Proceedings of the Subcommittee on Population Health
Issue 4 - Evidence, May 31, 2007
OTTAWA, Thursday, May 31, 2007
The Subcommittee on Population Health of the Standing Senate Committee on Social Affairs, Science and Technology met this day at 5:53 p.m. to examine and report upon the impact of the multiple factors and conditions that contribute to the health of Canada's population — known collectively as the social determinants of health.
Senator Wilbert J. Keon (Chairman) in the chair.
[English]
The Chairman: Honourable senators, I call this meeting to order. We are very delighted to have with us Mr. David Chartrand. We will begin with his presentation.
David Chartrand, Minister of Health, Métis National Council: I should like to thank all senators as well as the ones who will be joining us shortly on behalf of the Métis Nation for having us here this evening to make a presentation. Métis National Council, MNC, is the governing institution that represents the Metis from Ontario to British Columbia. Our homeland originates in parts of Ontario, the United States, the Northwest Territories and British Columbia.
I thank the Standing Senate Subcommittee on Population Health for inviting me to present to you on issues of population health.
I also want to thank you for making this hearing Metis-specific. Too many times, the Metis have been misplaced or lost under the description of the world ``Aboriginal.'' On many occasions when announcements are made by the government or even the Senate itself the word ``Aboriginal'' is referenced. However, when you look deep into what it means, it does not include the Metis. That is what we have found over and over again for too long, so I am pleased we are having a Metis-specific presentation this evening.
For the last two years, we have been trying to get a handle on the factors and conditions that contribute to the health of Metis Métis people. We have undertaken extensive research in this area and we will provide a brief snapshot of the results of our work so far.
Before getting into the presentation, I wish to share with you some of the systemic barriers that have impeded the development of our population and eroded the health status of our population. The greatest impediment to our development has been the failure of both levels of government to deal head-on with the Metis people and their issues and economic challenges in our communities.
Poverty, in large measure, stems from the failed land claims and script policy of the 19th and early 20th centuries. The failed land policies, which will be ruled on by the courts later this year, left the Metis landless and geographically divided in our own lands.
For your information, we have had a land claim going on for 25 years. We just concluded our arguments last year and are waiting for the judiciary to rule on that decision. We are looking forward to a favourable ruling.
In fact, because of that action alone, it has eroded our identity, undermined our self-confidence and left the majority of us unable to take advantage of the economic opportunities that emerged in the development of Canada. We hope to have a chance to present in the future on the issue of a landless people and what happens to us when we are pushed into no-man's land. You will find us always neighbouring reserves throughout our western homeland but denied any access to any opportunity or services. We are not entitled or allowed to receive any First Nations programs on diabetes or sectoral areas of adjustments that Canada has given. Even though they are 20 feet away from us, we cannot access them. Even as taxpayers we are not entitled to them.
The MNC has welcomed the recent report of the Standing Senate Committee on Aboriginal Peoples on Aboriginal economic development that was just completed. We have gone through some of the findings. We are just analyzing the report and are very pleased by some of the statements made in connection to our issues as Metis people. We look forward to following through on some of those recommendations in the report.
The issue, however, is that this systemic discrimination against the Metis has led to poor health conditions that, if not dealt with now, will be dealt with at a tremendous cost. That is something I have been saying personally for years now to federal and provincial health ministers in Canada. The health care system in the future will pay great dividends, not only from Canadian taxpayers, but Metis taxpayers ourselves. The higher costs of health care will affect all of us. The effects are tremendous. I can use my community of Duck Bay as an example. In nearly every household, you will find someone with diabetes. When you go house to house, you find other chronic illnesses that affect our communities.
Because of the continuation of denial that we exist as a people, everyone is trying to stay away from us. At the end, there will be a great cost. We have been trying to caution and warn government, even if you do not want to look at us as Metis people with rights, to look at us as Canadians. We are taxpayers. We are entitled to services, the same as any other Canadian. We have led the task of trying to educate politicians. Everybody has been fearful to sit down with us, on the basis that if Canada sits down with us the provinces say to Canada, ``You are responsible now, you just showcased that.'' If the provinces deal with us, the feds say that the provinces are responsible, that they just proved it by servicing them. It has been a challenge for us as Metis people.
We welcome your work, which I understand is to identify the actions that must be undertaken by the federal government to implement population health strategies. For our part, action must include the following: First, there must be an acknowledgment that all levels of government — federal, provincial and Metis governments — have shared responsibility to address the health needs of tax-paying Metis populations. Health Canada has opened the door to Metis in the last few years, and we are developing a strong working relationship with them. This must continue. This is the first time in our history that Health Canada has included us as a partner to their process.
Second, the Metis governments and institutions must be supported to ensure that Metis people play an effective role in the design, delivery and operations of the health care system. This does not mean a separate system, but rather a system where Metis people play an important role in working to improve the health conditions of Metis people.
Third, the commitment must be sustainable over a period of years. We must agree to implement long-term solutions. That is why the health blueprint we recommended was so important. It should be recognised that we have recently been invited to be included in Health Canada projects. We have made a start with Health Canada, but that funding is only for two and a half more years. The government needs to extend this to at least a 10-year horizon. It should be clearly understood that it has taken decades to put the Metis in the dangerous state that we are in today, and it will take several decades to get us out of it.
Fourth, we need to take an outcome-based approach and generate positive changes to the health status of our population. We need to set targets and adapt and manage the health care system to meet those targets.
Fifth, we need to increase our knowledge base and improve our collective capacity to make the necessary changes to health and wellness approaches.
In other governing states, such as Brazil and Australia, horizontal governance has been established to confront the social determinants of health of indigenous people. I applaud the direction of those other governing states. They are focussed. Every department has a direct effect on the issues as they pertain to the social determinants of health of indigenous people. They are now moving in horizontal measures instead of the vertical measures we find ourselves sometimes in Canada. I applaud those measures, and I look forward to every department coming forth on the commitments made in the budgets of each department in terms of how they are handling and dealing with social determinants of health in this country. I look forward to Canada one day adopting that kind of measure.
This also includes building Metis capacity and establishing new partnerships between the health care system and our governing members. We are ready, but in order to measure success in our challenge, it must be Metis-specific. I say that again — it must be Metis-specific. We cannot be buried in the word ``Aboriginal,'' because I assure you that we will be lost. We will be battling a bureaucracy that understands the word ``Aboriginal'' under Health Canada as First Nation and Inuit only. It is a challenge we have faced for too long, and we are finding that in all other departments as we move forward in our discussions and negotiations with Canada and sometimes the provinces.
