Proceedings of the Subcommittee on Population Health
Issue 2 - Evidence - March 25, 2009 (afternoon meeting)
OTTAWA, Wednesday, March 25, 2009
The Subcommittee on Population Health of the Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:06 p.m. to examine and report on the impact of the multiple factors and conditions that contribute to the health of Canada's population — known collectively as the social determinants of health (topic: population health policy for Aboriginal peoples).
Senator Wilbert J. Keon (Chair) in the chair.
[English]
The Chair: Honourable senators, we are pleased to have three wonderful witnesses today. You will notice that we have a photographer in the room. I trust it is all right with honourable senators that he does some photographing while we conduct the hearing.
We will begin today with Bob Watts, chief executive officer from the Assembly of First Nations (AFN), who is here in place of Chief Fontaine.
Bob Watts, Chief Executive Officer, Assembly of First Nations: Thank you for the opportunity to contribute to your study. I want to extend greetings from National Chief Fontaine and the executive of the Assembly of First Nations.
After two years of study, your subcommittee knows the well-documented health disparities which persist between First Nations and others in Canada. Reducing these disparities will require a profound change in the government's approach to developing and implementing public policy. I would like to highlight some steps we must take to develop an effective population health approach strategy for First Nations.
Many of the questions you invited me to answer today were addressed during the first 18 months of consultations which led to the first ministers' meeting in Kelowna, B.C., in 2005. The Kelowna Accord was a comprehensive 10-year plan developed in partnership with First Nations, and supported by provincial, territorial and federal governments, which aimed at closing the gaps between First Nations and other Canadians. The Kelowna Accord should be viewed as a starting point for establishing a population health approach for First Nations. Many of the recommendations I am about to make come from that accord.
The AFN requests that the Senate recommend actions that will address the real health needs of First Nations. First, we ask the Senate to recommend that health programs and services for First Nations receive the escalator clause that provinces and territories receive. Through the Canada health and social transfer, funding increases are based on cost of living, at about 7 per cent to 9 per cent annually. First Nations health programs and services do not benefit from this escalator clause and only receive 2 per cent to 3 per cent increases annually — funding is capped. This simply is not enough to cover the real costs of health. In some communities, salaries for health employees have been capped for a decade, which has grave implications for retention and recruitment. Despite the welcome contribution to First Nations infrastructure in the recent stimulus package, we still will not be able to meet the needs of First Nations communities with this relatively small increase.
If First Nations had received an escalator clause comparable to the provinces, we would have seen at least $14.5 billion in additional funding in the last decade to cover the cost-of-living increases. We can find no evidence or rationale that warrants First Nations receiving less for equitable programs and services than other Canadians. We request that the Senate make this recommendation for equitable health funding and annual increases for First Nations communities starting in fiscal year 2011, including funding to address the real needs in infrastructure backlog.
You know as well as I that a social determinants of health perspective, or 'whole' approaches to population health, means that the factors relating to health are not solely within the realm of Health Canada. If you find it within your mandate, please also make a recommendation that funding for housing, education and water also benefit from an annual escalator clause. Our children deserve equitable quality of education, water, housing and health, as does any other Canadian child; we are simply asking for equity.
Second, we request that the Senate make a recommendation regarding accountability from organizations which have a mandate to improve the health of First Nations. This is a specific request that I do not make lightly. There is much in Health Canada that is working and is a model for other departments, and I will share those later. However, we have an issue, one on which the Senate has made recommendations in the past, and that is with regard to the Public Health Agency of Canada.
The mandate of the agency includes First Nations as Canadians and we refuse to be excluded. Despite a Senate recommendation for immediate action, I regret to report that little has happened. No programs or services have been implemented in First Nations communities, and the agency has yet to determine how to proceed to include First Nations. This is inexcusable. First Nations public health requires immediate partnership and collaboration between the agency and the First Nations and Inuit health branch to address their critical needs. In the strongest way possible, we request the Senate call the agency to task on this matter. We cannot wait for a public health emergency to occur in a First Nations community. It is in all of our best interests to act now.
I mentioned a moment ago that there is much within Health Canada that is working. I want to commend the First Nations and Inuit health branch for their commitment and action on tripartite initiatives.
