Proceedings of the Subcommittee on Population Health
Issue 2 - Evidence - March 25, 2009 (evening 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 6 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 determinants of health (topic: population health policy for Aboriginal peoples).
Senator Wilbert J. Keon (Chair) in the chair.
[English]
The Chair: Honourable senators, I call the meeting to order. Our witnesses tonight are Erin Wolski, Health Director, Native Women's Association of Canada, NWAC, and Paulette Tremblay, Chief Executive Officer, National Aboriginal Health Organization, NAHO.
Erin Wolski, Health Director, Native Women's Association of Canada: I am a health director for the Native Women's Association of Canada. I am originally from the Treaty 9 territory in Northern Ontario and am a member of the Chapleau Cree First Nation.
I am very happy to be here.
It is important to tell members of the committee who may not be aware, and to remind those who are aware, that NWAC is the only national Aboriginal organization in Canada solely responsible for representing the interests of Aboriginal women. We take this responsibility very seriously. While we appreciate being invited here today, I must express our disappointment with the scheduling and the manner in which our organizations were grouped today. We are disappointed with the separation that occurred.
All too often, Aboriginal women are relegated to the sidelines, our perspectives dismissed and our concerns undermined. It is a constant struggle to keep our issues on the table, and very disheartening when these types of things occur.
Aboriginal women's voices have been silenced by a broad range of influences within both Aboriginal and non-Aboriginal society. It is our goal to raise awareness of the impacts of this, but also to provide concrete ways in which our voices can be heard.
This meeting represents an opportunity for NWAC to put this on the table and to let you know that we believe we have a solution and a way forward. We have been heavily involved in work related to culturally relevant gender-based analysis this past year with support from Health Canada. Our culturally relevant gender-based analysis framework provides a mechanism where both gender and culture can be incorporated into policy development processes.
I will refer to that as the CRGBA. The CRGBA framework is one way that we think a balance of perspectives can be brought into the scope of work being done in health and beyond, not only at this level, but locally, regionally and across the country where Aboriginal women and their families live, work and access services.
Our purpose today is to discuss issue 3 of the subcommittee's Issues and Options report: Implementing an Aboriginal Population Health Strategy, an important issue to be sure, and this meeting comes at a critical stage. However, it can be agreed by all of us here today that a strategy to sustainably address Aboriginal peoples' health has yet to be developed. The population health approach is a good one, and if we consider the diversity of perspectives at this table, the outcomes will be more sustainable.
We should make the most of our precious time today with members of the committee and the Aboriginal organizations at this table to discuss ways we might work together toward the development of an Aboriginal population health strategy, and to discuss how we can do this meaningfully, incorporating gender and culture.
I can say with confidence that the women I represent would be more than willing to dedicate the time and effort needed to ensure that the strategy is successful.
First and foremost, it should be acknowledged that, while Aboriginal people experience a disproportionate burden of ill health, Aboriginal women tip the scale in terms of experiencing multi-level impacts. Our women experience extreme burdens of ill health, more and more often. Aboriginal women are disproportionately represented in every aspect of society. We are the winners: We have the highest rates of poverty; we experience more violence and more chronic illness. We commit more suicides and we are incarcerated at the highest possible levels. Many of our women go missing and are murdered every year at astronomically high rates. These are the realities of the women I am here to represent. These are the realities created and perpetuated by Canada's legislative framework on Aboriginal peoples.
The culturally relevant GBA framework that I referred to earlier speaks to colonization, and the impacts and outcomes of the patriarchal institutions that were imposed upon our people through colonization.
It is important to preface my next comments by saying that colonization is not a historical event; it is a current event. Canadian legislation impacts Aboriginal people differentially and impacts Aboriginal men and women differentially. It impacts us today, every day in our day-to-day life.
With colonization came the systematic denigration of the value of Aboriginal women's roles in our society. Colonial laws were specifically targeted at Aboriginal women. Their connections to the land were recognized early on, and because land acquisition became a goal, Aboriginal women became the target. Through various laws, policies and Christian etiquettes, a demeaning and demoralizing portrayal became the identity of Aboriginal women in Canada, forcing them into an oppressed position in society.
The culturally relevant gender-based analysis framework we have developed captures the multi-level impacts of gender and cultural disadvantage, while revitalizing the value of Aboriginal women's roles and reconnecting culture and gender to positively impact health and healing.