We will also show in the next little while some demonstrations that the Metis have made greater strides in understanding our health conditions in the past few years than the federal government or the provinces have over the last three decades. Some of the graphs and portals we will show you shortly will give a good peak into the Metis state as it now finds itself and the potential danger this country will face.
I have always said personally as a leader of my people, and I have made it clear to ministers, that if we do not tackle this issue head-on soon, the cost will be humungous — not only to us today, but it will affect the future of children following us. They will pay the price of ignorance or the price of absenteeism by the actions of government.
I will conclude my comments here and pass it over to Dr. Bartlett, who will also provide a presentation that she has already handed out to you.
Dr. Judy Bartlett, Director of Health and Wellness Department and Associate Professor, Department of Community Health Science, Faculty of Medicine, University of Manitoba, Manitoba Métis Foundation: Good afternoon. I was asked to present as an academic from the University of Manitoba. I am also the Director of the Health and Wellness Department that I am developing for the Manitoba Métis Federation. Thank you for asking me to be a witness here today.
The key message I want to be able to pass on today is that suppression of nationhood and identity at both the individual and societal level are critical. This has profound health effects. You have seen them. They came about as a result of existing in a marginalized status. Self-governance is the most critical determinant of health that must be addressed. I want to be able to describe this a bit more.
I will cover six areas. One is setting the stage. How important is history? I will talk a bit about research and Metis health status. I will provide you several graphs and look at what I am calling an attention gap. I want to look at some selected indices, showing what we already know. In terms of culture and identity, what is so important about it, and what have other researchers had to say? I want to talk about the specific and broad approaches — I did not take the opportunity to read all the other sessions this committee has held on this topic — and reflect on that a bit. Finally, I want to talk about the need for indigenous population health promotion frameworks and how we can approach these serious issues.
The example I will provide is one example. There are probably many.
Metis ethno-genesis began quite early when Europeans first came. In fact, there was some growth in the east, albeit fledgling. Eventually, the Metis formed the homeland in the region of Manitoba at the forks of the Red and Assiniboine Rivers. Early on, at the forks, the Metis were basically a people who came together. By 1810, they were saying that a new nation had been formed.
The Crown's role in having forced a whole people underground and into marginalization is important. I do not think that has been recognized. I do not think any responsibility has been taken on that. We are just beginning to look at the edges of that now. There are survivors of the underground. There are certainly Metis people who clearly still live in Metis communities very discretely, but many Metis are diffused. They are reclaiming that historical and contemporary identity as Metis. That is happening as we speak throughout the Metis homeland.
Others, however, are significantly caught in the tensions between Canadians and First Nations. In one of my research studies, one woman observed:
I have white friends that want me to pretend I'm white, and then I have Indian friends that want me to pretend I'm Indian; and they don't like each other and I'm stuck in the middle.
If we look at the under-representation of Metis research — Young did a paper — he did a search of a very specific period, of around 250 articles of Aboriginal health, there were four on Metis. There are some reasons for this. One of the key reasons is there is no enumeration of Metis in Canada and there are no identifiers in provincial data user files. As well, the Metis are highly urbanized and diffusely situated. There are some discrete Metis communities. For example, in the city of Winnipeg, there are around 23,000 Metis people, which is a large number of Metis people in one place, but they are diffusely situated throughout the city.
Metis research needs and aspirations are being overlooked. There is a significant risk, with the current new CIHR guidelines, because the word ``Metis'' shows up in the title but nowhere else. All the examples are First Nation examples. It is so stringent and based on discrete communities that it has the risk of actually shutting down research for Metis people.
These are some of the data I want to show you quickly. I will not spend a lot of time on it. This was a descriptive study that was done by the University of Manitoba and the Manitoba Metis Federation. You can see there that 43 per cent of Aboriginal people who do not live in reserve communities are Metis in Canada. That is a huge proportion, yet we tend to be overlooked. The next graph tells you this is a very young population, and that has significant implications for what will happen in the future if we do not begin to deal with the issue of Metis disempowerment.
In terms of the incomes, 55 per cent of Metis people live on incomes of less than $20,000. I cannot imagine living on that kind of money. The income distribution of the Metis across Canada is not homogeneous; there are differences across provinces. It is something we need to look at and ask why that is occurring. What are the policy drivers that make that happen?
The next graph looks at chronic diseases. The Metis have significantly poorer health than the general population, except for hypertension, stroke and other long-term conditions. Other than TB and diabetes, there is no significant difference between Metis and First Nation health status.
You can see certain things, such as arthritis, are extremely high. Diabetes is further down the line but has significant impacts in terms of human suffering. Arthritis has not really been dealt with. There should be an article coming out shortly that I participated in publishing, looking at arthritis in the Aboriginal population in Manitoba.
The next graph is contact with health professionals. We can see that the family doctor use is around 72 per cent; from a previous study, the general population is about 83 per cent. Metis and First Nation access to family doctors is equivalent. They have less access to certain things, namely those things that really would not be insured, such as eye doctors and dentists. They have less access to those services.
We must remember that these are graphs and the differences might be small. They may not be significant, but they do show up in the graphs.
There are a few more things, such as chiropractors and physiotherapists, which might be related to living in urban environments. Not shown on this slide is the fact that all rural Metis have less access to health care than urban Metis.
I want to talk about culture and identity and what is so important about it. We can talk about a lost century. The Metis people became hidden or invisible in another cultural milieu. Essentially, people had to go underground in order to be safe in Canada. If you were light skinned, you tended to mix in. If you refused to mix in, you were marginalized.
One of the other things I think is important is that what we know does not always seem to bear on what we do. If we look back to the early 1970s, Becker, who is deceased now, was a social scientist who studied identity and ego formation. He said that identity is simply a measure of power and participation.
We definitely know that the Metis people have had little access to power and participation, as well as being forcibly dispersed across the West. Discrete communities having been dispersed, it makes it difficult. I will talk later about why that is important.
Metis become triply marginalized, in a sense. There is the initial marginalization of not being accepted in either society. Metis are not just marginalized from the Canadian society; they are marginalized from the Indian society by not being included in the Indian Act and having those benefits. Now we are having a triple marginalization through this thing called ``pan-Aboriginalism.''