The third recommendation is about tripartite. First Nations access health services from both the federal jurisdiction as well as the provinces and territories. Romanow and Kirby both touched on this topic in their commissions. Last year, the national chief had the honour of signing, with the then-minister of health, the policy framework for regional tripartite First Nations health agreements or, in short, the tripartite health policy. This sets out the principles of collaboration between First Nations, provinces, territories and the federal government on shared models of decision-making.
The federal minister of health shared it with provincial and territorial ministers of health. The tripartite policy is based on the following principles: First Nations are an equal partner in decision-making tables for First Nations health funding; shared models of health governance are not duplication but collaboration; and the system itself is a barrier, so the solution must be systemic. The B.C. tripartite health plan is an example of this policy and I believe it has great potential.
I request the Senate to make a recommendation that the tripartite policy be the model in which partnerships are developed in First Nations health, and that federal departments responsible for health implement this policy.
I believe there is also a way to use the principles of the policy to move the agenda forward on Jordan's Principle. Since the bill has passed in Parliament, Health Canada and Indian and Northern Affairs Canada have struggled to work together, and children continue to wait for services. I see an application of the tripartite policy on this particular file, as well as other files in which federal departments should simply be collaborating to leverage greater impact with First Nations.
Further, on the issue of tripartite, I also request the Senate to recommend that the existing Aboriginal health transition fund be renewed. This program sunsets in 2010 and currently supports large numbers of community-based tripartite projects in health. To complete the change in the system that we all agree is required, it needs to be renewed. I request the Senate to recommend that the program be extended and doubled in funding. I expect this program will have some of the strongest system-change outcomes in decades.
On the topic of things that are going well, I want to highlight the good work that the First Nations and Inuit health branch are doing in mental health. First Nations are struggling with mental health issues, compounded by the trauma of residential schools. The new health supports program for residential school survivors is providing resources for community-based supports in mental health. We think that the need for mental health supports in communities is about to far outstrip the available resources. Survivors should not be left to struggle on their own to cope and heal with the effects of residential schools. First Nations youth should not be left on their own to struggle with addictions, or the loss of hope and thoughts of suicide. Canada should not leave them behind. We can and should be doing more.
My fifth request to you is about mental health. First Nations request that community resources for mental health be increased to prevent future suicides and support those with painful mental illnesses.
The sixth and final recommendation is about health human resources. One of the lessons we have learned about negotiating tripartite agreements is that the lack of community capacity can be a barrier, but the problem is larger than that. First Nations struggle with a desperate need for qualified health human resources. Community health plans, suicide prevention and diabetes intervention are all held back by the lack of human resources. The Aboriginal health human resources initiative from Health Canada has made some progress since its inception in 2004, but we have not seen a measurable change in community-based health yet. My request to the Senate is that you make a recommendation to dramatically increase resources to develop and sustain First Nations community-based health human resources.
We need help to get our students through health bachelor's and master's degrees and with continuing education once they are working. Without a sustainable and resourced plan for First Nations health human resources, none of my other requests have the foundation for success. We need to also develop First Nations health leaders and policy-makers, and the AFN has a proposal ready for Health Canada to start a new centre of excellence for health management. This new entity would support health managers, support best practices in shared models of health governance, and build the research base in health management. Please consider showing your support for this initiative.
I have made numerous requests to you on behalf of First Nations — on funding escalators, on public health and the public health agency, on tripartite health, mental health and health human resources. These are key platforms in our drive to close the gaps in health. We have made progress, but I believe that equity is an achievable and necessary gold.
In Canada, June 11 will be the first anniversary of our Parliament's apology to residential school survivors. The apology was not only about acknowledging the past but also about fundamental change. It is time to fundamentally change health systems and achieve real equity. My children and your children deserve nothing less.
The Chair: Thank you, Mr. Watts. We will save the questions until the other witnesses speak but I would like to comment that your recommendations are certainly very close to what the committee has been thinking of in the way of recommendations. We are pleased with what you have had to say.
We will next go to Rosemary Cooper, director of executive services for the Inuit Tapiriit Kanatami.
Rosemary Cooper, Director of Executive Services, Inuit Tapiriit Kanatami:
[Editor's Note: The witness spoke in her native language]
Our president, Mary Simon, sends her regrets. She had prior commitments but she sends her 'hello' to the committee. With me here today is Elizabeth Ford, director of health and environment. I will now begin my presentation.