The following case study on diabetes in Aboriginal people illustrates how that framework works. It is important to segregate data related to diabetes in order to truly understand the implications for Aboriginal women and men. Note that the need to disaggregate data is a relatively recent development. Health research and clinical trials were historically conducted on men only. Biological or hormonal differences, including pregnancy, were labelled syndromes. This placed women at a great risk, as the findings derived from male-oriented trials, when applied to women, rendered false and, at times, dangerous results.
The data shows us that while Aboriginal people experience disproportionate rates of diabetes, Aboriginal women experience higher rates of diabetes than Aboriginal men. The data also shows us that men experience more amputations due to diabetes.
This information becomes critically important in dictating the direction of diabetes programming for Aboriginal people. Aboriginal women would benefit from preventive-type programs whereas Aboriginal men would benefit from self-care-type programs. However, when you add the cultural lens to this scenario, a clearer picture emerges about the disease that can broaden our understanding and perhaps trigger the development of more sustainable solutions. Through the CRGBA, facts will emerge that explain how and why Aboriginal women are predisposed to becoming diabetic and experiencing high rates of the disease.
The population health approach being proposed in this committee's paper is one that would be supported by the Aboriginal population given that it is akin to taking a traditional approach to health where the whole person is considered and issues are not looked at in isolation. While it is important to take measures to address Aboriginal peoples' health through a population health approach and through the development of a comprehensive strategy focusing on social determinants, it must be understood that these are outcomes. Our poor overall health standing is measured in poor housing needs, poor educational attainment and our low socio-economic status. These are all outcomes of a much bigger systemic issue.
Tackling Aboriginal issues in a symptoms-based approach will not bring about the type of sustainable, long-term change we need. We — each and every one of us here today — need to discuss the real issues, the root causes that have created our current situation. We cannot continue to ignore how our circumstances have been created and how they are being perpetuated — and, yes, these are complex issues. The Aboriginal condition in Canada today came about through a systematic, concerted agenda of a dominant culture to eliminate the Indian problem and will take a systematic, concerted agenda to change.
I would like to encourage you all to consider the cultural, gendered approach to Aboriginal health and health issues. We should consider for a moment the risks we are taking with our future if we choose to ignore this perspective.
As Aboriginal women, our priorities are our children, our grandchildren and our future generations. Our concerns are for family and community health and well-being. We need to be thinking in this context and ask ourselves: What actions are we taking today that will impact the health of our children, our families and our communities? If we make our children the priority, the things we choose to focus on today might be different.
To reiterate, I do believe that it is important to address the social determinants of health, as you have identified them. However, the missing elements — the most critical elements — are the systemic issues. We should not be focused on beating the odds. We should be focused on changing the odds.
The Chair: Thank you. I want to apologize for the disruption that occurred today. Life in a place like this does not always go smoothly. We did not really mean any harm, but I am sorry. Ms. Tremblay, please proceed.
Paulette Tremblay, Chief Executive Officer, National Aboriginal Health Organization: I would like to extend warm greetings to the chair of the subcommittee, Senator Keon, and the senators on the committee.
Thank you for inviting the National Aboriginal Health Organization, or NAHO, to participate in this public hearing about the extremely important topic of First Nations, Inuit and Metis population health policy in Canada. I am a Mohawk from the Six Nations of the Grand River Territory in Southern Ontario and I belong to the Turtle Clan. I am here today in my role as chief executive officer of NAHO. NAHO was established in 2000 to influence and advance the health and well-being of First Nations, Inuit and Metis peoples and communities by carrying out knowledge-based activities and strategies.
In responding to the issues posed and the options available in the most recent report, Population Health Policy in Canada: Federal and Provincial/Territorial Perspectives, NAHO supports the following options as the 'future focus' to address First Nations, Inuit and Metis population health policy in Canada. We extended this looking at all three options because we thought it was more viable than being restricted to just option 3.
First, we believe that a comprehensive population health strategy for First Nations, Inuit and Metis peoples, with a 'whole government approach' that links health to other policy fields and the interaction among the determinants to better understand the health and well-being of First Nations, Inuit and Metis peoples, is absolutely essential. This deals with issue 2, option 4. We would like to bring your attention to the fact that you cannot implement something before it is developed. The word that was used was "implementation." We would say that we need to develop it first, before we can implement.