One of the things I would suggest is would we say, for instance, we will have a pan-Asian policy and tell Chinese and Japanese people that we will totally ignore your cultural differences because, purely for pragmatic reasons, we need one policy.
We would not think of a pan-doctor/nurse type of institution. Some of us would as population health people, but we are not there. Doctors and nurses get focused attention in Manitoba. There are 2,000 doctors that get focused attention and 56,000 Metis that do not.
I think the Aboriginal Health Transition Fund is a good start. There is a real re-emergence of a robust Metis cultural identity. The one thing we absolutely need is health information. In Manitoba, we are undertaking a fairly significant health status and health service utilization study with the University of Manitoba, and our province has been involved in that.
I want to look at specific versus broad approaches. These were talked about in one of the other sessions. Three of the witnesses had talked about the usual specific kind of policy interventions that are health promotion-based, to some extent. Some of them are about reducing poverty, but there are reducing risk factors in those.
I was particularly taken by the testimony of Dr. Stachenko and Dr. Glouberman. Dr. Stachenko talked about the need to understand the determinants and their interactions. This is something I have been working with for many years. Dr. Glouberman said we need to get a more fundamental understanding of the complexity of interaction to provide a broader picture. He also said that we should be thinking about the things that will release the efforts of individuals and small groups throughout society. It is not only broad, country level or even province level; it is local activity, local action and empowerment to act.
The RCAP, way back in 1996, did a paper where they had done some of the work in looking at international literature, which I said I had done later on, looking at the issue of locus of control. The evidence shows that a loss of control has significant impacts. They surmised that it is likely that a loss of control by Aboriginal people of the majority of life decisions has contributed to their poor health status. The European studies are clear. I call for a science of self-governance, that is, loss of control has physiological consequences. I did a significant paper looking at diabetes and stress, and that was one of the things that came out very clearly. There are significant physiological consequences when you do not have locus of control in your life.
Looking at a rationale for indigenous population health frameworks, we need to be able to support groups and individuals to understand the complex interactions of the many aspects of their lives. This includes looking at self- governance tools. Looking at indigenous population health promotion, we need to think about the cognitive and emotional dissonance and identity confusion that has occurred from triple marginalization — original forced marginalization, the cultural dispossession, which was often very subtle, and disorientation by Canada. Within families, people with different colours of skin were treated differently by society. That creates a huge impact within the family. Finally, the pan-Aboriginal idea is not a good thing because it is just one more level of marginalization in subsuming a whole people inside other cultural orientations.
As a Metis people, we are dispersed and diffusely situated. We need to be able to articulate the meaning of ``Metis'' to ourselves in order to help other people figure out what they need to do that is Metis-specific.
Earnest Becker said that an individual's self-worth is embedded in ego and identity. I think the Metis, particularly our youth, need to see themselves reflected as valuable in Canada. That does not exist today. It is an essential part of youth development.
Evans and Stoddart talk about moving beyond disease. If one disease is cured another will simply take its place. Bandura, a social scientist, said that social cognitive theory rejects a dualism between individuals and society. You need to look at the individual and the society concurrently. Finally, Corin argues for the need to include categories of cultural, political, economic and social issues. She was talking about a health measurement framework. Hertzman also talked about this and he looked at the inclusion of life stages.
The framework I have worked on since 1994 has been implemented in a number of ways. The most important thing is not the framework itself but the process of development. It includes both agency and structure, or the individual and society, as well as other layers. It meets the challenge of integrating those.
If we look at health in a holistic manner, we think of health as being a balance of the spiritual, emotional, physical and intellectual aspect of a child, a youth, an adult or an elder who live as individuals and as members of families, communities and nations within various cultural, social, economic and political environments. Every individual, every group, every community lives these uniquely. A First Nations perspective might look at it this way where a general population society might look at it within the form of a matrix.
The matrix is helpful to some extent. I have worked with hundreds of people to begin to refine the content of these individual words. I work with people in workshops and get them to do a personal assessment of all the words, then a group assessment of all the words. I then take them through a workshop where they can actually develop minimal standards of wellness. I always thought if we have minimal standards of critical care, why not have minimal standards of wellness care? It is a simple process of talking getting the personal meanings, talking about them in the group, and not trying to find a single meaning but asking what we all think.
Finally, it is a process of looking at this little table and, when you take the words physical, spiritual, emotional and intellectual as a group, determining what they are about. You gave a name to each one of these rows and columns. This is refined from probably 60 or 70 workshops over the years with hundreds and hundreds of people. It was not an academic exercise; I did it entirely as a volunteer because it is what I like to do.
This is the way to use it as a wellness model: The person is in the middle and you work with them so they understand the framework you want to use to be able to walk a life path — a life promotion framework not a health promotion framework — to prevent us from getting stuck in the health sector.
We talk about nature. Who are we? What identity do we want to create? What developmental stage are we at? What relationships do we need? How does that influence the networks we can have in our lives? How do networks influence the supports? How do the supports influence the environment you live in? Finally, how does that help you have a voice? It is about a process of saying I know what the meaning of this framework is on a personal level and I can actually travel with it.
We can put anything in the middle of this circle. It can be diabetes or a policy or anything. It does not matter what goes in the circle. It is very important that we take the time to be able to work with Metis people and begin to clarify in an academic research manner what these things mean to us and how we can proceed forward with them.
That is the example I provide of one indigenous population health promotion framework.
The Chairman: Thank you, Dr. Bartlett. I understand Mr. Chartrand must leave in about five minutes.
Mr. Chartrand: Yes. I will leave in 20 minutes, Mr. Chairman, to catch a plane home.
We have a short presentation by Mr. LeClair on a portal we did within the last few years. It will be insightful and helpful to your committee as you look at recommendations on ways to change the Metis community today.
I must impress, I am pleased to have a Metis-specific opportunity here. Too often, we are lost in the word ``Aboriginal.'' It creates mass confusion for us at home.
The Chairman: We were most anxious to have this opportunity to meet you separately tonight because tomorrow we will be entering into a round table. If you have difficulties at this point in time as to your identity and where you fit in Canadian society, you can imagine the difficulties we have in trying to determine the same.
