From material circumstances (housing standards, access to necessities, safety) to psychosocial components (isolation, access to social services support), from health behaviours to genetic predispositions, the overall well-being of First Nations, Inuit, and Metis people continue to be affected by an inequitable parallel health system in Canada.
The World Health Organization (WHO) lists the following as social determinants of health:
- Income and social protection
- Education
- Unemployment and job insecurity
- Working life conditions
- Food insecurity
- Housing, basic amenities and the environment
- Early childhood development
- Social inclusion and non-discrimination
- Structural conflict
- Access to affordable health services of decent quality
These determinants of health provide a framework by which to understand health outcomes of groups of people. For instance, life expectancy for Inuit is a decade less than the Canadian average. Why is this so?
- The rates of tuberculosis in Canada are highest among Inuit with a rate over 300 times that of the Canadian-born non-Indigenous population.
- A recent report prepared for the Nunavik Regional Board of Health and Social Services (NRBHSS) indicated a 300% increase in suicides between 2014 and 2018, and 84% of these deaths were young Inuit males under the age of 25 (Séguin, Chawky, & Affleck, 2019).
- Total fetal and infant mortality in the Inuit-inhabited areas was 2.66 times that in the rest of Canada. Inuit-inhabited areas had substantially higher rates of stillbirth and infant, neonatal and postneonatal death. (Luo, Senecal, Simonet, Guimond, Penney, & Wilkins, 2010).
- the cost to operate a comfortable temperature indoors can cost up $57 per day in Nunatsiavut or up to $500 per week in Rankin Inlet, Nunavut
- Federal housing advocate Marie-Josee Houle reports that the hamlet of Pangnirtung, Nunavut (population 1,500), “…hasn’t seen a new build in a decade. A single wait-list for public housing included 120 families as of March 2022, some of which had been on the list for more than 10 years.” (Passafiume, 2023).
While positive efforts continue to be made to undo a harmful colonial legacy, a study of Indigenous physician access in Canada between 2017-2020, funded by Indigenous Services Canada, confirmed that “Remoteness and economic deprivation” (Yangzom, Masoud & Hahmann, 2023) contribute to the inequitable disparity in accessing a regular healthcare physician.
True North Aid commits to addressing the harmful effects of historical and present-day health inequities by supporting Indigenous-led health initiatives in various practical, holistic ways at the request of the communities themselves. Learn how.
History of Indigenous Health in Canada
Social, economic and political factors are key to understanding the many and varied social determinants of health among Indigenous populations in Canada. These factors are rooted in historical, colonial systems of governance and unfair public policies (or lack thereof), all influencing the social and physical conditions that Indigenous people are born into.
Prior to contact, Indigenous communities practiced holistic and diverse methods of healing unique to each nation, which were often determined by local plants and animals. Settler colonization not only brought contagious diseases which depleted Indigenous communities but also persistent and evasive authority over Indigenous lives, thereby separating Indigenous people from their traditional medicinal practices.
The displacement of Indigenous people through the establishment of residential schools and the creation of reserves, and the perpetual underfunding of each, testify to the government’s long-term intention and unwillingness to invest in Indigenous wellbeing from pre-Confederation until the present day. This is evident in the 1872 charge by the Chief and Council of Peguis First Nation in Manitoba, which condemned the Crown’s reluctance to provide healthcare items and services, a responsibility of the Crown as stipulated in Treaty 1.
In addition to the Peguis First Nation’s protest, an excerpt from the Canadian Encyclopedia on Indigenous Health states, “Amendments to the Indian Act in the late 19th and early 20th centuries criminalized and prohibited Indigenous healing practices. These laws, combined with poor living conditions, poverty, racism, loss of land and declining access to food resources, had devastating consequences on the health of Indigenous Peoples.”
Healthcare for Indigenous people in Canada in the decades that followed continued to be both negligent and oppressive. The creation of Indian hospitals between the late 1930s and 1980s and the nutritional experimentation on Indigenous children between 1942 and 1952 are evidence that the intention of the Crown was never to uphold their Treaty agreement.
In 1969, Harold Cardinal, a Cree political leader, responded to Canada’s new Health Plan for Indian Health Services, saying it was a violation of Treaty rights to pass jurisdiction to the provinces, which would force Indigenous people to pay health premiums to them. Cardinal and Alberta Chiefs further pressured the Canadian government to honour all Treaties, challenging the government to maintain its promise of providing medicine and services.
References:
https://www.thecanadianencyclopedia.ca/en/article/aboriginal-people-health
Indigenous Health in the 21st Century
It is important to remember that while Canada’s Constitution Act of 1867 determined each province to be responsible for managing hospitals and the healthcare system, Indigenous healthcare was the responsibility of the federal government as per the Indian Act of 1876.
In 1979, David Crombie, the Minister of Health and Welfare at the time, proposed the Indian Health Policy. It was just over two pages in length but suggested a “new era of recognition in health policy-making” (Kelly, 2011; O’Neil, 1995; Castellano, 1999) while simultaneously strengthening the federal government’s commitment to First Nations health.
The Indian Health Policy has provided the foundation for both the First Nations Inuit Health Branch (FNIHB) and the Non‐Insured Health Benefits Program (NIHB). This is a subsidiary health insurance program for Status First Nations registered under the 1876 Indian Act, and Inuit recognized by an Inuit land claim organization (Indigenous Services Canada, 2021b; Moeller, 2013; Health Canada, 2012). The FNIHB is a program sector of Indigenous Services Canada, responsible for funding, planning, and delivering health services to status First Nations and Inuit communities (Indigenous Services Canada, 2021b).
A 10-year plan to improve Indigenous health was co-developed with Indigenous representative organizations and the federal government, provinces, and territories and written into the 2004 Health Accord. Still, it expired in 2014 and has not been replaced.
With the Canadian government controlling Indigenous livelihoods and well-being at a federal level, most funding and services at a socioeconomic level, including healthcare, are provincial responsibilities. This reality has produced a convoluted system in which Indigenous people continue to be failed and forgotten.
References:
https://www.researchgate.net/publication/369070792_Appraising_Canada%27s_1979_Indian_Health_Policy_Informing_co-development_of_distinctions-based_Indigenous_health_legislationhttps://yellowheadinstitute.org/2021/02/04/the-failure-of-federal-indigenous-healthcare-policy-in-canada/#:~:text=The%202004%20Health%20Accord%20between,promises%20from%20the%20Liberal%20government.
Indigenous health services often hampered by legislative confusion
References
- https://www150.statcan.gc.ca/n1/pub/41-20-0002/412000022023005-eng.htm
- https://yellowheadinstitute.org/2021/02/04/the-failure-of-federal-indigenous-healthcare-policy-in-canada/
- https://www.thestar.com/opinion/contributors/a-history-of-canada-s-medical-colonialism-against-indigenous-people-and-why-it-needs-to/article_f84c51af-df0c-5df7-beae-3dd4cf9ab2ab.html
- https://www.thestar.com/news/canada/inuit-life-expectancy-lags-as-rest-of-canada-living-longer/article_f1228362-063f-5f52-b9aa-61f621f6577f.html
- Tuberculosis in Canada 2014: Pre-release
- https://pauktuutit.ca/health/
- https://www.sciencedirect.com/science/article/pii/S2667321522000312#:~:text=Currently%2C%20the%20rate%20of%20suicide,the%20Inuit%20territory%20of%20Nunavik
- https://www.cmaj.ca/content/cmaj/182/3/235.full.pdf
- https://www.cbc.ca/news/canada/north/inuit-housing-crisis-houle-report-1.7041217