Given the interacting influence of the determinants of health, focusing on selected determinants is inadequate. According to the 1946 World Health Organization, WHO, a broad definition of health that transformed the analysis of health from an 'absence of disease' model to one that encompasses a holistic wellness approach is what NAHO would support. The emergence of the WHO definition states the preferred approach, namely an integrated approach linking together all the factors related to human well-being, including the physical and social surroundings conducive to good health. Thus, the focus is on wellness and good health.
To ensure this approach to address population health is effective, it is of utmost importance to engage First Nations, Inuit and Metis leadership from the outset, from ministerial-level meetings to the technical-level discussions and planning. Furthermore, the effective participation of First Nations, Inuit and Metis communities and organizations will require the provision of additional new resources for these bodies to be able to participate.
Second, in order to be successful, an unprecedented level of collaboration and intersectoral action which engages First Nations, Inuit and Metis communities, federal government departments, the federal, provincial and territorial governments, First Nations, Inuit and Metis governments, and the non-governmental sector will be required. This is issue 2, option 6. Working across sectors is necessary to address the determinants of health and to determine which interventions at the community levels are most promising and producing positive results. This needs to be a staged process of inclusive evidence and partnership building. It should include the establishment of health goals, objectives, indicators and targets that are derived from an investment in First Nations, Inuit and Metis-specific research.
That is why I am using the three terms. We do not use "Aboriginal" at NAHO; we say First Nations, Inuit and Metis. Although it is in our name, we are trying to get the focus to be population specific. We are a search organization and this is very important. This is issue 2, option 2.
It will also be necessary to examine and modify Treasury Board authorities to allow for cross-sectoral and intergovernmental collaboration. All departments will have to be involved. Therefore, Treasury Board and Health Canada need to share the mandate to develop a First Nations, Inuit and Metis population health strategy. Investments must be made in order to track health outcomes and support research on interventions.
I cannot emphasize enough how important this is. The ability to make targeted interventions and evaluate them is the key to enhancing the health of First Nations, Inuit and Metis. Currently in Canada, the systems for tracking and evaluating interventions are seriously underdeveloped.
Third, it would be beneficial to combine an investment in more population health research and the enhancement of knowledge translation — this is issue 1, option 2 — with strengthening peer learning among First Nations, Inuit and Metis populations. This is issue 3, option 3. The investment in research would create the necessary indicators, baseline of health outcomes, disparities and what works. Promising practices recommend disaggregated data generated under the leadership of, or with full cooperation of, First Nations, Inuit and Metis communities in the design and implementation of research and surveillance projects and programs.
NAHO, working in collaboration with partners such as the Institute of Aboriginal Peoples' Health or the Canadian Institutes of Health Research, the Aboriginal Health Research Networks, and the First Nations, Inuit and Metis community colleges, is prepared to play a major role in this area. NAHO has a history of success in knowledge translation, promotion of First Nations, Inuit and Metis health, and public education.
The federal government must make investments at the community level. They must ensure community-level priorities are addressed in a community-driven approach. It is well known that a top-down approach does not, and will not, work — only a community-driven approach will ensure the built-in flexibility to accommodate the diversity of First Nations, Inuit and Metis populations in Canada. Community control over resources has an amplifying effect on results. When programs and decisions are under the control of an appropriate community authority, outcomes are improved compared to similarly resourced but externally controlled and applied processes.
NAHO is unique. We are a non-profit organization founded upon and committed to unity while respecting diversity. We are community focused. NAHO gathers, creates, interprets, disseminates and uses both traditional First Nations, Inuit and Metis and contemporary western healing and wellness approaches. NAHO reflects the values and principles contained in traditional knowledge and traditional healing practices.
NAHO has three centres that focus on population-specific health and well-being initiatives: the First Nations Centre, the Inuit Tuttarvingat and the Metis Centre. NAHO also has a communications research unit that looks at crosscutting initiatives, highlighting two or three of the populations — First Nations, Inuit and Metis. For example, NAHO has the following crosscutting resources available on our website: the Honouring Life Network, which is a suicide prevention resource; the National Aboriginal Role Model Program, which is hugely successful across the country, where role models go out to communities to work with community youth; the Aboriginal Children's Circle of Early Learning, a website on early childhood development; and the Journal of Aboriginal Health. This is simply a few of the resources. I encourage you to visit our website at www.naho.ca where there are many more resources available, including some specific to population health.