Mr. Chartrand: As background, I come from the Department of Justice and I took a leave of absence and became a political leader for my people. In previous opportunities, I spoke in different universities in eastern Canada. I was quite shocked when I asked how many people actually knew who the Metis were. In a room of maybe 500, I saw 20 hands go up. This is Canada. This is where I am from. I was born and raised in Red Deer. I was taken aback. We are lost in the emblem of identity and we need to impress upon that. We are left out when programs and directions of institutions of deliverance come from government. The word ``Aboriginal'' is used and you, as Chair of the Senate Aboriginal Committee, might think we are getting something because we are Aboriginal when, in fact, we are not. I will pass it on to Mr. LeClair.
The Chairman: In case I forget to tell you, minister, Senator St. Germain told me he would be here tonight if he could make it. Things were mixed up when we left the Senate, so I do not know if he will make it.
Marc LeClair, National Advisor to the Minister of Health, Métis National Council: As I listened to Dr. Bartlett, it reminded me of former Prime Minister Trudeau talking about multiculturalism. He said that a strong sense of Canadian identity was linked very much to a person's personal identity, which in turn was linked to their cultural group.
Clearly, the message from Dr. Bartlett is that it is important for population health and it might be applied to other multicultural groups in Canada in terms of improving their health conditions. We have to pay attention to identity and empowerment. All of those things underscore Dr. Bartlett's presentation.
I will present to you a piece that we have been working on — it is not complete by any means — about population health and a theory about population health. We tripped into this because we were trying to analyze as much data as we could that was available about Metis health in Canada.
We found that, in the health care system, sometimes it is like you start drinking your own — some ideas come up. One of the ideas was there was no data on Metis. In fact, from 1990 on, we have been collecting a lot of data on Metis through Statistics Canada, but no one analyzed it because no one is taking full responsibility for Metis health. Hence, we have a lot of data; we will just profile a bit of it here. We are in the process of populating this portal, but let me tell you the theory behind it.
It is consistent with other population health models and comes, to a large degree, from the Aboriginal Health Reporting Framework. We see that Metis health and well-being status — we measure their well-being, physical, mental and emotional. Those factors and the indicators behind the health status are shaped by these broader baskets of health determinants. How are we doing in social environment? What is our physical environment like? What kind of economic opportunities do we have? What are our income levels? What are our labour market participation rates? Do we have access to health care? We know that is an issue for Canadians generally in the hinterland. Do we have access to lifelong learning education and supports, including individual supports behind that? What kind of lifestyle habits — coping, spirituality and those kinds of things — do we have around us that help build a healthy person? As Dr. Bartlett pointed out, governance is a critical factor in a person's independence.
All of these things shape our health and well-being status and they should also shape what needs we have.
There is another part of the story, which is the demographics — the age structure of our population. We have found that, while we are a very young population, we are aging. There is a combination of an aging population and poor health that results in increased utilization rates. Increased utilization rates are driving the costs of the health care system that cannot be supported down the road. While we might have been ignored in the past, we are a very large population now. In Western Canada, we are closing in on 300,000 people, or more. It is growing as people throw off the yoke of marginalization and identify more, which is a healthy thing. This is not a negative story, it is a positive one. Your committee is looking at what structures are in place to improve that storyline — less utilization rates, a healthier population.
We have all of these factors that we are researching, and in behind each of these buttons is the data that we have. Dr. Bartlett went into some of it. We are populating this to get time series data over time. It is an innovative tool. There is a graphic interface and there is a database behind it. Health Canada is very interested in it and StatsCan loves this because it is a way to tell a story. This sponsorship program is the population health story.
All of those factors should drive our health and well-being needs. In these areas, we are working on diabetes, health, human resources, our capacities to help with suicide and recently in cancer for the first year. We are trying to find out in this area what is happening in the other areas. Once we find the needs, it should help shape program design by both levels of government.
In terms of health and well-being programs and services, all of this research, this capacity that we need to develop and learn more about, we need to transmit that knowledge into the program design. We then get into issues of: What kind of program is it? What are the reach of the programs? How effective are the programs — because these programs work on these broader health determinants? There is a circle. You can work forward and backward on this.
Your study is looking at how these broader determinants interact? How do they impact on health status? What is the system of supports that we have in place, including our ability to analyze what the needs are so that we can better shape our programs and services?
Behind some of these things, in terms of programs and services, we will go in and list what the national and provincial programs are. We are trying trying to get a sense of the program infrastructure out there. We have mapped it right to the hospital level in the rural, regional health authorities.
This is a dynamic portal with a lot of information, but does it tell us what the next steps are? It givers us a sense of where we need to go.
We do know that, in the last two years, if we do not do it, no one else is doing it for us. We need to have the capacity — that is the number one recommendation we have — to continue to do this long term. We have problems with the provinces, there is no question about that. Health Canada is aware of it. Some provinces are better than others.
If you look at the health care system at the provincial level for the Aboriginal population, even in the Western provinces where there is enormous population, the provincial health departments will have one, two or three persons working on it. They will have invested specific money, not even on Metis, just Aboriginals — a couple of million dollars here or there. There is little level of engagement at the regional health authority where the money is spent. It is very difficult to influence how that medical paradigm is addressing what are very acute population issues.
The biggest crisis concerns the preventable things — FAS, FAE, and so on. Those are preventable. Once you do not deal with them, you have a continued problem. It is long-term beds, and so on. That is so preventable. It is about changing behaviours.
What is our ability to change behaviours? Two years ago, we had very little ability to change behaviours. We had a very small role in population promotion and that sort of thing. We have a number of areas where we need to move critically now. We are not integrated into the health care system for long-term care for elders. This is a growing problem. The provinces are not building or factoring us into the capital plans of those facilities. FAS, all those dependants, is growing at an enormous rate. We want to build capacity and get into the health promotion area. We need to influence the population and we need to change behaviours. Those things we can do.
We will not create, as Minister Chartrand said, a separate system, but we need a separate focus with very aggressive health promotion initiatives and it needs to be targeted Metis-specific. You will probably hear the First Nations say it needs to be First Nations-specific; they will speak for themselves.
Health Canada moved from 2004 and they have a heck of a problem in terms of meeting the demands on the existing system and the problems that First Nations have.
