual respect, trust, openness, accountability and transparency will be the basis of the understanding and foundation of the relationship established under this Letter of Understanding.

4.2 Ensuring cultural safety is of paramount importance to the effectiveness of and access to, health services provision. Where Cultural Safety is defined by the health services recipient.

4.3 The cultural safety of Secwepemc people will require ongoing education, dialogue and active participation and engagement between parties including:

4.3.1 Collaboration on Indigenous Cultural Competence (ICC) supplementary training and documents, including innovation of techniques and relationship building.

1 Duplicated from the 7 Nations Unity Declaration

4 4.3.2 Supporting the interaction of all levels of IH staff with Aboriginal and Secwepemc people at cultural, non-cultural, and IH hosted events. 4.3.3 Collaboration on the evaluation of cultural safety improvement measures and grievance mechanisms for Aboriginal and Secwepemc employees and customers.

4.4 Every effort will be made where possible to create culturally safe services to harmonize and integrate programs and services. Including potential expansion to include social determinants of health.

4.5 Activities will be carried out with a view to maintaining principles of sustainability, efficiency, and effectiveness without limiting innovation, improved access or quality and by building on existing best practices.

4.6 Appropriate methods will be used to measure outcomes, including a strengths based approach (e.g. client focused, holistic or “wrap-around”).

4.7 Mutually agreed upon indicators of health and indicators of success will be followed as a baseline for measurement, and there will be a balance of qualitative and quantitative outcomes.

Indicators such as but not limited to:

4.7.1 Improved service accessibility and use of health resources for First Nations and other Aboriginal people in Secwepemc Territory. 4.7.2 Coordinated health service planning and delivery between Secwepemc Health Caucus and the Interior Health Authority. 4.7.3 Stronger linkages are developed (e.g. referrals, service integration) between Secwepemc Health Caucus and the Interior Health Authority. 4.7.4 Partnerships to improve health service for First Nations citizens 4.7.5 First Nations eHealth initiatives in Secwepemc Territory are coordinated with Secwepemc Health Caucus. 4.7.6 Partnerships with other ministries, municipalities and non-profit service providers are established to address the social determinants of health including those specified by Secwepemc people beyond the conventional social determinants.

5.0 Activities

5.1 To improve the health outcomes for Secwepemc people, the Parties will carry out specific actions including but not limited to the following:

5 5.1.1 Develop service delivery systems which better respect and reflect the cultural and socioeconomic context of Secwepemc and non-Secwepemc Aboriginal people in Secwepemc Territory. 5.1.2 Develop a consistent and harmonized planning process. 5.1.3 Establish common indicators, targets, milestones, benchmarks. 5.1.4 Review alignment within health plans, including setting standards, outcomes and measurements. 5.1.5 Engage in dialogue, identify linkages and establish networks with other Aboriginal and non-Aboriginal stakeholders. 5.1.6 Identify those matters including policy issues that will address gaps and eliminate duplication. 5.1.7 Establish at the program level communication and collaboration with the First Nations Health Authority.

5.2 The Parties will establish a Joint Committee to oversee the activities set out in the work plan See Appendix D.

6.0 Implementation

As per 5.2 above, the Parties will establish a “Joint Committee” comprising representatives from all parties that will be tasked with responsibilities which may include, but are not limited to:

6.1 Development of a strategy for building relationships between the Parties, including an engagement strategy and communication/consultation processes.

6.2 Development of protocols between the Parties including the sharing of information on initiatives that are of interest/shared between the Parties.

6.3 Development of annual work plans and;

6.4 Evaluate outcomes related to annual work plans.

6.5 Prioritization of services.

6.6 Laying the foundation for relationship documents between the Parties on specific service- related issues.

6.7 Where appropriate, establish and implement a process for establishing and reviewing the activities of specific working groups to ensure that their work builds upon existing processes, explores and incorporates best practices and maximizes the value added to planning processes and services delivery (including Terms of Reference and deliverables).

6.8 Reviewing the Parties’ Health Plans to ensure alignment with each other, the Tri-Partite First Nations Health Plan, the First Nations Health Authority, the Provincial and Federal Governments and others;

6.9 Determine and agree upon the process and procedures for the evaluation of this Letter of Understanding and the implementation of subsequent recommendation.

6.10Formation of a Research, Ethics and Data Sub-committee charged with the responsibility to:

6.10.1 Develop and implement an evaluation and approval procedure for any and all data collection involving or affecting Secwepemc people in Secwepemc Territory. 6.10.2 Oversee and ensure application and compliance with the Secwepemc Health Caucus Research Policy (See Appendix C) on all research projects involving or affecting Secwepemc people and communities. 6.10.3 Develop a Data Sharing Agreement to be ratified and implemented by the “Joint Committee.” 6.10.4 Ensure the highest standards of privacy, protection and confidentiality are applied to all data collected from programs or projects involving or affecting Secwepemc people in Secwepemc Territory. 6.10.5 Forward recommendations regarding research and data use as well as relevant amendments to this LOU.

6.11The Joint Committee representatives will report through their respective organizations and where appropriate to affected Aboriginal citizens and communities.

7.0 Resource Requirements

7.1 It is acknowledged that through the Ministry of Health, Interior Health Authority is responsible for the provision of health services to all citizens.

7.2 The Parties will identify the human, financial and capital resources and potential sources of funding required achieving the goals of the Letter of Understanding.

7.3 The Parties will work cooperatively to secure resources, both internally and externally.

8.0 Communication and Information Sharing

8.1 Communication between the Parties will be transparent, consistent, reciprocal and timely.

7 8.2 The Parties will work together within the legislative framework e.g. Freedom of Information and Protection of Privacy Act (FOIPPA) etc. To coordinate and determine the most effective and efficient means of data exchange, system integration, and information – sharing to the fullest extent possible.

8.3 The principles of Ownership, Control, Access and Possession (OCAP) will be consistently and judiciously applied wherever applicable.

9.0 Evaluation of Letter of Understanding

9.1 The Parties will review the Letter of Understanding annually.

9.2 The Joint Committee will determine and agree on the process and procedures for the evaluation and implementation of subsequent recommendations.

10.0 Other Agreements

10.1.1 Enabling Agreements (i.e. contracts). 10.1.2 Federal Health Transfer Agreement including the Tri-Partite Agreement. 10.1.3 Protocols or Agreements between Secwepemc Health Caucus and other Aboriginal or non-Aboriginal entities.

11.0 Process

11.1 This Letter of Understanding does not extend to the following processes:

11.1.1 Interior Health Authority Corporate planning. 11.1.2 Secwepemc Health Caucus planning. 11.1.3 Planning processes conducted by the 17 Secwepemc Communities (i.e. strategic planning, community plan.)

11.2 The Parties agree to use a consensus – building model.

11.3 Resolution of issues: the Parties will work towards remedy of any issues pertaining to this Letter of Understanding through a mutually agreed process (such as mediation).

8 12.0 Term

12.1 Duration: The term of the Letter of Understanding will be three (3) years from the date of the signing.

12.2 Extension: The term of the Letter of Understanding may be extended by mutual consent of the Parties.

12.3 Termination: If mediation and/or resolution cannot be achieved, the Parties agree that either Party may terminate this agreement by providing sixty (60) days written notice, including the cause for termination.

13.0 Amendment

The Letter of Understanding may be amended by the Parties at any time by mutual consent of all Parties, in writing.

9 Dated on the 10th, day of September 2013

Secwepemc Kukpi7’s

1. Kukpi7 Nelson Leon Adams Lake

2. Kukpi7 Randy Porter Bonaparte

3. Kukpi7 Judy Wilson Neskonlith

4. Kukpi7 Paul Sam Shuswap Indian

5. Kukpi7 Rita Matthew Simpcw

6. Kukpi7 Ron Ignace Skeetchestn

7. Kukpi7 Wayne Christian Splats’in

8. Kukpi7 Shane Gottfriedson Tk’emlups

9. Kukpi7 Mike LeBourdais Whispering Pines

10. Kukpi7 Michael Archie Canim Lake

11. Kukpi7 David Archie Canoe Creek

12. Kukpi7 Bev Sellars Xats’ull

13. Kukpi7 Ann Louie Williams Lake

14. Kukpi7 Felix Arnouse Little Shuswap Lake 15. Kukpi7 Fred Robbins Esketemc

16. Kukpi7 Larry Fletcher High Bar

17. Kukpi7 Robert Shintah Ts’kw’aylaxw

Interior Health Authority

1. Dr. Halpenny CEO / President IHA

2. Norman Embree Board Chair, IHA

3. Andrew Neuner Vice President Community Integration, IHA 4. Colleen LeBourdais Witnessed by: Health Director – QHS 5. Brad Anderson Director Aboriginal Health IHA

10 Appendix A SHC Membership

The Secwepemc Chiefs will be comprised of the current Chief or their designate from the following First Nations.

Chief: Sexqeltqín – Adams Lake Chief: St’uxwtéws – Bonaparte Chief: Tsq’éscen – Canim Lake Chief: Stswécem’c/Xgét’tem’ – Canoe/Dog Creek Chief: Esk’étemc – Alkali Lake Chief: Llenllenéy’ten – High Bar Chief: Tk’emlúps – Kamloops Chief: Qw7ewt – Little Shuswap Lake Chief: Sk’atsin – Neskonlith Chief: Simpcw – North Thompson Chief: Ts’kw’aylaxw – Pavilion Chief: Kenpésq’t – Shuswap Chief: Skítsesten – Skeetchestn Chief: Xats’úll – – Soda Creek Chief: Splats’in – Spallumcheen Chief: T’éxel’c – Williams Lake Chief: Stil’qw/Pelltíq’t – Whispering Pines/Clinton

The Secwepemc Health Directors Hub will be comprised of the current Health Director and or the First Nation’s designate from the following First Nations.

Health Director: Sexqeltqín – Adams Lake Health Director: St’uxwtéws – Bonaparte Health Director: Tsq’éscen – Canim Lake Health Director: Stswécem’c/Xgét’tem’ – Canoe/Dog Creek T’éxel’c – Williams Lake Xats’úll – – Soda Creek Health Director: Esk’étemc– Alkali Lake Health Director: Llenllenéy’ten – High Bar Health Director: Tk’emlúps – Kamloops Skítsesten – Skeetchestn Stil’qw/Pelltíq’t – Whispering Pines/Clinton Health Director: Qw7ewt – Little Shuswap Lake Health Director: Sk’atsin – Neskonlith Health Director: Simpcw – North Thompson Health Director: Ts’kw’aylaxw – Pavilion Health Director: Kenpésq’t – Shuswap Health Director: Splats’in – Spallumcheen

11 Appendix B SHC Principles

The Secwepemc Health Caucus will be guided by the following principles adopted from the 7 Nations Unity Declarations. 2

 Health and Wellness Outcomes and Indicators will be defined by each Nation.  Partnerships will be defined by each Nation.  Agreements will be negotiated and ratified by the Nations.  No Nation will be left behind; needs are addressed collectively.  The federal fiduciary obligations must be strengthened, not eroded.  Services will be provided to all of our people regardless of residency/status.  Adequate funding will be provided for our corporate structure(s).  Socio-economic indices will be incorporated into planning and projections – plan for 7 generations.  Negotiations will be interest based – not position based (Nations define).  Community hubs will be linked to the health governance process.  Documents will be kept simple and understandable.  The Interior Leadership caucus will meet regularly.  Liability will be minimized; the Nations will inherit no liability from other entities.  Celebration will be included in all activities.  The speed at which development occurs will be determined by the Nations.  The authority to govern rests with each Nations, as does the responsibility for decision- making.

The Secwepemc Health Caucus will also apply the five main principles found in the Canada Health Act. 3

 Public Administration: All administration of provincial health insurance must be carried out by a public authority on a non-profit basis. They also must be accountable to the province or territory, and their records and accounts are subject to audits.  Comprehensiveness: All necessary health services, including hospitals, physicians and surgical dentists, must be insured.  Universality: All insured residents are entitled to the same level of health care.  Portability: A resident that moves to a different province or territory is still entitled to coverage from their home province during a minimum waiting period. This also applies to residents which leave the country.  Accessibility: All insured persons have reasonable access to health care facilities. In addition, all physicians, hospitals, etc., must be provided reasonable compensation for the services they provide.