The Inuit Tapiriit Kanatami represents Canada's Inuit on matters of national concern. There are roughly 53,000 Inuit living in 53 communities. Inuit Nunaat, the term used to describe the homeland of Inuit of Canada, is divided into four regions: the Inuvialuit region, Nunavut, Nunatsiavut and Nunavik. Our Arctic homeland comprises one-third of Canada's land mass and 50 per cent of its shoreline. We are a small number of people stretched across an enormous part of Canada. Inuit Tapiriit Kanatami's primary role is to secure a more equal and equitable place for Inuit within Canada. It is a national voice for the Inuit and addresses issues of vital importance to the preservation of Inuit identity, culture and ways of life.
Our population is young, with 53 per cent under the age of 15. This compares to 18 per cent of the total Canadian population. There are many key public policy challenges facing Inuit as they struggle to improve their standards of living and family and individual well-being. These issues highlight the tremendous gaps in Inuit health status in Canada. It is not responsible for us to continue to report on these gaps unless we are willing to work together on innovative ways to address these issues.
Regarding quality of early life, early childhood experiences have a long-term effect on mental and physical health. High rates of anaemia and respiratory tract infections among Inuit infants are attributed to inequity in prenatal and postnatal nutrition and widespread smoking in crowded homes. Another health problem related to early life of great concern to Inuit communities is fetal alcohol syndrome disorder, or spectrum disorder.
Housing shortages, poor quality of housing and crowding are an urgent public health priority in all Inuit regions. Housing problems have been linked to low achievement at school, spousal abuse, depression, substance abuse and respiratory tract infections. According to a 2006 report, the overall rate of tuberculosis in Inuit communities is 90 times that of the non-Aboriginal Canadian population.
With regard to addictions, substance abuse is another challenge facing Inuit communities. The prevalence of alcohol abuse and smoking in Inuit communities is symptomatic of deeper social economic problems. This underlines socio-economic inequities that result in serious daily stress and unhealthy coping mechanisms. These must be viewed as a fundamental determinant of health.
Acculturation has occurred rapidly for Inuit as they moved from a life on the land to a modern one. Although permanent settlement has had some positive outcomes, the dramatic socio-cultural challenges that Inuit have experienced, and continue to experience, affect their mental, physical, emotional and spiritual health.
Inuit communities have experienced dramatic changes that have challenged the effectiveness of Inuit social support networks. This is evidenced by the high suicide rates in many communities. Family relationships have changed due to changing social conditions and loss of language resulting from close contact with non-Inuit cultures. Some Inuit grandparents and grandchildren have difficulty communicating with each other because of language loss. Relocation and the removal of children to residential schools have had lasting negative impacts arising from the early separation from parents, community, language and culture.
The concept of productivity for Inuit is inclusive of hunting, harvesting, sowing, child rearing, and family and community commitments, as well as paid and voluntary employment.
Income distribution is skewed as a result of marginalization due to poverty. This limits access to education, employment, good housing and nutritional food. Poverty also weighs heavily on mental well-being by lowering self-esteem and increasing dependency. Not only do Inuit find themselves more often than non-Inuit without a job, but those jobs are frequently seasonal or part time. Entry level jobs are more often held by Inuit while management level jobs are dominated by non-Inuit.
Access to education in the Arctic has its challenges. There is a strong need to enhance the infrastructure and curriculum for early childhood development, primary and secondary education, and post-secondary opportunities. Currently, only a quarter of Inuit students graduate whereas only a quarter of students do not graduate in the remainder of the country. That comes from Thomas Berger's report of 2007.
Food security is impacted by several factors that inhibit Inuit access to sufficient quantity and quality of nutritious food. Income level is the most significant barrier. The cost of market food can be two to three times that of market food in the south. Healthy perishable foods are often not edible by the time they reach Inuit communities. Inuit food security includes the harvesting of country foods. Some Inuit are unable to do this because of the high cost of equipment necessary for hunting or the lack of hunting skills.
Inuit have limited access to comprehensive health care services due to geography, program design, program funding, capacity, resources, language and culture. Most Inuit communities have only primary care services, so patients must travel to regional centres or southern cities for specialist consultations, operations and childbirth. This standard first line of care is not comparable to the rest of Canada. Nurses, rather than physicians, are the first line of care. Challenges at this level include recruitment, retention and cultural competency of the qualified health professionals.
