Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 7 - Evidence - November 17, 2011
OTTAWA, Thursday, November 17, 2011
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:46 a.m. to examine the progress in implementing the 2004 10-year plan to strengthen health care.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to this meeting of the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
My name is Kelvin Ogilvie. I am a senator from Nova Scotia and the chair of this committee. I will introduce senators.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Braley: David Braley from Ontario.
Senator Demers: Jacques Demers from Montreal, Quebec.
Senator Martin: Yonah Martin from Vancouver, British Columbia.
Senator Champagne: Andrée Champagne from the province of Quebec.
Senator Cordy: Jane Cordy from Nova Scotia.
Senator Merchant: Pana Merchant from Saskatchewan.
Senator Verner: Josée Verner from Quebec.
Senator Eggleton: Art Eggleton, deputy chair of the committee, from Toronto.
The Chair: Today, we continue our study on the progress of implementing the 2004, 10-Year Plan to Strengthen Health Care in Canada. This tenth meeting deals with the communiqué on Aboriginal health. We will examine commitments made by the federal government, first ministers and leaders of the five national Aboriginal organizations as part of a separate communiqué related to the 10-year plan based upon a meeting held September 13, 2004.
We will hear from two panels of witnesses today. The first panel will end at 11:45 a.m., and the second panel will end at 12:45 p.m.
Is that agreed?
Hon. Senators: Agreed.
The Chair: I welcome the witnesses. I will introduce you as I call you to speak. It is my understanding that you agreed to appear in the order on the agenda, which means that our first presenters are from the Congress of Aboriginal Peoples: Betty Ann Lavallée, National Chief; and Barbara Van Haute, Director of Population Health.
Betty Ann Lavallée, National Chief, Congress of Aboriginal Peoples: Thank you, and good morning senators.
I would like to begin by thanking the committee for inviting the Congress of Aboriginal Peoples to participate in the work of the committee as it examines and reports on the progress in implementing the 2004, 10-Year Plan to Strengthen Health Care.
As I am sure you are aware, the Congress of Aboriginal Peoples is a national Aboriginal organization that represents the interests of off-reserve, status and non-status Indians and Metis peoples living in urban, rural and remote areas throughout Canada. We are also the national voice for this constituency and their affiliate organizations that make up the Congress of Aboriginal Peoples, CAP.
In 2004, the Government of Canada committed to a 10-year plan to improve our health care system. The cost of this commitment amounted to approximately $41 billion and included an increase in Canada Health Transfer payments to provinces, accompanied by an escalator clause, as well as $700 million directed toward improving the health of Aboriginal peoples over a five-year period. The commitment to improving the health of Aboriginal peoples was outlined in detail in the 2004-05 Blueprint on Aboriginal Health: A 10-Year Transformative Plan.
In many ways, we have moved a long way forward from where we were in 2004. The Government of Canada has maintained its commitment to seeking ways to improve not only our health care system but also its commitment to improving Aboriginal people's access to, and benefit from, that system. However, the remainder of my remarks to you today will reflect an assessment of the implementation of the blueprint and what gaps remain in the improvement of health care to Canada's off-reserve Aboriginal peoples.
The main areas for this assessment are derived in part from the overall goals of the blueprint as well as from information received from various public and local sources regarding the progress and impact of the implementation of various health policies and programs. The development of an integrated whole health system requires commitment from all levels of government — federal, provincial and territorial — and from Aboriginal organizations. From a federal perspective, Health Canada initiated the Aboriginal Health Transition Fund, AHTF, in 2005 to facilitate this development. The objective of this initiative was to work with provincial and territorial Health Canada representatives from each of the five national Aboriginal organizations to develop mechanisms and programs that encourage or promote integration.
In reviewing various AHTF interim project assessments last year, CAP noted that while AHTF was a complex project to manage, Health Canada managed the distribution of public funds in an exemplary manner. We also noted, however, that it appeared as though the majority of projects funded by Health Canada over a five-year period were directed toward First Nations on-reserve communities and groups. Of equal importance, it appears as though this process of clear preference is being continued with regard to Health Canada's funding restrictions for non-reserve- oriented national Aboriginal organizations for the next four years.
As an example, in the Health Services Integration Fund, which is the follow-up program to AHTF, each national Aboriginal organization is limited to different annual funding amounts for the next four years. The Assembly of First Nations, including provincial-territorial organizations, PTOs, is allowed to request $1 million per year. ITK, including its PTOs, is allowed to request $500,000 per year. The Métis National Council, MNC, is allowed to request $100,000 per year. Each of MNC's PTOs is also allowed to apply for $150,000 per year. However, CAP and the Native Women's Association of Canada, NWAC, are limited to a total of $100,000 per year.
It should be noted that CAP also has provincial affiliate organizations that are fully recognized by the Government of Canada, along with one that is the largest band in Canada — the Qalipu Mi'kmaq First Nation Band located in Newfoundland and Labrador. Given that reality, CAP has yet to receive a clear explanation as to why Health Canada has chosen not to reflect the federal recognition of CAP's PTOs in their determination of project funding that is related to developing an integrated system of health care.
Although one of the goals of the 2005 Blueprint on Aboriginal Health: A 10-Year Transformative Plan was to see to it that the Aboriginal peoples benefited directly and fully from the reforms that we enabled in the health care system in general, the question remains as to how Aboriginal groups and organizations might measure or access this direct benefit to all of Canada's Aboriginal peoples.
In order to determine whether equality has been developed in each of these areas, we all know that both public and private analysts must have a realistic framework to collect, assess and share relevant information. As it stands with CAP, we lack the capacity to develop the framework, much less to implement it. As a result of the lack of capacity- building support, CAP must rely on either anecdotal or report-based information to access equity development in all of these areas.
The Aboriginal Diabetes Initiative, the National Aboriginal Youth Suicide Prevention Strategy, and the Aboriginal Health Human Resources Initiative, AHHRI, all serve as excellent project examples of the federal government's commitment to improving the health care system for Aboriginal peoples. CAP has participated in these projects, however, at a minimum.
AHHRI, in particular, allowed many Aboriginal students to receive training in health careers and facilitated many Aboriginal groups and organizations to assist graduates in finding jobs in the health care system. Unfortunately, it appears that many of these projects are experiencing cutbacks in funding amounts and are due to sunset in 2015. Maintenance of the federal commitment to this type of project would be of great importance to Canada's off-reserve Aboriginal peoples.
Many of the jurisdictional debates that exist between federal and provincial health care officials are often related to the question of fiduciary responsibility. While presentation before the committee may not be the appropriate time to further this debate, it is clear that until this debate is resolved, many off-reserve Aboriginal peoples will not have comparable access to quality health care.
The fiduciary responsibility debate is most easily framed in the issue around limited access to Non-Insured Health Benefits for first Nations and Inuit. Currently, the NIHB program is open only to status First Nations and northern Inuit peoples. Through it, these Aboriginal peoples can afford expensive medications and treatments for chronic diseases such as diabetes and cancer. They also have travel costs for medical treatments and dental and optometric costs covered.
However, off-reserve and Metis people living below the sixtieth parallel who have no access to NIHBs, often live below the low income cut-off line or live in remote communities do not have these costs covered by either the federal or provincial government. As a result, many of these Aboriginal peoples must make life-altering choices between paying for health treatment and buying food and meeting monthly expenses. We all know that whatever their choices may be from month to month, their health and perhaps that of their families and community will suffer at some point.
Perhaps this lack of coverage or assistance is why Statistics Canada tells us that, as of June 2010, not only are First Nations and Metis people living off-reserve more likely to report themselves as being in poor health but also more than 40 per cent of their individual populations are reporting incomes of less than $20,000 per year. Senators, clearly most Canadians would agree that no one in Canada should have to choose each and every month whether to have an important prescription refilled or feed their children and pay the rent.
We understand that global economic shifts are influencing the Canadian economy and understandably the federal government's choices regarding the expenditure of public funds. We also know that the health and well-being of any state is intricately linked to the health, well-being and security of its people. It is the fiduciary responsibility of all governments, organizations and community members to work collaboratively and compassionately to ensure that we, the forgotten people, as Canadians, need to maintain and improve our health, well-being and security, as well as that of others of this rich and vibrant home we call Canada.
CAP would like to invite you to join us to continue this dialogue in an effort to improve our current progress and subsequent results in this health portfolio.
The Chair: I ask Valerie Gideon, Director General, First Nations and Inuit Health, to proceed.