2 (Duplicated from the 7 Nation Unity Declaration signed by: Chief Geronimo Squinas, Chief Ko’waintco Michel, Chief Arthur Adolph, Chief Shane Gottfriedson, Chief Jonathan Kruger, Chief Bernie Charlie and Gwen Phillips)

3 Canadian Health Care: Canada Health Act http://www.canadian-healthcare.org/page2.html

12 Appendix C Secwepemc Health Caucus Research Policy

14 Policy Rationale

Research is the front line of knowledge crea tion, transmission, transla tion and storage. It is one of the major factors in fluencing the way we look at, in terpret and in teract wi th the world around us and thus an in tegral part of our I iving cul ture. The process of conducting research can itse lf perpetua te the colonization of Secwepemc knowledges and ways of knowing by privileging Western research techniques and knowledge over Secwepemc research techniques and knowledge keepers. Researchers must understand the historical relationship Indigenous peoples have had with research and be committed to, and held accountable through, relationsh ips wi th the people and community they partner with. This research policy is meant to be a vehicle to ensure research is conducted in partnership with Secwepemc communities and individuals wi th the aim to strengthen the Secwepemc Na tion on Secwepemc terms.

The Secwepemc Heal th Caucus (SHC) recognizes its du ty to develop protocols to address the need for an organized, transparent and accoun table approach for individuals and/or groups conducting research in Secwepemc Territory related to Heal th.

These protocols have been developed to aid researchers in ensuring they abide by the protocols of the Secwepemc comm unities when conducting research in their territory. Where there is any discrepancy be tween the protocols of an individual Secwepemc com munity and those in this policy, the com munity protocols will take precedence.

Application

Thi s Secwepemc Heal th Caucus Research Policy applies to all individuals and I or groups conducting research wi thin the Secwepemc Na tion, who request to consul t with members of the Secwepemc Na tion and whose research will or could potentially impact Secwepemc Na tion members, ancestors, descendants or territories (including but not limited to land, air and wa ter).

Health Information

Heal th in formation includes any in formation relating to the heal th and wellbeing of individuals and communities (as defined by the individuals and comm uni ties) including physical, emotional, mental, spiritual, and in tergenerational wellbeing.

Point of Contact and FN Community Participation

Each Secwepemc First Na tion will be con tacted via the Heal th Director/Heal th lead and the Chie f and Council. Each FN will fo llow their in ternal process to determine if and how their community will participate.

16 Informed Consent and Voluntary Participation

Researchers w ill clearly and concisely offer information on the research (including aims and an ticipa ted outcomes) and obtain consent of ind ividuals prior to commencement of the research. Re searchers w ill recogn ize and respect the historica l relationship Indigenous people have had with research(ers) and ensure a re lationship o f reciprocity is fostered. The part icipa tion must be free, volun tary and where possible, compensated. Consent must be provided based on being " informed" about the research and research activities. Conditions of the informed consen t will be jointly decided by the Hea lth Director/lead and researcher and where appropriate, provisions for oral consent w ill be made.

All researchers must apply the following when seeking and obtaining "consen t":

1. Obtain written and/or oral consent from ind ividuals I community prior to the commencement of research, and on an ongoing basis. 2. The "consent agreement" must be easily understood and thoroughly explained to the participan t in a respectfu l and non-i ntimidating manner 3. If the participan t is an Elder, the Researcher must ensure tha t the Elder has a member o f the community, whom the Elder is fam iliar, present to ensure tha t the Elder understands the detail s and implications of consent 4. The signed consent forms and/or oral consent recording or w itness accoun t must be ava il able to the Hea lth Director for review 5. A provision will be made where the participan t may w ithdraw from the research program without penalty 6. A provision will be made where the participan t may revoke any and all information provided to the research program including beyond the program's completion

Privacy and Confidentiality

All da ta must be kept secure at all times following accepted standards for health research. The identity of responden ts must be protected at all times and researchers must ensure tha t all data re leased ensures the anonymity of the participan ts.

Ownership, Control, Access and Possession of Data

A written research agreement will be created collaborative ly between the community, group and/or Hea lth lead and researcher addressing the following (bu t not li mited to):

1. How the principles of Ownership, Control, Access and Possession will be applied and upheld 2. How the community will benefit from the research program itself with the training of research assistan ts and other capacity bu il ding

18 Appendix

Ownership, Control, Access and Possession (OCAP) Principles

The Secwepemc Hea lth Caucus adheres to the principles of Ownership, Con trol, Access and Possession (OCAP) as a tool for the assertion of First Na tions rights to se lf-determ ina tion and Na tion bu ilding w ithin the area of Hea lth.

• Ownership: Ownership refers to the relationship of First Nations to the ir cu ltural knowledge, da ta, and information. This principle sta tes tha t a community or group owns information collectively in the same way that an ind ividual owns his or her personal information.

• Control: The principle of control affirms that Firs t Nations, the ir communities and representative bodies are within their rights in seeking to control over all aspects of research and information management processes that impact them. Firs t Nations con tro l of research can include all stages of a part icu lar research project-from start to finish. The pri nci pie extends to the con trol of resources and rev iew processes, the planning process, management of the information and so on. Control from conception to completion.

• Acce ss: Firs t Nations must have access to information and data abou t themselves and the ir communities, regardless of where it is currently he ld. The principle also refers to the righ t of Firs t Na tions communities and organizations to manage and make decisions regarding access to their collective information. This may be ach ieved, in practice, through standardized, formal protocols.

• Possession: While ownership identifies the relationship between a people and their information in pri nci pie, possession or stewardship is more concrete. It refers to the physica l con trol of data. Possession is a mechanism by which ownership can be asserted and protected.;

• And further declared within our co llective position to honour the politica l re lationship proposed in the Memorial Sir Wil fred Laurier, Premier of the Dom inion o f Canada.

The Secwepemc Hea lth Caucus supports the research protocols and principles as outlined by the Assembly of First Nations (AFN) Ownership, Control, Access and Possession (OCAP) standards;;, as follows:

; 2009 First Nations Information Governance Center

;; Assembly of Fi rst Nations - Environmental Stewardsh ip Un it. (March 2009}. "Ownersh ip, Control, Access and Possession" (p.21} in Eth ics in Fi rst Nations Research. Retrieved 04-01-2012 from: http://www.afn. ca/u ploads/fi les/rp-resea rch ethics fi na I. pdf

19 These Principles,

• Apply to all research, data, and information initiative s that involve First Nations Health Issues. • Helps ensure self-determination over all research concerning First Nations is respected and adhered to; • Provides a means to decide - what research w ill be approved; how collected informat ion and data will be used; where information w ill be stored; and who w il l be able to access the information.

In agreeing to these principles, the Secwepemc Health Caucus recognises and affirms:

• Secwepemc Title, j urisdiction, and self-determ ination on Secwepemc territory and guardianship over the preservation, dissemination, and use of traditional knowledge and cultural heritage;

• The crucial importance of the active participation and leadership of Indigenous research partners in all phases of research, including its application and management of all project phases and funds. Thus, all research partners are entitled to be fully informed of and discuss the nature, scope and u lt imate integration of their participation, knowledge and narratives in all stages of the thesis work, as well as i ts potential publication, dissemination, and use;

• That material relating to the Secwepemc people t hat are collected by the researcher or any of h is/her project team is owned by the Secwepemc People and u l timately housed in the Secwepemc Health Caucus archives. This includes oral testimony (transcripts) h istorical, genealogical, anthropological, tradit ional use study, resource based data and studi es and other relevant material;

• The research will be conducted in an ethical, open and respectful manner;

• That the raw data obtained from interviewees must be rev iewed and approved by the interviewees prior to finalizing and/or inclusion in a research document/thesis;

• That the copyright of the final written report w ill remain w ith the Secwepemc Health Caucus as the author and the project funder (if outlined accordingly) but it is understood that the Secwepemc retain their respective inherent r ights, including a ll intellectual property rights associated now and in the future, and have ownership of all cultural information obtained from them;

22 Appendix D Secwepemc Health Caucus – Interior Health Authority Workplan 2013 – 2014

Letter of Understanding

Between the Parties: Northern St’át’imc

And Interior Health

(each a ‘Party’, collectively ‘the Parties’)

Table of Contents Definitions ...... 3 1.0 Purpose ...... 4 2.0 Preamble ...... 4 3.0 Principles ...... 7 4.0 Geographic Area ...... 8 5.0 Service Provisions, Activities and Outcomes ...... 8 6.0 Implementation ...... 9 7.0 Resource Requirements ...... 10 8.0 Evaluation of Letter of Understanding...... 11 9.0 Other Agreements ...... 11 10.0 Process ...... 11 11.0 Term ...... 11 12.0 Amendment ...... 12 Signatures ...... 12 Appendix A: Northern St’at’imc Membership ...... 13 Appendix B: Interior Unity Declaration ...... 14 Appendix C: St’at’imc Territory Map ...... 15 Appendix D: Interior Health Authority Map ...... 16

Northern St’at’imc – Interior Health Authority LOU Page 2 of 16

Definitions

St’at’imc: The St’at’imc Traditional Territory is 20,500 square kilometres and is home to 11 St’at’imc communities: Xwisten, Sekw’el’was, Tsal’alh, T'it'q'et, Xaxli’p, Ts’kw’aylaxw, Lil'wat, N'Quatqua, Samahquam, Skatin, and Xa’xtsa. The St'át'imc are the original inhabitants of the territory which extends north to Churn Creek and to South French Bar; northwest to the headwaters of Bridge River; north and east toward Hat Creek Valley; east to the Big Slide; south to the island on Harrison Lake and west of the Fraser River to the headwaters of Lillooet River, Ryan River and Black Tusk. The St'át'imc way of life is inseparably connected to the land. Our people use different locations throughout our territory of rivers, mountains and lakes, planning our trips with the best times to hunt and fish, harvest food and gather medicines. The lessons of living on the land are a large part of the inheritance passed on from St'át'imc elders to our children. As holders of one of the richest fisheries along the Fraser River, the St'át'imc defend and control a rich resource that feeds our people throughout the winter, and serves as a valued staple for trade with our neighboring nations.

Northern St’at’imc: the six communities are Tsal’alh (Seton Lake Indian Band) which is considered remote, and the rural communities of Xwisten (Bridge River), Ts’kw’aylaxw (Pavilion), Xaxli’p (Fountain), T’it’q’et (Lillooet), and Sekw’el’was (Cayoose Creek) (Appendix A).

Southern Stl’atl’imx – the five communities are Lil'wat, N'Quatqua, Samahquam, Skatin, and Xa’xtsa.

British Columbia Health Authorities: The province of BC is organized into 5 geographic regions for purposes of health-care service delivery. Interior Health and Vancouver Coastal are the provincial Authorities whose operating regions align within the territory of the St’át'imc. The Government of British Columbia created the Health Authorities through the Health Authorities Act, for the purpose of delivering health services and planning.

Interior Health Authority - The Interior Health Authority (IHA), is the party with whom the Northern St'at'imc primarily relate with respect to delivery of health services to their citizens. Interior Health is governed by a Board of Directors, and delivers its health services through the President and Chief Executive Officer and the staff of Interior Health, according to the Vision, Mission and Values for Interior Health, and within the broad directions of the Ministry of Health. Interior Health, pursuant to its Vision, Mission and Values has established a Strategic Plan which enunciates four Goals. Goal #1 is to Improve Health and Wellness. Under this goal, item 1.2 is, “Meet the needs of First Nations and Aboriginal communities by collaboration with them to plan and deliver culturally sensitive health care services.” Interior Health, pursuant to the Goal Statement 1.2 noted above, has developed an Aboriginal Health and Wellness Strategy 2010-2014 which is based on 5 key strategies: 1. Develop a Sustainable Aboriginal Health Program; 2. Ensure Aboriginal Peoples’ Access to Integrated Services; 3. Deliver Culturally Safe Services across the Care & Service Continuum; 4. Develop an Information, Monitoring and Evaluation Approach for

Northern St’at’imc – Interior Health Authority LOU Page 3 of 16

Aboriginal Health; 5. Ensure ongoing Meaningful Aboriginal Participation in Healthcare Planning. Interior Health supports the concept that the First Nations that are party to this Accord may represent other organized groups of Aboriginal people, provided there are written formal agreements to that effect.

