Proceedings of the Standing Senate Committee on
Aboriginal Peoples
Issue 13 - Evidence, March 5, 2002
OTTAWA, Tuesday, March 5, 2002
The Standing Senate Committee on Aboriginal Peoples met this day at 9:35 a.m. to examine access, provision and delivery of services, policy and jurisdictional issues, employment and education, access to economic opportunities, youth participation and empowerment, and other related matters.
Senator Thelma J. Chalifoux (Chairman) in the Chair.
[English]
The Chairman: Aboriginal issues have been studied at length, and we now need an action plan for change, which will include, as partners, the Aboriginal communities and agencies across this country. In that way, we can come together to examine what needs to occur in the communities in partnership with all Aboriginal communities. That is why this action plan is so important.
I welcome our witnesses today, Mr. Scott Broughton, Mr. Claude Rocan, Mr. Keith Conn and Ms Wendy Birkinshaw. Mr. Broughton, please proceed.
[Translation]
Mr. Scott Broughton, Assistant Deputy Minister, Population and Public Health Branch, Health Canada: I have with me today Claude Rocan, Director General of the Centre for Healthy Human Development within the same branch, Keith Conn, Acting Director General of Community Health Programs in the First Nations and Inuit Health Branch of the Department, and Wendy Birkinshaw, Senior Policy Analyst in the Division of Childhood and Adolescence.
I bring regrets from Ian Green, our Deputy Minister, who was unable to be here today. He has asked that I make this presentation on his behalf. I am pleased to be here today to share with you Health Canada's contributions to the health and well-being of urban Aboriginal youth. I will begin by describing the context in which we provide programs and services to this population, and move into a more detailed discussion of our participation in the Government of Canada Urban Aboriginal Strategy, the types of programming our Department provides for Aboriginal people, our activities that promote health child and adolescent development, and other departmental initiatives that benefit young Aboriginal Canadians in urban settings.
[English]
While Health Canada has little programming targeted specifically at urban Aboriginal youth, a wide range of departmental activities is of benefit to this population. The department takes a preventive approach, one that promotes healthy human development, particularly during early childhood, in order to prevent problems from appearing later during developmental stages.
Consistent with the population health approach, which seeks to address the many factors that impact on health, our department has implemented a variety of activities targeted towards children, youth and families in vulnerable situations, all of which reach urban Aboriginal youth. Health Canada's programs and services for Aboriginal people target First Nations on reserve and Inuit in Inuit communities. Aboriginal people living in urban areas or off-reserve areas receive services from provinces and territories or through collaborative federal-provincial-territorial initiatives.
However, the high level of mobility of Aboriginal individuals and families poses challenges for policy and program design and implementation and tends to blur federal-provincial-territorial jurisdictional boundaries. Other departments have made presentations to you that include data on population structure, growth, mobility and various socio-economic indicators. I am unable to provide you with health status data for urban Aboriginal youth. While the health status of the on-reserve First Nations population can be quite adequately determined, for those living in the North and off-reserve there is currently no reliable way of separating data on Aboriginal Canadians from that of the general population.
Although our national population base surveys on health collect the necessary data, the sample sizes are too small to allow for meaningful interpretation of data for the Aboriginal population. For the most part, provincial registries do not include information on Aboriginal status. This can have significant implications for policy and program design.
I shall now move to slide 4.
[Translation]
Health Canada actively participates in the federal Urban Aboriginal Strategy to maximize the effectiveness of existing resources through greater internal coordination and partnership arrangements with provinces, municipalities and Aboriginal organizations.
Nationally, Health Canada contributes to interdepartmental initiatives in support of the Strategy, such as the development of a guide to programs and services for urban Aboriginal people.
Regionally, Health Canada participates in the implementation of the Urban Aboriginal Strategy through the Committees of Senior Federal Officials.
In Vancouver, for instance, the Health Canada Centre provides a 24-hour first point of contact for individuals wanting respite from the street, including Aboriginal youth.
Also in Vancouver, Health Canada partnered with Justice Canada, the City of Vancouver, Vancouver Police, and the RCMP to support a program for urban aboriginal youth to reconnect with their traditional way of life through canoe voyaging. As one of the determinants of health, cultural identity and attachment is critical for this population.
In Winnipeg, Health Canada has taken a leadership role in UAS-Winnipeg, a tripartite approach between the federal, provincial and municipal governments to meet the priorities of the city's Aboriginal population, including youth.
In Alberta, Health Canada's regional offices and aboriginal organizations will hold an Aboriginal Youth Conference for the province in May 2002.
[English]
Health Canada's programs and services for Aboriginal people address youth as a segment of their reach. Although most of these programs and services are provided to First Nations people on reserve and Inuit in Inuit communities, several initiatives are more pan-Aboriginal in nature. For example, the Canadian Diabetes Strategy funds 40 projects for Metis, urban Inuit and off-reserve First Nations youth and their families. Also under this strategy, the Heart and Stroke Foundation is adapting an existing school-based curriculum resource to increase relevance for Aboriginal children.
National Addictions Awareness Week, operated through the Nechi Institute in Edmonton, provides a focus for all Aboriginal youth and their communities to address addictions and their impacts. Health Canada's approach to solvent-abuse prevention and treatment involves a focus on Aboriginal youth. Approximately 20 per cent of the youth treated in the nine Health Canada-funded youth-solvent-abuse areas are from urban areas.