Major threats to the Arctic environment such as global warming and contaminants strongly affect Inuit food security, and spiritual and cultural values.
Self-determination improves health outcomes since communities that control their resources and services can initiate programs to match their needs. This reduces delivery gaps and creates valuable support networks for vulnerable groups. Control over fiscal resources enables communities to plan enduring, well-integrated economic, social and health programs that spawn lasting changes. Furthermore, self-determination generates new employment opportunities associated with running institutions and programs.
It is vitally important that coordinated and innovative approaches be taken, not only to treat the ill but also to address, in a holistic manner, the factors contributing to the health status of Inuit.
The Chair: Thank you, Ms. Cooper.
Finally, we have Robert Doucette, President of the Metis Nation — Saskatchewan.
Robert Doucette, President, Metis Nation — Saskatchewan: Thank you, honourable senators. I have been thrust into this delicate position. They think I am the ace of the bull pen. We will see if I can throw a spinner.
Some of the languages that Metis speak in Canada are Cree, Dene, French and English. On behalf of Metis throughout Canada, I would like to thank you for allowing me the opportunity to address this committee with regard to the population health of Metis people in Canada.
Governments always take the right first step by inviting Metis to participate in these discussions. However, the benefits fall short as the relationships do not extend beyond discussion.
Currently, Health Canada separates Aboriginal groups into the following: First Nations, Inuit and Aboriginal. I assume Metis fall into place somewhere. However, as this separation is evident on Health Canada's website, it is a clear symbol of the jurisdictional black hole Metis fall into federally, provincially and municipally. Metis are marginalized by government and this continues to marginalize Metis further. It is First Nations Inuit Branch and we think it should be FNMIB, First Nations, Metis and Inuit Branch, There should be a letter change here, not FNIB but FNMIB.
To support the need for government to work with Metis separately out of respect and the need to identify health indicators according to risk factors and other disparities, I would like to quote from a presentation made to the National Aboriginal Health Organization, NAHO, by Dr. Carrie Bourassa, a Metis woman from Saskatchewan, and a research expert on Metis health indicators. I have presented the honourable senators with a copy of the report, The Impact of Socio-economic Status on Metis Health: A Brief Introduction for Community.
Results from the Aboriginal Peoples Survey, the 2001 Census and the 2001 Canadian Community Health Survey indicate that Metis suffer a lower socio-economic status — lower incomes, wages, employment, and levels of educational attainment.
This is in spite of similar levels of involvement of Metis and non-Aboriginal Canadians in the workforce. Even among individuals with similar education, Metis earn lower incomes compared to non-Aboriginal Canadians. Clearly, class and race issues combine to affect the socio-economic status of Metis. The lower socio-economic status among Metis appears to affect their health.
Specifically, Metis with low income and education report lower self-rated health compared to non-Aboriginal Canadians with low income and education. Clearly, these issues need to be further examined and better quality data is required. There is also a need for programs to address socio-economic disparities in order to attain optimal health and well-being for the Metis in Canada.
The lack of data on Metis is due to the lack of willingness, we think, among government agencies over the years to recognize Metis separately. As I have said, as an example, it is FNIB, it is not FNMIB.
This is contributing to the lack of proper comparisons between Metis and non-Metis, resulting in a lack of specific targeted programming that is developed by Metis people for Metis people in the areas of health care and health care delivery. There is absolutely no data on Metis infant mortality rates and this is the standard for determining the health of any group of citizens. As there is no data, there is no adequate response to the stress on Metis health of some Metis people, who are at five times a greater risk than non-Metis to suffer from a chronic disease.
How does this affect our community? To give you a couple of examples, in a stimulus package, when they set aside I think it is $325 million for First Nations and Inuit health, not one dime was set aside for the Metis, not one cent. How does this impact us at the community level? I will give you an example.
In Saskatchewan where we had a really tough winter, a Dene Metis Elder from Laroche had to put on his Ski-doo suit and hitchhike over 400 kilometres to go to a health appointment in North Battleford because he did not have the money. He could not get a ride in the taxis provided to First Nations, despite the fact that their communities are side by side. The taxi was full so he hitchhiked in his Ski-doo suit to get to his appointment. I had to go in turn and get a hotel room for him and give him some money so he could eat, sleep and then return to Laroche. That is in Canada today.