Valerie Gideon, Director General, First Nations and Inuit Health Branch, Health Canada: I would like to thank the chair and all the committee members for the invitation to speak here today on behalf of Health Canada.
As you are aware, improving the health of First Nations, Inuit and Metis is a shared responsibility among multiple partners, including all levels of government and First Nations, Inuit and Metis communities and their leadership. Like all other Canadians, First Nations, Inuit and Metis access health services through provincial and territorial governments, including insured hospital care and primary health care provided by physicians and other health professional services.
[Translation]
Within this broader health system, Health Canada has a policy mandate to supplement insured health services provided by provinces and territories to help reduce disparities in health status and improve access to health services for First Nations and Inuit.
In carrying out its mandate, Health Canada supports a number of programs and activities, with planned spending of $2.18 billion for the 2011-12 fiscal year.
[English]
At the 2004 special meeting of first ministers and Aboriginal leaders, an agreement was reached on the need for an action plan to improve health services for all Aboriginal people and to close the gap in health status between Aboriginal people and the Canadian public. This historic agreement was reached between first ministers, the Assembly of First Nations, the Inuit Tapiriit Kanatami, the Métis National Council, the Congress of Aboriginal Peoples and the Native Women's Association of Canada.
As part of this commitment, the Government of Canada, through Budget 2005, provided $700 million over five years for programs centred on health promotion and disease prevention, as well as the Aboriginal Health Human Resources Initiative and the Aboriginal Health Transition Fund to look at new ways of integrating and adapting health services for First Nations, Inuit and Metis.
Based on the promising outcomes we have seen over the first five years, Budget 2010 provided $730 million for these initiatives for an additional five years, until the end of the 2014-15. This renewed investment is key to supporting First Nations, Inuit and Metis communities in achieving their aspirations for health and wellness and addressing the disparities in health status and access to health services among these populations.
Based on evaluations and feedback from communities, we know these programs are on track and are making a positive impact. For example, we know that community members value these programs highly and have designed and implemented them in such a way as to be relevant and effective, community-based and community-paced.
Our partners have also said that collaboration between all parties has increased. In particular, First Nations and Inuit are taking an even greater role in service planning and delivery, both within provincial and territorial systems and within their own community services.
[Translation]
Through the community-based health promotion and disease prevention programs, we have been able to significantly increase the capacity in First Nations and Inuit communities to address key health risks and ensure better screening and follow-up for chronic disease. The programs have also enhanced opportunities for First Nations and Inuit children to have a healthy start by improving maternal and child health, increasing school readiness and promoting the early adoption of First Nations and Inuit languages and cultures as protective factors.
[English]
For example, through the Maternal Child Health Program, community members have been trained as home visitors, leading to improved healthy birth weights, increased breastfeeding rates, improved oral health preventative care, increased knowledge of positive parenting and good healthy choices. Overall, the program supports 125 projects, serving over 2,200 families in approximately 225 First Nations communities.
The Aboriginal Diabetes Initiative has been successful in training 330 community workers to date and going forward will expand to support the training of up to 500 nurses and diabetes clinical practice guidelines and best practices in the management of chronic diseases.
Evidence does demonstrate that Aboriginal Head Start is improving children's language and literacy skills and their overall readiness to learn. It also shows that it contributes to an increased awareness of healthy behaviours among parents.
Through the National Aboriginal Youth Suicide Prevention Strategy, we have seen an increase in a range of protective factors among First Nations, Inuit and Metis youth, such as participation in cultural activities and overall community involvement, along with a decrease in risk factors such as substance abuse.
While more needs to be done, renewal of funding for youth suicide prevention will allow Health Canada to work in partnership with the national and region Aboriginal organizations and communities to support up to 200 community- based suicide prevention projects, community-based mental wellness teams and ongoing training for mental wellness and suicide prevention workers.
We are also making improvements to health systems serving First Nations and Inuit. For example, funding under the Aboriginal Health Human Resources Initiative, which also includes Metis, has resulted in over 2,220 students enrolled in health career studies through bursaries and scholarships, training for over 600 First Nations health managers, support to 62 Aboriginal medical students and 436 nursing students and the adaptation of 39 health science curricula at post- secondary institutions.
In addition, as mentioned, the Aboriginal Health Transition Fund has supported a total of 311 projects, which were completed between 2004 and 2010, to better integrate and adapt federal, provincial and territorial health systems for Aboriginal people. Nearly 75 per cent of those projects were directly led by First Nations, Inuit or Metis organizations and communities.
As we go forward, the new Health Services Integration Fund will build on lessons learned and partnerships established under the Aboriginal Health Transition Fund, but it will allow us not only to continue our efforts but also to provide a focus on projects with a much broader scope and reach and including coordinating services for multiple communities at once.
In closing, this is only a brief overview of some of the successes of these programs that have been achieved in collaboration with First Nations, Inuit, Metis and provincial and territorial partners.
[Translation]
The parties at the 2004 special meeting of first ministers and Aboriginal leaders all recognized that improving Aboriginal health outcomes would require serious and dedicated efforts. The investments in Budget 2010 have demonstrated the federal government's ongoing commitment to improving the health of First Nations, Inuit and Metis populations, and reaffirmed the positive outcomes of those investments to date.
[English]
We know that improvements in Aboriginal health status will take time, and Health Canada remains committed to working with First Nations, Inuit and Metis and all levels of government to reduce barriers to accessing provincial and territorial health services and enhancing the capacity of communities to address their health priorities.
Thank you for allowing me the opportunity to be here today, and I will be happy to answer any questions.
The Chair: Thank you. I would like to turn to the Assembly of First Nations.
Jonathan Thompson, Director, Health and Social Secretariat, Assembly of First Nations: Thank you, Mr. Chair, and good morning and thank you to your colleagues on the committee. I would like to extend an acknowledgment as well from the National Chief of the Assembly of First Nations for extending the invitation to the AFN to be here this morning.
As I am sure you all know, much has been written on the issue of First Nations health. You referenced that in your opening, Mr. Chairman, going back to the communiqué and accord itself, the Royal Commission on Aboriginal Peoples and the Romanow report. However, it is important to note that a lot of common themes run through a lot of that dialogue, and certainly they are a number of principles that I would like to touch on here this morning and that I would like to see certainly picked up on through to 2014.
First Nations involvement in controlling health care, the governance of it by First Nations, will be something that we will be looking for, with direct input into the types of services. As Ms. Gideon mentioned, we are seeing an increase in that, but there is a way to go yet.
There should be First Nations' involvement in the upcoming first ministers' discussions on this, as occurred back in 2004. The Romanow report touched on that as well, going back to that report where it stated, "The challenge of moving forward will be in the hands of Aboriginal leaders and the federal, provincial and territorial governments," and we will be looking to further that type of approach within the Assembly of First Nations.
As you are probably aware, despite the research and publications and the good work of all the parties, we are still suffering from rather poor health outcomes. You have a PowerPoint presentation that touches on a few. There are many more. It touches on youth suicide and life expectancy. I would like to reference as well the jurisdictional challenges that we continue to face in First Nation communities.
I think these certainly speak to the need for a First Nations voice at those tables, the First Nation jurisdiction at the community level being federal, but the community members constantly dealing with both the federal and provincial systems. Unfortunately, that often leads to a lack of clarity around roles and responsibilities, not only for the federal and provincial governments but certainly for the communities themselves. This is something we feel is an ongoing challenge and barrier to increased health outcomes for First Nations.
We readily acknowledge the challenges in the overall health landscape. When you look at Manitoba and Ontario with close to 50 per cent of their program spending on health, you do not need to be an economist or rocket scientist to see the challenges, and those challenges are being experienced at the community level as well.
There is a slide there that talks about the skyrocketing costs for NIHB. We would certainly like to explore, in a multi- jurisdictional fashion, some of the challenges and the opportunities that exist even within existing resources. Certainly, we will be needing to speak to fair and equitable and, I think, new fiscal arrangements in this area.
What is it we are seeking within the context of your work? As has been suggested by numerous reports and research, and certainly by the Assembly of First Nations, affirming our rights and supporting the advancement of First Nations systems that are culturally appropriate and effective will require support from all jurisdictions. Again, Romanow certainly spoke to that one. Again, however, as I mentioned a moment ago, any initiative or efforts to be pursued must include fair and equitable fiscal arrangements. The 2004 accord includes a 6 per cent escalator. As well, I would be mindful to mention that the federal election commitments also included an extension of approximately that same amount, if not slightly more. Yet First Nations communities continue to struggle under an approximately 2 per cent escalator transfer for First Nations transfers. Where is the parallel First Nations commitment?