Recent demographics paint a clear picture of the tremendous growth of the First Nations, Inuit and Metis populations. This creates an opportunity for Canada to make significant investments in human resources that have the potential to make positive and long-lasting contributions to communities and the country. There are benefits to be gained from investment, action and collaborative ongoing relationships. According to the Statistics Canada 2006 Census, there are 1,172,790 Aboriginal peoples that accounts for 4 per cent of Canada's population. Of these populations, First Nations account for 60 per cent, Inuit are 7 per cent and Metis are 33 per cent.
The First Nations, Inuit and Metis populations are the fastest growing segment of the population, growing nearly six times faster than the 8 per cent increase for the non-Aboriginal population. Metis are growing more than 11 times faster and First Nations and Inuit are both growing at three times a faster rate than the non-Aboriginal population. These are significant growth rates.
Fifty-four per cent of Aboriginal people live in urban areas and 48 per cent of the First Nations, Inuit and Metis population consists of children and youth aged 24 years and under, compared to 31 per cent of the non-Aboriginal population.
However, the most striking statistic that we must pay attention to is the next one. The First Nations, Inuit and Metis populations are young. Half of the Inuit population is 22 years and younger; half of the First Nations population is 25 years and younger; and half of the Metis population is 30 years and younger. This compares to half of the non-Aboriginal population, which is 40 years and younger.
This means we have to pay attention. Our children are very important and they need us today, not tomorrow. The time to act is now.
In conclusion, I commend you on embarking on this arduous, but necessary, journey. Please remember that an approach that engages the right parties from the very beginning, with communities as the focal point of any intervention, is the one that will be successful.
The Chair: Thank you, Ms. Tremblay. We have with us Rose Sones who would like to clarify some of the testimony that occurred earlier this afternoon.
Rose Sones, Assistant Director, Strategic Policy for Health and Social, Assembly of First Nations: There were two questions asked and I thank you for the opportunity to clarify them.
One of the questions was in regard to the Blueprint on Aboriginal Health. I should clarify that we referred — maybe in error — to the blueprint also as the Kelowna Accord. We use them somewhat interchangeably. The actual document, the Blueprint on Aboriginal Health, is a public document and was fully supported by the provinces and territories.
The question arises about what happened to it and who has responsibility to move this forward. In the fall of 2005, the provinces, territories and the federal government, as well as all five national Aboriginal organizations, including the AFN, were at the table. We signed off on if. It was a surprising turn of events when the election occurred and the next government refused to acknowledge it. In fact, I think the next government referred to this document as a press release. It was a surprising turn of events. First Nations communities continue to show their support for this. Provinces and territories have said publicly that this was a good plan. We needed to move forward with it.
To emphasize the continuing support for it, a private member's bill, C-292, was passed by the House of Commons and the Senate to implement the Kelowna Accord. It demanded that the federal government be accountable and report back yearly on its progress.
The Prime Minister noted in his apology on behalf of Canada to residential school survivors that this was a new beginning and an opportunity to move forward together in partnership. We are still waiting for movement. We believe that, for the federal government, this is now the time to act.
The question also asked about the comprehensiveness of the Blueprint on Aboriginal Health. It is now a dated document; it was written in 2005. It was done in full consultation. First Nations in every single region of the country did a lot of work and prepared regional plans on it as well. We could update it, particularly to match some of the evolution in technology in health. However, the base principles in that document are still worth pursuing.
You had one other question around the cap on funding, if I have the opportunity to clarify that as well. The question was whether it was based on population. This has been lost somewhat in corporate history now. In the late 1980s, development on the long-term strategic finances for non-insured health benefits drove a lot of the funding that occurs now.
In the 1980s, the decision was made to hold at a lower level of yearly increase because it was believed that First Nations populations would not grow. Therefore, our funding is essentially locked at that 1980's population. I do not have the statistics in front of me on how much the population has grown since then. However, the funding certainly does not reflect population growth, and it does not reflect the cost of increases, the real cost of doing business.
I thank you for that opportunity to clarify these points.
The Chair: Thank you, Ms. Sones.
Senators have questions for all of you, but before moving on I want to ask Ms. Wolski about empowerment of women since you represent the Native Women's Association of Canada. It has seemed to me for a long time that one of the most powerful instruments to eliminate many of the problems, indeed, in the world, but certainly in our own country, revolves around the empowerment of women.