I am sure you are all aware of the fact that Metis are the only Aboriginal group in Canada who do not have access to receiving coverage for non-insured health benefits. Metis people must pay the costs for transportation to medical appointments and prescription drugs and other medical supplies themselves. Given the lower levels of income and employment for Metis people, having to pay these additional costs makes it even more difficult for Metis people and organizations to improve the health of the population. This is an unfair practice and it creates even more challenges for an already-challenged Aboriginal population group.
I can tell you a funnier story. I went to the dentist and had to get my teeth fixed. My younger daughter, Julie, was sitting beside me. I was paying my $373 and she looked at me and said, "Dad, how come you're paying for your teeth? Every time I come to get my teeth fixed they don't charge me." She is registered as First Nations. I said, "Well, my girl, I am Metis and you are First Nations and I have to pay because there is no health coverage for Metis." She said, "Well, that's not fair." She pulled out her treaty card and said, "Here, put it on my card." The dentist said, "No, it does not work that way. Your dad has to pay because people in Ottawa will not cover that."
I do want to turn this around and tell you that there is much positive work presently being done by Metis in the areas — and the federal government — of developing Metis health indicators. Health Canada, through its Aboriginal health transition fund, has acknowledged the need to build capacity in Aboriginal organizations to start dealing with the lack of knowledge, the lack of data and the lack of a relationship that has hampered the Metis from being a part of public health policy.
Metis know the need for focusing more attention on the health of Metis, and some organizations have been working hard over the years to build expertise in this area. For example, the Manitoba Metis Federation has 78,000 Metis on file and is creating the data infrastructure that will create linkages to measure and monitor chronic diseases such as diabetes, cancer and HIV. It has taken Dr. Judith Bartlett, a previous presenter to this committee, 15 years of sheer determination to get to the point Manitoba Metis are at now.
In Saskatchewan, only in the last year, with funding from the Aboriginal health transition fund, AHTF, has the Metis Nation of Saskatchewan been collaborating and pulling together health care officials to identify Metis health indicators. It is starting with a provincial-wide survey, which will determine indicators for programming specific to health issues brought forward by Metis. We hope the success of this undertaking through funding from Health Canada is met because we are driving the agenda. We get our direction from our communities and our people. We can no longer afford to wait for someone else to take care of us.
The gap in Metis health public policy over the years has created a very hard wall to climb. A standard disconnect has been created by the territorial relationship between Health Canada and provincial health departments that for the most part, as we can see, are adversarial and focus primarily on bottom-line costs.
The AHTF is a good start but it must develop into a strong and collaborative relationship between willing partners who sense the urgency and the need in our communities. As my colleague, Bob Watts, said, all of our children deserve better. Yes, there should be a comprehensive Aboriginal health policy but the framework must be developed in the communities by First Nations, Metis and Inuit, not by policy-makers in institutionalized systems so far removed from where the front-line workers reside.
The health of the Metis people is important to all us of us as Canadians. Over the past several years the Metis National Council and its governing member organizations have engaged federal and provincial representatives, as well as our communities, in an effort to determine the status of our health, and develop policies and programs that will improve both the health and conditions of our people and our great country, Canada. From our contributions to the development of a federally managed national framework on Aboriginal health in 2004, to our work with various provincial government departments to build Metis recognition and rights, and our work with the Office of the Federal Interlocutor in 2008 to establish the Metis protocol, we have demonstrated both our commitment to and the gaps in improving the health in the Metis population in Canada.
We remain hopeful that we will see a clear verbal and fiscal commitment by the federal and provincial governments to assist us in improving the health of the Metis citizens of this country. I would just give you three or four recommendations. Like my colleagues, Mr. Watts and Ms. Cooper, you should encourage Parliament to build a tripartite relationship between the Metis National Council, governing members, and the provincial and federal governments to alleviate the health issues of Metis people, renew the Aboriginal health transition fund, increase funding to Metis governing members, and create Metis-specific health data. I do not know how could you do that, maybe through the Census of Canada and Health Canada to create Metis-specific health services for Metis citizens across this country.
Thank you for allowing me to do this presentation. God bless all of you and your families. Marci choo.