I would like to state that a parallel commitment, by the federal government, would begin to speak to the principles of fairness and equality. It would also be necessary, I think, to secure provincial and territorial confidence that the federal government is showing leadership and support to First Nations' governments. I would go further to say that there should be, as there is for provinces and territories, consideration for equalization and costs associated with delivering programs and services in northern and remote communities. We certainly experience those high costs in many, many communities across the country.
We will, of course, also be looking for improved coordination. Effective intergovernmental cooperation and partnership is also the key to moving forward, as we move into the future and beyond 2014.
As Ms. Gideon mentioned, an excellent example of this would be the recent and historic signing of the B.C. Tripartite Framework Agreement on First Nations Health. Certainly, this agreement reflects the above-noted principles: First Nations control, improved fiscal arrangements, and inter-jurisdictional cooperation.
In conclusion, we seek your support for these principles and for First Nations leadership to be at the table when plans concerning the future health of their communities are being discussed. Canada's endorsement of the United Nations Declaration on the Rights of Indigenous Peoples, and the Prime Minister's apology, would also suggest this is a great opportunity for Canada, the provinces and territories to move forward on the basis of reconciliation. Thank you.
The Chair: Thank you very much. I will turn to my colleagues for questions that I hope will further outline these issues. I would remind my colleagues that we have only 30 minutes, so I would like to keep each question within a four- minute period.
Senator Eggleton: Welcome. Ms. Gideon, you have cited a number of statistics on different components of the programs that flow out of the blueprint and the communiqué prior to that. I think the Aboriginal community representatives indicated that there has been some success, but they have said there is a long way to go. I am trying to determine what outcomes, over and above these statistics, are happening on the ground. Back in 2008, the Health Council of Canada said that the blueprint had languished and that financial support initially promised to support its objectives had dwindled. Has what happened since then brought it back on track?
The Chair: Who would like to answer?
Ms. Gideon: I will certainly start. It is an overarching question, so I will tackle it that way. In terms of the overall impacts of the $700 million investments outside of the statistics, obviously we know that concrete impacts on health outcomes take time, longer than a five-year time frame, in most cases. We can certainly show things such as increased breastfeeding rates, but we need to have continued efforts in order to be able to build community capacity and to enable them to also develop and deliver interventions that can be shown to be effective over time. A lot of the impacts of the targeted upstream investments have been to be able to establish that dedicated community capacity for important health issues like diabetes.
You are seeing not only new community workers but also community workers who are being certified and trained and developing that expertise in those particular areas. As well, they are developing relationships within provincial and territorial health systems, in order to be able to draw more effectively on specialized expertise that would be offered through those systems, such as partnerships with multidisciplinary teams that might be established in a nearby city or through a regional health authority. Those would be examples, loosely speaking.
Under the Aboriginal Health Transition Fund, there is certainly a whole series of new inter-jurisdictional tables established to specifically discuss Aboriginal health issues which would not have existed previously. Those tables are not only at a provincial level, but they are also at a local level, at the regional health authority level, for instance. There is some collaborative planning around service delivery, funding allocation and recruitment and retention of professionals and paraprofessionals that is occurring at these tables.
Senator Eggleton: Ms. Lavallée, from the Congress of Aboriginal Peoples, talking about the National Aboriginal Youth Suicide Prevention Strategy and the Health Resources Initiative, said that their participation has been at a minimum. What about this collaborative effort you just talked about? It does not sound like there is very much collaboration.
Ms. Gideon: There certainly have been resources specifically for off-reserve Aboriginal people that have been allocated through the National Aboriginal Youth Suicide Prevention Strategy. Certainly, there has been support for collaborative discussions in terms of the program development and allocation.
The Chair: Ms. Lavallée, would you like to comment?
Ms. Lavallée: According to my provincial and territorial leaders, we have had no access whatsoever to the suicide prevention strategy, and suicide is an epidemic in our community. We have not had access to maternal health. I think the main problem is that the health transfer is transferred to the provincial government, and the provincial government then narrows the focus, unfortunately. That is where I talked about the jurisdictional issue that we who reside off- reserve get caught in. I know that, as the former chief in New Brunswick, I had to fight, when the program first came about, just to get access to the capacity to have a health care worker within our organization, just to be able to interface with the regional health authorities and the provincial health departments. They have since cut that position. We are right back to where we began.
Out of the last Aboriginal Diabetes Initiative, only one of our organizations got access to the diabetics program. People are falling through the cracks.
The Chair: I think the key that I am hearing in this and in other issues you put forward is a jurisdictional issue. When you leave here, would you each think about this aspect and perhaps follow up with us with more aspects of that particular issue? It would be very helpful to us on these issues.
Senator Merchant: Thank you very much, and, again, thank you for being here. Ms. Gideon, you talked about working upstream, which is what we have heard from others, too; it is easier to get a holistic view and start working, instead of letting things escalate and then trying to deal with illness. Given the very young demographic in your communities and the high birth rate, I would like a little more information about maternal health and about early childhood programs.
I would also like to know how the 10-year plan has been implemented, what the results have been, and what you hope to see in the next phase after 2014.
Ms. Lavallée: There is very little I can contribute to that conversation because we do not have access to information on maternal health. One of our provincial organizations has a little bit, but it is a program that they have implemented on their own. As well, we have had no access to the early childhood program.
Mr. Thompson: You raise a very good point in terms of the young demographics — certainly, the fastest growing population with quite high birth rates. This is a serious issue. The maternal child health program is in play in many First Nations communities, but, as Senator Eggleton pointed out, there are bigger challenges. It goes back to addressing in a more comprehensive fashion all of the social determinants that impact on these families. Maternal child health, as a single program, can certainly assist, but the pressures around those families and single mothers are immense.
When faced with those challenges, a single program operating in isolation is not likely to have the results we would want to see. This also brings into the discussion the jurisdictional issue because these individuals and families are operating between both — they bounce back and forth between jurisdictions. The more cooperation and collaboration there is between jurisdictions, the more control those First Nations communities have over where those resources go and how they are allocated. We feel that is the way we need to go forward.
The upstream programs are very welcome. However, going back to 2004 and 2005, there are also aspects that were not realized but would have spoken to many of those broader social determinants that are wreaking havoc in the communities.
The Chair: In dealing with the jurisdictional issue, could you give some specific examples, as you have been doing in response, to illustrate the specific aspect of the jurisdictional issue? It would help us to deal with this as we move forward.
Mr. Thompson: Certainly. A simple illustration would be of individuals forced to leave Northern Alberta, for example, because there are no dialysis units in and around their community. They often are forced to move to Edmonton to receive treatment. The NIHB program provides support to them for three months. If there were greater collaboration and cooperation between the jurisdictions, hopefully there would be no gap left between the time NIHB cuts them off after three months and the provincial system picks up coverage. If there were greater collaboration, maybe the jurisdictions could find a way to establish a dialysis unit in closer proximity to those communities in Northern Alberta. That example could be used in Northern Manitoba, Saskatchewan and Ontario as well.
As I mentioned earlier, we see a great lack of clarity around roles and responsibilities. You may be familiar with Jordan's Principle. It is probably the best known example of jurisdictions squabbling over who will provide the services to a child, rather than providing the services first. If there were greater cooperation and collaboration between the jurisdictions, these issues would be dealt with readily, and access to health services would be the first priority and the administration of it the second priority.
The Chair: I was referring to those kinds of examples, thank you. If you can illustrate your subsequent written response to us with additional examples, it will help us greatly.
Senator Martin: I am trying to follow the money to determine where the gaps and the barriers seem to be. It seems that there has been a commitment by the government to renew this funding to Aboriginal, Inuit and Metis health. You are designing these programs, which you have described. They all seem essential and important.
Ms. Lavallée said that access to the programs has been an issue. You can have great clinics and great programs but people have to be able to access them. Is there a problem in the overall communication plan? In the joint task group model, where you are working together with Health Canada, how often do you meet? What is the communication plan in working together to develop culturally sensitive programs? Where are the gaps? In terms of the rules and responsibilities, should that be articulated in the blueprint? Obviously, it is a framework and guide, but maybe there needs to be very specific identification of those rules and responsibilities. Who would do that? Would it be a collective effort? How does this task group work? How often do you meet or discuss by teleconference? What is the plan? How does the communication work to ensure that everyone can access these wonderful programs being created? It may have to require a written response as well.