Moving to slide 6: The Indian Inuit Health Careers Scholarship and Bursary Program provides $500,000 each year to support young Aboriginal Canadians who choose to pursue post-secondary education in the health field. Since the mid-1980s, Health Canada has funded the Native Role Model Program to encourage a healthy lifestyle through the example of young Aboriginal Canadians, many of them well-known for their achievements in a variety of fields.
Health Canada supports the youth award at the annual National Aboriginal Achievement Awards, providing an incentive for young Aboriginal Canadians to reach for the top. Health Canada's social-marketing activities for the Aboriginal population target youth in areas such as fetal alcohol syndrome, non-traditional tobacco use and diabetes. Many products are made available through the Aboriginal media, including the Aboriginal Peoples Television Network, to all Canadians.
I shall now turn to slide 7. Health Canada has funded a 30-minute segment of the television series The Seekers, which promotes the mental health and well-being of young Aboriginal Canadians. The Aboriginal Youth Network received funds to produce a Web site that includes up-to-date information on health- and lifestyle-related topics such as abuse, sex, pregnancy, smoking and addictions.
The Non-Insured Health Benefits Program provides benefits to approximately 700,000 eligible First Nations and Inuit people, regardless of residency, to supplement provincial and third-party programs. This coverage includes prescription drugs, dental benefits, medical equipment, transportation, vision care, payment of provincial health care premiums in B.C. and Alberta, and short-term and crisis mental health counselling.
I shall now move on to slide 8.
[Translation]
Health Canada's activities around healthy child and adolescent development benefit Aboriginal youth in three important ways: firstly, they promote healthy child development which sets the stage for healthy adolescence; secondl they help to create ongoing health-promoting behaviours among the adolescent population; and third, they support youth who are pregnant or are parents.
[English]
Slide 9: The department's community-based programs aim to ensure that children get a healthy start in life, often focusing on parenting skills and nutrition. The impact of these programs carry through the growth and development years and contribute to the children entering adolescence in a healthier state while preventing the development of health problems. The programs also involve a high degree of community control in terms of the identification of priorities and the design and delivery of programs and services offered.
The Canada Prenatal Nutrition Program funds community groups that develop programs for vulnerable pregnant women. The Community Action Program for Children funds community coalitions to deliver programs addressing the health and development of preschool children living in conditions of risk. In both the CPNP and CAPC, Aboriginal women and children are given particular attention in most of the protocols between the federal and provincial- territorial governments.
Aboriginal Head Start is an early-intervention program for Aboriginal children and their families who live in urban centres and large northern communities. While the AHS program serves preschool children and their parents, positive effects have been found for older siblings as well, since improvements in family nutrition and parenting behaviours have an impact on parenting of older children.
The Fetal Alcohol Syndrome/Fetal Alcohol Effects Initiative promotes healthy pregnancies and improved birth outcomes. A significant proportion of the target population is Aboriginal women of childbearing age and their partners.
Let me now turn to slide 10. Research initiatives into the determinants of healthy child and adolescent development are undertaken in-house, contracted through non-governmental and academic institutions and supported through partnership activities. Health Canada contributes to national population-based surveys and targeted studies that provide valuable data on adolescent health. However, these studies do not generate information specific to the Aboriginal population.
In October 2000, Health Canada launched the Centres of Excellence for Children's Well-Being to conduct focused research on issues associated with child and adolescent health, well-being and development. These centres will provide policy advice, generate and communicate information, and forge local, national and international networks. The program's guiding principles state that all centres must give special consideration to the unique needs of Aboriginal children, their families and communities.
Three of the five centres address issues with important implications for Aboriginal communities. The Centre of Excellence for Child Welfare will build on the work of the Canadian Incidence Study of Reported Child Abuse and Neglect to describe data specific to First Nations populations. The Centre of Excellence for Child and Youth-Centred Prairie Communities will investigate factors affecting healthy child development with a focus on the unique challenges of urban Aboriginal communities. Finally, the Centre of Excellence for Children and Adolescents with Special Needs will investigate the incidence of special needs children in rural and northern communities with a view to improving health care to these populations.
Moving to slide 11. The period of adolescence needs to involve an increase in positive risk-taking behaviour among youth. Challenging themselves with competitive sports, community leadership or performance arts can be helpful in assisting youth to establish an identity and sense of self. On the other hand, harmful risk-taking behaviours are also associated with this age group. Health Canada supports youth in making healthy lifestyle choices by providing information and promoting healthy behaviours to ensure adolescents and their families are equipped for this period.
Canada's drug strategy aims to reduce the harm alcohol and other drugs inflict on individuals, families and communities. The Alcohol and Drug Treatment and Rehabilitation Program, a component of the strategy, provides funding to provinces and territories to improve accessibility to new and innovative treatment and rehabilitation programming. Aboriginal youth living in our urban areas are a prime target for this program.
The Youth Action Committee established under the Tobacco Reduction Strategy provides advice on effective tobacco-control measures for youth. Committee members, including five Aboriginal youth, are actively involved in national and regional media program activities to help youth live smoke-free, and promote smoke-free environments in homes and communities. This concept of youth participation in decisions affecting them is finding its way into more departmental programming for young people.