We were lucky, I suppose. In 2004, we got a commitment from the Prime Minister and the premiers to invest $700 million in additional money for Aboriginal health initiatives, of which we now get a small share that we are grateful for. That is a three-year program. It has taken a couple of years because of the minority-government situation and the supply bills and so on to get the money up and running. We have it going and are running as fast as we can, but the key here is that we need a long-term commitment.
Mr. Chartrand: If I can conclude, as the leader of the West, I sometimes take strong offence when I hear that there is enough being spent on Aboriginal people. Not so long ago, there was reference in the national news where the minister made it clear that $10.9 billion was being spent on Aboriginal people. Let me tell you that less than 1 per cent comes to the Metis people. We did a quick analysis last year. We paid $531 million in federal taxes as Metis people, and we got less than 1 per cent of the money being announced that is out there. There is Aboriginal money out there, but it is not coming to us.
At the end of the day — you and I will agree — I am still a Canadian. I will still use the hospitals, the doctors and the institutions and infrastructure in this country.
If you are not focused on our people or our situation, it will have an effect. Speaking of the social determinants and our traditional economies, right now there is a crushing event occurring in Western Canada. Our commercial fisheries are going down. Over half the people who work in that industry are Metis. Our forest industries are being taken over by big companies in the United States. Our small entrepreneurial industry is gone from that area. The trapping industry is gone. Tourism is crashing now because fishing and hunting are being affected, and that affects our communities.
As our economic engines are crashing, social problems occur and they are get bigger. Previously, we were able to take care of ourselves somewhat, because we are an entrepreneurial and hard-working people, but we are coming to a state where leaving the Metis out for jurisdictional issues between two governments will affect every Canadian in this country.
For a second, forget the issue of rights. Sit down with the Metis people. In the Constitution of this country, we are protected, but, more important, sit down and ask what the issues are. No one can come and tell you that I know every situation of my people in Manitoba, where I am the president, or the vice-president nationally, but I can tell you that no one has told you what great educational levels our children are at now. Tell us how many people have chronic illnesses in a certain house. What kind of illnesses are in that house? What kind of jobs? What is the income of that particular community? If there were more in-depth reviews being done of that nature, it would help.
I hear governments coming along with 10-year plans for education. How can you have a 10-year plan for my people when you do not know the status of my people or the state of my people? At least, First Nations documents everything, because the province sends the bill to Ottawa. There is a reason they have to tag every service and potential that comes with that relationship. For us, it is better not to say anything about how you are serving me because you will blame the other ones and say that they are responsible.
As Metis people, we find ourselves in a challenging position. I have been leading in politics since 1988. Over the last several years in visiting my communities, not only in Manitoba but throughout the West, this is the first time I have had a sense of fear inside of me that I see such a dismal future, already for the elders and now for people my age. Imagine what is happening to the generation coming after us. If there are no jobs, what will happen? We have always worked and paid taxes. I believe in paying taxes. The sad part is that no one wants to treat me or service me because they are afraid that they might have a jurisdictional responsibility or have to take responsibility in some form or fashion.
I always say to ministers: ``I can be somewhere in the middle of a bush in Manitoba and you will find me to pay my taxes, but if I am sitting out there for a service, you will never come to find me to provide me services.''
Senator Keon, you have a significant role as chair. I encourage you to look at the Metis file and, if possible, be a champion for our file. I believe these commissions and committees have a strong relation to what can happen in the future. I encourage the other committee members to play a role in helping the Metis because we do not know where else to turn. We will continue to bring our issues forward, but we need someone to be there to help us.
The Chairman: I an assure you that you are preaching to the converted. The reason for this population health study is so that we can focus on population groups that are not in the same state of health as the others. Fundamentally, we can break it down to three health groups in Canada: the rich and healthy, who live in the cities; the not-so-rich and not- so-healthy, who live in the country; and the poor and very unhealthy that live in underprivileged areas. Our ambition is to get at these pockets of people that are not enjoying the same standard of health as the average Canadian.
Sometimes it is easy. When we eventually get through this study and get down to recommendations that will work and can get services to you, where we can get at community models, it will be relatively easy. You indeed have a truly complex problem with a rather diffuse population spread out, and you do not have these pockets of people in communities, as far as I can see now. We will learn some more tomorrow and we will learn more as we go along. We will work with you and we will find a way to give you autonomy on the ground — that is, the control of your own destiny as it relates to health, we hope, and to get your health status improved to the point of the average Canadian.
Before you go — and I appreciate that Dr. Bartlett and Mr. LeClair will be with us tomorrow morning — I want to address our methodologies. Fundamentally, they will allow us to look at population groups that are not enjoying good health and to analyze why they are not enjoining good health. There are about 12 or 13 determinants of health. The most important one is wealth; then we have education, housing, nutrition, and the list goes down.
What will be different about our report from other reports is that we want the government to look at the whole nine yards and not just someone's bad tonsils, but why they have bad tonsils; in other words, because they have not been eating the proper food, they have not had the proper housing, and so on. We want to make recommendations along those lines.
I am stealing the other senators' time here. Since I have you here, I want to know how we can apply our methodologies to the Metis. Senator St. Germain is a great help; I talk to him a lot. For example, with the native peoples, we can go up to Iqaluit or Baffin Island; we can look at the communities and talk about a community facility that provides health and social services for these people. When we are talking about Metis, however, I am puzzled as to how we will recommend that kind of control for your own people for your own destinies.
Mr. Chartrand: I can share this with you. The Metis governance structure is very strong in the West. In fact, one thing I am proud about is that provincially we are the only Aboriginal people in Canada that are democratically elected by ballot box across the province. For me, I have to campaign in the entire province of 80 communities. We know in general what the larger populated Metis communities are and where you would find that the Metis consume the community and are the majority and not the minority. We know which communities we are in the minority and how we can work with them. The governance structure is one of the avenues where you can turn to. As referenced by Dr. Bartlett, the governance of the Metis nation is fundamental. Our elected officials and our people come right from the community. Our local infrastructure of governance, of service and delivery, is managed right in the community.
A good example is our human resource development that we have in partnership with Canada. The decisions of who gets training and how and what fields the training should be in is decided right in the community. Who better to decide? They live right there.
With housing, for example, we have not had a house built in Metis communities for over a decade. In Manitoba, we are finally getting four houses built now — yet our waiting lists are sometimes for 200 families. I have been in meetings where families have physically fought for a house because one house has become vacant, and this is social housing that Canada has developed over time.