Ms. Gideon: It is a complex question, but I will do my best to simply answer it. The mandate of the First Nations and Inuit Health Branch of Health Canada is to supplement provincial and territorial services, specifically for First Nations and Inuit primarily. The majority of these investments target those populations in the context of areas where First Nations and Inuit would not have access to a comparable provincial or territorial situation within their community. Inuit in the territories are served by territorial governments as are all other residents. For the Inuit population, we would be talking specifically about Inuit in Newfoundland and Labrador, for instance, or in Quebec, where we have arrangements.
There are some specific off-reserve Aboriginal investments as well under the Aboriginal Head Start Program, which is managed under the Public Health Agency of Canada, who, I believe, was a witness here. The total amount of funding for the Aboriginal Head Start in urban and northern communities is $32 million per year plus the supplementary funding, which has been allocated since the first ministers meeting in 2004. It is now at $25 million over five years.
In terms of the task group and our working relationship, our minister, the National Chief of the Assembly of First Nations and the president of the Inuit Tapiriit Kanatami have endorsed agreements to work together on separate task groups with the Public Health Agency of Canada. In the context of those processes, we have specific strategic priorities that have been identified. We have multi-year work plans where we mandate each of our organizations to work together in order to be able to achieve those.
Some of the examples of priority areas that have been identified, for instance, with the task group with the Assembly of First Nations, include establishing a continuum of mental health services to look at the social determinants of health from a First Nations perspective and explore differing models of First Nations governance, such as lessons learned from British Columbia's Tripartite First Nations Health Plan. Those are examples of some identified strategic priorities that are intended to influence future program design and implementation. I hope that has helped a bit.
A written submission would help to more fully or explicitly describe this.
Senator Martin: What about the challenge of the roles, responsibilities and trying to determine who should do what? Could that be articulated clearly?
Ms. Gideon: Yes. The primary rationale behind the Aboriginal Health Transition Fund was to improve collaboration across the jurisdictions. The new Health Services Integration Fund will be more focused and will build on the capacity and the knowledge that has been gained through the previous fund. It will specifically look at projects or initiatives that can help to promote and realize the integration of federally and provincially funded health services that target Aboriginal peoples.
To identify projects, it is mandatory to have a multi-party advisory committee, which includes the provinces and territories, representatives of Aboriginal people as well as the federal government to develop multi-year work plans and identify projects that meet the strategic priorities in those work plans. Those partnerships have to be established to inform the funding allocation. It is not done unilaterally by either party.
Senator Hubley: Five years ago this committee produced a report called Out of the Shadows at last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. It looked at mental illness among Canadians, but there was a real focus on the Aboriginal community and issues disproportionately facing Aboriginal communities. I wonder if you might share with us whether you have seen changes over the last five years, whether there are still gaps and whether there are still serious issues pertaining to mental illness among our young Aboriginals and all Aboriginal peoples.
Mr. Thompson: Sadly, that remains a major struggle. As Ms. Gideon mentioned, it is one of the key components to the task group as we go forward and as the Minister of Health agreed to move forward on. We are trying to get a handle on approaching it in a more comprehensive fashion. I go back to the silos of programs out there that are not having the impact that we want to see. Certainly, you still hear in the media reports of young First Nations people taking their lives. We are still struggling very much with the impacts of the residential school experience, which has been demonstrated through residential school survivors and the process for the Truth and Reconciliation Commission of Canada.
One of the overarching pieces with respect to mental health is getting a better handle on what the need is and how best we at the AFN in conjunction with FNIB can support communities to address that. Good work has been done recently on the Native Alcohol and Drug Abuse Program, but it has to go beyond that. If you are familiar with the field, drug addiction and alcohol addiction need to be addressed — they are symptoms of a deeper-rooted problem. As a collective, we need to find ways to support communities to address those problems. It remains a high priority for me in my work. We continue to strive to address that with our partners and look to, for instance, the Mental Health Commission of Canada as a partner as we move forward on that issue.
[Translation]
Senator Verner: First off, thank you for being here this morning and welcome. My question will probably be more for Ms. Gideon from Health Canada.
As part of the Blueprint on Aboriginal Health, all the parties committed to addressing the specific needs of Aboriginal women and their children. They agreed to ensure gender equality in health services through the application of a culturally relevant gender-based analysis and the engagement of women in the development and delivery of women-specific health and healing action plans.
What steps has Health Canada taken to ensure that the needs and views of Aboriginal women are reflected in its programming? Does the department incorporate culturally relevant gender-based analysis in its research and policy development?
Ms. Gideon: I will give you a few examples if that is okay. In the case of the Aboriginal Health Transition Fund, the $200-million fund, every project had to submit a gender-based analysis before it could receive funding approval.
In addition, the Native Women's Association was, of course, one of the stakeholders involved in the transition fund steering committee. The association's involvement is ongoing through the advisory committee for the Health Services Integration Fund, the new $80-million fund.
Clearly, we also focused our efforts on health services for women in First Nations communities and on the Maternal Child Health Program, as I mentioned. That program has made a big difference, helping to significantly enhance follow-up services for women who are pregnant or who have young children. As a result, women are able to get a more comprehensive picture of their health and that of their families, and to connect with health care professionals in other fields, either within the community or through the provincial system.
[English]
The Chair: Following Senator Cordy, I still have three senators who wish to put questions. We will not have sufficient time to put those questions and have oral responses. I ask that senators put their questions to the witnesses and that the clerk follow up with those questions in writing to you. We will not have your answers on the record today, but we need to have them for our study. It is important that we get all the questions on the table. I will go to Senator Cordy and then follow up with each remaining senator.
Senator Cordy: Ms. Lavallée, the Congress of Aboriginal Peoples represents peoples living off-reserve. What percentage of people live off-reserve?
Ms. Lavallée: According to the ancestral data provided by Statistics Canada, it is up to 80 per cent.
Senator Cordy: That means 80 per cent of Aboriginal people do not have access to the federal programs on maternal health, the National Aboriginal Youth Suicide Prevention Strategy program and the First Nations Head Start program.
Ms. Lavallée: They do not have access, to my knowledge, if they are living in rural, remote or urban areas, unless they have a tripartite agreement with their provincial government. According to my provincial and territorial organizations, at this time, one has a diabetic program that is being used as a model for delivering the Aboriginal Diabetes Initiative. The rest were unsuccessful in obtaining the programs. The Head Start program is not delivered by our PTOs to our people throughout Canada. I tried very hard to get them when I was in New Brunswick.
Senator Cordy: That is incredible, in a bad way.
Ms. Lavallée: We are not part of the special relationship with the minister; and that needs to be resolved.
Senator Cordy: The fastest growing demographic, as Senator Merchant said, is young Aboriginal people. In the new accord being drawn up by Health Canada under the minister, what should be reflected to show the needs of this demographic? The percentage of young Aboriginals under the age of 25 is large, so should that not be reflected in the new accord?
Ms. Lavallée: I believe it has to be reflected, but there has to be a shift in thinking on programming today. We have to deal with the new modern reality, which is that our people are mobile. They go back and forth but there is a very large off-reserve population.
We have to stop tossing Aboriginal people, their health and their welfare through this jurisdictional issue. That is the problem for off-reserve Aboriginal peoples. The provinces do not want to recognize us. Quite simply, it is easier for them to deal with the chiefs and the reserves, and they take the easy way out. I think it has to be specified in some of these health transfer agreements that are going to be negotiated that they must work with all Aboriginal peoples regardless of status or residency. We cannot afford to lose another generation of our Aboriginal youth.
[Translation]
Senator Champagne: In a communiqué on improving Aboriginal health, the federal government said that it would examine, together with the other levels of government — we are still in an area of shared jurisdiction — and Metis leaders, health issues affecting Metis people.
Has there been any success so far in terms of identifying Metis-specific health concerns? Has there been any progress when it comes to finding preventive measures and treatment services that are conducive to healing?
[English]
The Chair: That is the question. We will have a written follow-up to you. Thank you very much Senator Champagne.
I would now like to put two issues before you. One, to repeat this issue that keeps coming up, is your problems in dealing across the jurisdictions through which the Aboriginal peoples cross. Obviously, based on your responses, there just is not a continuum of recognition. Please really follow up on that.