Canada works with provinces and Aboriginal organizations to assess the extent of HIV/AIDS and associated risk behaviours among injection drug users, many of them Aboriginal, to make prevention and control recommendations. Nationally, Health Canada works with the Aboriginal working group on HIV epidemiology and surveillance to improve collection, understanding and use of surveillance data. The AIDS Community Action Program allows urban Aboriginal communities to provide support, education, out-reach advocacy and peer education to develop culturally sensitive prevention initiatives to influence the behaviours of urban Aboriginal youth.
In the area of hepatitis C, the department funds national Aboriginal organizations as well as community and youth groups to survey information needs, distribute educational materials and undertake prevention activities. Aboriginal youth between the ages of 15 and 24 have the highest sexually transmitted infection rates and the largest rate increase in recent years. Health Canada works with provinces, territories and Aboriginal communities to build capacity, remove barriers to surveillance, research, health promotion, prevention and treatment of sexually transmitted infections in this population.
For mental health, the department has supported the production of a pilot Web documentary designed to provide Aboriginal youth with an opportunity to explore social issues such as labelling, cultural transitions and conflicts. In promoting active living, the department jointly hosted a national round table on Aboriginal peoples to address health and social issues related to physical inactivity. The round table resulted in a declaration promoting a holistic approach to physical activity, and a joint working group is now identifying strategies to address the round table's recommendations.
[Translation]
Many Health Canada activities are not specifically targeted to urban Aboriginal youth yet provide them with benefits in different ways.
The Family Violence initiative headed by Health Canada and involving 13 other federal departments, creates and distributes publications and video resources for service providers and researchers to address family violence in Aboriginal communities, including issues of sexual abuse and child maltreatment.
The Health Transition Fund encourages and supports evidence-based decision-making in health care reform, with focus areas in Aboriginal and children's health. Projects in these streams include early intervention programs and testing of integrated service delivery models for disadvantaged populations in inner-city areas.
The Primary Health Care Transition Fund, intended to accelerate primary health care renewal, includes an envelope specifically to support aboriginal initiatives. The aim is to respond to the greater needs of aboriginal populations by promoting large-scale sustainable changes to enhance access to integrated primary health care services.
[English]
The Population Health Fund supports numerous projects benefiting urban Aboriginal youth as members of the larger youth population. In addition, 17 projects specific to urban Aboriginal youth address issues such as tobacco reduction, school adjustment and success, health of young women, social integration for at youth at risk, homelessness, healthy sexuality, substance abuse, recreation and health promotion.
The Centres of Excellence for Women's Health, CEWH, support research initiatives that have an impact on the health of young Aboriginal women. For example, funding was provided to address the wellness needs of Aboriginal women living in Montreal, as well as identifying and recommending how to dismantle existing barriers to accessing services. A second study focused on conducting a health assessment of urban Aboriginal women in Nova Scotia and determining how to ensure their input into the health care policy decisions.
Two of the Canadian Institutes of Health Research, CIHR, provide a particular focus on Aboriginal youth. The Institute of Aboriginal Peoples' Health will examine the mental health of Aboriginal children and youth, touching on issues such as tobacco, alcohol, drug and substance abuse, and suicide. The Institute of Human Development and Child and Youth Health addresses research priorities for Aboriginal youth. This month, these two institutes will co- sponsor a symposium on fetal alcohol syndrome to bring together researchers and identify clear research priorities in this area.
Health Canada is contributing to the promotion of health of young urban Aboriginal Canadians, both before and during the period of adolescence. The department emphasizes a preventative approach, focusing on early developmental stages to set the stage for healthy child development and healthy adolescence. Through continuing partnership, research policy development and program interventions, we seek to improve the health of this often vulnerable population, thus ensuring Aboriginal youth receive the best possible start in life and continued support as they grow and mature.
We would be pleased to answer any questions you might have.
The Chairman: Thank you for your very in-depth presentation.
Throughout my years of work at the community level in urban centres and rural communities, I found that the best intentioned programs are often led astray because the bureaucracy within your department at the community and regional level still has Indian-agent syndrome, where they feel they do not want to go into partnership but, instead, control.
I should like to know how you are addressing that issue. Are you training your staff in cross-cultural education? The Aboriginal communities and people have progressed tremendously. We have well-educated Aboriginal people who are still facing the discrimination of Indian-agent syndrome within those communities.
Secondly, I should like to address your Aboriginal Head Start Program. I have heard several concerns from the Metis Aboriginal Head Start Programs, where it seems that the Aboriginal Head Start people are trying to do away with the Metis culture and only deal on First Nations. I know that from the Metis head start groups in British Columbia, Alberta, and Saskatchewan.
How you are dealing with the different cultural components of our history and cultures in Canada? There are three separate, distinct nations in the Constitution, the Inuit, Metis and First Nations, which comprise the 52 different nations of Canada.
I think that must be addressed, not only at the community level but within your department, so they understand the different identity issues facing the Aboriginal communities in this country.