Vancouver Coastal Health Authority - Vancouver Coastal Health Authority (VCHA) is the party with whom the Lower Stl'atl'imx primarily relate with respect to delivery of health services to their citizens. The Lower Stl'atl'imx communities have not created a Letter of Understanding with VCHA to date.

1.0 Purpose 1.1. The Parties wish to define a collaboratively developed engagment process for the planning of Aboriginal services, programs and operations across St’at’imc Territory for delivery of health services and improvement of health outcomes for St’at’imc people.

1.2. The Parties seek to improve the health outcomes for St’at’imc people by achieving effective shared decision making that will reduce the barriers for St’at’imc people to access better health services.

1.3. The Parties commit to working together through meaningful participation and collaboration, to increase the influence of the Northern St’at’imc in decisions related to health services that impact their members and other Aboriginal peoples residing within the St’at’imc Territory.

1.4. The Parties agree that health outcomes held in common with all residents of British Columbia should be equal or exceeding for St’at’imc citizens and health outcomes beyond these, as defined by St’at’imc citizens, pursued with equal vigor and diligence.

2.0 Preamble 2.1 The First Nations of British Columbia, the Province of British Columbia and the Canadian Government, ratified the Tripartite Framework Agreement on First Nation Health Governance, which will empower B.C. First Nations to take-over the administration of Health Canada programs and services and identifies additional provincial resources, to be administered by a First Nations Health Authority.

2.2 Under the First Nations Health Authority, BC First Nations Governments will be fully involved in decision-making regarding the health of their people, and in defining how health services and programs are planned, designed, managed and delivered. They have agreed that First Nations should avoid the creation of separate and parallel First Nation and non-First Nation health systems, and develop a more integrated health and wellness system with stronger linkages to the provincial health-care system and the creation of new approaches to achieving the desired health and wellness outcomes of each Nation.

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2.3 The First Nations of B.C. are now modeling a provincial First Nations Health Authority to implement the Tripartite Framework; defining its structure and functions, in relation to the structures and functions of their own local health governance authorities. They envision a provincially coordinated wellness system that:

2.3.1 will result in improved quality, accessibility, delivery, effectiveness, efficiency, and cultural appropriateness of health care programs and services for First Nations; 2.3.2 reflects the cultures and perspectives of BC First Nations and incorporates First Nations’ models of wellness; 2.3.3 embraces knowledge and facilitates discussions in respect of determinants of health in order to contribute to the design of First Nation health programs and services; 2.3.4 provides First Nations in all regions of British Columbia with access to quality health services that are at a minimum, comparable to those available to other Canadians living in similar geographic locations.

2.4 First Nations on a Regional/Nation basis, are now forming structures and processes through which to carry out engagement, research, planning and development work required, to define the authority of the First Nations Health Authority, and to shape the final form it will take:  The First Nations Health Council Interior Governance Entities Terms of Reference describe the roles and responsibilities of the parties that are working together to advance the formation of the First Nations Health Authority. The Interior Region Nation Executive Table acts as an executive body to the Interior Region First Nations Community Health Caucus and carries out directions in between Caucus sessions. They also ensure that the First Nations Health Council is being accountable (implementing the work plan as approved), and responsive to regional issues. Executive Membership consists of 1 member from each of the following Nations: Dãkelh Dene, Ktunaxa, Secwepemc, Syilx, St’át'imc (Northern), Tsilhqot’in, Nlaka’pamux, selected in accordance with Nation-approved processes and appointed through resolution.  The Parties of the Interior Partnership Accord; the Interior Health Authority and the 7 Nations in the Interior are committed to improving the health and wellness outcomes for First Nations people of the Interior Region. The purpose of the Interior Partnership Accord is to clarify the roles and relationships of each of the Parties as they work together to fulfill this commitment. The overall objectives are to establish a coordinated and integrated First Nations health and wellness system in the Interior that: a) will contribute to the achievement of Interior Nations’ wellness goals, by continually improving quality, accessibility, delivery, effectiveness, efficiency, and cultural appropriateness of health care programs and services for First Nations in the Interior; b) reflects the cultures and perspectives of Interior First Nations, incorporates First Nations’ models of wellness, builds First

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Nations health human resource capacity, and respects that the Nations have and will continue to work together; c) affords equitable recognition in strategies to address First Nations who have limited capacity, including small and isolated communities; d) embraces knowledge sharing and facilitates discussions in respect of addressing broader determinants of health; and e) is based on respecting and addressing the lands, history, health, safety, food security, dignity and well-being of all Interior First Nations people (p.7) . One of the success indicators of the Interior Partnership Agreement is Letters of Understanding [will be] developed and implemented between Interior Health and each of the Seven (7 ) Interior Nations (p.8);

2.5 The Parties agree to enter into a mutually beneficial relationship that will work towards, in a quantifiable and qualitative manner, shared responsibility and shared decision making as it impacts the provisions of Health Services to Aboriginal people within the St’at’imc Territory.

2.6 The Parties agree to use a cooperative, collaborative approach to improving the health status of St’at’imc individuals, families and communities through the design, delivery and evaluation of culturally safe health programs and services.

2.7 Interior Health Authority acknowledges the inherent and Aboriginal rights (including but not limited to self-determination and freedom from discrimination) of the St’at’imc People. Further, Interior Health Authority recognizes the St’at’imc regardless of residency and supports the St’at’imc pursuit of its rights to retain responsibility for the health, safety, survival, dignity and well-being of St’at’imc children and families, consistent with the UN Convention on the Rights of the Child and the UN Declaration on the Rights of Indigenous people.

2.8 This letter of understanding does not abrogate nor derogate from St’at’imc Aboriginal Rights as per Section 35(1) Constitution Act. 1982.

2.9 The Parties agree and understand that this Letter of Understanding pertains to the Interior Health Authority’s roles and responsibilities according to the purpose and description under the Health Authorities Act which states that:

“5 (1) The purposes of a board are as follows: (a) To develop and implement a regional health plan that includes (i) The health services provided in the region, or in a part of the region, (ii) The type, size and location of facilities in the region, (iii) The programs for the delivery of health services provided in the region. (iv) The human resource requirements under the regional health plan; and,

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(v) The making of reports to the minister on the activities of the board in carrying out its purposes.

(b) To develop policies, set priorities, prepare and submit budgets to the minister and allocate resources for the delivery of health services, in the region, under the regional health plan.

(d) To deliver regional services through its employees or to enter into agreements with the government or other public or private bodies for the delivery of those services by those bodies.

(e) [Repealed 2002-61-4] therefore not applicable

(f) To develop and implement regional standards for the delivery of health services in the region.

(g) To monitor, evaluate and comply with Provincial and regional standards and ensure delivery of specified services applicable to the region.

5 (2) In carrying out its purposes, a board must give due regard to the Provincial standards and specified services.”

3.0 Principles

This Letter of Understanding is based upon the following principles:

3.1 The St’at’imc will be guided by the principles adopted from the 2010 Unity Declaration of the 7 Nations. (Appendix B)

3.2 The Parties acknowledge and respect jurisdictional and fiduciary relationships and responsibilities, and will seek to remove jurisdictional impediments and improve progress in integration and flow of health services for St’at’imc People.

3.3 The planning, coordination and implementation of Interior Health Authority services for Aboriginal people in St’at’imc Territory will be more effective with increased participation of the St’at’imc in the planning of services.

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3.4 This Letter of Understanding (LOU) is a living document that will respond to changes within the Parties and will represent an integrated approach to the enhancement of the relationship and development of services.

3.5 The Parties acknowledge and respect the need for transparency, reciprocal accountability, and accountability to the communities affected by decisions made by The Parties.

3.6 Mutual respect, trust, openness, accountability and transparency will be the basis of the understanding and foundation of the relationship established under this Letter of Understanding.

3.7 Indigenous cultural competency.

4.0 Geographic Area The activities referred to in this Letter of Understanding will be applicable within that portion of the St’at’imc Territory as shown in Appendix C.

5.0 Service Provisions, Activities and Outcomes The Parties agree that:

5.1 Every effort will be made where possible to harmonize and integrate programs and services in the Northern St’at’imc territory.

5.2 Commitments will be made by the Parties to pursue a model of wellness that is client/family/community -centred, health promotion/ disease prevention focused, builds on relationships, integrative service delivery, builds on St’at’imc strengths, integrates St’at’imc traditional values and concepts of healing, is holistic including the social determinants of health, and has high standards in quality of care .

5.3 Activities will be carried out with a view to maintaining principles of sustainability, efficiency, and effectiveness without limiting innovation, improved access or quality and by building on existing best practices.

5.4 The St’at’imc may represent other organized groups of Aboriginal people, and organizations that represent off-reserve Aboriginal Peoples provided there are formal written agreements to that effect.

5.5 As capacity grows, planning and provision of health care may extend beyond care for St’at’imc citizens to include other people, neighbours within the St’at’imc Territory.

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5.6 Mutually agreed upon indicators of health and indicators of success will be followed as a baseline for measurement, and there will be a balance of qualitative and quantitative outcomes.

6.0 Implementation

The Parties will establish a “Joint Committee” comprising representatives from all Parties, develop a Terms of Reference that outline responsibilities which may include, but are not limited to:

6.1 Development of a strategy for building relationships between the Parties, including creating communications, engagement and consultation protocols. This will include the roles of the appointed Northern St’at’imc political and technical representatives to the Interior Region Partnership Accord Leadership Table.

6.2 Draft a St’at’imc Model of Wellness in collaboration with IHA that builds from the Northern St’at’imc community health plans.

6.3 Ensure the Parties’ Health Plans are in alignment with the Tri-Partite First Nations Health Plan, including the Tripartite First Nations Health Authority Health Actions and other relevant partners.

6.4 Establish and implement a process for establishing and reviewing the activities of specific working groups to ensure that their work builds upon the principles and concepts of this LOU, i.e. the development of annual work plans, prioritization, indicators, targets, milestones, benchmarks, including evaluating their outcomes. For Example: The formation of a working group or committee that works towards ensuring cultural safety which is of paramount importance to the effectiveness of and access to, health services provision. The cultural safety of St’at’imc people will require ongoing education, dialogue and active participation and engagement between parties including the following outcomes:

6.4.1 Collaboration on Indigenous Cultural Competence (ICC) supplementary training and documents, including innovation of techniques and relationship building 6.4.2 Supporting the interaction of all levels of IH staff with Aboriginal and St’at’imc people at cultural and non-cultural events. 6.4.3 Collaboration on the evaluation of cultural safety improvement measures and grievance mechanisms for Aboriginal and St’at’imc employees and customers.

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6.4.4 Develop service delivery systems which better respect and reflect the cultural and socioeconomic context of St’at’imc and Aboriginal people in St’at’imc Territory.

6.5 Formation of a Research, Ethics and Data Sub-Committee with the following outcomes:

6.5.1 Develop and implement an evaluation and approval procedure for any and all data collection involving or affecting all St’at’imc (on or off-reserve). 6.5.2 Oversee and ensure application and compliance with the Lillooet Tribal Council Research Ethics Policy on all research projects involving or affecting St’at’imc people and communities. 6.5.3 Develop a Data Sharing Agreement to be ratified by their respective organizations and implemented by the “Joint Committee.” 6.5.4 Ensure the highest standards of privacy, protection and confidentiality are applied to all data collected from programs or projects involving or affecting all St’at’imc. 6.5.5 Forward recommendations regarding research and data use as well as relevant amendments to this LOU. 6.5.6 The principles of St’at’imc Ownership, Control, Access and Possession (OCAP) will be consistently and judiciously applied wherever applicable.

6.6 The Joint Committee representatives will report through their respective organizations and where appropriate to affected Aboriginal citizens and communities.

7.0 Resource Requirements 7.1 It is acknowledged that through the Ministry of Health, Interior Health Authority is responsible for the provision of health services to all citizens residing in its service delivery area.