Ms. Lavallée, you identified the issues of small communities, distance, communication and so on.
I did not recognize any specific example or novel use of the modern communications capabilities to help bring access to health into your communities. I am wondering if you could follow up on that aspect as to whether you see potential there — examples of innovative uses that have already worked would be even better to use as a reference — or things that have been written about that you feel might well be of benefit to the issues you have dealt with.
You have covered a range of issues. You have recognized the social determinants, in a broader sense, as being really important here. This jurisdictional issue that keeps coming up in all these areas is obviously tremendously important.
I want to, on behalf of my colleagues, thank you all for being so clear and naturally frank with us in terms of the information that you have given us today. If you can think of specific examples, after you leave here, reflecting on your presentations and the questions that you have heard, and get back to us with more details, we would most certainly welcome it.
Thank you very much for being here. Thanks to my colleagues for being very efficient.
Senator Eggleton will take the chair for the next session, as I am required to be elsewhere for the next hour or so.
Senator Art Eggleton (Deputy Chair) in the chair.
The Deputy Chair: We are dealing with the 2004 health accord and, specifically, the communiqué on improving Aboriginal health, and the blueprint on Aboriginal Health. We have heard from two organizations from the community, and from Health Canada in the earlier panel. On this panel, we will hear from the Inuit Tapiriit Kanatami. Elizabeth Ford, Director, Health and Social Development, will speak on their behalf. Assisting her is Udloriak Hanson, Special Advisor to the President.
I am sorry. Did I get that wrong? Oh, it is the other way around. Ms. Hanson will speak for ITK. Sorry about that.
For the Native Women's Association of Canada, Erin Corston, Director of Health, is here. Welcome to all of you.
Udloriak Hanson, Special Advisor to the President, Inuit Tapiriit Kanatami: [The witness spoke in Inuktitut.]
Good morning and thank you for the invitation to speak here today. As previously mentioned, I am special adviser to Mary Simon, President of Inuit Tapiriit Kanatami, ITK. I would like to introduce my colleague, Elizabeth Ford, Director, Health and Social Development.
The work of our organization centres on ensuring that Inuit interests are reflected in national priorities affecting the Arctic and on spearheading initiatives that unite our four regions.
We are pleased to provide you, today, with our views on progress to implement the 2004 10-Year Plan to Strengthen Health Care.
As you know, this plan was the result of a 2004 meeting between provincial and territorial premiers, national Aboriginal leaders and the Prime Minister of the day, the Right Honourable Paul Martin.
It was not billed as a first ministers meeting, but ITK's president at the time, the late Jose Kusugak, famously told the assembled group of leaders, "If it walks like a first ministers meeting, acts like a first ministers meeting and smells like a first ministers meeting, then it must be a first ministers meeting."
It was at this meeting that first ministers and Aboriginal leaders agreed that we need an action plan to improve health services for Aboriginal Canadians. They recognized that all governments have an important role to play in improving the health of and the delivery of health services to Aboriginal peoples.
Inuit are facing serious and, in some cases, escalating health issues, on a scale experienced by very few other Canadians.
For example, life expectancy in the four regions that make up our homeland is an average of 12 years lower than it is in Canada as a whole, and this gap is widening. The rate of tuberculosis for Inuit is 127 times the Canadian-born, non- Aboriginal rate. Infant mortality in our regions is almost three times higher than in Canada as a whole. The suicide rate for Inuit is 11 times the national rate.
As a direct result of that meeting in 2004, ITK worked in partnership with federal, provincial and territorial governments and other Aboriginal organizations to develop a blueprint on Aboriginal health that outlines ways we can all work to transform health outcomes.
The key to transforming health outcomes is to address the social determinants of health, factors such as clean water, education, adequate housing and access to nutritious food, that all play an essential role in physical health. For Inuit, this is one of the most important components of the blueprint. It is also one of the least advanced.
Housing, for example, notwithstanding the blueprint's commitment to funding for infrastructure, remains far below national standards across our regions. All the key indicators — space per person, safety, affordability and so on — lag behind the national norms. Thousands of new units are needed, and thousands more need major repair.
It is hard not to be discouraged by this when we know that overcrowded and substandard housing contributes directly to poor mental health and our extremely high TB rates.
Another part of the blueprint addresses engagement and inclusivity. Critically, it emphasizes that Aboriginal organizations must work as equal members with federal, provincial and territorial governments.
Unfortunately, this has often translated into a pan-Aboriginal approach, which does not serve Inuit interests or may not lend enough time and consultation for effective engagement.
First ministers and Aboriginal leaders did, in fact, recognize in the blueprint that public health issues for Inuit, Metis and First Nations are very different, and that Inuit-specific strategies must be adopted to accommodate the unique conditions of Arctic environments, the distinctive features of Inuit culture and the requirements of the land claims agreements.
Furthermore, the blueprint obliges governments to ensure that a continuum of mental health care is made available to Inuit in, or close to, their home communities.
Inuit are in a state of deep and protracted mental health crisis, and such services have never been more urgent. There remains a pressing need for mental health infrastructure and services, including counselling and addictions treatment centres in the Arctic.
We believe these problems are so severe that there must be immediate dialogue among federal, provincial and territorial ministers of health to consider immediate intervention in our communities.
Two other initiatives arising from the blueprint provided some welcome results for Inuit. The Aboriginal Health Transition Fund allowed Inuit to implement projects to improve the integration of FPT-funded health systems, and it adapted existing health programs and services to better serve the needs of Inuit.
It also helped increase the participation of Inuit in the design, delivery and evaluation of health programs and services and created several new Inuit regional engagement coordinator positions.
Unfortunately, the program proved to be unsustainable. Projects created under the initiative are no longer being funded.
The Aboriginal Health Human Resources Initiative allowed for progress in a number of important areas including community-based worker training and health career promotion. However, it too suffers from a one-size-fits-all, pan- Aboriginal focus.
Going back to the goals of first ministers and Aboriginal leaders in 2004, the blueprint was meant to be a transformative plan. It is a solid document that sets out a solid framework.
As the title suggests, it is also a work-in-progress. Specifically, the recommendations on mental health and housing and on creating Inuit-specific systems require more work and more progress.
The message we would like to leave you with today is that Inuit are committed to working with governments to take direction and immediate action on implementing these recommendations. I thank you once again for your invitation to speak here today. We will do our best to respond to any questions or comments you may have.
The Deputy Chair: Thank you very much. That was a very clear and succinct presentation.
Erin Corston, Director of Health, Native Women's Association of Canada: Thank you for the invitation to offer testimony today. ClaudetteDumont-Smith, the executive director of the Native Women's Association of Canada, NWAC, was unable to be here and sends her regrets.
I am Erin Corston. I am the health director and the acting director of the environment at NWAC. My family is of Cree ancestry. I was born and raised in Northern Ontario and am a member of the Chapleau Cree First Nation.
I have three key messages for you today. The first message is that current approaches to addressing Aboriginal women's health in this country are inadequate in proportion to the burden of ill health and social exclusion faced by Aboriginal women.
Second, Aboriginal women continue to face alarming levels of health disparity. Insufficient attention is paid to the social determinants of health. In some cases, such as with the justice system, our social determinants of health are worsening.
Third, solutions involve funding parity and the provision of sustainable capacity and resources to facilitate Aboriginal women's equitable participation in the development, implementation and evaluation of health policies, programs and services.
With that, I will describe for you who the Aboriginal women are that NWAC represents. Sixty per cent are First Nations and 33 per cent are Metis. These statistics have been gleaned from Statistics Canada.
We make up more than half of the rapidly growing Aboriginal population. We are very young; 28 per cent of us are under the age of 15. We can expect to live about seven years less than non-Aboriginal women in this country. We commit suicide at three times the national average and we are three times more likely to contract HIV and AIDS. We are three times more likely to be violently victimized, and we are five times more likely to die as a result of violence. Sixty-seven per cent of Aboriginal women are overweight. Almost one quarter of Aboriginal women 65 and older have diabetes. Almost half of our women live in poverty.
These statistics demonstrate the gross disparities and overwhelming challenges faced by Aboriginal women in this country. While we share a common legacy of marginalization and oppression with our Aboriginal brothers, we do not receive the level of attention and support from government, from non-Aboriginal Canadians or from male leadership within our communities necessary to create and sustain the type of changes we need to improve our health.
The Native Women's Association of Canada was incorporated almost 40 years ago to collectively advocate for culture and gender equality within both Aboriginal and non-Aboriginal society. This is why we are here today.