In the past week and half, having been back in Alberta, I have been dealing with a group in Edmonton, composed of the Metis, the non-status and the urban Aboriginal, who are from the street. This group is organizing. The off-reserve Aboriginals have joined the Metis, you might say, within the city Edmonton. These young people have been involved with gangs and with prostitution. Now they want to change.
What programs do you have that I could direct them to, in order to begin work within their own community? This group has had a street-life education. As a peer group, they could really help. What do you have for peer groups in that area?
Mr. Claude Rocan, Director General, Centre for Healthy Human Development, Population and Public Health Branch, Department of Health Canada: We certainly recognize the importance of partnerships in the delivery of these initiatives. As Mr. Broughton mentioned, the department's three main programs for children are all community-based programs: the Community Action Program for Children, the Canada Prenatal Nutrition Program and the Aboriginal Head Start Program. These programs are based on partnerships, and they operate very much at the community level.
As far as Health Canada is concerned, our regional offices take the lead role in delivering these programs. The regional offices establish committees with provincial governments and municipal governments, as well as community organizations, including Aboriginal community organizations, in defining, shaping and delivering these programs.
We try to ensure that the community influence and the sensitivities that are required are part of the actions that we take.
With regard to the Aboriginal Head Start Program, I have not heard the comment to which you refer. We can certainly look into it. Again, it is one of our important community-based programs. Again, as Mr. Broughton said in his presentation, these programs are very important to us as preventative initiatives. They are not targeted specifically at urban Aboriginal youth. They are targeted at children, and it is our hope that they will allow children to develop a strong base so that, as they go on with their lives, they might be able to avoid some of the difficult issues that urban Aboriginal youth often confront, including the negative at-risk behaviours that they participate in. This program is extremely important.
Culture is important as well. The programs must encourage a sense of pride in the cultural backgrounds of these children. That is one of the main objectives of the initiative.
We certainly will take note of the concern, specifically about Metis, and try to address it with our regional offices and the others who are involved in it. I think it is an important issue.
With regard to the group of young people, Metis and off-reserve, who are organizing and who want to be helpful, we would have to determine whether there is something that Health Canada could do in terms of working with this group. Other federal departments may have an interest in working with them. Their interest may be more direct than ours, given what I said earlier about the preventative focus that we take at Health Canada.
The Chairman: You still have not answered the question: Do you provide cross-cultural training for your staff in the regions?
Ms Wendy Birkinshaw, Senior Policy Analyst, Division of Childhood and Adolescence, Population and Public Health Branch, Department of Health Canada: Some years ago, I had the privilege of working in the Saskatchewan region with Health Canada. While I was there, there was definitely cross-cultural training undertaken by all of the staff involved in working with Aboriginal people, whether it was directly through the First Nations and Inuit Health Branch or through the other branches of Health Canada that would come into contact with Aboriginal people through the community- based programs.
Elders and other Aboriginal individuals were brought in to teach us to answer staff's questions, to help us understand more deeply what would be the best way to interact with Aboriginal people in order to meet their needs more appropriately. Certainly in Saskatchewan, that was a model used. I believe that was being done across the country.
The Chairman: ``Aboriginal'' is a generic term. We will take Saskatchewan as an example. Were you given any information regarding the Metis culture, such as their historical background? Were you given any information regarding the Cree, the Saulteaux in Saskatchewan?
``Aboriginal'' is a term that everybody uses. Identity has been lost because the language, history and culture of each nation has been denied. This is why it is so important.
With the Metis, everybody figures, ``Oh, they are just a bunch of rag-tag half-breeds.'' We are not. We have a definite history and language.
This is what I mean by cross-cultural education. When I had the opportunity to do cross-cultural workshops with Stephen Brant several years ago, I was amazed to discover that the participants in those workshops were not aware of the different nationalities within the communities. It is not just Aboriginal or elders; it is a whole history that has to be understood by all participants if we are going to have a good partnership.
Suicides are increasing, alcoholism is increasing, teenage pregnancy is increasing. Despite all your programs, I do not see a decrease in the statistics. How do we work together in partnership with the Aboriginal communities to examine what is going on?
In my experience, we have the same stereotype, that we cannot do it. We can do it with the educated people we have, with the wisdom of the communities. That is what I mean by that.
Mr. Rocan: We will certainly take note of your concern. You mentioned in your comments the importance of working with the Aboriginal community organizations. We can certainly make use of the resources that they have to further our work in that area.
The Chairman: One would hope that this action plan for change will be of benefit to your department also, to really look at how we can work together as Canadians to help each other.
Senator Callbeck: I am not a member of this committee, but I thank you for your presentation.
You have outlined a lot of programs here. Many of them are of a preventative nature. Is any follow-up measure in place for these programs? How long have the programs been in effect? Do you follow them up every three years, every five years? How do you know whether they are effective?
Mr. Rocan: I will refer specifically to the programs for children that I was referring to, the three major community- based programs. There are evaluation studies done on all of those on a continuing basis.
I will mention the Canada Prenatal Nutrition Program. We are now in the final stages of performing a national evaluation of the program, which we will roll out in the course of the year.
As I understand it, some evaluations of that program have been done on a regional basis, where the information generated was used to provide some adjustments to the way the program is run. We know specifically with regard to that program that key indicators are showing promising trends. For example, in the area of breastfeeding and the length of time that women breastfeed their babies, there is an improvement there. We also note an improvement in the birth weight of babies that we have monitored. We have solid information to show that the initiative is actually providing some positive results.