There has been significant progress in the non-Aboriginal world. However, women certainly are still not empowered the way they should be. In areas of less affluence, it appears that women's empowerment is really compromised. How can we do something useful in the report for the empowerment of women?
Ms. Wolski: First and foremost, the culturally relevant gender-based analysis framework we have developed has a fundamental piece about inclusion. Aboriginal women want to be at the table. They want to be included in policy development and processes and in dialogue occurring around issues that impact them. Too often, they are either made tokens or other organizations or people say they are representing the women.
To a large degree, we simply want to be at the table. That is what we have been striving for over the past 35 years since NWAC was originally incorporated. We want that voice at the table because our perspective is often lost. Women's priorities are different from men's priorities. By incorporating those perspectives, we have a better ability to reach and achieve sustainable change. It is simply inclusion.
The Chair: Do you think you are making significant progress?
Ms. Wolski: I feel we are. I feel there is a movement occurring right now. I honestly and truly believe that something is happening. I am quite excited about what will happen over the next five to ten years with Aboriginal women. There are more of us proportionally in school today. Significant changes and acknowledgements are being made.
Statistics are still fairly negative in terms of the high levels of poverty. Seventy-one per cent of Aboriginal women live away from the reserve. There is not a lot of acknowledgement of that. Eighty per cent of those women are raising their families single-handedly. Forty per cent of those are living in poverty. We are raising families while we are in school, and we are doing it in poverty. There is much to be said for the achievements that we have made recently. There is momentum.
Senator Eggleton: I was interested to hear about whether we should take a comprehensive or an incremental approach. Ms. Tremblay answered that quite well.
I take it Ms. Wolski would also prefer a comprehensive approach.
I asked earlier about the blueprint, and I think I got a response on that, so my questions have been answered.
Senator Pépin: You just told us about what is going on with women, saying that they are single parents living in poverty, et cetera. With regard to health, I know that you do not have enough nurses and doctors. I know that you are not the decision makers in other areas, but are you leaders with regard to health services? How is it organized, and how would you organize it better? How could the government help you with that?
Ms. Wolski: Aboriginal women are clearly taking the lead role in delivering health services in our communities and in urban centres. Women in general are taking that role, and Aboriginal women in particular. However, there must be attention paid to those women who are struggling in poverty and do not have equitable access to health services. While there are a number of us in health care services, there are more of us trying to access those services. There are currently many initiatives to adapt health care services to better meet the needs of Aboriginal people.
Senator Pépin: Do they listen to you? Women are the ones providing the services. You are the majority and you know best.
Ms. Wolski: Exactly. We are accessing the services and bringing our children to access them. Change is underway, as I was saying earlier. Initiatives have been taken by Health Canada, for example. It is to be determined what type of impact they will have, but there is a lot of good news.
Senator Pépin: Is there a way to measure the impact, to know whether it is positive or how it could be corrected?
Ms. Wolski: It is currently measured in outcomes. We could use different ways of measuring whether it is having a true impact. Aboriginal women are currently experiencing the highest rates of diabetes, obesity and heart disease.
As I said in my opening remarks, it has much to do with the systemic issues. We need to make a concerted effort to deal with the outcomes, but we also need to look at the root causes. We need a concerted effort on both ends.
Senator Pépin: If the children are provided with good education and food, it will be much easier for the next generation.
Ms. Tremblay: Some of the health areas we are working in relate directly to women. You could tell a story in your report that highlights women from the point of view of making decisions and childbirth and going back to midwifery practices. There is leadership there to maintain the work and momentum in the midwifery movement. We have to continue the work in that area, both prenatal and after birth.
There is much tradition to bring back, and that is starting to happen across the country. We have to look at family and the fallout from the residential schools together. There is a reclaiming of who we are and of the tradition of the birthing process with the family in the room.
This is a very strong and positive movement. It puts the woman at the core of the family as opposed to sending women away from communities and making childbirth a medical experience in a hospital. Women can be isolated from their communities for three months. In this way, the family is brought back into the process with the mother at the core as has been the tradition for First Nations, Inuit and Metis peoples.
It is true that more women are in the education systems than men. They are making a difference and they are having a louder voice. However, we must remember that half of our peoples are under the age of 25. We must pay attention to that fact. We have to bring those people along, so education becomes even more important.