The Chair: Thank you to all three of you. The senators would like to ask questions. I will be brief. One of the issues we have difficulty in dealing with, Mr. Doucette, is the fact that the Metis do not seem to be as structured as the Inuit and First Nations. They seem to be more spread out. Developing models of community health, well-being and productivity for First Nations and Inuit is simpler than it is for the Metis.
I passed out a suggested model for a platform of population health and the support of the life cycle on that platform, which might, in some form, make its way into our report. However, the problem is to identify communities of Metis where you can build community strength and deal with a dozen or so determinants of health. Would you tell me where you think such communities could be found for prototypes?
Mr. Doucette: To be honest, since the 1800s when they set up the reserve system, you will find a Metis community wherever you find a reserve. As an example, Metis Nation in Saskatchewan represents over 100,000 Metis people in the Province of Saskatchewan, as represented through 133 Metis-specific communities.
From Uranium City in the north to Arcolain the south, we have identified Metis communities that send representatives which are elected to our Metis Nation Legislative Assembly every year. By way of example for statistics, 70 per cent of the total Metis population in Saskatchewan live in three cities: Regina, Saskatoon and Prince Albert.
If there was a need to look at specific communities, those are communities right there. You have Metis-specific communities in northwest Saskatchewan such as Buffalo Narrows, La Loche — La Loche has 3,000 to 5,000 Dene Metis-speaking people — Ile-à-la Crosse and Cumberland House. Those communities have been around since 1776, so there are Metis-specific communities that could be targeted for specific health services and programs. I do not see that as being a problem.
The problem is capacity. I do not want to take a swing at anyone, but it is capacity and it is the commitment to actually lay out some money so that there are Metis-specific dollars there. For goodness sake, it says something to me when a Metis Elder hitchhikes in minus 50-degree weather to have a piece of metal removed from his eye. I think if the willingness is there to sit down with governing members of the Métis National Council, I think we could do a really good thing for this country and address the health issues of the Metis people. By the way, the Metis are Aboriginal peoples as listed under section 35 of the Constitution but we are treated like we have no rights.
Health is not an Aboriginal right; it is a human right.
I do not know if that answers your question.
The Chair: Yes, it does.
Senator Eggleton: I am trying to determine what might be the way forward. I appreciate all the comments that all three of you have made and you have outlined quite well how your communities are affected.
However, I am looking for a way forward. For example, the subcommittee's report, Poverty, Housing and Homelessness: Issues and Options, with respect to Aboriginal Canadians, talked about whether we should take a comprehensive approach — to cover all of these. Remember, the determinants of health are comprised of many things, including employment, education, poverty and housing; all these things can impact on a person's health, as you know.
The comprehensive approach to it, of course, covers a lot of government departments at all levels. That said, there could be a more incremental, step-by-step approach; a bit at a time, step-by-step.
There is another possibility. In 2005, there was an agreement among federal, provincial and Aboriginal leaders on the Blueprint on Aboriginal Health. I do not know if you are familiar with that. This was to be a guide for future decision-making involving all the orders of government and the First Nations, Metis, Inuit and those communities.
Is that a kind of framework that you think might be a good one to follow in the case of population health, if it were broadened out into these other determinants of health, or is there some other way forward?
What is your vision of how we could move forward with this and be organized to deal with these issues? That is a big part of it because there are so many aspects to population health.
Mr. Watts: As we outlined in our submission, some of the ideas we put forward in terms of tripartite policy fall into some of the same principles identified in the blueprint for health. Therefore, I think those principles are still good.
I recognize what you said, too, senator. It is sometimes hard to get two federal departments to sign the same document, let alone a number of provinces and perhaps other departments around the same table to agree to the same thing.
To us, the idea of a comprehensive approach makes absolute sense. We have been "incrementalized" to death and we need a comprehensive approach; we need the players around the table who have the infrastructure, money and willingness to work with us. We have lots of ideas in terms of how to deal with these issues and these ideas come right from our communities.
We need some willing partners. That is what we talk about in terms of a tripartite vision: Trying to bring those resources and that expertise all around the same table so we can focus on these issues.
We do not think it is that tough to do it. We have done it before. The Kelowna Accord was an incredible process where we had every level of government at the table, agreeing on a number of principles, goals and objectives to deal with issues from health to education to housing to jobs and everything in-between.
We know it can be done if the will exists to do it.
Ms. Cooper: In the Inuit world view, health, education and social conditions are all intertwined. It is a real challenge when you have departments that work pretty much in silos. How does one ensure that it is culturally based and relevant to the world view of Inuit?