7.2 The Parties will identify the human, financial and capital resources and potential sources of funding required achieving the goals of the Letter of Understanding.

7.3 The Parties will work cooperatively and seek opportunities to secure resources, both internally and externally.

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8.0 Evaluation of Letter of Understanding 8.1 The Parties will review the Letter of Understanding annually, 8.2 The Joint Committee, in collaboration with their respective organizations, will determine and agree on the development of the process and procedures for the evaluation and implementation of subsequent recommendations.

9.0 Other Agreements 9.1 The Parties acknowledge and agree that this Letter of Understanding is between the Parties identified and should not be interpreted as having any influence, bearing or impact on other agreements including, but not limited to:

9.1.1 Enabling Agreements (i.e. contracts) 9.1.2 Federal Health Transfer Agreement including the Tri-Partite Agreement. 9.1.3 Protocols or Agreements between the St’at’imc and other Aboriginal or non- Aboriginal entities. 9.1.4 The Parties agree that this Letter of Understanding is not prejudicial to the implementation of any inherent right of self-government or any agreements that may be negotiated with respect to self-government.

10.0 Process 10.1 This Letter of Understanding does not supersede the following processes: 10.1.1 Interior Health Authority Corporate planning. 10.1.2 St’at’imc Health planning 10.1.3 Community Health Plans conducted by the 11 St’at’imc Communities 10.2 The Parties agree to use a consensus – building model. 10.3 Resolution of issues: the Parties will work towards remedy of any issues pertaining to this Letter of Understanding through a mutually agreed process (such as mediation).

11.0 Term 11.1 Duration: term of the Letter of Understanding will be three (3) years from the date of the signing.

11.2 Extension: The term of the Letter of Understanding may be extended by mutual consent of the Parties.

11.3 Termination: If mediation and/or resolution cannot be achieved, the Parties agree that either Party may terminate this agreement by providing sixty (60) days written notice, including the cause for termination.

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12.0 Amendment The Letter of Understanding may be amended by the Parties at any time by mutual consent of all Parties, in writing.

Signatures

Dated this 21st day of March, 2014

Party Signatories:

St’at’imc Chiefs

1. Chief Arthur Adolph Xaxli’p

2. Chief Kevin Whitney T’it’q’et

3. Chief Larry Casper Tsal’alh

4. Chief Michelle Edwards Sekw’el’was

5. Chief Susan James Xwisten

6. Chief Robert Shintah Ts’kw’aylaxw

Interior Health Authority

1. Dr. Halpenny CEO / President IHA ______

2. Norman Embree Board Chair, IHA ______

Witnessed by: ______

______

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Appendix A: Northern St’at’imc Membership

The Northern St’at’imc Chiefs will be comprised of the current Chief or their designate from the following First Nations.

Chief Arthur Adolph Xaxli’p (Fountain) Chief Susan James Xwisten (Bridge River) Chief Larry Casper Tsal’alh (Seton Lake Indian Band) Chief Michelle Edwards Sekw’el’was (Cayoose Creek Indian Band) Chief Kevin Whitney T’it’q’et (Lillooet) Chief Robert Shintah Ts’kw’aylaxw (Pavilion)

The Northern St’at’imc Health Directors/ Leads will be comprised of the current Health Director and or the First Nation’s designate from the following First Nations.

Angela Wrede, Health Director Xaxli’p (Fountain) Fay Michell, Health Lead Xwisten (Bridge River) Angela Alexander, Health Lead Tsal’alh (Seton Lake Indian Band) Kelsey Schwindt, Health Lead Sekw’el’was (Cayoose Creek Indian Band) Franny Alec, Health Director T’it’q’et (Lillooet) Cora Watkinson, Health Lead Ts’kw’aylaxw (Pavilion)

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Appendix B: Interior Unity Declaration

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Appendix C: St’at’imc Territory Map

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Appendix D: Interior Health Authority Map

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LETTER OF UNDERSTANDING

Between

Tsilhqot’in National Government and the six member communities of Xeni Gwet’in First Nations Government, Yunesit’in First Nations, Tl’esqox Indian Band, Tsi Deldel First Nations, ?Esdilagh First Nations and Tl’etinqox-tin Government Office.

And

Interior Health Authority

(each a”Party” and collectively “the Parties”

1.0 PURPOSE 1.1 The Parties wish to work together to develop a process that allows the Tsilhqot’in Nation to engage in planning of Aboriginal services and operations that impact the health services of its members.

1.2 The Parties seek to establish effective shared decision-making to reduce the barriers for Tsilhqot’in people and to allow for better access to culturally appropriate health services.

1.3 The Parties agree that health and wellness outcomes should be comparable to those outlined in the Tsilhqot;in Wellness Plan.

2.0 FOUNDATION 2.1 The Parties agree to enter into a mutually beneficial relationship that will work toward, In a quantifiable and qualitative manner, shared responsibility and shared decision making as it impacts the provision of Health Services to Aboriginal people.

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2.2 The Parties agree to use a cooperative, collaborative approach to improving the health status of the Tsilhqot’in Nation including Aboriginal individuals, families and communities through the design, delivery and evaluation of culturally appropriate health programs and services

2.3 Interior Health Authority acknowledges the inherent rights of the Tsilhqot’in people. Further, Interior Health Authority recognizes that the Tsilhqot’in National Government and the six member communities represent their citizenry regardless of residency and supports the Tsilhqot’in pursuit of its rights to retain responsibility for the health, safety, survival, dignity and well-being of Tsilhqot’in children and families, consistent with the UN Convention on the Rights of the Child and the UN Declaration on the Rights of IndigenousPeoples.

“(1) The purposes of a board are as follows: (a) To develop and implement a regional health plan that includes (i) the health services provided in the region, or in a part of the region, (ii) the type, size and location of facilities in the region, (iii) the programs for the delivery of health services provided in the region, (iv) the human resource requirements under the regional health plan, and (v) the making of reports to the minister on the activities of the board in carrying out its purposes.

(b) To develop policies, set priorities, prepare and submit budgets to the minister and allocate resources for the delivery of health services, in the region, under the regional health plan.

(d) To deliver regional services through its employees or to enter into agreements with the government or other public or private bodies for the delivery of those services by those bodies.

(e) [Repealed 2002-61-4] therefore not applicable.

(f) To develop and implement regional standards for the delivery of health services in the region.

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(g) To monitor, evaluate and comply with Provincial and regional standards and ensure delivery of specified services applicable to the region.

(2) In Carrying out its purposes, a board must give due regard to the Provincial standards and specified services.”

3.0 PRINCIPLES

The development of this Letter of Understanding was based upon the following principles:

3.1 The Parties acknowledge and respect established and evolving jurisdictional and fiduciary relationships and responsibilities and will seek to remove impediments to progress by establishing effective working relationships.

3.2 The planning and coordination of Interior Health Authority services for the Tsilhqot’in Nation members will be more effective if there is increased participation of the Tsilhqot’in National Government and the six member communities.

3.4 The Parties acknowledge and respect the need for transparency and reciprocal accountability.

4.0 GEOGRAPHIC AREA

The activities referred to in this Letter of Understanding will be carried out within the Tsilhqot’in Territory.

5.0 SERVICE PROVISION

The Parties Agree that:

5.1.1 the planning for and the provision of health services will be inclusive of all Aboriginal people and services will be culturally appropriate. 5.1.2 Mutual respect, trust, openness, accountability and transparency will be the basis of the understand and foundation of the relationship established under this Letter of Understanding 5.1.3 The Tsilhqot’in National Government may represent other organized groups of Aboriginal people provided that there are formal written agreements to that effect. 5.1.4 Every effort will be made between the parties where possible to create culturally appropriate services and to harmonize and integrate programs and services.

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5.1.5 Activities will be carried out with the view of maintaining principles of sustainability, efficiency and effectiveness without limiting innovation, improved access or quality and by building on existing best practices. 5.1.6 Appropriate methods will be used to measure outcomes, including a strengths based approach (e.g. client focused, holistic or “wrap-around”) 5.1.7 Mutually agreed upon indicators of health will be followed as a baseline for measurement and there will be a balance of qualitative and quantitative outcomes. 6.0 ACTIVITIES 6.1 To Improve the health outcomes for Aboriginal people, the Parties will carry out specific actions including but not limited to the following: 6.1.1 Review of the existing standards 6.1.2 Development of service delivery systems to better reflect the cultural context of Aboriginal people. This may include localized training on cultural competency. 6.1.3 Development of a consistent and harmonized planning process.

6.1.4 Alignment of services with existing health plans to identify service overlaps and gaps. 6.1.5 Establishment of standards, targets, outcomes and measurements as well as common indicators, milestones and benchmarks. 6.1.6 Engagement in dialogue, identification of linkages and establishment of networks with other Aboriginal and non-Aboriginal stakeholders

6.2 The Parties will establish a Joint Committee and working groups (with specific terms of reference and deliverables) to carry out the activities set out in paragraph 6.1.

7.1 Development of a Strategy for building relationships between the Parties including an engagement strategy, communication strategy and consultation process.

7.2 Reviewing the Parties Health Plans to ensure alignment with each other and with the Tripartite First Nations Health Plan

7.3 Ensuring that the Nation is consulted prior to any changes to existing and future services to ensure equitable health care .

7.4 Development of Protocols and Strategies for ensuring that First Nations applicants are considered when hiring for position and retaining those positions.

7.5 Development, agreement and implementation for Data Sharing Agreement between Interior Health Staff and Community Health Staff.

7.6 Prioritization of Services

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7.7 Development of Culturally Appropriate Practices within Interior Health Services.

7.8 Identification of barriers to access to culturally appropriate health services for Tsilhqot’in members as well as concerns relating to outcomes for Tsilhqot’in members, and mutual development of strategies and procedures to address these barriers and concerns.

7.9 Ensuring that culturally appropriate protocols are developed and followed for complaints.

7.10 Determination of and agreement upon the process and procedures for the evaluation of this Letter of Understanding and the implementation of subsequent recommendations

7.11 Determination of and agreement upon the process and procedures for the implementation of subsequent recommendations

7.12 The Joint Committee representatives will report through their respective organizations.

8.0 RESOURCE REQUIREMENTS 8.1 It is acknowledged that through the Ministry of Health, Interior Health Authority is responsible for the provision of health services to all citizens.

8.2 The Parties will identify the human, financial and capital resources and potential sources of funding required to achieve the goals of the Letter of Understanding including Tsilhqot’in participation in the Joint Committee.

8.3 The Parties will work cooperatively to secure resources, both internally and externally.

9.0 COMMUNICATION AND INFORMATION SHARING 9.1 Communication between the Parties will be transparent, regular and reciprocal. (as per 7.1)

9.2 The Parties will work together within the legislative framework, e.g. Freedom of Information and Protection of Privacy Act etc, to coordinate and determine the most effective and efficient means of data exchange, system integration and information sharing to the fullest extent possible.

9.3 The principles of the OCAP ( Ownership, Control, Access and Possession) will be consistently applied wherever possible.

10.0 EVALUATION OF LETTER OF UNDERSTANDING

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The Parties will review the Letter of Understanding annually or as otherwise agreed by all Parties. As per paragraph 7.10 above, the Joint Committee will determine and agree the process and procedures for the evaluation and implementation of subsequent recommendations.

11.1.1 Enabling Agreements (i.e contracts) 11.1.2 Federal Health Transfer Agreement including the Tri-Partite Agreement 11.1.3 Protocols or Agreements between the Tsilhqot’in National Government and other Aboriginal or non Aboriginal entities. 11.2 The Parties agree that this Letter of Understanding is not prejudicial to the implementation of any inherent right to self government or any agreements that may be negotiated with respect to self government.

12.0 PROCESSES

12.1 This letter of Understanding does not extend to the following processes: 12.1.1 Interior Health Authority organizational/business planning 12.1.2 Tsilhqot’in National Government organizational/business planning 12.1.3 Planning processes conducted by the six member bands (for example strategic plans and community plans)

12.2 The Parties agree to use a consensus-building model.

13.0 TERM

13.1 Duration: The term of the Letter of Understanding will be four years from the date of signing.

13.2 Extension: The term of the Letter of Understanding may be extended by mutual consent of the parties 13.3 Resolution of Issues: The Parties will work towards remedy of any issues pertaining to this Letter of Understanding through a mutually agreed upon process (such as mediation)

14.0 AMENDMENT The Letter of Understanding may be amended by the Parties at any time by mutual consent of all Parties in Writing.

