module 4 health gov. self determination

8/7/2019 Module 4 Health Gov. Self Determination

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Health Governance

and SelfDetermination:

How is health caredelivered to

Aboriginal peoples in

Canada?


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A quick note on taxes

Many people have the misconception that Aboriginalpeople do not pay taxes

Only status Indians whose incomes are earned on reserve

are exempt from personal income tax.

Only a small number of people live and work on reserves.Furthermore, the income of people who work on reservesis quite low, and often do not earn enough to be subject to

personal income tax.

Purchases made on reserve by a status Indian is alsoexempt from HST/GST.

Joseph & Joseph, Working Effectively

with Aboriginal Peoples, 2007


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First

Nations

and InuitHealth

Status Indians and Registered Inuit

account for less than 60% ofAboriginal peoples in Canada.

Medical services and special

health benefits for Status Indians

and Registered Inuit through First

Nations and Inuit Health (Federal)

Broken into two components: Non-Insured Health Benefits Program

(NIHB)

First Nations and Inuit Health Program

(FNIHP)


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Non Insured Health Benefits

Pharmaceuticals, medical supplies, andequipment, dental services, vision care,medical transportation, individual mentalhealth counselling.

Only when not available through anyother federal, provincial, territorial, orprivate health or social program

Crisis counseling O

nly short-term crisis Benefits are provided for the initial

assessment, development of treatment plan.intervention is covered.


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First Nations and Inuit Health

Programs Community Based

Primary care in northern and isolated communities

Often nurse or community health rep with physician

back up by phone or radio

Community Programs such as:

National Native Alcohol and Drug Abuse Program

Brighter Futures Program HIV/Aids Program

Canadian Prenatal Nutrition Program


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Mtis

But unique health care issues that may be

different than Canadian population.


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Broader Determinants of Health

Income and social status Social support network

Education

Employment and workingconditions

Social environment

Physical environment Personal health practices and

coping skills

Healthy child development

Genetic endowment

Access to health services

Gender

Culture

Determinants of health in an

Aboriginal context

Colonization

Globalization Migration

Cultural continuity

Territory

Poverty

Access Self determination

Naho, 2006


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Access to care and health

information One-third of Aboriginal communities are remote, isolated, or semi-isolated. Barriers exist to basic and specialized services.

Travelling to receive care alienates people from familial, community, and culturalsupports.

Communication barriers exist, both linguistically and in health literacy.

There are capacity, human resources, and infrastructure issues related to tele-health/e-health.

Discuss possible outcomes when you combine the above factors with theseother determinants of health:

Income and social status

Social support network

Education

Employment and working conditions

How would you address this inequity of access to care and health information?

Naho, 2006


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Self Determination and Health Care

Self Determination-Free choice of one's own actsor states without external compulsion.

Many Indigenous communities seek selfdetermination of social services (welfare),education, land, economics, political structure.

1979 Indian Health Policy stated that to betterimprove the health of Aboriginal Canadians theirinput is needed and that spiritual health is asimportant as physical health


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1986 Indian Health Transfer Policy

First Nations could develop, through stages, tothe point where they ultimately obtained controlover the delivery of health services.

90s: Program changed to Integrated Community-Based Health Services, then to Inherent Right toSelf Government Policy.

By 2002 81% of eligible communities wereactively involved in the health transfer in somemanner.


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William Charles First Nation

W.C FN at Montreal Lake Saskatchewan was thefirst to obtain control of health care under thetransfer policy.

Built a health center

Programs Developed: Education, prevention, school-based, immunization,

pre-natal, alcohol, chronic disease.

Members felt more secure about their health as theyhad qualified professionals

Emergencies could be handled at the communitylevel

Education program helped people home manageminor illness

More Elders seeking care Use of Cree language and culturally safe care

Immunizations increased


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Self Determination or Cost

Containment? Motivation for policy is questionable, many

scholars belief the underlining goal of selfdetermination by the federal government is costcontrol.

The policy has been marketed as a mechanism forself determination but its formation has beenguided primarily by political economic factors.

Limited benefits in many communities.

Jacklin & Warry, 2004


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Self Determination or Cost

Containment? Prior to the Health Transfer Policy their was a

shift towards devolution of responsibility to theprovinces.

Many attempts at offloading responsibility The final policy did not include training for

transfer.

But it did have a no enrichment clause that

froze budgets at the time of transfer. Given some administrative control but still there

were many structural constraints.



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The case ofWikwemikong

The case of Wikwemikong Reserve, Ontario

Despite a long and involved process they signedtheir first Health Transfer Agreement in 1994 to

be negotiated every 5 years. Renewals are subject to appropriation of funds by

parliament.

Lack of any guarantee that a contract will benegotiated.



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The community had a favourable external evaluation and sothey thought that renegotiation wouldn't be challenging in1999.

They also had growing needs: A growing population,increase rate of disease, and serving many off reserve bandmembers. Aids wasn't even an issue for Wikwemikong when they went

into negations in the 80s.

The community was told it was not a negotiation, only arenewal. Only change was 3% increase in wages



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One of the community goals was to deliverholistic health services and revitalizetraditional medicine.

Health Transfer will not find traditionalmedicine or mental health programming.

Funds are to deliver mandatory programs andsupport underfunded FNIHB programs.



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FNIH told Wikwemikong that the reason theycant find traditional healing is for liabilityreasons, even though we believe in it.

Malpractice liability risk

Coverage for traditional medicine liability isavailable in Canada and had been purchasedby the Wikwemikong Reserve.



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When a Wikwemikong leader asked why their was nomental health policy at the federal level.

The FNIH representative stated Mental Healthremains an issue, but there is no money. There is crisismoney available-this is a proposal driven process.

This patchwork approach to mental health has been

criticized at the national level: Chiefs are placed in a position of watching their children

die before being able to apply pressure to the governmentto provide crisis programming.



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The case of WikwemikongConcluding Thoughts

If Health Transfer truly represents amovement toward self-government,funding would need to increase inrelation to community identified

needs.

Poor economic conditions andunhealthy communities mean thatthere is little opportunity todevelop self sustaining resources ora tax base for the foreseeablefuture.

How do Canadians pay

for health care?

Tax

How do you suppose you

get a reserve with no

economic opportunities

to produce taxes?



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The case of WikwemikongConcluding Thoughts

Transfer policy simply puts Aboriginal people

in the lowest levels of health care

administration in the Canadian Health Care

system.

In some cases First Nations will be left with

little more than the responsibility to

administer their own poverty.



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Discussion

We have seen two different views of self determination from two different

authors (Waldram et al. & Jacklin and Warry). We also now know that

cultural continuity and self determination can increase health in a

community, such as lowering suicide rates (Lalonde and Chandler). Discuss

your thoughts on the government attempting to offload costs andwhether this makes you think differently about Self Determination in

Canada.

module 4 health gov. self determination

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