I will talk a little bit about the evolution of the health department of which I am the director. The health department at NWAC began to take shape during the Kelowna Accord discussions in 2004-05. Prior to this time the organization had no capacity to participate in national-level initiatives such as these. Aboriginal women's perspectives, their issues and their concerns were not considered part of the solution to Aboriginal people's poor health status. We make up over 50 per cent of the total Aboriginal population, yet our perspectives are ignored.
Kelowna in fact marks the first time NWAC was ever invited to a First Ministers meeting. While we certainly viewed that in itself as progress, we are here today to report that it was and is not enough. The health department emerged out of the need to increase awareness of the harsh realities of Aboriginal women's lives as they relate to health. While it is true that Aboriginal women carry the heaviest burden of ill health in this country, it is important that the realities be contextualized. It is up to us as Aboriginal women to do the research, to interpret the evidence and to communicate the facts about our health and well-being.
Our demographic profile has changed very little in the past 10 years, but what is important is that we know that the current approach is not working and we know what needs to change.
I have been involved in Aboriginal health policy at different national Aboriginal organizations for about a decade here in Ottawa. Since I have been director at NWAC I have managed to build my team to a core group of eight. The health department is 100 per cent dependent upon project funding, and we aggressively seek out new and alternate funding sources and opportunities and have experienced a fair degree of success with this. We are actively building our capacity to do primary research, reflected for example through a research study exploring the impacts of neurological conditions on Aboriginal women, their families and communities. This project is part of a national population health study on neurological conditions funded by the Public Health Agency of Canada.
The health department has also conducted community-based research on elder abuse, and has worked with our grandmothers across the country to explore the impacts of abuse on their lives. This project was funded by HRSDC.
Further, we are presently seeking support through a grant proposal to the Canadian Institutes for Health Research to undertake research towards addressing the ongoing epidemic of HIV/AIDS among the Aboriginal female population. While a series of national initiatives implemented by Health Canada, which you have heard a lot about this morning, such as the Aboriginal Diabetes Initiative, the Aboriginal Human Health Resources Initiative, the Aboriginal Health Transition Fund and the National Aboriginal Youth Suicide Prevention Strategy, they have all helped to support the capacity development within the health department and at the community level. However, contributions are irregular, unpredictable, and often do not reach recipients until well into the fiscal year. They are typically year-to- year funding and they are not multi-year funding envelopes. That creates a lot of challenges for our level and at the community level.
The health department represents a population with the highest health disparities, as I have explained. NWAC is the only national Aboriginal organization solely dedicated to Aboriginal women's issues. We are urgently advocating for funding parity with other national Aboriginal organizations so that we can do a better job of representing half of the Aboriginal population.
Federal investments in Aboriginal health since the first ministers meeting of 2004 have represented an opportunity for government, in collaboration with Aboriginal organizations, to take action to break the cycle of poverty, violence and poor health in our communities. We consider these contributions as positive steps toward raising awareness of health issues and concerns and building capacity, as I have mentioned, to support programming. However, it is simply not enough.
We raise these issues today because we believe that this committee could assist in advocating for changes in the federal funding processes related to the implementation of those initiatives because many of those initiatives have been extended for another five years, and we look to you for support in improving the processes related to the allocation of funds.
Regarding Aboriginal women's health status and the way forward, any discussion on Aboriginal people's health status must be preceded by acknowledgement of colonization and its impacts. These impacts continue today through the child welfare system and through the justice system. For many, the healing has just begun; for others the struggle continues. This has all been well documented. Poor health status, as you heard earlier as well, is linked to the inequalities in social determinants such as housing, education, socio-economic status, income and employment. The health status picture for Aboriginal women as it relates to social determinants includes the following, and I will mention a couple of statistics.
Seventy-one per cent of Aboriginal single-parent households live off-reserve, and over 80 per cent of those households are headed by single female parents. More than half of all female single-parent households live in core housing need. Aboriginal women make up 32 per cent of the Canadian prison population. The number of Aboriginal women federally incarcerated increased by 151 per cent between 1997 and 2007. In 2005, the average income of Aboriginal women was almost 30 per cent less than Aboriginal men. These are some of the social determinants and the statistics related to that.
The health and socio-economic outcomes of Aboriginal women in Canada underscore the need for change. For us, health status is solidly rooted in the imposition of colonial, patriarchal laws and policies. A new more effective approach to Aboriginal health in this country would see a reshaping of our relationships. The approach would be reshaped to be inclusive of gender perspectives. NWAC has long held this position. Systemic change is the only real way to sustainably improve Aboriginal women's health.
Aboriginal women experience the highest rates of chronic illnesses, mental health issues and spousal abuse and are at higher risk of succumbing to alcohol and substance abuse as a result. We have higher rates of unemployment, poverty and victimization compared to any other sector of the Canadian population. Young girls are attempting suicide at rates never before seen. They are being drawn into gang activity and are increasingly vulnerable to exploitation and abuse.
Aboriginal women face multiple barriers locally, and are generally not active participants in local governance, as is evidenced by their low representation in leadership positions at that level. I was at an event just last week where a well- respected First Nations leader referred to Aboriginal women as servants in their communities.
Perhaps the most challenging thing in moving forward is creating shifts at the local level with regard to Aboriginal women's roles. Certainly our roles as traditional knowledge holders, as teachers, as givers of life have changed over time and we remain central to the family unit, grounding our future leaders with cultural continuity, security, support and hope. However, servants we are not.
This leader's words illustrate how internalized colonization misrepresentations of gender roles are. His words affirm for me how important it is that Aboriginal women be represented by Aboriginal women.
The Deputy Chair: Thank you. That was a clear document and some very troubling statistics that you gave us.
Committee members, perhaps I could start off with a couple of questions while I get names down here and we will take it from there.
Let me pick up on something that you said, Ms. Hanson, when you were talking about the blueprint:
. . . it emphasizes that Aboriginal organizations must work "as equal members" with federal, provincial and territorial governments. But this has often translated into a pan-Aboriginal approach, which does not serve Inuit interests, or meaningless "too-late-in-the-game" consultations.
Can you expand upon that a bit? Maybe Ms. Corston might also have some thoughts.
Ms. Hanson: I will start us off and then I will have Ms. Ford speak to it as well because that is her department.
What happens across the board, in terms of being classified as Aboriginal, is that typical Canadians seem to think that First Nations, Inuit and Metis are all the same, especially because we have this Aboriginal umbrella. We tend to see that with government employees as well. When it comes to programming, it is easier to have policies and programs set for Aboriginals as though we are equals. We are all equal Canadians, but when it comes to specific programming and services — and this was supposed to be set out — in the blueprint it said "distinctions-based approach" as a framework.
In some cases we have not seen it; in others, unfortunately, more work needs to done in that regard. I will pass it to Ms. Ford now.
Elizabeth Ford, Director, Health and Social Development, Inuit Tapiriit Kanatami: The other issue that we have — and I came in a bit late for the other one — involves jurisdictional issues. Inuit regions extend through provinces and territories. We all have land claim agreements and we all do have a role to play in health care. I think part of the issue is that because we do not necessarily deliver health services — that is the province, although we do some in terms of the Nunatsiavut delivering public health — when we come to the table to talk about health issues, Inuit regions are not always seen as equal players, and the land claim organizations are not seen as equal players at an equal level in talking about programs and policies around Inuit health. I think that is another issue that we have.
The Deputy Chair: Are you saying that there should be separate consultations as opposed to the pan-Aboriginal approach? That is what I took from the comments that were made by Ms. Hanson.
Ms. Ford: We would advocate for an Inuit-specific approach, but in terms of Inuit regions delivering health services or providing input into the policies and programs that impact Inuit in those regions, we would have Inuit organizations as an equal player in how that might roll out or how the policies around health care would roll out.
The Deputy Chair: Ms. Corston, is your organization present at the table during these discussions? Are you part of these as well? You have obviously got some issues here that need to get attention. Are you part of it, or is it just the other major organizations?
Ms. Corston: No, we have been part of it since 2004-05. We have been provided some capacity support to engage at the national level for sure. What happens, though, is that typically the perspectives that are brought to the table are brought to the table, particularly in First Nations circumstances, by First Nations chiefs who represent their communities, that is, their members who live on-reserve. There are two aspects that are missed when First Nations chiefs act on behalf of their membership, including the gender piece, because the majority of chiefs in this country are men. Oftentimes, the gender perspective gets lost in that, as well as the off-reserve perspective. I think that, particularly for Aboriginal women, the majority of us do not live on an Indian Act reserve. We typically live in urban centres. That perspective is also missed many times in these discussions by virtue of chiefs being at the table.