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Dated on this ____ day of ______, 2013

Signed by:

Interior Health Authority Tsilhqot’in National Government

______Dr. Robert Halpenny Chief Joe Alphonse President and CEO Tl’etinqox-t’in Government Office

Norman Embree Chief Bernie Mack Board Chair, Interior Health Authority Esdilagh First Nations

______Chief Roger William Xeni Gwet’in First Nations

______Chief Russell Myers Yunesit’in First Nations

Chief Percy Guichon Tsi Deldel First Nations

Chief Francis Laceese Toosey First Nations.

May, 28, 2013

Appendix F: Interior Health Authority Context and Aboriginal Programs and Services

Region Interior Health (IH) is mandated by the Health Authorities Act to plan, deliver, monitor, and report on publicly funded health services for the people that live within its boundaries. Interior Health’s Vision, Mission, Values, and Guiding Principles inform how it delivers on its legislated mandate.

Interior Health provides health services to over 744,000 people across a large geographic area covering almost 215-thousand square kilometres and serves larger, urban centres alongside a large number of small, rural and remote communities. Only 11 of the 59 incorporated communities in the health authority have a population of 10,000 or more.1 Within IH there are 55 First Nations Bands, the majority of which are rurally located.

In 2006, there were 44,900 people who identified with an Aboriginal group living in the Interior Health region, constituting 6.7 per cent of the overall IH population (British Columbia’s overall rate is 4.8 per cent).2 While improvements in overall mortality and increasing life expectancy in the Aboriginal population have been made, significant gaps in health status between Aboriginal and non-Aboriginal populations still exist. For instance, the Aboriginal population in B.C. experiences a disproportionate rate of chronic diseases and injuries compared to other British Columbia residents.3

Interior Health has 19,428 staff, 1563 physicians (which includes 954 general practitioners) physicians and 5,312 nurses.4 There are 2 tertiary level hospitals, 4 service area hospitals, and a network of community hospitals and health centres offering services to the population of the region.

Interior Health Structure

Structurally, Interior Health has both service delivery and support portfolios. Service delivery portfolios include: Community Integrated Health Services, Residential Care, and Acute Services. The Aboriginal Health Program is one program area within the Community Integrated Health Services Portfolio and includes specific programs and services such as the Aboriginal Patient Navigator Program, Aboriginal Tobacco Reduction Coordinator and Aboriginal Addictions Knowledge Exchange Lead.

Service delivery is coordinated through a regional “network of care” that includes hospitals, community health centres, residential and assisted living facilities, supports for housing for people with mental health and substance use problems, primary health clinics, homes, schools, and other community settings.

Aboriginal Communities

The IH region includes a large number of First Nations reserve communities. Figure 1 identifies the 55 First Nations Bands within the Interior Health service region. This includes five Bands that are located

1 BC Stats. Demographic Analysis Section. Ministry of Citizens’ Services and Open Government. Municipal Estimates, 2006 – 2012. 2 BC Stats. Statistical Profile of Aboriginal Peoples 2006, Interior Health Authority. 3 British Columbia Provincial Health Officer (2009). Pathways to Health and Healing – 2nd Report on the Health and Well-being of Aboriginal People in British Columbia. Provincial Health Officer’s Annual Report 2007. Ministry of Healthy Living and Sport. 4 Source: MSP Information Resource Manual 2011/12; Interior Health HR Planning extracted from Meditech Payroll data Oct, 2012; LHA definitions and PEOPLE 2013

1 within the boundaries of other regional health authorities, but who may access services from IH because of local tribal affiliations. Many of these 55 Bands are rurally or remotely located.

Figure 1: First Nations Communities in IH Region

Interior Health Aboriginal Specific Programs and Services

Our vision is to improve the health status of Aboriginal people within Interior Health by improving access and creating a culturally safe environment and culturally appropriate care for Aboriginal people and acting as a resource for health care service providers. Our mission is to improve access and ensure Aboriginal people receive culturally safe and appropriate service

Aboriginal Patient Navigator Program Aboriginal Patient Navigators are located in community or acute sites across Interior Health. Aboriginal Patient Navigators support families by providing resources to help connect them to appropriate health care services and provide cultural support. Aboriginal Patient Navigators also work with health care workers to provide resources to assist in providing culturally appropriate care and to connect them with external Aboriginal services. There is no financial cost to clients that access the services.

The Aboriginal Patient Navigator works as part of the Interdisciplinary Care Team, and as required, acts as a resource for both Aboriginal patients and health care providers to ensure care is culturally specific, ethno sensitive and patient centered. 1. For every Aboriginal person who presents and requests APN service at identified referral sites to have timely access to Aboriginal Patient Navigator Services. 2. For Aboriginal Patient Navigators to support culturally safe and appropriate care in health care and community settings through education, advocacy, identification of service gaps and barriers 3. The APN provides referrals, services, and/or resources for patients to meet the unique health needs as identified by the patient, family, and/or interdisciplinary care team. 4. The APN functions as an active member of interdisciplinary healthcare teams.

The target Populations are: 1. Individuals who identify as Aboriginal (Metis, First Nations Status and Non-Status, Inuit). 2. Healthcare Providers

Aboriginal Health and Wellness Strategy

The Aboriginal Health and Wellness Strategy is a primary guiding document for the Aboriginal Health team and Interior Health. Interior Health’s Aboriginal Health and Wellness Strategy, 2010-2014, presents a strategic framework that consists of 5 specific strategies, with the goal to improve the health of the Aboriginal peoples we serve. The strategy relies on a good understanding of the health issues faced by the Aboriginal population and the opportunities for improvement. Reflecting our renewed direction in Aboriginal Health, this strategy is consistent with the aims of the Tripartite First Nations Health Plan, and affirms the ongoing need to nurture locally based relationships with Aboriginal peoples. The 5 strategies are: 1. Develop a Sustainable Aboriginal Health Program 2. Ensure Aboriginal Peoples’ Access to Integrated Services 3. Deliver Culturally Safe Services across the Care and Service Continuum 4. Develop an Information, Monitoring and Evaluation Approach for Aboriginal Health 5. Ensure ongoing Meaningful Aboriginal Participation in Healthcare Planning

Aboriginal Governance Structures

Aboriginal Health and Wellness Advisory Committee (AHWAC) is a committee of the Interior Health’s Board of Directors that is composed of representatives from First Nation’s communities, Friendship Centers, and the Métis Nation BC, plus members of IH’s Board of Directors and Aboriginal Health Program to provide advice to Interior Health on matters pertaining to the improvement of health and health services for Aboriginal people.

The Partnership Accord signed in November, 2012, in Kamloops, details the foundations of working relationships with the 7 Nations in the IH region. This agreement ensures that the Nations are partners in health care decisions that impact their communities and peoples. The agreement aligns with IHA Goal #1 “improve health and wellbeing”. The Partnership Accord Leadership Table is comprised of Interior Health and First Nations Representatives for the implementation of the Partnership Accord.

3 Letters of Understanding (LoU) have been signed with several Aboriginal Nations within Interior Health. The purpose of the LoU is to enhance direct relationships between decision makers to improve health outcomes of the respective Aboriginal group. Decision makers may include Aboriginal leadership (such as Health Directors, HUB coordinators, etc.), IHA Aboriginal Health (Practice Lead and/or Director) and IHA representatives (Program and Operations representation).

Other Aboriginal Health Funding Opportunities, Initiatives, and Partnerships

Aboriginal Health Contracts Aboriginal Health contracts are awarded to qualified not-for-profit Aboriginal organizations. The contracts support grassroots programs that will improve health of Aboriginal people in their communities and within IH. Funds are distributed by a population based funding formula, with the statistics derived from the 2009 Stats Canada data. The proposals are received and evaluated by an internal team that cleared conflict of interest guidelines.

Interior Health awards three different types of contracts to allow for flexibility and innovation of programs that will work with each community's specific needs. 1. AHIP I funding is designated for projects that fall into the Community Health Education and Community Health Collaboration categories. 2. AHIP II is directed towards health promotion and disease prevention programs that run for over 2 years. These programs support community development and health education, health promotion, and or disease prevention activities. 3. Lastly, Direct Service contracts are contracts are currently focused on Mental Health & Substance Use.

Aboriginal Self Identification (ASI) Project The Aboriginal Self Identification was implemented as a result of the Ministry of Aboriginal Relations and Reconciliation (MARR) which sponsored development of Aboriginal Administrative Data Standard (AADS) in 2007. Following the development of this process, the Ministry of Aboriginal Relations and Reconciliation (MARR) formally recommended the standard to the Government of British Columbia. British Columbia adopted the standard and mandated it to several Ministries including Health. Since 2007 most provincial Ministries have implemented the standard, with Health being the notable exception.

Interior Health’s Aboriginal Health & Wellness Advisory Committee (AHWAC) recommended in 2007 that Interior Health adopt the standard and implement Aboriginal Self-Identification. AHWAC approved the Aboriginal Health & Wellness Strategy 2010-2014 which featured Aboriginal Self Identification as one of the key projects to be implemented by the Aboriginal Health Program.

ASI is foundational to: 1. Closing the health status gap between Aboriginal and non-Aboriginal populations via an evidenced based approach. 2. Delivering client-centered, culturally competent, appropriate care to Aboriginal people. 3. Obtaining a base-line understanding of: a. Current Aboriginal service utilization by program/service by Aboriginal sub-populations;

4 b. Variance in needs across Aboriginal populations and compared to non-Aboriginal populations. 4. Enhancing care continuity, service coordination, flow optimization to appropriate services thereby reducing wasted patient days, transitional service gaps and unnecessary and preventable acute care admission and recidivism. 5. Creating the basic conditions to support culturally appropriate, effective and efficient, evidenced-based, research, planning, policy, and program development. 6. Performance monitoring and evaluation of programs or services serving Aboriginal people. 7. Increasing accountability and ‘ability’ at all levels across all stakeholders. 8. Improving Aboriginal peoples access to services by better understanding barriers to access and then acting to reduce or eliminate these barriers based on evidence. 9. Improving Aboriginal people’s attachment to primary care providers by understanding the dimensions and scope of the current gap. 10. Creating novel business and funding models to more effectively allocate scarce financial resources to programs and initiatives that demonstrably target populations with the greatest needs and prevalence of disease and disability in an equitable and sustainable manner. 11. Realizing the potential and promise of IH community integration via: a. Appropriately sharing de-identified Aboriginal Health Information to empower Aboriginal Communities, Bands, Tribal Councils, and other Provincial or Federal entities responsible for service delivery and planning to the benefit of Aboriginal people. b. Integrated case management, shared care planning, and improved service transitions across diverse and multi-jurisdictional service organizations: 1. Integrated EMR’s and transactional sharing of personal health information; 2. Discharge notices, referrals, client instructions for home care, etc. 3. Creating a single virtual ubiquitous client health record and thus: 4. Eliminating the need for Aboriginal and Non-Aboriginal people having to repeat their stories to every service provider they choose to engage with 5. Eliminating false provider economies and increasing consumer choice and purchase power.

Diabetes Strategy The Aboriginal Health program’s involvement in the Interior Health Diabetes Strategy ensures Aboriginal participation and representation occurs at all stages of strategy planning and implementation.

The focus of the Diabetes Strategy work included engagement and communication about the three year pilot in select Interior Health communities where Aboriginal participation is promoted and encouraged. This component of the strategy focuses on those living with diabetes, specifically target populations such as Aboriginals. The focus has been on communicating and promoting the strategy to garner interest and participation of local Aboriginal stakeholders in the select communities. Participation is important to ensure that the Aboriginal perspective and experience of living with diabetes is shared with stakeholders in the strategy.

5 The selected communities represent urban, rural, on-reserve and Métis populations with high rates of current and projected diabetes. In addition, this work included collaboration and information sharing with Health Canada to determine the services and work from federal departments related to diabetes for on-reserve populations.