Rosemary Cooper, Director of Executive Services, Inuit Tapiriit Kanatami: As I mentioned earlier, our world view is holistic when it comes to social, health and education. Everything links to everything else and things cannot be broken out.
Given that, many of our men are falling through the cracks with regard to justice issues and incarceration. When you look at the Inuit value, you must look at the family as a whole unit. I was very happy to hear the presentations tonight. However, we need to be cognizant that the values of the Inuit world are based on the family unit and the world view.
Our women have become much stronger over the years and they are the ones who are dealing with the social issues, the conditions in the communities. They are the counsellors, providers and child rearers, but we cannot forget our men and our children in this process. We need to be cognizant of giving men equal attention.
Senator Pépin: If I understand correctly, it seems that women are becoming the leaders and men are having big problems right now. You are telling us we have to do what we can to improve their lives also.
Ms. Cooper: There is movement taking place for Inuit men as well. There are more healing programs for them. It is not considered normal for a man to share or cry. It is important, especially for former residential school students, to express the challenges they face. They need healing to improve their life cycle. Women are really pushing for men to take more ownership and to take control of their lives.
Senator Pépin: As long as they will listen.
Ms. Cooper: We have strong male leaders as well, which is great.
The Chair: This is fascinating. We have been holding hearings for a couple of years, and the consistent message, which we have heard again from Ms. Tremblay, is that we have to get to the communities, that the communities must build themselves. We must stop trying to tell them how to do it but, rather, facilitate the ability of communities to build themselves.
Ms. Cooper, I will tell you an interesting anecdote. In Iqaluit, a year or so ago, I was talking to a young man about mental health, and he mentioned something that you just mentioned.
He said our women are evolving; they are better educated than we are. We used to be the hunter/gatherers. We used to provide the food, but our role is diminishing every day, and we do not quite know what to do. It is not a good time to be a 20-year-old male in Iqaluit, which is very interesting.
I want to get your feedback because we are getting down to the end of our journey here and the writing of our report. The community model that we want to push, that will connect into the all-of-government approach and the intersectoral approach, would be a platform of population health — all the determinants of health from housing to food to income, et cetera. The health care delivery system has to be there as well, along with a look at genetics and this kind of thing.
It must use the life cycle in that community so that there is reinforcement from preparenting to parenting to early child development, to early education, to secondary education, to post-secondary education, to community involvement, to the workforce, to healthy aging, to grandparenting and so on, so that communities can build themselves.
I want to get feedback from all of you, including Ms. Sones, Ms. Tremblay, Ms. Wolski and Ms. Cooper, about this concept because we really want to get this right. Ms. Tremblay, I will challenge you to go first.
Ms. Tremblay: I am from Six Nations and we have the largest populated reserve in Canada with 22,000 people and 12,000 in the community. We have well-developed systems because our gift is people. We engage people in all elements.
I think it is smart to have a team approach in the community where you have an educator, a health person and a team that includes the traditional people. Working in teams is wonderful because you can draw upon the strength of each other. You get many opinions and viewpoints.
Looking at things in a holistic way from preconception to old, I think we have to do it. In our communities, our way of life has always supported that approach because you took what you needed from nature. The only thing we have to keep in mind here, the thing I see missing, is the spiritual realm where you bring in the spirit. That is so important because the elders will tell us about dreams and messages from our ancestors. We do not come into a room by ourselves; we come in with our ancestors behind us and with us in spirit.
We heard a story in Albuquerque about having blood memory of your ancestry — that you carry it with you and you see some of the messages in dreams to achieve your goal and purpose while you are here on this earth walk. For me, this looks good but I would like to see it circular. I would like to see somehow the connection to animate and inanimate objects because we relate to the land. Everything has a life so we relate to land, to place and all those concepts also.
I would like an additional component that is part of how we view the world. That is nature. When we give thanks from an Iroquoian perspective in our ceremony and our languages, we are always thankful. We leave the creator to the last. We start with the animals, the waters, and go the stars and to the creator.
We have to be cognizant that the human being is the smallest element in the whole picture. We are so dependent on everything else that is provided in our universe. I would ask somehow for this model. That is one whole quadrant, the spiritual realm, that I do not see here, which really is important to mental health. It is important to knowing who you are; it is important in educating our people. That is what I would suggest.