I mean no disrespect to First Nations. I commend them and I wish them well. Our people watch next door and they see houses being erected in the First Nation community and not in ours. The overcrowding continues. With that, of course, are the effects. One of the things I am working on, and Dr. Bartlett is working on in Manitoba, is more of an in-depth process of gathering the data necessary. I am looking at a more province-wide, direct chronological accessing of data.
I want to go house to house and collect everything there is to know from that family. I want to know how many kids live in that house. I want to know the household income. I want to know about any chronic illnesses they may have in that house. I want to know the jobs they perform and their education level. When we develop an actual plan — I will not have that data; I am the president and I do not have that data for my people because I do not have the financial tools to actually do this. It will cost several million dollars, but there is money to be saved. No one wants to collect our data. I will make that clear to you. Canada does not want to recognize that data, nor does the province, because they will have to deal with us. Once that data is there, with it comes the information. Right now, Stats Canada's numbers are all guesstimates. There is no one going directly into the community to finally get a good snapshot.
I would recommend that as the first wise thing to do. If we do not, you and I may be throwing money up in the air, too, because we are not sure where we are going. We need to establish the primary focus of how we invest this money. More research needs to be done. We do not just want to jump and say diabetes is a problem — it is a major problem right now throughout the West.
I will give you an example of how hard it is. Some of our elders are sneaking in rides with these vans that come in from the reserve. I am now getting negative calls from the reserve demanding that I pay because one of my Metis elders took a ride because he could not afford to get to his dialysis treatment. They are sneaking in there because they do not have the money. Many of the elders are living on Old Age Pension, and ours is not paid for, we are on our own. We have to make our way into the cities to get dialysis. They are putting some in the First Nations communities, which I commend again, but we are not entitled to access those.
When looking at the demographics of our people, the best thing I can say is that we do have strong governance. Work with the Metis governance and I assure you will get that part of it. Let us do more in-depth research and get the answers, so when the government decides to invest in regular expenditures, perhaps the primary should be first and then the secondary should come. We need to develop education and we need to know what primaries we should invest in first. If you say we need to deal with diabetes as a primary but my economics are still crumbling, then we will not solve anything because there is no money to buy proper food.
I will give a Manitoba example. I was so happy, my Minister of Aboriginal Affairs announced gardens for Aboriginal people in the North. It did not go to my community but it went to First Nations. I was so mad that, as a Manitoban, a founder of Manitoba and a taxpayer and a Metis rights bearer, this gardening improvement was not coming to my community to help my community eat better and get better nutritional foods. We did not even have our own store. Imagine that. There are 800 people there. How do they get their vegetables and proper foods? They do not. They are eating the cheap foods. That is what is causing a lot of these things. Economically, we cannot afford it anyway, but there are no programs helping on that aspect.
This is a passionate thing for me, but I must express the best way to encourage more research and investment capacity as referenced by Mr. LeClair, but definitely with our governance structures. That will guarantee success because we must be accountable for every dollar. I am not afraid of any accountability. People can come and audit me until they are blue in the face, and I will never be fearful of that.
Senator Cook: I come from the province of Newfoundland and Labrador. I believe the Metis nation in Labrador is not part of your jurisdiction.
Mr. Chartrand: No, in fact we make it very clear that the Metis nation is a western-based nation and history has proven that.
Senator Cook: Who looks after them?
Mr. Chartrand: They fall under the category of Inuit, the mixed blood of the Inuit or whatever First Nation they are connected with. In our position, they have a group that is organized that sits down with government. They do call themselves Metis because in French the word ``Metis'' means mixed blood. That is what they connect themselves to, but the Metis nation is a nation of a people and we originate and have developed in the West.
The Chairman: They speak Inuktitut, do they?
Mr. Chartrand: I believe so, yes.
Senator Cook: No. They are from William's Harbour. There is an M.P. who is head of the Metis nation, Todd Russell.
Mr. Chartrand: Todd Russell, yes. Our full position at the Métis National Council is that the Metis nation is a western-based people. They do have relations with Canada but from a different context. The infinity flag represents two nations coming together forever. This flag was first known in 1816 in the Battle of Seven Oaks. We won that battle, but it was called a massacre because we won. If they had won they would have called it a victory. It is important that the phenomenon of our culture is now being proudly expressed everywhere and it is gaining a lot of ground.
I sincerely thank you for allowing me to be here today.
The Chairman: I have been dominating this discussion, honourable senators. We do have these two people before us tomorrow, but if you want to address anything tonight, please feel free to do so.
Senator Cook, I would be pleased if you wish to follow up on what you have just said. I had an experience some years ago that had nothing to do with me being a senator. I think it was before I was in the Senate. I was helping the people of Baffin Island and, at that time, the Northwest Territories get an electronic connectivity down into the south of Canada for telehealth, and so on. I raised the question of languages and they told me that in that area they fundamentally had some French, but it was mostly English and it is mostly Inuktitut, and that if you can do a translation from Inuktitut to English you can pretty well cope with everyone. Senator Cook, as usual, has straightened me a bit here. I had probably the wrong impression. Can you clarify that?
Mr. LeClair: I do not know much about that group, but there is a group that identifies itself as Metis and has a sense of nationalism over there.
Senator Cook: They live in the community south of Cartwright.
Mr. LeClair: It is a small and important population group, but we are kind of different.
Senator Cook: You are a nation and they are a group. They come under the umbrella of the services offered by the province. Their health and well-being and their education would come from the Province of Newfoundland and Labrador. Their means would be met in that manner.
Mr. LeClair: Yes. Theoretically, I suppose they would have a difference of opinion as to whether they are adequately met.
I want to return to your question, Mr. Chairman, to Mr. Chartrand. We are geographically dispersed, but there is a big population concentration that Dr. Bartlett talked about. About 70 some per cent of us are in five or six major cities in Western Canada and we do have a hinterland group. The important point that Mr. Chartrand was getting at is that there is a political structure in place. They are province-wide political structures that are democratically elected, and there is a service-delivery structure in place in the province. For example, in Manitoba, in employment and training, an allocation of some $14 million or $15 million is allocated notionally within all the regions addressing all of the employment issues. We have recently signed with Health Canada an agreement for health scholarships and bursaries for Metis students in the health care sector. We have allocated those by province and blocked it out in the regions so that everyone shares in it.