Thompson Rivers University Dementia Care The Aboriginal Health program is pleased to support the Thompson Rivers University based research project on culturally safe dementia care for elderly Aboriginal people. The research, funded through the Michael Smith Foundation, is lead by Dr. Wendy Hulko with the intent to translate findings to support healthcare professionals caring for Aboriginal clients with dementia.

Advanced Care Planning This innovative working group, accountable to the IH End of Life Care Collaborative Committee, was established to provide knowledge and recommendations on the strategic planning for Advanced Care Planning, including identification of cross service linkages.

The Aboriginal Health Program’s largest contribution was the development of the Aboriginal specific brochure to accompany the provincially legislated My Voice workbook. This was done to make the workbook more culturally safe for Aboriginal people. The brochure was developed with collaboration of Aboriginal people in the area to ensure the topic of ‘end of life’ was communicated in a respectful and relevant way for Aboriginal people. The Advance Care Planning brochure is now being accepted provincially to accompany the My Voice workbook. The brochure assists in directing Aboriginal patients on how and where they can express their future traditional health care choices. The work results from participation on the Advance Care Working Group and previewing the “My Voice” workbook. It was noted that this workbook was an opportunity for Aboriginal persons to express traditional and ceremonial rites that are culturally relevant and important to them.

Doula Initiative: The Aboriginal Health Program recently participated in the Tripartite First Nations Aboriginal Doula Initiative with the goal of “improving maternal health services for Aboriginal women and bringing birthing closer to home and back into the hands of women”. This goal was identified within the priorities outlined in the Transformative Change Accord First Nation’s Health Plan (Nov 2006) that First Nations, Provincial and Federal governments are working towards.

As a member of the Aboriginal Doula Implementation Working Group, directed by the Tripartite Maternal Child Health Planning Committee, the Aboriginal Health program worked towards addressing the many barriers Aboriginal families within our region face today in accessing culturally appropriate and accessible maternity care.

The BC Aboriginal Doula Initiative was one way we are working towards achieving our goal. The role of the Doula is to build on the more traditional role of aunty, a lay woman recruited from the community who bridges language and cultural barriers and provides the woman, her partner and family with continuous emotional support, physical comfort and assistance in obtaining information before, during, and just after childbirth.

Our region was selected to host Doula training which took place in Kamloops. Twelve Aboriginal women attended the training from a variety of communities across the health authority. As a part of our commitment to this initiative we were also offered demonstration funding to hire a 0.5 FTE Aboriginal

6 Doula Liaison to help support the Aboriginal women trained within our region to achieve certification as a Doula, in order for them to be able to provide these much needed services in their local communities.

Aboriginal HR Strategy: The Aboriginal population represents approximately 6.7% of the total population in the southern interior (BC Stats, 2009). Compared to other Health Authorities, Interior Health has the second highest total Aboriginal population in the province (Statistics Canada, 2006). From data collected through the Employee Aboriginal Self-Identification Project, 2.24% (422) of the total Interior Health employee count have identified as Aboriginal as of December 2012. This rate is below a representative workforce target of 6.7% of the total Interior Health Aboriginal population.

The government of British Columbia and the First Nations Health Society are signatories to the “Transformative Change Accord: First Nations Health Plan” [Accord], designed to support the health and wellness of First Nations in British Columbia. Health Canada later signed the “Tripartite First Nations Health Plan” that, in effect, has all parties adopting the Accord. One of the key elements in the Accord is: “Each regional health authority will increase the number of professional and skilled trades First Nations in health professions. Health authorities will identify emerging employment opportunities, share the information, and link Aboriginal learners with appropriate training institutions.”

The expectation is that health authorities in British Columbia will work to meet this commitment. Interior Health’s Aboriginal Human Resource Plan will support this on-going commitment.

The Plan was built upon a scan of best practices “Building an Aboriginal Strategy” and stakeholder involvement “Aboriginal HR Strategy: Summary of Focus Groups”, to ensure the Plan was relevant and informed by the Aboriginal peoples in Interior Health. Four cornerstones were identified that will form the foundation for ongoing work: 1. Employee Engagement, 2. Workplace Readiness, 3. Recruitment and 4. Education.

Appendix G: Interior Health Authority Aboriginal Strategy 2010-2014

Aboriginal Health & Wellness Strategy

2010-2014

October 27, 2010

Acknowledgements

This Strategy draws from the contributions of numerous individuals dedicated to Aboriginal health. Participants at our health planning meetings included representatives from First Nations communities, Friendship Centres, urban Aboriginal health and social service organizations, Métis organizations, First Nations Health Council, Health Canada, Provincial Health Services Authority, academic institutions, and Interior Health staff and physicians. We appreciate the rich insight provided by all participants – thank you for generously sharing your time and expertise.

We would like to acknowledge the ongoing contributions of the Aboriginal Health and Wellness Advisory Committee (AHWAC) to health planning for Aboriginal peoples in the Interior Health region. AHWAC remains an important means by which we liaison with Aboriginal community members.

This Strategy distills what we have learned to date, and leads the way for our renewed direction in Aboriginal health.

This document was prepared by Geeta Cheema, Community Integration, Interior Health

2 Message from the Board Chair On behalf of the Interior Health Board of Directors, I am pleased to present the Aboriginal Health & Wellness Strategy, 2010-2014. The Board is confident that this strategy provides a sound direction for Interior Health’s continuing and evolving work to improve the health outcomes of Aboriginal peoples.

Interior Health is concerned that Aboriginal peoples’ health lags behind other residents of our region. We recognize the barriers that Aboriginal peoples face in attaining good health, including challenges in accessing healthcare services. The health authority assumes responsibility for eliminating the barriers that we can control, and mitigating the barriers that we can influence.

The Board of Directors acknowledges the vital partnerships that we have with Aboriginal communities and organizations to ensure Aboriginal peoples’ health needs are met. We are committed to local relationships as the foundation of our successful efforts, including Interior Health’s role in implementing the Tripartite First Nations Health Plan.

I wish to extend my support to the Community Integration portfolio for its leadership in providing inclusive health services. The Board will be interested in learning about the outcomes of this strategy.

Norman Embree Chairman of the Board, Interior Health October 27, 2010 Message from the CEO Interior Health is currently engaged in a significant restructuring process in order to achieve a vision of “One IH” – that is, an organization where consistently high quality healthcare services are provided across our vast geography in ways that ensure accessibility and responsiveness to patients’ needs. This vision is particularly relevant to reducing the health inequities experienced by the Aboriginal population. As outlined in this Aboriginal Health & Wellness Strategy, we will ensure that Aboriginal peoples’ health needs are integral to “One IH”.

Local Aboriginal peoples have a deep rooted connection to the lands within the Interior Health region. Interior Health acknowledges the history of this area, and the special relationship that Aboriginal peoples have with Government. To counter the often-devastating experiences Aboriginal peoples have had within residential schools and healthcare facilities, and the effects of ongoing marginalization, we are committed to providing inclusive, culturally competent care.

With leadership from the Community Integration portfolio, Interior Health is accountable to our stakeholders for successful implementation of the Aboriginal Health & Wellness Strategy.

Dr. Robert Halpenny President & Chief Executive Officer, Interior Health

Table of Contents

Acknowledgements ...... 2 Message from the Board Chair ...... 3 Message from the CEO ...... 3 Table of Contents ...... 4 Executive Summary ...... 5 Introduction ...... 7 Background & Context for Aboriginal Health ...... 9 Strategic Framework for Aboriginal Health ...... 14 Implementation ...... 15 References ...... 16 APPENDIX A: Key Terms ...... 17 APPENDIX B: First Nations Communities ...... 19 APPENDIX C: Friendship Centres ...... 20 APPENDIX D: Métis Communities ...... 21

4 Executive Summary Interior Health’s Aboriginal Health & Wellness Strategy, 2010-2014, presents a strategic framework with the goal to improve the health of the Aboriginal peoples we serve. Our Strategy relies on a good understanding of the health issues faced by the Aboriginal population and the opportunities for improvement. Reflecting our renewed direction in Aboriginal health, this Strategy is consistent with the aims of the Tripartite First Nations Health Plan, and affirms the ongoing need to nurture locally-based relationships with Aboriginal peoples.

Aboriginal people – including First Nations, Métis and Inuit persons– constitute 6.7% of the population in the IH region (BC Stats, 2009), yet experience disproportionate rates of many diseases and injuries compared to other residents. For instance, there are wide disparities in the childhood dental surgery rates, cervical cancer mortality rate, and life expectancy for Status Indians in the IH region (BC Provincial Health Officer, 2009). Interior Health is committed to closing the gap on such health inequities.

The health system’s impact on Aboriginal health outcomes can be amplified when the determinants of health are considered. In addition to commonly understood health determinants such as income, education, and access to health services (Public Health Agency of Canada, 2010), Aboriginal health determinants include colonization, cultural continuity, and self-determination (National Aboriginal Health Organization, 2006).

This Strategy supports the principle that healthcare for Aboriginal people is most effectively delivered through inclusion in all service streams across the continuum of care. Inclusion does not preclude the need for specialized approaches in order to meet the needs of Aboriginal clients.

With the aim for inclusion, this document presents 5 key strategies that define our renewed approach to Aboriginal health. They are:

1. Develop a Sustainable Aboriginal Health Program

2. Ensure Aboriginal Peoples’ Access to Integrated Services

3. Deliver Culturally Safe Services across the Care & Service Continuum

4. Develop an Information, Monitoring and Evaluation Approach for Aboriginal Health

5. Ensure ongoing Meaningful Aboriginal Participation in Healthcare Planning

The Community Integration portfolio within Interior Health (composed of Promotion & Prevention, Mental Health & Addictions, Primary Healthcare, Community Care, and Aboriginal Health) assumes primary accountability and leadership for implementation of these key strategies. Community Integration will monitor implementation of the Strategy and report on Aboriginal health outcomes.

5 Having established inclusive services across their Care & Service Continuum, the Community Integration Leadership Team will be able to facilitate inclusion of Aboriginal health across other IH Programs.

6 Introduction Interior Health’s Aboriginal Health & Wellness Strategy, 2010-2014, presents a strategic framework with the goal to improve the health of the Aboriginal peoples we serve. Resulting from extensive stakeholder consultations, this document distills the key strategies for our renewed direction in Aboriginal health.

The health of Aboriginal peoples merits particular attention. While the Aboriginal population is a relatively small proportion of the entire regional population, we recognize that Aboriginal health is influenced by historical and contemporary determinants of health that have resulted in disproportionate rates of disease and injury. In order to close the gap in Aboriginal health status, we must pay special attention to these health determinants and collaborate with Aboriginal people to identify healthcare solutions that will meet their needs.

This Strategy acknowledges that for Aboriginal health gains to occur, efforts are required across the Care & Service Continuum (see Figure 1). As depicted within the Continuum, Interior Health’s services are collectively directed towards “Staying Healthy”, “Getting Better,” “Living with Illness” and “Coping with End of Life”. By providing a client-centered approach to health services, the Care & Service Continuum serves as a roadmap for health services integration.

This Strategy supports the principle that healthcare for Aboriginal people is most effectively delivered through inclusion in all service streams (i.e., Programs) across the Care & Service Continuum. This Strategy relays expectations for inclusive health planning and service delivery that will contribute to Aboriginal health. By ensuring services are accessible and responsive to all residents – and particularly those with the greatest health needs – Programs will direct their efforts to achieving population health gains and reducing health inequities. In the aim for inclusion, Aboriginal health will provide clear impetus for action. Successful approaches learned through experience in Aboriginal health will be applied to parallel initiatives across the health authority.

While this Strategy is based on the premise that Aboriginal health will improve through inclusive, integrated service delivery, this does not preclude the need for specialized approaches suited to the needs of Aboriginal peoples. For instance, the Aboriginal Health and Wellness Advisory Committee provides a vehicle for participation in Aboriginal health planning, and Aboriginal Patient Navigators are vital to ensuring cultural safety for Aboriginal clients. This Strategy affirms that inclusion will be supported through practices appropriate for Aboriginal people.