With the Community Action Program for children, there are regular evaluations done to monitor the effectiveness of the program.
Aboriginal Head Start is a program initiated in 1995. Projects began at the earliest in 1996. No formal evaluation has been done yet because we have had some difficulty finding culturally appropriate measures for that program. The ones that we had looked at before were not seen as sensitive enough to the particular cultures of the people we were dealing with. We now feel we are developing some and are very close to being able to provide a more detailed evaluation of that program as well.
We do try to track the programs and the initiatives to ensure that they are producing the effects intended.
Senator Callbeck: Is that done with every program, or are there programs that are put in place and then go interminably, without any assessment or changes made?
Mr. Rocan: As you mentioned, there are a number of initiatives that we have mentioned here. I cannot speak with confidence on every one of them, but certainly all the initiatives that I am aware of must be subjected to an evaluation.
Senator Callbeck: With respect to the need for Aboriginal people in social services, child welfare, mental health and other areas, there does not appear to be an organized program to support the training and professional development of these people. How is your department addressing this? Perhaps there is an organized program I am not aware of.
Mr. Keith Conn, Acting Director General, Community Health Programs Directorate, First Nations and Inuit Health Branch, Department of Health Canada: The Indian and Inuit Health Careers Scholarship and Bursary Program is an organized program. It is currently administered in partnership with the National Aboriginal Achievement Foundation. Currently, Health Canada invests about $500,000 in a bursary and scholarship program that benefits Metis, First Nations, and Inuit students attending post-secondary institutions. That will encourage and support Aboriginal students in the pursuit of studies in health careers, leading them into health professions, whether medicine, nursing, radiotherapy, all kinds of health professions. That is deemed as a success in our department. We have a lot of broad- based support, with many graduates from the program continuing on their studies.
On average, we have about 116 or 120 recipients each year. In the last count of our statistics, the vast majority, about 87 per cent, were of Metis descent, in terms of recipients of that program.
We believe it is a good, solid program. We certainly would like do more. The department is certainly looking more broadly, strategically and long term, in terms of a comprehensive human health resource strategy. We see this as a part of that. Certainly, the royal commission was well publicized in the demand and need in terms of future needs of 10,000 health and social workers. This is seen as a contribution towards that. As well, we see the education sector of the Department of Indian and Northern Affairs certainly supporting Inuit and First Nations in terms of post-secondary and, in some respects, leading to choices in the health professions.
Senator Callbeck: How long has that $500,000 bursary been in effect?
Mr. Conn: That has been in effect since, I think, 1982, approximately.
Senator Callbeck: That is the only initiative.
Senator Pearson: Can I follow up on that? I wanted to give a plug for Diana Fowler LeBlanc's scholarship program for Aboriginal social workers, which has only now been in existence for two years. I think that will also help. That is a fund that is separate from Health Canada. I do not know where it is being organized.
Mr. Conn: That is correct.
Senator Pearson: It is another recognition of the need.
Senator Callbeck: That has been in effect since 1982?
Mr. Conn: I will have to confirm that, but that is my understanding.
Senator Callbeck: This really is the only initiative that the department has taken?
Mr. Conn: It is a targeted, directed approach to support and encourage individuals pursuing professions in the health field. It complements other programs and supports in terms of post-secondary education and support from the Department of Indian Affairs. I do not have figures on that, but we certainly can request them of our colleagues at the Department of Indian and Northern Affairs in terms of investments in education support, and, if possible, what is targeted or supported in terms of health professions and social services.
The Chairman: I must deeply apologize to our presenters, as Senator Callbeck and I have been called to a special Senate meeting. Senator Sibbeston will be taking over the chair.
Senator Nick G. Sibbeston (Acting Chairman) in the Chair.
Senator Pearson: It looks like an impressive list of programs. One always wonders why does it not seem to be making more of a difference. We do not seem to have the data to show where some of the differences are being made, except for something concrete like the Canada Prenatal Nutrition Program, because that is a concrete program with concrete objectives. Aboriginal Head Start has a good deal of success, but it is harder to evaluate where the success is.
I am interested in a number of issues, some in the areas of early childhood, sexual abuse and exploitation. You remember the study that Cherry Kingsley and Melanie Mark did on sexual abuse and sexual exploitation in Aboriginal populations. Their research and other research for the urban Aboriginal population show the following is needed: safe houses, detox, more outreach workers and service providers, particularly people with experience — not the kind of experience that you have — but the experience these young people have at being exploited. They make excellent supporters, but they are not the professionals that go through the bursary programs because they have spent their adolescence being exploited, not being educated in traditional ways.
This feeds into the comment about the National Native Alcohol and Drug Abuse Program. To what degree have you been seriously thinking about giving support and encouraging the presence of experiential youth in resolving and assisting these programs?
There is constant tension there between the culture of the service provider and the culture of the youth participant. Those are two quite different ways of approaching the resolution of problems. Often the people who provide services feel quite threatened about making partners of the kids with whom they are actually working. I am just throwing that out to see if any of you have examples of programs that are beginning. You already mentioned that people were beginning to recognize the need for youth participation. How would you respond to that, particularly around this question of sexual abuse? The issue of sexual abuse is huge among the Aboriginal population — as well as in many other populations, to be frank — as is exploitation, drugs and drug-related issues, and so on.