It is not as though nothing is going on, but we are talking about the overall investment in the important indicator areas of employment and training of roughly $50 million in total for five provinces. That sounds like a lot of money, but there are a lot of people and the conditions are as Dr. Bartlett described.
Senator St. Germain was on the right track about economic development. As I read through the report of the Committee on Aboriginal Peoples, there are in this area some common recommendations that we have seen over the last 15 years on employment development and economic development. We keep seeing the same recommendations, but we see very little follow-up on the other side. It does not matter which stripe of government is operating on the other side. We have yet to fundamentally deal with the central recommendation of the Royal Commission on Aboriginal Peoples, which is to get people working and earning incomes. Those are the things that will make a major difference.
On our side, the $10 million we have for three years is the full amount of the scholarships we have access to. We have tried to use some of our other programs to put scholarship money here and there, but Canada and the provinces are not investing in Metis education at the post-secondary level. We are very thankful for what is there, but by no means is it meeting the needs of the population. To the extent the Millennium Scholarship Fund is providing some bursaries, it is good, but it is not getting the job done. We see the statistics that show we are not in those institutions in the numbers we should be.
The real tragedy is that we are completing high school at greater rates than First Nations, but we are not represented in those institutions in the same way. We are the best investment Canada never made, and Canada needs to make an investment in our population.
Senator Cochrane: Why are your people so different in regard to education? You are doing very well in getting your children educated, into universities and trade schools, and we are not hearing that with other groups. What are you doing that the other groups do not do with these kids?
Mr. LeClair: Dr. Bartlett might want to answer this. It is a very good question. There is more of a learning culture and a generational impact. We have been in the workforce. My father, for example, worked in the mines. We got the summer jobs because we were working the mines. The kids who lived on the reserve down the road did not get the summer jobs because they were not working in the mines.
Senator Cochrane: Are you talking about a push from the parents to work?
Mr. LeClair: Absolutely. At the same time, even though the work ethic is there, the economic opportunities presented by this country to so many have not worked to our advantage. The reason the indicators are bad in so many areas is that we have not had the access to capital and the diaspora of the population as a result of the failed land claims policies — not that long ago, only 100 years ago — left us renting on our own lands. Therefore, the intergenerational effect of not being able to pass on, as most people can, the fruits of their successful careers to their children and grandchildren has a cumulative effect over time, which results in the populations not doing as well as they could, even though there is an attitude.
Someone from the far right might say: They are doing better than the others and they do not have the tie to the federal government; therefore, the solution must be to ensure they do not get tied to the federal government because they are doing better. There is a problem with that, as Dr. Bartlett pointed out. Imagine this: Seventy per cent of us live in urban areas where we do not have the economic impediments that First Nations do because of their isolation, yet the conditions of the population are as bad. That is tragic. We did not come here to plead poverty. We are here to say: Let us figure it out and find out where the supports are.
The Chairman: Could it be said that you are compared to the off-reserve conditions of some of the other Aboriginals?
Mr. LeClair: As Dr. Bartlett pointed out, we are almost the majority of the off-reserve. There are two generations of First Nations or status Indians that are off reserve. The government stated that now there are some 100,000 First Nations that have been off reserve for some time from those policies of the 1960s. They have come back, but they are still off reserve because there is no housing on reserve. Now we have the hemorrhaging of that status Indian population because of the new Bill C-31 double marriage rule, and all of a sudden you are out of your status again.
We have all of those nuances in the population, but, by and large, we are the off-reserve population.
Senator Cochrane: Metis have a population of 300,000 people; is that correct?
Mr. LeClair: Roughly, yes.
Senator Cochrane: And roughly 23,000 live outside, in the urban areas?
Mr. LeClair: That is Winnipeg only.
Senator Cochrane: That is not Manitoba?
Mr. LeClair: No. Manitoba is a much larger population. There are 66,000 in Manitoba.
Senator Cochrane: The others come from Saskatchewan and Alberta?
Mr. LeClair: Yes. About two thirds of the population come from the Prairie provinces.
Senator Cochrane: You are speaking about these three provinces?
Mr. LeClair: Yes, and Ontario and B.C. We have had a large migration. We come from the historic northwest, primarily concentrated in northwestern Ontario. As the fur trade grew and the West developed, we moved through that area up into the Mackenzie Valley area, because that is where the fur trade expanded, and up into the Peace River District of British Columbia. Those are the historic boundaries.
Since then, we have had migration of Metis into the Lower Mainland of British Columbia. We have had migration east, but it is primarily a migration west. That population is in Northern Ontario, up through the Central Canada Corridor. In the boreal forests, there is a large hinterland population. As Mr. Chartrand mentioned, the rural population is generally not as well off as the urban. Their conditions are very much like First Nations in those northern areas but without access to adequate services.
Senator Cochrane: We have that everywhere in Canada. I have that in my home province. That is something we all have to overcome.
Let me ask you about this, then. Are there measured differences in health outcomes among the settlement population and other Metis groups?
Mr. LeClair: The Metis settlements in Alberta?
Senator Cochrane: Yes.
Mr. LeClair: We would have to come back to you with that information. My understanding is there is very little difference between the two population health groups on those settlements and in Alberta.
Senator Cochrane: I want to ask you about job development and the opportunity for jobs for the Metis people. Do you feel that because you are Metis you are discriminated against in getting work?
Mr. LeClair: I think that is happening less and less now. Canada has evolved quite a bit. In my father's generation, it was not like that. In my generation, there is still a bit of it. I hope for my children that there will be less and less of it.
Remember, where we primarily come from in Western Canada, we were, along with First Nations, the only visible minorities in Western Canada up until just recently. As there are more brown faces around, there is less discrimination and more acceptance. I think generally Canada is maturing.
Senator Cochrane: Do your youth who go to urban areas and become educated, talented and everything else, come back to the rural areas and help the rest of the Metis people?
Mr. LeClair: Sometimes.
Senator Cochrane: Do they do not come back generally?
Mr. LeClair: It is like the depopulation of rural Canada, generally. There are different things going on. There is less opportunity, and it is sort of a self-reinforcing spiral.
In a lot of Metis communities, we were looking at some partnering arrangements with some large companies that are doing call centres. We asked if there was a way for us to build call centres so that we can get the technological pipe into the rural area, because they will not leave, but they will work. They will show up, but they do not want to go to the city. We have a lot of communities like that.