[Translation]
Senator Champagne: It is great to hear all three of you talk about the current agreement, which, at times, was inadequate and in serious need of improvement, and to hear your hopes for the next agreement.
Ms. Hanson, you said you want to work with the government. Nonetheless, right now, you have, in cabinet, an excellent spokesperson within the Department of Health, Ms. Agglukak. She is actually the one who asked us to undertake this study.
You mentioned something I found quite shocking, and that is the high number of tuberculosis cases. I have a hard time wrapping my head around the fact that the disease is still so prevalent in your communities, given the BCG vaccine. Under the transition fund aimed at improving health, is it not a priority to vaccinate children against tuberculosis at a very young age? Is that not something that should be happening? BCG has been available for years and is quite effective.
You also talked about diabetes. I realize just how common this disease is in all Aboriginal communities, both Inuit and others. Those living on reserves up north face problems as far as diet and food are concerned, but even people who live in cities are very often diabetic. Is it a genetic problem? Those of you in health care may be able to answer those questions.
Another problem you mentioned was HIV/AIDS. First and foremost, it is a problem that has to do with education, even before health. Given all the work being done to educate Aboriginals living on and off reserves, up north and all over, I would think this would be one of the first things young men and women learn, because HIV is passed on and we all know how.
We are dealing with an education problem and a health problem since there is no vaccine. Is diabetes genetic? That requires people who are more in the know than I am, but it is something I am wondering.
[English]
Ms. Ford: I am not sure. In terms of tuberculosis, it is a disease that a lot of people think is no longer around. The high rates for Inuit are surprising to a lot of people. I am not sure that it is genetics. It is not Inuit TB; it is TB in Inuit communities. I believe some regions still do vaccinations. We are working on an action plan. Earlier, we talked about the social determinants of health and how big of an impact that is on Inuit communities and on health. With overcrowding and with the lack of screening, a lot of our communities do not have access to X-rays, for example, to do the testing. In terms of latent TB, once people are getting older, then it can be reactivated. There is a lot of overcrowding in our homes. If someone is in close contact with someone who may not be diagnosed — and always being diagnosed is a big issue.
Senator Champagne: If we could send H1N1 vaccines all over, I do not see why tuberculosis vaccines could not be made available to everyone. I am not saying that tuberculosis would be genetic. I was mentioning that for diabetes, maybe.
Ms. Ford: Fortunately for us, right now diabetes rates are lower for Inuit. Again, there is always the issue of whether it is lower because we do not have the same screening. For the issue of diabetes, we can hopefully do something before it reaches higher rates. Yes, it is an issue that we need to keep a close eye on and do a lot of work on, but at this point it is not as high as some of the others. I think in some cases it is closer to the Canadian rate. Again, screening is an issue and it is something that we would have to keep an eye on and do a lot of prevention beforehand to ensure that it does not reach those higher rates.
The Deputy Chair: Did you have anything to add to that, Ms. Corston?
Ms. Corston: Not necessarily with regard to TB, but I can speak a little bit about diabetes and HIV.
I would not say that diabetes is genetic, but would I say that it is linked to things like poverty and some of the social determinants that have been mentioned. I also think it is linked to the fact that for a lot of our women who live away from reserve, or even away from their traditional territories, it is lack of access to traditional foods, such as foods that are high in protein — fish, wild game and that kind of thing.
There is a misunderstanding with regard to when people leave their communities and their reserves. There is a perception that you automatically become healthy and wealthy when you leave the reserve, when in fact that is not true. Poverty and living high-risk lifestyles to get by and put food on the table are even more prevalent off-reserve for many of our women.
What we have been discovering in the work we have been doing on the issue of HIV and AIDS is that, in fact, education and awareness are still very low. We have done environmental scans on the education and awareness materials that are available for Aboriginal populations. They are not culturally relevant or gender-specific, so they are not speaking to the populations that they should be.
As well, if I could close with this comment: What I have learned most recently about HIV and AIDS is that many of our women are not being diagnosed at the HIV stage; they are being diagnosed once they have full-blown AIDS. There are issues with our women getting tested. We are missing something there, for sure.
Senator Martin: It is nice to see three strong, articulate women. I think that is one important way forward, for young Aboriginal, Inuit and Metis women to see what you are doing. Thank you for being here.
In terms of health care that is delivered by the territorial governments — as it should be, because it needs to be culturally specific and relevant — I am curious to know the relationship you have with Health Canada. Should one of the goals be to ensure that your presence there is working towards greater influence on program development? Health delivery is done by the territorial governments, but program development itself could be more relevant and more culturally specific. Is that where the focus should be?
Ms. Ford: Yes. We do work closely with Health Canada, and we work very well in some areas. There is the jurisdictional issue. Of course, provinces and territories do deliver the health care, and we understand that. We want to work with the provinces and territories, as well as with the federal government. That is where we want to ensure that, in the development of programs and policies, Inuit are at the table talking about those programs and policies and how they should be developed in order to work well in their communities and regions. One thing the federal government can do is to ensure that when you are funding programs that are relevant to Inuit, that Inuit are an equal player at the table in the development of those programs.
Senator Martin: It was my error to say that in the development it would be in working with the territorial and provincial governments, and that that is their jurisdiction.
You are at the table at this time. Do you not feel like an equal partner in working with the territories and provinces per se? Do you feel that they are really listening to your input on designing the programs, as well as in certain delivery of these programs? I am not sure how that would be articulated or enforced, but I know you are at the table and you are a very well-respected organization. How can that improve, in your opinion?
Ms. Hanson: There are two ways of looking at it. One is that when you try to describe when you have the most impact and effect in the communities, how does that look? ITK is a national policy organization. We do not actually deliver any programs, but what we do is bring all the partners to the table. Our National Inuit Committee on Health brings all parties to the table to discuss how we can move forward on delivering programs or how we can affect policy. It is two-forked.
We have two different aspects of it. When we look at the blueprint and ask that there be Inuit-specific programming or approaches, we have the delivery in the regions, but then we also have the program development at the federal level.
Having the Minister of Health has been very helpful, and it is great to see that. We like to remind people, though, that she is only one person at a very large cabinet table.
There are other aspects to this that need to be considered. Jurisdictionally, we have four different Inuit regions. When we try to experience economies of scale, it is not just one region and one minister. We have four ministers and four presidents of land claims agreements; and, as Ms. Ford touched on briefly, we also have one of the regions that deliver some public health aspects of it as well. There are many different players at the table.
The Deputy Chair: We have to move on. Sorry about that.
Senator Martin: I will submit my question to the clerk.
The Deputy Chair: I will ask if Ms. Corston has anything to add.
Ms. Corston: I do have an anecdote to share that might shed some light in terms of program development. When we talk about culturally relevant and gender-specific programming, I will use diabetes as an example. I always use this story because it makes it real for a lot of people.
We have high rates of diabetes in our communities. We know that. If we look at the data, we can see that Aboriginal men, in fact, have greater issues with complications related to diabetes, such as amputations, foot problems, and those kinds of things. If we look at programming to address things like diabetes, we have to look at the data and gender- desegregate the data. If we do that, then clearly programming at the local level with regard to foot care should focus on men as opposed to women. We know who gets the most pedicures; it is women. However, if you look at the data and you are trying to create programming for diabetes, you would make sure that we access the men in terms of programming for foot care.
Senator Merchant: I am wondering exactly how you involve women in the decision making. You can have the funds and you can set up the programs. Are you able to engage young women, and older women, because of course seniors have problems too? It is just that you find there is a general — not apathy — but it is difficult for people to engage. We see this at all levels.
How can government programs help you engage? You are speaking on behalf of women here. How can you engage more women so that you are working together to bring some solutions rather than, as you said, sometimes the chiefs are men, there are not enough women? How can we help? What can the government do to try to engage more Aboriginal women? I think they are the best people to try to give input and maybe try to work together for solutions.
Ms. Corston: I will tell you what we do to engage our women. You can draw it from the statistics as well. We know that 40 per cent of our women live in poverty, for example. We know that the vast majority of our women are raising their children single-handedly. Those two pieces, if you want to engage Aboriginal women in whatever program you have going, clearly you have to provide them perhaps with a bus ticket or a meal when they get there, or a babysitter, those kinds of very basic things. They do come out. They will engage. They are more than happy to come out and share.