Mr. Conn: For the First Nations and Inuit Health Branch, we have two critical investments in programming, namely, the solvent abuse prevention treatment program serving Aboriginal youth between the ages of 12 and 19. Currently, we have nine treatment centres across the country, involving national residential inpatient treatment programs. The National Native Alcohol and Drug Abuse Program serves approximately 550 communities. There are about 730 workers out there and 6,700 national beds through 57 treatment centres across the country. On average, we serve between 3,500 and 5,000 clients per year.
There has been a national review of the NNADA program, with a view to re-engineering or redesigning its mandate and its services in terms of youth and women. On average, it is fair to say that the NNADA treatment programs more or less targeted the young adult male. There is a movement afoot, in partnership with First Nations and the NNADAP centres and other partners, to look at potentially redesigning some of those centres to focus on the needs of youth broadly. That is in the midst of discussion as we speak here today. We hope to see some support and changes in that direction.
Through the treatment centres, in terms of whether it is treatment for either solvent abuse or alcohol and drug abuse specifically, a number of the case workers are highly trained individuals in a number of areas, including the recognition and identification of potential of sexual abuse of individuals and clients. There is that level of intervention and support.
Senator Pearson: I wonder how many of the caseworkers have been sexually exploited. They are an invaluable group of young people to call on.
Mr. Conn: That would be difficult to ascertain.
Senator Pearson: Yes. Many are perfectly willing to admit to it and offer their services but they do not have the academic qualifications.
Mr. Conn: I have had the occasion of attending meetings and conferences in a closed environment where individual workers have admitted their own experience. They have dealt with that experience and have gone through a healing process. They have received all the necessary support and have become prevention/addiction support workers, but I cannot quantify that.
Senator Pearson: I urge that to be considered and for certain kinds of requirements to be put aside. As young people are coming through your program, I urge you to say: ``We would like your help. Would you work with us to work with this population?'' There are a few examples that are beginning to emerge. For example, a young woman in Winnipeg is opening a shelter for young girls to turn to, but they need that. They need to feel confident that the person with whom they are speaking has been there and knows what it is about. I admire all these highly qualified professionals, but they have not been there. That is a point that I am trying to encourage in all programming with youth, namely, that you have the youth with you, working on the solutions and giving them hope that there is some kind of job for them afterwards where they can use their experience to share and help others. That is what they want to do. They want to help prevent other kids from being exploited. That is a challenge, but I wanted to mention it.
Senator Tkachuk: What is the cost of the health care program for the Aboriginals that are a federal responsibility, namely, the reserve Indians or the treaty Indians?
Mr. Conn: Essentially, the federal investment through Health Canada for First Nations and Inuit and for First Nations living on-reserve is approximately $1.3 billion. That is serving some 700,000 eligible clients across the country. That includes the territories.
Senator Tkachuk: Does that include programs involving prescription drugs?
Mr. Conn: Yes.
Senator Tkachuk: If you separate what Canadians in general do not get, for example, prescription drug service or eyeglass service, how much would that be?
Mr. Conn: At a global level, of that $1.3 billion, approximately $658 million is designated for community health programs — addictions programs, head start, et cetera.
Do you want me to separate the cost for uninsured health benefits in terms of dental, vision and prescription?
Senator Tkachuk: Yes. How much of that group is part of the $1.3 billion, or is that in addition to that amount?
Mr. Conn: Approximately $588 million of the $1.3 billion. There is then another $27 million in hospital services and approximately $96 million in terms of program delivery and administration.
Senator Tkachuk: We then have all the Aboriginal programs where the Metis would be a provincial responsibility, is that correct? I notice you have Metis programs here. Are those joint programs? How do you deal with the non-status Indians and the Metis? I notice programs here for Metis, but why would the Metis be any different than me, in Saskatchewan, for example?
Mr. Rocan: In the off-reserve circumstances, that Metis people and non-status Indians and so forth would receive their health care from provincial governments just as any other Canadian.
Senator Tkachuk: These would be specially targeted programs because the federal government has seen a need that this is a special case and they want to administer a program with the provinces. Is that how it works? Does Quebec deal with it the same way as Saskatchewan deals with it?
Mr. Rocan: Going back to the three main programs for children that I mentioned before, those are not health care programs. They are programs that we have in place, as was mentioned earlier, to try to prevent some of the more difficult issues from coming to the surface later on in life. They are federally funded programs, but we deliver them in cooperation and in partnership with provincial governments and community organizations.
Senator Tkachuk: Fetal alcohol syndrome is not just a problem for Aboriginal people; it is a social problem that must be death with. How much do you spend there, on top of the $1.3 billion?
Mr. Rocan: Are you referring specifically to fetal alcohol syndrome?
Senator Tkachuk: No. I am referring to the other programs that designate as part of the Aboriginal spending.