The Community Integration portfolio within Interior Health assumes primary accountability and leadership for implementation of the key strategies identified in this Strategy. Community Integration provides community-based health services in 5 program areas: Promotion & Prevention; Mental Health & Addictions; Primary Healthcare; Community Care; and, Aboriginal Health. Having established Aboriginal inclusion across their Care & Service Continuum, the

7 Community Integration Leadership Team will be able to facilitate change across other IH Programs.

Interior Health is committed to having an impact on Aboriginal health. Community Integration will monitor and report on the implementation of this Strategy and key Aboriginal health outcomes.

Figure 1. Care & Service Continuum, Community Integration (CI) (source: IH Prevention Services, modified by the Central Okanagan Community Integration Managers)

Population Based Individual Based Highest Level of Wellness Lowest Level of Wellness

GETTING LIVING with STAYING HEALTHY BETTER ILLNESS COPING with PRIMORDAL Care PRIMARY SECONDARY END OF LIFE PREVENTION; TERTIARY PREVENTION PREVENTION PREVENTION PROMOTION Continuumof Preservation & Prevent promotion of Individuals and Support healthy groups from Lower incidence Eliminate or reduce long-term comfortable and

oal determinants & becoming “at of established impairments, disabilities and

G respectful end of reduction of risk.” Modify cases of disease. complications. life. unhealthy risk factors & determinants. contexts.

Whole At Risk Whole Population – Individuals with established Individuals nearing Individuals & Population Universal & disease end of life Pop’n Groups Targeted Promotion & Prevention

Mental Health & Addictions Primary Healthcare Community Care CI Programs Aboriginal Health

8 Background & Context for Aboriginal Health

In order to take an inclusive approach to Aboriginal health, we rely on a good understanding of the health issues faced by the Aboriginal population and the opportunities for improvement. This section provides an overview of Aboriginal population health status and health determinants, identifies important developments in Aboriginal health policy, and highlights key aspects of IH’s Aboriginal Health Program.

ABORIGINAL PEOPLES SERVED BY IH As embedded in Section 35 of the Constitution Act (1982), the term Aboriginal refers to people of First Nations, Métis and Inuit ancestry. Status Indian is a legal term that refers to a First Nations person registered with Indian and Northern Affairs Canada. These and other key terms are defined in Appendix A.

The service area of Interior Health is the traditional territory of many culturally distinct First Nations, and is also home to many Aboriginal people from other parts of the province, country and continent. Diversity among the Interior’s Aboriginal peoples is marked by varying cultural practices, languages, residency (i.e., on- or off-reserve) and Status.

The 2006 Census enumerated 196,075 self-identified Aboriginal people in British Columbia (4.8% of the total provincial population); within the Interior Health region, there were 44,900 self-identified Aboriginal people (6.7% of the total regional population) (BC Stats, 2009).

In 2006, there were 27,475 First Nations people residing in the IH region, comprising 61% of the Interior’s total Aboriginal population (BC Stats, 2009). 42% of First Nations people in the IH region reside on-reserve, in one of 53 First Nations communities (BC Stats, 2009). See Appendix B for further information about First Nations communities within the IH region.

58% of the First Nations population in our region reside off-reserve (BC Stats, 2009). Friendship Centres provide health and social services to ‘urban’ Aboriginal people, and there are seven of these organizations within the IH region. Appendix C provides further information about Friendship Centres in the IH region.

According to the 2006 Census, 16,200 Métis people reside in the Interior Health region, which constitutes 36% of the Interior’s total Aboriginal population (BC Stats, 2009). There are 13 Métis Chartered Communities within the IH region (Métis Nation BC, 2009). Further information about Métis communities is provided in Appendix D.

AN OVERVIEW OF ABORIGINAL HEALTH STATUS IN INTERIOR HEALTH The ability to profile the health status of Aboriginal people is limited. In most cases, provincial health data can only be sourced for the Status Indian population, because non-Status Aboriginal

9 persons are not identifiable within the records. Population health surveys, such as the Métis Nation BC Survey, provide some information to supplement the available provincial data.

The BC Provincial Health Officer’s 2007 Annual Report provides the most current analysis of health information for British Columbia Status Indians (BC Provincial Health Officer, 2009). In assessing population health changes that have occurred from 2001 to 2006, the Provincial Health Officer (PHO) states, “some progress has been made in improving both the determinants of Aboriginal health and health outcomes. Nonetheless, significant gaps in health status continue to exist” (p xxxi).

The PHO report provides an analysis of health indicators by regional health authority. For 48 indicators, the report presents the “gap” between Status Indians and Other Residents of the Interior Health region. Indicators where Status Indians fare better than or the same as Other Residents are:

 All Cancers  Ischemic Heart Disease  Prescriptions for Cerebral  Lung Cancer  Chronic Lung Disease Stimulants  Female Breast Cancer  Smoking Attributable  Preventable Admissions to  Prostate Cancer Mortality Hospitals

Status Indians fare worse than Other Residents for numerous indicators. Such indicators related to ‘Healthy Beginnings’ and ‘Disease & Injury ‘are presented in Table 1. Here, the last column (“ratio”) shows the degree of the inequity. Because they are sometimes ambiguous to interpret, ‘Health Services’ indicators are presented separately in Table 2.

Table 1. PHO Indicators for Healthy Beginnings and Disease & Injuries, Status Indian vs. Other Residents, Interior Health (BC Provincial Health Officer, 2009) RATIO: STATUS INDIAN / HEALTH INDICATORS STATUS INDIAN OTHER RESIDENTS OTHER RESIDENTS Indicators for Healthy Beginnings Dental Surgery Rate, 0-4 years (per 1000) 47.2 10.8 4.4 Dental Surgery Rate, 0-14 years (per 1000) 21.5 6.1 3.6 Dental Surgery Rate, 5-9 years (per 1000) 20.6 7.9 2.6 Post-Neonatal Mortality Rate (per 1000) 2.9 1.2 2.3 Infant Mortality Rate (per 1000) 8.6 4.1 2.1 Neonatal Mortality Rate (per 1000) 5.7 2.9 2.0 Teen Pregnancy Rate (per 100) 3.7 1.8 2.0 Preterm Birth Rate (per 100) 9.4 7.4 1.3 Stillbirth Rate (per 1000) 9.0 6.8 1.3 Low Birth Weight Rate (per 100) 6.4 5.3 1.2 Indicators for Disease & Injuries Age Standardized Mortality Rate; per 10,000 HIV Disease 0.6 0.1 5.3 Cervical Cancer 1.2 0.2 5.2 Alcohol Related Deaths 19.0 4.7 4.1 Digestive System Diseases 6.4 2.2 2.9 Unintentional Injuries 8.8 3.6 2.4

10 Motor Vehicle Accidents 3.6 1.6 2.3 Medically Treatable Diseases 0.9 0.4 2.2 External Causes 11.2 5.0 2.2 Colorectal Cancer 2.4 1.5 1.6 Pneumonia and Influenza 3.0 1.9 1.6 Respiratory Diseases 7.8 5.3 1.5 Accidental Poisoning 1.1 0.7 1.5 Cerebrovascular Diseases 5.2 3.7 1.4 Drug-Induced Deaths 1.4 1.0 1.4 Diabetes 2.4 1.9 1.3 Suicide 1.6 1.2 1.3 All Causes of Death 74.5 57.6 1.3 Endocrine / Nutritional / Metabolic 2.8 2.4 1.2 Circulatory System Diseases 18.6 17.5 1.1 Life Expectancy 75.2 79.8 0.9

Table 2. PHO Indicators for Health Services, Status Indian vs. Other Residents, Interior Health (BC Provincial Health Officer, 2009) OTHER RATIO: STATUS INDIAN / HEALTH INDICATORS STATUS INDIAN RESIDENTS OTHER RESIDENTS Indicators for Health Services Medical Services Plan Utilization (per 1000) 703.1 844.2 0.8 Prescriptions for Antimanic Agents (per 10,000) 12.3 29.5 0.4 Prescriptions for Anti-Infectives (per 100) 36.9 34.2 1.1 Prescriptions for Antidepressants (per 1000) 79.5 125.3 0.6 Prescriptions for Antipsychotics (per 1000) 18.1 23.4 0.8 Prescriptions for Antixiolytics (per 100) 7.0 10.8 0.6 Hospitalization Rates, Attempted Suicide/Suicide 93.6 35.7 2.6 (per 100,000) Hospitalization Rates, Attempted Homicide 137.5 41.0 3.4 /Homicide (per 100,000) Community Follow-up for Mental Health Clients 67.5 81.5 0.8 (per 100)

Tables 1 and 2 demonstrate the magnitude of health inequities experienced by Status Indian people. This is one source of information that can be used to set priorities for the Aboriginal Health Program. It is also necessary to consider the number of people affected by the health issue, the impact on quality of life, the burden on healthcare utilization, and the ability of the healthcare system to intervene.

While not as extensive as the Status Indian data featured above, the 2006 Métis Nation BC Survey provides some perspective on Métis health status in BC based on survey responses from nearly 1500 Métis households. The results infer that the Métis population faces similar health disparities as those profiled for Status Indians. Commenting on the survey results, the Provincial Health Officer (2009) explains, “overall, Métis health indicators appear to be closer to the indicators for the Status Indian population rather than other residents” (p. xxxvi).

11 The three most commonly reported health concerns of the adult Métis survey respondents were Dental Care, Prescription Assistance, and Traditional Healing, while Métis youth cited Drug Addiction, Teen Pregnancy and Smoking as their most important health issues.

DETERMINANTS OF ABORIGINAL HEALTH Health status indicators vividly convey the health inequities experienced by the Aboriginal population. In order to effectively address these inequities, it is vital to understand the determinants of Aboriginal health.

Health outcomes are related to a variety of factors and influences. It is estimated that the healthcare system contributes only 25% towards health outcomes (Senate Subcommittee on Population Health, 2009). As identified by the Public Health Agency of Canada (2010), the determinants of health are:

 Income & Social Status  Social Environments  Biology & Genetic  Social Support Networks  Physical Environments Endowment  Education & Literacy  Personal Health Practices &  Health Services  Employment / Working Coping Skills  Gender Conditions  Healthy Child Development  Culture

The National Aboriginal Health Organization (2006) affirms the relevance of these determinants of health for Aboriginal people, but adds the following factors:

 Colonization  Cultural Continuity  Poverty  Globalization  Territory  Self-Determination  Migration  Access (remoteness)

These health determinants imply that the health system’s impact on Aboriginal health outcomes can be amplified when the broader determinants of health are considered.

DEVELOPMENTS IN ABORIGINAL HEALTH POLICY The landscape of Aboriginal health policy in British Columbia has been shifting rapidly. The most substantial developments originate from the Transformative Change Accord: First Nations Health Plan (2006) and the subsequent Tripartite First Nations Health Plan (2007). The Tripartite First Nations Health Plan (TFNHP) is a 10-year agreement between the Government of Canada, the Province of British Columbia and the First Nations Leadership Council to close the gaps in health status between First Nations and other British Columbians.

The First Nations Health Council was created in 2007 as a coordinating body mandated to implement the TFNHP, and is composed of representatives of the First Nations political organizations in BC; however, the FNHC does not speak on behalf of First Nations in the region.

12 IH works with a Community Development Liaison designated by the FNHC who facilitates engagement between IH and First Nations communities.

The TFNHP will result in significant changes to the delivery of health services to First Nations communities, and will require the involvement of health authorities in the development of strategies, plans and implementation. The IH Aboriginal Health & Wellness Strategy is consistent with the approaches and aims of the TFNHP.

The IH Aboriginal Health Program will also be connected to the provincial table on Community Integration, currently known as the “Tricouncil” (composed of Primary Healthcare, Community Care, and Mental Health & Addictions). Aboriginal Health will join membership of this group in early 2011, and a Work Plan will be developed provincially to guide Aboriginal Health Program delivery across the regional health authorities.

In addition to these provincial developments, IH’s relationship with the Ktunaxa Nation continues to be guided by a Letter of Understanding signed in January 2008. This agreement establishes a collaborative process for planning and provision of health services within the Ktunaxa Nation’s traditional territory (in BC).