Therefore, we tend to look at these issues in a more holistic manner, ensuring that we are looking at the gaps and how they relate from housing to health and all these other indicators that are associated. It is a real challenge for Inuit to work with a system that operates in silos.
The Blueprint on Aboriginal Health is a good model but it needs to be Inuit-specific for us, as we see it.
In 2007, the Inuit held a health summit in Kuujjuaq with all the provincial and territorial parties participating. There is a model there, as well, that is very Inuit-specific. If you like, we can provide that report to this committee as background information.
Mr. Doucette: Thank you, Senator Eggleton. I think a comprehensive approach, as my colleague, Mr. Watts, has said is a good way to go. As First Nations and Inuit believe, the Metis believe that it has to be holistic, too. I think that is echoed in Ms. Bourassa's paper about how everything is intertwined.
As the example of employment and training, we have the Aboriginal human resource development agreement which sunsets in 2010. I think the federal government should renew that with the Aboriginal groups because there is a benefit. That allows us to target specific resources to the socio-economic problems that Metis people face. That is an example.
The Aboriginal health transition fund, again, as Mr. Watts said, sunsets in 2010. That is another good program and there should be specific funding earmarked for Metis. No housing money is targeted for Metis. As for post-secondary education, while First Nations and Inuit receive 48 months of funding to get an undergraduate degree and 10 months to get a master's degree, there is nothing for Metis.
Yes, I would like to see an incremental approach. We do not see that there. We do not see any approach.
I cannot really comment on the Blueprint for Aboriginal Health. Like I said, I am just a right-handed pitcher thrown in out of the bullpen on this.
Senator Eggleton: I am sorry to throw you a curve.
Mr. Doucette: You just drove it back at me from home plate. There must be some Metis-specific, earmarked capacity from the federal government, in partnership with the provincial governments, to deal with things in a holistic manner. That is the way to do things. That is the Canadian way, the Metis way.
The Chair: Our plan is a recommendation for a whole-of-government approach that will get wired to the ground at the community level. I think that is what you want.
Senator Callbeck: Thank you for coming and for your presentations.
Senator Eggleton talked about the blueprint, Mr. Watts, and you said you agree with the principles in it and a comprehensive approach. This came out in 2005. Has there been any follow-up? My understanding is that this was a guide that was agreed to. I have the blueprint right here. All the governments were there, including the federal government, the national Aboriginal associations, Assembly of First Nations, Congress of Aboriginal Peoples, the Inuit, Metis, the Native Women's Association of Canada. After this came out, was there any follow-up — or what happened?
Mr. Watts: My staff will be able to go into more detail later. I do not know if you can draw a straight line from the blueprint to the tripartite model I talked about in B.C., but I think it finds some inspiration there, and it finds some inspiration in the Kelowna Accord. Some of the work being done on health professionals is certainly there. Health Canada has been doing some thing in terms of implementing this, but in terms of provinces moving lock-step with the federal government and with ourselves, we are not seeing a whole lot of that. There may be some things on a sub-regional basis being done, but certainly not something where you could say that, as a nation, we have the provinces and the federal government and First Nations peoples moving together to address these issues.
Senator Callbeck: Who was to take the initiative on this?
Mr. Watts: That is a good question. I think it is incumbent upon all of us. We all put our names to it. Parts of the agreement were not written into the agreement. We had talked extensively about a health escalator, for example, and we thought we had a deal on an escalator, and that never manifested itself. In terms of pointing fingers, I am not really keen to do that. I can tell you that we have consistently and persistently knocked on doors of provinces and many federal departments to try to get them around the table to move these ideas forward. As I noted in the presentation, we have had some success in some areas, but in terms of what Senator Eggleton would call a comprehensive approach and bringing everyone to the table, that has not manifested itself.
Senator Callbeck: You mentioned the escalator clause in your comments. You want the same as the provinces, but is your health and social transfer based on per capita?
Mr. Watts: I do not believe it is based on per capita because it has been capped for so many years. It is on a base that was established a number of years ago, and it has increased at 2 per cent to 3 per cent. As both of my colleagues to the right and left of me have said, our population is booming. It is growing at a far faster rate than that of the rest of Canada. The Canada health transfer goes at between 7 per cent to 9 per cent, we are being funded at increases of 2 per cent to 3 per cent, but our population growth is two, three, four and sometimes five times as great as the rest of Canada. Imagine how much we fall behind every year.