Mr. Rocan: I do not have a global figure, but I will go over a few figures that might be germane. For example, in the Aboriginal Head Start Program for people living in urban and northern circumstances, the annual budget there is $22.5 million. I mentioned the Canada Prenatal Nutrition Program. The budget allocation for the fiscal year 2000-01 was approximately $27 million. In relation to that program, that is not specifically an Aboriginal program but it is a program that Aboriginal people have access to and participate heavily in western provinces.
Senator Tkachuk: That is a national program everyone can participate in, not necessarily Aboriginal persons only. You do not make that distinction?
Mr. Rocan: These are universal programs, and the same would apply to the CAPC program, with an annual budget of $59 million. That is a universal program that Aboriginal people access, particularly in western Canada.
Senator Tkachuk: How much does this $1.3 billion compare to what the federal government spent 10 years ago and 20 years ago?
Mr. Conn: We do have some historical data that we can provide to you.
Senator Tkachuk: Is it less?
Mr. Conn: A lot less.
Senator Tkachuk: Do we have information as to what works and what does not? What reserves have better health standards? Do we have information like that? Do we study why a particular reserve is so bad, like Davis Inlet? Why is one reserve good, with not many health problems or fetal alcohol syndrome? Do we have those studies that compare reserves?
Is the federal government part of that from your perspective, insomuch as administrating health care to Aboriginal people, and how we decrease costs to make this a more efficient program?
Mr. Conn: My understanding is that some research has begun in terms of looking at comparing communities in terms of healthy communities and not so healthy communities. That research is underway through the Canadian Institutes of Health Research, in part.
I am not aware of any explicit research that compares one community to the other. We certainly can look at some of our research networks within Health Canada and others, as a commitment to follow up on.
Senator Tkachuk: Going back to the health care debate, which is headed up by Mr. Romanow, will your department make presentations on that respecting the health care program for Aboriginal people in Canada?
Mr. Broughton: We will be dealing with the commission, but we would have to check to see if we will specifically deal with Aboriginal issues. I do not know that today.
Senator Tkachuk: I am thinking about the health care budget in Saskatchewan. It used to be $1.3 billion for the whole province in the late 1980s. Obviously, you should be part of this debate. You spend more than Nova Scotia, Prince Edward Island and New Brunswick on health care today.
Why does the federal government provide the non-insurable programs such as eye care or dental care?
Mr. Conn: That is provided as a matter of policy within the Department of Health. Again, policy is a key word for all citizens of any given province. Provinces provide insured services to citizens, including Aboriginal peoples. In this situation, in terms of First Nations on reserve, we provide non-insured health benefits, that is vision and dental, as a matter of policy and support in addressing those needs of the community.
Senator Tkachuk: Has a discussion taken place vis-à-vis whether if people were responsible for their own health, that is, having to pay for their services, they would look after their health a little more? Do you ever have those policy discussions, or is that not a question?
Mr. Conn: That has been an ongoing internal policy discussion within the federal family at large in terms of the capacity of individual First Nations to pay for certain benefits. We are looking at the social economic status of communities and individuals as part of the equation. It has been the departmental policy to provide health benefits and services based on need.
Senator Tkachuk: If it is based on need, does everyone qualify?
Mr. Conn: Essentially, all First Nations, status Indians and Inuit are eligible for non-insured health benefits, regardless of residency.
Senator Tkachuk: As well as regardless of income?
Mr. Conn: Yes, also regardless of income.
Senator Tkachuk: Is that a good thing?
Mr. Conn: I am not sure how to answer that question.
Senator Tkachuk: You are not the politician. I understand that.
Mr. Conn: I am not the politician.
Senator Tkachuk: I am asking you as a professional, is this a good thing? You told me earlier that the policy was based on need, and then you said that everyone qualifies, so it is not based on need.
Mr. Conn: In terms of past discussion, I think it would be rather difficult to implement in terms of an income means- based test to provide those benefits and services. Overall, in terms of broad social economic conditions and employment rates, et cetera, it is felt that it is better to look at providing those benefits and services. The critical discussion is whether we should shift from treatment of recurring health problems to health promotion, prevention education, self-care, primary health care and more effective service delivery to reduce burdens on the system. That is where the shift and debate is today in terms of future directions and investments.
Senator Léger: With all your statistics, programs, strategies and so on, I often heard the word ``including'' Aboriginal youth. There are many examples of higher incidences of diseases and health problems. When we look at the statistics for all these programs and strategies, are the same proportion of monies are given, 6.6 times greater, or two, three times more for Aboriginals? In other words, is your department offering more because the problem is that many times greater?
Mr. Rocan: For one thing, there are a number of initiatives. It is difficult to generalize in such a way that it affects all of the initiatives that that we have. In some cases, the initiatives that we have are targeted specifically, that is the expression we use, at the Aboriginal population. In other cases, there are programs of universal allocation that Aboriginal people access, and perhaps access significantly, depending on what part of the country they come from.
I will leave it at that.
Senator Léger: In this meeting, we are talking about the Aboriginal aspect, which is part of the universal aspect and which has become such a major concern. With the problems we have facing us today, I have the feeling your department must be directing the same proportion of help to all of these problems.
What do you mean by ``cultural transition''? That sounds as if an Aboriginal person goes to an urban setting there must be a transition to our culture. Is that what ``cultural transition'' means?