HIGHLIGHTS OF THE ABORIGINAL HEALTH PROGRAM IN IH The 2010-2014 Aboriginal Health & Wellness Strategy is the third cycle of dedicated Aboriginal health planning since Interior Health’s inception in 2001. Following are a few key highlights of our efforts to work closely with Aboriginal patients, communities and organizations over nearly a decade:

Aboriginal Health Program Team. Led by a Program Director, this Program team is dedicated to closing the health status gap experienced by the Aboriginal population.

Aboriginal Health & Wellness Advisory Committee (AHWAC). AHWAC is a health planning advisory body that is composed of representatives from First Nations communities, Friendship Centres, and the Métis Nation BC, plus members of IH’s Board of Directors and Aboriginal Health Program.

Aboriginal Patient Navigators (APNs). IH’s seven Aboriginal Patient Navigators are located throughout the region, and act as a resource to patients and healthcare providers to ensure culturally competent care. APNs assist healthcare providers with needs assessment and discharge planning, and connect Aboriginal patients with community services.

13 Strategic Framework for Aboriginal Health

This Strategic Framework presents five key strategies. Together, these provide clear direction for Interior Health to close the health status gap experienced by the Aboriginal population.

1 Develop a Sustainable Aboriginal Health Program

Through Practice Leads, the Aboriginal Health Program will provide consultation to ensure that all Community Integration Program strategies are inclusive of Aboriginal Health. The Aboriginal Health

Program will be sustained through stabilized funding and a positive working environment for staff.

2 Ensure Aboriginal Peoples’ Access to Integrated Services

Access to health services requires a connection between patient and provider. The patient-provider connection will be facilitated through communication, community engagement, transportation, outreach and telehealth. Aboriginal Patient Navigators play a special role in connecting patients and providers. Accessibility also presumes the delivery of culturally competent care.

3 Deliver Culturally Safe Services across the Care & Service Continuum

Services are culturally safe when Aboriginal people experience culturally competent service delivery within welcoming environments. Cultural safety also considers continuity of care when Aboriginal people return to their home communities. Mechanisms to promote cultural safety will include Indigenous

cultural competency training, culturally competent clinical practice (e.g., discharge planning), spaces for cultural/spiritual practice, and the services of Aboriginal Patient Navigators.

Develop an Information, Monitoring and Evaluation Approach for Aboriginal 4 Health

Information on the health needs of Aboriginal people supports good service delivery, and monitoring and evaluation allows us to determine our effectiveness. Our approach will include monitoring key performance indicators through the Community Integration Dashboard, implementing the Aboriginal Self-identification Project, sharing information with Aboriginal communities, and evaluating selected initiatives.

5 Ensure ongoing Meaningful Aboriginal Participation in Healthcare Planning

Participation of Aboriginal people improves health planning. We will work with the Aboriginal Health & Wellness Advisory Committee and through the Letter of Understanding with the Ktunaxa Nation to provide meaningful opportunities for Aboriginal participation. Liaison with the First Nations Health Council will enhance our role in the implementation of the Tripartite First Nations Health Plan.

Implementation

The Community Integration portfolio within Interior Health assumes primary accountability and leadership for implementation of the key strategies identified in this Plan; this will occur under the guidance of the Community Integration Leadership Team.

Once inclusive services are established across the Community Integration Care & Service Continuum, the Community Integration Leadership Team will identify mechanisms to facilitate inclusion of Aboriginal health in other IH Programs.

Accountability related to this Plan will be demonstrated through two primary channels:

(1) Semi-annual dissemination of a newsletter highlighting accomplishments in Aboriginal Health, for internal and external stakeholders, and;

(2) Quarterly reporting of performance indicators identified within the Community Integration Dashboard, to Senior Executive and to the Aboriginal Health & Wellness Advisory Committee.

15 References

BC Stats (2009). Interior Health Authority – 1. Statistical Profile of Aboriginal Peoples 2006. Accessed at: http://www.bcstats.gov.bc.ca/data/cen01/abor/HA06/aborHA1.pdf

British Columbia Provincial Health Officer (2009). Pathways to Health and Healing – 2nd Report on the Health and Wellbeing of Aboriginal People in British Columbia. Provincial Health Officer’s Annual Report 2007. Victoria, BC: Ministry of Healthy Living and Sport. Accessed at: http://www.hls.gov.bc.ca/pho/pdf/abohlth11-var7.pdf

Indian and Northern Affairs Canada (2010). First Nation Profiles. http://pse5-esd5.ainc- inac.gc.ca/fnp/Main/Search/FNListGrid.aspx?lang=eng

Ktunaxa Nation and Interior Health (2008, Jan). Letter of Understanding Between Ktunaxa Nation Council and Interior Health Authority.

Métis Nation BC (2009). Regional Contacts. Webpage: http://mnbc.ca/index.asp

National Aboriginal Health Organization (2006). Broader Determinants of Health in an Aboriginal Context. Accessed at: http://www.naho.ca/english/pdf/2006_Broader_Determinants.pdf

Public Health Agency of Canada (2010). What Determines Health? Webpage: http://www.phac- aspc.gc.ca/ph-sp/determinants/index-eng.php#determinants

Senate Subcommittee on Population Health (2009). A Healthy, Productive Canada: A Determinant of Health Approach. The Senate Standing Committee on Social Affairs, Science and Technology. Accessed at: http://senate-senat.ca/health-e.asp

16 APPENDIX A: Key Terms

Aboriginal People: Includes all indigenous people of Canada. The Canadian Constitution recognizes three groups of Aboriginal people, Status and Non-Status First Nations, Métis, and Inuit, each having their own unique heritages, languages, cultural practices and spiritual beliefs.

Band: Many First Nations communities have legally changed their name from “Indian Band” to “First Nation”. A First Nation or “band” is usually made up of one or more land bases, more commonly known as reserves. Generally, First Nations identify themselves as communities and not bands.

Chartered Métis Communities: Communities of Métis citizens as registered through the Métis Citizen registry.

First Nation: A term that came into common usage in the 1970s to replace the word “Indian.” Although the term First Nation is widely used, no legal definition of it exists. The term First Nation generally refers to the Indian people of Canada, both Status and Non-Status.

First Nations Community: For the purpose of this Aboriginal Health Plan, this is defined as Status First Nations people residing on-reserve. This definition facilitates the use of available statistics.

Inuit: The Inuit are people of Aboriginal descent in northern Canada who generally reside in the Northwest Territories, northern Quebec and Labrador with a small percentage living throughout the rest of Canada. The Inuit are officially recognized as Aboriginal people in the Constitution.

Non-Status First Nation: A person of Aboriginal ancestry who is not registered under the Indian Act but traces their ancestry back to a First Nation, Métis or Inuit person.

Reserve: “A tract of land, the legal title to which is vested in Her Majesty, that has been set apart by Her Majesty for the use and benefit of a band.” Indian Act, 1876.

Status First Nation or Registered First Nation: Status First Nation or Registered First Nations persons are defined as” Indian” under the Indian Act and are usually members of a First Nation or Band. Prior to the mid-1960s, most Status First Nations lived on-reserve; however, recently a steady migration to urban centres has seen almost 50 per cent choosing to live off-reserve.

Métis: "Métis" means a person who self-identifies as Métis, is distinct from other Aboriginal peoples, is of Historic Métis Nation ancestry, and is accepted by the Métis Nation. The Métis have been recognized as Aboriginal people under the Canadian Constitution.

Defined Terms in National Definition of Métis: i. "Historic Métis Nation" means the Aboriginal people then known as Métis or Half-breeds who resided in the Historic Métis Nation Homeland

17 ii. "Historic Métis Nation Homeland" means the area of land in west central North America used and occupied as the traditional territory of the Métis or Half-breeds as they were then known. iii. "Métis Nation" means the Aboriginal people descended from the Historic Métis Nation which is now comprised of all Métis Nation citizens and is one of the "aboriginal peoples of Canada" within the meaning of s.35 of the Constitution Act 1982. iv. "Distinct from other Aboriginal peoples" means distinct for cultural and nationhood purposes. v. Métis identity and citizenship is established in the Métis Nation British Columbia (MNBC) in partnership with Indian and Northern Affairs Canada. Métis identity is verified through Métis ancestry. Genealogy review with supporting documentation, determines citizenship.

18 APPENDIX B: First Nations Communities

First Nations Communities within the IH Region (Source: IH Information Support, 2010).

First Nations Communities Located within the IH Region 684 Adams Lake Band 702 High Bar First Nation 597 Penticton Indian Band 712 Tl’etinqox-t’in 709 Alexandria Indian Band 688 Kamloops Indian Band 595 Seton Lake Indian Band Government Office 710 Alexis Creek/Tsi Del Del 704 Kanaka Bar Indian Band 698 Shackan Indian Band 603 Tobacco Plains 685 Ashcroft Indian Band 689 Little Shuswap Indian Band 706 Siska Indian Band 718 Toosey 686 Bonaparte Indian Band 606 Lower Kootenay Indian 691 Simpc 594 Ts’kw’aylaxw First Nation 700 Boothroyd Indian Band Band 687 Skeetchestn Indian Band 722 Ulkatcho First Nations 701 Boston Bar First Nation 695 Lower Nicola Indian Band 707 Skuppah Indian Band 697 Upper Nicola Band 590 Bridge River Indian Band 598 Lower Similkameen Indian 716 Soda Creek Indian Band 599 Upper Similkameen 713 Canim Lake Indian Band Band 605 Shuswap Indian Band Indian Band 723 Canoe Creek Indian Band 705 Lytton First Nation 600 Spallumcheen Indian 601 Westbank First Nation 591 Cayoose Creek Band 690 Neskonlith Indian Band Band 702 Whispering Pines 464 Coldwater Indian Band 696 Nicomen Indian Band 708 Spuzzum 719 Williams Lake Band 604 Columbia Lake Indian Band 699 Nooaitch Indian Band 602 St. Mary’s Indian Band 592 Xaxli’p First Nation 694 Cooks Ferry Indian Bands 616 Okanagan Indian Band 717 Stone Indian Band 714 Xeni Gwet-in First 711 Estetemc (Alkali) First 692 Oregon Jack Creek Band (Yunesti’in) Nations Government Nation 596 Osoyoos Indian Band 593 T’it’q’et Administration

19 APPENDIX C: Friendship Centres

Friendship Centres provide off-reserve services to Aboriginal peoples; these services may or may not include healthcare. Friendship Centres also act as a significant political voice for off- reserve/urban Aboriginal peoples.

There are seven Friendship Centres located in the IH region:

Kamloops Interior Indian Friendship Centre Kelowna Ki-Low-Na Friendship Centre Lillooet Lillooet Friendship Centre Merritt Conyat Friendship Centre Penticton Ookanakane Friendship Centre Vernon First Nations Friendship Centre Williams Lake Cariboo Friendship Centre

Besides Friendship Centres, Aboriginal people may access numerous other community organizations for off-reserve health and social services.

20 APPENDIX D: Métis Communities

The Métis Nation is governed by the Métis Provincial Council of BC, and is divided into seven Provincial governing regions. Region 3 (Thompson/Okanagan), Region 4 (Kootenays) and Region 5 (North Central) are completely or partially within the IH service area.

The IH region includes 13 Métis Chartered Communities, plus 3 non-Chartered communities.

Metis Communities, Chartered and non-Chartered, within the IH Region (Source: IH Information Support, 2010).

Charted and non-Chartered Métis Communities Located within the IH Region

Boothroyd Merritt District Métis Association South Local - Trail Boston Bar Métis Heritage & Cultural Council Spuzzum Cariboo Chilcotin Métis Association Métis Nation Columbia River Society Two Rivers Métis Society Central Local - Cranbrook North Local – Golden Invermere Vernon District Métis Association East Local - Elk Valley Salmon Arm Métis Association West Local - Nelson Kelowna Métis Association

21 Appendix H: Interior Team Charter

The Interior Team Charter is under development and will take direction from the priorities laid out in this plan. The purpose of the Charter is to establish a Regional Team to support the work of the Interior Region, including the functions of the Regional Office, the implementation of the Interior Partnership Accord, and other regional efforts of the Regional Caucus, Regional Table, FNHC, FNHDA, and FNHA.