Senator Callbeck: There are advantages to this blueprint, but are there improvements to be made here?
Mr. Watts: Most certainly. There are some advantages in there, but in terms of how it manifests itself, I would say there are certainly improvements to be made. We have learned things in the meantime, too, in terms of new technologies and ways of doing things, and they need to be incorporated.
Senator Callbeck: Ms. Cooper, you mentioned that the Inuit came up with another plan in 2007. Was that just for the Inuit?
Ms. Cooper: Yes.
Senator Callbeck: Are you familiar with this blueprint?
Ms. Cooper: My director is more familiar with it, yes.
Senator Callbeck: I wanted to ask Mr. Watts about the sustainability resource plan for First Nations health and human resources. Are we making any headway there?
Mr. Watts: I think we are making headway. If we count the number of First Nations doctors in the country compared to what it was five years ago, there has been an increase. If we count the number of First Nations nurses, there is an increase. In terms of health and human resources, there has been some improvement. At the same time, as I noted in terms of being able to deliver the services at the community level, that is capped, so the ability to retain the very best in our own community makes it impossible. There is so much competition for those folks. It is not all doom and gloom. We are making progress. If we had programs that were funded in a manner that we could keep our people in the communities and working on these issues, it would be immeasurably more successful.
Senator Pépin: Ms. Cooper, you mentioned in your presentation that, although most communities do not have hospitals, every Inuit community has one or more, but the challenges include recruitment and retention of qualified staff and nurses and things like that. You also mentioned that there is a conspicuous absence of traditional Inuit knowledge in health service delivery. How would you see it? How would you organize it? If we have a plan and we want to make some recommendation to the government, how would you organize your nursing and doctor health delivery?
Ms. Cooper: Specifically, in Nunavut, the Government of Nunavut does have a nursing program now, and they do take the nursing program in Iqualuit, but again, there is the matter of the social conditions and being removed from there.
Senator Pépin: The distance?
Ms. Cooper: Their family and the social conditions impact on completing these nursing programs, so the mobility of training courses would be an example of providing the proper training required.
Another example is midwifery. As I mentioned, many of our pregnant ladies are going to central communities up to three months before their delivery date. Imagine, if you will, being away from your family, your husband and children, and the added stress on the individual. I used to work in public health, and I used to watch some women actually hit their stomachs because they wanted to deliver and get this over with. In what should be the most celebratory time in delivery, they do not have their family with them. You go back home with a new baby and your children greet the baby, and there is not that bonding that should have been occurring with your family.
In a traditional setting, I have experience where the whole family is surrounding you. When I was about seven years old, I actually saw how a woman delivers. My mother was teaching me, "This is what you will experience when you become an adult and you rear your children." It is so far removed from the traditional way of giving birth to be in a cold environment that takes the mother away from the family.
There are many examples. There have been efforts that have looked at mobilizing training developments from community to community, to see what works. The technology today is also advantageous, to go online to take courses, but again it is the education levels that impact.
ITK held a very Inuit-specific summit on education. We are just around the corner now from signing an education accord in April that has the federal-provincial-territorial partners along with our four land claim signatories. The practitioners, the teachers and the policy-makers were all at this summit. There are very specific strategies that we have highlighted for this national committee that will come into play to focus on how to deal with the gaps on education.
We encourage you to also monitor this and see how we address it. Again, it is how to get the communities to take ownership of these social conditions.
There is a high level of turnover with nurses and doctors. If you are dealing with mental health, an individual may see a psychiatrist for 15 minutes and a determination is made within this 15-minute period that he or she has an illness. The person is labelled on his or her medical record with this, and many times there is no way of getting around that.
Retention is a real issue for us. Again, we need to put in that investment for Inuit to be front-line workers. It is a real challenge when we get the certified or university-degree Inuit. We are competing for them in different sectors, because we need the educated people.
We need to find the balance of ensuring that the expertise for the communities is retained for the long-term period.
The Chair: Thank you. Unfortunately, we have to adjourn. It is five o'clock. We will reconvene at six o'clock. I ask all guests to leave the room because we are going in camera for social affairs.
(The committee adjourned.)