We have a number of advisory committees, made up of Aboriginal women, that help us do the work that we do. A big piece of that is ensuring they can get there.
Ms. Hanson: I would like to add that we are actually quite proud of the ratio of Inuit women leaders, which I think should go on the record.
I know there is not enough time to name of all them, but within the regions we have premiers, ministers and presidents of the land claims organizations. We have mayors. We are talking about a very high rate of Inuit.
Also, at the board level, ITK has Pauktuutit on our board and NIYC, the National Inuit Youth Council, which is represented by a young woman and, of course, our president, Mary Simon. We ensure that we have women helping with these important decisions on delivering health care or creating policy with these committees. We have Pauktuutit or other women representatives as well, just by virtue of their gender, on the board.
Senator Hubley: Welcome to you all, and thank you for your presentation.
My question will probably go to Ms. Corston. You may correct the percentages, because I was jotting them down as you were presenting your paper this morning.
I think it was 71 per cent of Aboriginal single-parent households live off-reserve. You gave another percentage on those households where the female was the sole provider. What was that percentage? Was it 80 per cent? Can you give me a profile on the number of children who might be in each of those households? Do you have that information? Are you able to share that with us?
Ms. Corston: I believe that there was a written submission provided to you. I may have included it in there, but it is at 2.6, compared to, I think, 1.3 for the non-Aboriginal population.
Senator Hubley: Being off-reserve, does that, in itself, present special problems? Perhaps there are no grandparents to help out or there may not be that kind of at-home caregiver. Is that something they have experienced?
Ms. Corston: For sure. I can refer to one of the initiatives that was referred to earlier with the Aboriginal Health Human Resources Initiative that looks at promoting health careers among the Aboriginal population, for example.
One of the pieces that we look at is the fact that many of our women, first of all, drop out of high school. The vast majority of them drop out because of family-related responsibilities, so we know our women are having children much younger. We also know that they are returning to school later and are typically the older students in the class. They are also typically having more children and raising them on their own.
When they move away from their home communities to pursue education and employment, they are typically on their own. They then do not have those support structures, such as child care and those types of things, to thrive and succeed in those endeavours.
[Translation]
Senator Verner: I want to thank all three of you for being here. I will be addressing Ms. Corston mostly since we are short on time. My question has to do with achieving gender equality through the application of a culturally relevant gender-based analysis and the engagement of women in program development.
Shortly before you arrived, a Health Canada official told us that gender-based analysis was used in Health Canada's programs and that Aboriginal women were consulted and involved in developing those programs.
You listed some very disturbing, and I would even go so far as to say shocking, statistics for a modern society. There are so many factors that come into play in terms of the issues you addressed. What would the solution be when working out the next health agreement? Should conditions be imposed? Should a special instrument be created to fund Aboriginal women's groups? I appreciate that most of your leaders are men. I am trying to figure out a way to improve these statistics. We cannot be immune to the situation, and above all, we cannot do nothing.
[English]
Ms. Corston: That is a great question. One of the messages that I really did want to relay in coming here is that with the health accord there will be national initiatives that are part of that and will funnel money to address Aboriginal people's poor health status.
One of the big pieces — and I referred to it briefly in my speaking notes — is with regard to how those funds flow. I think that what happens a lot of times, and particularly at the community level, is that with year-to-year funding you are constantly spending time chasing the dollar.
Aside from program development, very fundamentally, if we looked at ways to improve the process by which funding flows to communities, that would go a long way. What is happening, and what happens with our organization and many others across the board, is that you are constantly chasing those year-to-year funding envelopes. You are developing work plans, you are identifying deliverables, and by the time you receive the money, oftentimes, you have to report on them. It is a continued cycle where a lot of times the effort that should be going into creating more meaningful programming is spent on reporting and chasing the dollars. That is one piece that I wanted to relay here today.
With regard to Aboriginal women's involvement in program development, one of the pieces that impacts our ability to engage equitably is the piece that I spoke to with regard to poverty. All the social determinants that I mentioned earlier play into that. Honestly, I do not think there are enough women, aside from Inuit women, participating in the process to ensure that those kinds of messages are relayed. Really, it is all about making sure that the dollars funnel to where they are most needed, and for that to occur, the system and process changes need to occur. I hope I answered your question.
Senator Cordy: I was also going to ask about your working relationship with the department and how much influence you have as the women's association, so if you could keep that in your head because I would like to go back to what we have been talking about during much of the session, namely, the social determinants of health. We have been talking about clean water, housing, poverty, nutritious diet and education. Each of those individually would have an effect on the health of the Inuit women, First Nations and Aboriginal peoples. However, we have an accumulation of those things affecting the community. Going forward, as Senator Verner said, we are making recommendations as to what should be in the new health accord.
I do not see how we can skip the social determinants of health if we are making recommendations for Aboriginal, First Nations and Inuit peoples in the accord. How do you see that fitting in? How do you see what we recommend to the minister in terms of what we should suggest be in the new accord? The social determinants of health are the basis for the whole thing.
Ms. Corston: If you look at things in perspective, we are looking at culturally relevant, gender-based perspectives on the issues. In moving forward, we cannot ignore the social determinants because an indigenous worldview in looking at the issues ensures that we incorporate all of those aspects into the solution. A piece of that as well, as I spoke to briefly, is with regard to the impacts of colonization, residential schools, and now, as we are seeing, with the child welfare system and the justice system. All those pieces have to be woven in to create the change we need. If we look at things in a piecemeal fashion, we will not create the changes that we need.
Ms. Ford: As Ms. Hanson talked about earlier, the social determinants for the accord were one of the areas least advanced. The Inuit, for the last number of years, have been looking at it through a social determinants of health lens, recognizing that we will not be able to change all of these issues without addressing the social determinants of health. It is a challenging area because it does cross so many departments and jurisdictions. I think we do have to emphasize, again, that we need to work together to be able to work across the departments. We do think holistically, and without housing improvements and education improvements, we will not be able to address health issues in our Inuit communities. It needs to be the strongest part of the way moving forward and how we work together to address the social determinants of health.
The Deputy Chair: To follow up on that, the Blueprint was supposed to contain social determinants of health, programs such as housing. What went wrong? Was there not enough money, or was it the jurisdictional problem? You are saying it is still a big problem. Obviously, it has not been addressed.
Ms. Ford: I am not sure what the issues are. I think part of it is just the challenge of departments being used to working on health issues and looking at health and how do you address health, but it has to be broader and look at the social determinants of health, access to health care and to affordable nutrition, but it is not in the purview of one place. It is how we work together.
Ms. Hanson: You asked a very important question: Where are we going wrong and why is it that we are not seeing any results in that area?
In terms of each aspect of it, we have all sorts of tools. Ms. Ford came with all sorts of different action plans, strategies and jurisdictions who have come together to look at new ways of trying to solve problems and solutions. However, these are tools, and the tools are not adequately funded. They are not given everything that is needed in order for these problems to be resolved. I am sure you are probably tired of hearing it, but it is a fact of life that was mentioned by Ms. Corston, that investment and a new infusion of resources are needed. There needs to be a way to look at how to do that.
Perhaps that is the problem with the health accord, a new health accord, that the time is taken to consider how new investment and how new resources are used in actually using these tools effectively. All those tools together spell out political will. There is most definitely political will out there and interest to get it done. It is a matter of how we do it.
The Deputy Chair: Thank you very much.
Colleagues, we are at adjournment time. Were there any other questions that you wanted to get on the table that we could put to our witnesses while asking them not to comment now but to give us their thoughts in writing? Do senators want to add anything that they never got a chance to ask?
Senator Martin: I had a question in writing that I was going to give to our clerk. Regarding the ITK, you mentioned that you wished to be more of an equal partner at the table. Obviously, you are at the table already, and you described your very specific role or focus in looking at policy and advising governments.
My question would be: What is missing or what is weak in the current model or framework that needs to be added or changed or tweaked or strengthened to help you feel that sense of equality or that your impact is greater in that relationship? How do we strengthen that?
The Deputy Chair: Are there any other questions we want to put to our witnesses?
Thank you very much to all three of you. You have helped inform us about the issues that you are facing. They are part of the different Aboriginal people's communities. You have been most helpful to us and we thank you.
With that colleagues, were now adjourned.
(The committee adjourned.)