The Chair: Would you give some thought to that, Ms. Tremblay, and write back to me about where we could display the spiritual component with appropriate impact?
Ms. Tremblay: Absolutely.
The Chair: Do you want to go next?
Ms. Wolski: Sure. I definitely support what Ms. Tremblay has verbalized with regard to the missing elements. I have a few comments on some of the components here.
Parenting is a huge priority right now in our communities and in terms of our health status. That was a key element that was lost through decades of residential schools. Much of what is happening today is the result of poor parenting and coping skills. That is a critical element that you have here.
I wanted to note the healthy aging component. I like the age spectrum that you are using. Granted, we do have a very young population. At the same time, we have a growing senior population, and a lot of our grandmothers are raising our grandchildren today. That is an issue that I think may or may not come out through this model but it is important to note that is happening.
There are several policy implications for that because what is happening is a lot of our grandmothers are living on social assistance and at the poverty line. They have their grandchildren living with them, but how do they make ends meet with extra mouths to feed? That is an issue facing a lot of our older population right now.
I wanted to make note as well with regard to the educational components. Those are critical. An element that might be missing from this is the cultural component as far as education is concerned. Definitely, there is something to be said for formal education and getting your degrees and this kind of thing, but cultural awareness, cultural knowledge and cultural continuity are key elements of community health and well-being.
Research shows again and again that, without that cultural continuity, we will continue to have the high rates of suicides and the poor health outcomes. If that could be a component somewhere along the educational piece, that would be important to include.
I wanted to make note of two more pieces. I see you have the physical environment here. In the work we do with regard to the gender-based analysis and the linkages that we have to land, I do not know whether that component is strong enough in this model.
The connection to land is critical. What is happening with our health is there has been a disconnect that has occurred and that continues to occur, especially where women are concerned. Seventy per cent of our women live away from their traditional territories today. They do not have access to their communities and to their land as they once did.
It can be linked directly to the increase in diabetes, obesity, heart disease and all those big diseases because people are not on the land like they used to be. I do not know if that piece is strong enough in this model.
I have one more comment with regard to the gender piece, which I am happy to see in there. As we think of Aboriginal health and health status in terms of the life cycle, it is also important to consider it in terms of the gender spectrum. There are more than two genders and, from an Aboriginal perspective, when looking at health and the age spectrum, certain points in our life are more feminine and certain points in our lives are more masculine. As we age, we go through changes in our genders as well. I do not know how it would be incorporated but gender is inclusive of men and women and the other genders as well. We all display different genders as we go through life.
Senator Cook: I have a general question. I come from the province of Newfoundland and Labrador where we have a very small First Nations Aboriginal population. You will forgive me for not knowing or understanding. I am preoccupied with the dogma of residential schools. It is like something that continues to smother us. I would love to hear about and to understand the term, when will we be free? How can we move? I am a member of the United Church of Canada, so I heard the first apology. No matter how all of us strive, we cannot seem to get out from under that cloud. There has to be a way. I would like to hear your thoughts on it.
Barbara Van Haute, Director, Programs Development, Metis National Council: That is an interesting question: When will we be free? We will be free when everyone is open and acknowledges the long-term effects of multigenerational abuse and minimalization. The basis of that abuse and minimalization has political, social and moral overtones, and we do not need to get into that. When you are dealing with the question of families and communities over long periods of time who experience that same sense of minimalization, you find that it becomes ingrained — that sense of being less than and marked in some way. It becomes ingrained in the dynamics of the individual psyche and the family psyche. People act without even realizing why they are acting in that way.
Until that relationship is dealt with openly by individuals, by Aboriginal populations, communities and by all levels of government, it will not go away. It is a hidden mark, just as the mark left on children who have been abused sexually, physically or emotionally in a domestic environment. Until that child is dealt with and comes out into the open, that mark never goes away, not for that child and not for the person with whom they interact. The same thing applies to Canada's Aboriginal population. The apology was a moving experience. People that I know from the United States and Europe were absolutely amazed that this happened and that it happened almost simultaneously with the apology in Australia.
As wonderful as that is, it is not enough, just as it would not be enough for a child to get an apology from the person who abused them. It is nice and good but there is much more to do. That is where we are now — coming to terms.