Mr. Rocan: That clearly is not the meaning and is not what we meant to say. Perhaps I will ask Ms Birkinshaw to cite the specific reference where that might have come up in the presentation.
Ms Birkinshaw: I do not recall those words. Do you remember in which part of the presentation that reference was made?
Senator Léger: I forget the exact moment, but when the words ``cultural transition'' were mentioned I wondered what that meant. Even if you do not find the reference, what does that mean? I am happy to hear you say that it does not mean what I said.
Mr. Rocan: It certainly does not, and we recognize its importance. This relates to some of the questions Senator Chalifoux was asking earlier. We recognize the importance of Aboriginal people integrating their own culture, coming to terms with their own culture and having a feeling of pride in their own cultural. A number of the initiatives in the Aboriginal Head Start Program are a shining example of that. One of the major objectives of that initiative is to try to give young children a sense of pride in their background and where they are from.
Senator Léger: Of course, as Senator Pearson was saying, the only people who can develop that sense of native culture is the Aboriginal people themselves. That is where I feel some benefit can be achieved through the use of peer groups. They can greatly assist our efforts.
Mr. Rocan: My understanding is that members of the community are very much encouraged to act as resource people for the Aboriginal Head Start Program. For example, elders of the communities come in, speak to the children and make a connection with them. As well, other individuals from the Aboriginal community are encouraged to be resource people for the head start project. That is a very important part of the program.
Senator Léger: The culture must be taught by the Aboriginal people themselves. Your department has the control, but it is important that some of the control be shared.
The word ``we'' has often been used here. Does that term include peer people, those who know about the culture? That is the aspect that causes me concern. I know we must be effective, and our response must be more than emotional, but it is only the people themselves who can help us help them.
Mr. Rocan: Yes. It is the principle reason that we consider it important to work at the community level to make these connections, to work with community organizations and to feel grounded in terms of the initiatives that we put forward.
Senator Pearson: I am still interested in the issue around these enormous statistics with respect to solvent abuse, and Mr. Conn's description of the alcohol and drug treatment abuse programs where you had centres and so on. We are conscious, both through the media and through some of our own connections, of the fact that when we take youth out of their setting, treat them and send them back to their setting, they start all over again. It is back to the issue around best practices and around this issue that for me is becoming increasingly important, which is that most of our government policies with respect to children should be what I call ``family enabling.'' We should be focusing on enabling families to look after their children because they do a much better job than the state, if I may say so. The state does not make good parents.
In terms of the work that has been done in the drug treatment programs, how do you strengthen the family to receive the child back? Have you any comments on that?
Mr. Conn: Yes, that is an excellent point. As I mentioned, in terms of the NNADAP review, among other reviews, there has been a strong recommendation to look at the needs beyond the individual, to the individual's family and community setting in terms of residential treatment. You raised the valid point that it is often difficult to remove a person from a community, put them through a treatment process and then send them back to the same environment. Hence, we see the shift to community-based supports, family centres and supports to look at the needs of the entire family and ultimately the community. We see many land-based projects, including camps, where extended families are brought together to provide the necessary support. There are broader activities in terms of supporting the needs of the community and the family as a whole.
We are also aware of many interesting projects supported by the Aboriginal Healing Foundation in terms of bringing together individuals, families and communities as a whole. It takes a community of support to heal individuals. We see a shift occurring, in that you cannot necessarily isolate an individual in terms of his or her needs for healing.
Senator Pearson: That is encouraging because that shift is fairly recent. For people who look at public policy, there is an interesting book, edited by a man named Potter, on the making of public policy that identifies the problem. However, at one stage in the process one must look at best practices before investing a huge amount in a fully blown policy. One must look at what works, what does not work, and how to evaluate that. I am encouraged by that and by the fact that it looks like you are getting some better indicators to evaluate the Aboriginal Head Start Program. I will be interested to see what they are when you feel free to share them.
Mr. Rocan: I wish to mention as well that in relation to the community programs that I mentioned, for example, the Canada Prenatal Nutrition Program, strengthening the family is part of that program as well. Women who are at risk come to access services. They have access to nutrition counselling, as well as personal counselling, parenting skills, many things that obviously should help to strengthen the family. A few years ago, that program was expanded to include fetal alcohol syndrome and fetal alcohol effects as well. Again, those initiatives are targeted at strengthening the family and the life skills required.
Senator Pearson: I am always wary, and in fact the research is beginning to show, that some of these parenting programs that have been put together for all kinds of populations do not necessarily work because what you are looking at is the whole family context. People will do a better job if some of the other pressures in their lives are addressed, and there sometimes needs to be a shift of focus. If you think you have delivered a parenting program, I do not think you may have actually done what you think you are doing because that is what the research is telling us, that is, that they do not actually work as well as people think they do. However, if you have helped that family to reduce the chaos of their living environment, then you may have done much more for enabling them to be the kind of parents they want to be than by telling them what they should do. I am encouraged, on the whole, by some of the things you are saying.
Senator Tkachuk: I have a follow-up question on the $1.3 billion. Could you break that down per province when you send the information? You said you would look back 20 years, as to what that number could have been. It would be helpful to us if you could also break it down by province.
The Acting Chairman: There being no other questions, I thank you for your presentation here today and for the time you spent preparing the presentation.
The committee adjourned.