Ms. Tremblay: There was more than a century of that experience so it is well ingrained. Those who experienced physical and sexual abuse carry those scars inside forever. They are wounded. You can address it and accept it so that it does not hurt as much. They happened during the formative stages of the young and when the children were school aged. Many were taken away between the ages of 6 and 10 years when still forming cognitively. A child cannot learn about family and how to go to mom and dad because they are not there. A child does not know what mom and dad are because they do not have that connection. You have to build the skills and build the love. Children learn how to love people from experience, so when they do not have those experiences, they do not even know what they have lost until they go out and try to relearn it. Instead, they have all this hurt and pain to try to let go of. It is difficult for those children because they have learned a different way.
It will take a long time. I agree with Ms. Van Haute. We need to have people talk about it so they can get rid of it. It is like being an alcoholic and having to go to Alcoholics Anonymous and say, I have a problem. That is how healing begins to take root. We all have to do it and acknowledge how serious it was. The last school closed in the 1990s. It is still very much a part of our lives. Ms. Wolski said it is not in the past. It is a current issue. Having said that, Senator Keon, I would like you to put our chart as a social determinant of health — residential school healing — because it is huge. The federal government set up a truth and reconciliation commission to address some of this and to help. Important work has to be done. We have to tell that story because it is just a void. If we want healing, we need to do that. It is really important. People have begun those processes on their own and that is how the issue came forward so eloquently. It will be a time-consuming journey but people want to heal and to be healthy.
Senator Cook: Yesterday, I picked up a magazine call Saltscapes from the Maritimes. I opened up the middle of the book and there was a double page picture of home children. Have you heard of home children? They were orphaned children of the First World War in the British Isles who were sent to Canada to work on farms. They were aged seven years and up. You have no idea, and I thought of residential schools. It is worth getting a copy of the current Saltscapes because a picture is worth a thousand words. The article was called Lost Identity, the story of a man who knew he had sisters in Great Britain. His mom was too poor and he was sent to Canada to work on a farm.
I can understand the residential schools having an impact on all of us, not only those who have experienced it but also those of us who have tried to walk with you. Is there something here that we can build on? I hear those young women over there talk about the Kelowna Accord. I cannot believe no one has taken the first step on it. We say all of these wonderful things but we do not put our foot in the water. I do not understand it.
Ms. Tremblay: We do not either.
Ms. Sones: This is a question that many Canadians ask. I hear the question often. My parents were both in residential schools. I did not grow up in a home with my parents. We have both the personal and the societal approach. We have hundreds and thousands of people who grew up in residential schools. Of course, not all of them suffered the abuses that we hear of, but a number of them did. It impacts the individual, the family, it ripples through the community, and their relationships become strained.
Something we have started to talk about more recently, and the Aboriginal Healing Foundation has taken a lead on this, is what it means for Canada to reconcile? What does it mean for Canadians to have an understanding of what truly happened, that it really was an assimilative policy to get rid of the Indian? It was not simply that First Nations, Inuit and Metis children were not in safe homes. They were in safe homes. They were in fully connected communities. It was a truly racist policy. We all try to live with the remains of that racism and its impact on our country.
I still wonder about how we work as a country after the apology. The apology was not enough. It was a first step, a beginning. I am thankful that we build on a whole bunch of commissions, including the Royal Commission and others. We will get there, but it took place over 100 years ago, and we will probably take a generation.
Ms. Cooper: You asked what other elements should be considered in this. Mental wellness is an important element. When we look at physical environment for Inuit, our connection to the land is essential as well. Just to point out, sustainable employment is an issue. The high turnover rate is a real issue for employment.
To get to your question, when will Canadians be supportive of Aboriginals being equally on the ground, whether it is social or health conditions? I just throw that back. We should not be begging for support. Rather, the acknowledgement of Canadians and the government to be proactive in its work is essential as we move forward.
We do have hope. We have really good examples that have worked. The intergenerational effect of residential schools is very much there. It will not go away today. It has been said repeatedly here. I am an effect of that generation as well. I have seen too many suicides. Back then, there was no such thing as mental health support or any type of support. It was the norm to see abuse going on at almost every door. It was a norm to see alcoholism. It is all related to residential schools.
Today, it is may be every five doors. We will see the progress over time, but again it goes back to communities taking back their lives and taking ownership of how we have lived in the past, and fostering that with today's modern society.
The Chair: Thank you so much. We will end on that note. I thank all of you. It has been fascinating.
(The committee adjourned.)