Senator Cochrane: I have people in my office this week from the mining industry. They are mostly from the mining industry from that area. They tell me that they hire quite a few of the locals. They did not specifically say Metis or Aboriginal or whatever. He said they hire a large number of the locals in their mining industry. You do have mining up there in those areas. Are you finding there is quite a bit of employment there, or is there very little?
Mr. LeClair: Those mining interests have done better over the past years in ensuring that local and Aboriginal populations are included in those opportunities. They have serious retention issues, where they cycle through a lot of people.
Some would argue that given the geographic location and the majority of the population being Aboriginal in those areas, even though they are 15 or 16 per cent in the Ekati Mine in Northwest Territories, and some of the uranium mines in the North are 16 or 17 per cent, it is not good enough because 100 per cent of the population is Aboriginal in those areas.
We have a shameful approach to employment equity in Canada where we find still, of those 600 major companies in Canada, the banks, telecos, transportation agencies, we make up 1.7 per cent of the employees. In terms of the federal public service, which has done pretty well in the last few years, the number is 3.9 per cent. When you go to Saskatchewan, Manitoba or Alberta, all those banks, all the employment equity required by legislation to report — go on the website and pick any company you want. The Ottawa airport made a huge stride last year — they hired one Aboriginal. Do you know how much we use that airport? Do you know how much the Department of Indian Affairs uses that airport? When you go to the Vancouver airport, you have all of those fantastic statutes. There are hundreds of them. I want to count them one day because Harper's magazine has this index, how many Aboriginal carvings there are in the Vancouver airport. There might be a few hundred. How many Aboriginal people are working there? There are two. Welcome to the world in 2010.
When you travel through Western Canada in all those populations, you try to find out whether there is an airline steward, a pilot, a security guard, somebody working the kiosk or scrubbing the floor, but you will not find an Aboriginal. The numbers are scandalous. It is like that in the airline industry. The banks are worse than ever. Transportation is better because we have a bit in truck transportation. The telecommunications industry is the lowest at 1.3 per cent.
Therefore, when you come to social determinants of health, you always hear the argument, especially in the federally regulated area. We regulate those areas because they have a monopoly, and they get a licence to ply their trade, so we are able to influence that, but we do not. You only hear, ``The banking sector is going down, the transportation sector is going down, so we cannot bring on the Aboriginals,'' but the Aboriginals are the first to get shaken out of those industries. We have 600 companies every time. We have 625,000 employees in those areas, but we cannot get past 1.6 per cent of Aboriginals. I do not know why that is. WestJet has a huge growth factor and they have a handful of Aboriginal employees.
Those are the social determinants. It does not involve just putting money into a job for Aboriginals or giving them economic opportunities to set up a business. How about knocking on corporate Canada's door and asking for jobs for Aboriginal Canadians? We will not get out of where we are now without a collective commitment on the part of Canadians and Canadian companies to do better. It will not happen. They will be whining about putting this employment program together, or supporting this ma-and-pa business. It does not work that way.
Procurement is another area. There is a huge federal government purchase of goods and services. They support 1,300 companies that sell to the federal public service. They are all required under the Employment Equity Act to pay attention to employment equity, to have plans to hire Aboriginals, minorities, women and disabled. They are just a little bit better, and that is Fortune 500 Canada.
I am sorry to be ranting on about this, but social determinants are about a social, collective enterprise to bring Aboriginal people into the Canadian economy, and it is demand side and it is supply side.
The Chairman: You have to start on the ground with educational programs and so forth so that they are qualified to get into them.
Senator Pépin: It is important to speak about students in university and about work. We know we must start with investment in children as well as the modern women.
[Translation]
What are the health determinants that are most specific to Metis women? In terms of the health of the population, what approach would be appropriate for Metis women? What are the deficiencies that we need to overcome, and how do we go about it?
[English]
Dr. Bartlett: Again, I do not think there are very good statistics out there. I find that the most difficult environment is not having the facts because it is almost impossible to think about that.
Dealing with Metis women's issues is critically important but it is as important to deal with men's issues because they must be balanced. An increasing number of programs are starting to look at why Aboriginal men are so disempowered. Therefore, the usual thing that happens, in any human population, is that when someone feels disempowered he or she takes that power out on someone else.
Senator Pépin: It is not that I wanted to discriminate. I thought of women Metis as mothers who will be looking after the children. When we talk about the children, what can we do as an investment to have better development for the health of children? What is missing?
Dr. Bartlett: Certainly, some things can be done. Generally, there has been a more pan-Aboriginal approach so you do not get Metis specificity. When you think of some of the early childhood learning programs such as Head Start, as I said in my presentation, you have individuals and families being asked to attend programs that are not culturally cogent to them. It is one more level of confusion, particularly as Metis people migrate into urban settings.
I do think we need a Metis-specific early childhood development program. In one of the programs I was involved in developing, a Head Start program, some of the families in that program had an introduction to the school for the first time ever that was a positive liaison introduction instead of the first time they hear from the school is when their son or daughter is in trouble.
One thing about the Head Start literature was that if you do not have a maintenance plan of some kind of connection with the child between the Head Start program and school, you actually lose any kind of gains that you have made
One thing done in that particular program was to say it must be about the whole family and not just about the child. It must be about families participating. The basis is that they are the best teachers of their children.
In terms of Metis, we must begin to have Metis-cultural specificity, because it is just one more level of confusion when you are forced to live within a cultural environment that is just not yours.
Mr. LeClair: The other aspect of that is that, before the Kelowna accord, we put a very big priority on early childhood development because all the studies say it is critical for the learning environment for them to succeed. We looked at the federal program for early childhood development. It funds a number of sites. When we go to the data and check out the number and the age cohorts, there are 16,000 Metis children 3 to 5 years old, and our coverage in that program was about 500 kids.
When the Liberal government introduced it, I remember Senator Fairbairn and a senator from Nova Scotia, Senator MacEachen, first pushed the off-reserve ECD program. It was supposed to be an urban program. Now it is all over the country and it is diffused. If you ask them to tell you where there is one Metis early childhood development site, they cannot name one.
We had this myopic view that we were dealing with the problem when we did not really deal with it because the coverage was too low, and then we pan-Canadianized it on the Aboriginal side and set up a committee to look after it. That is a recipe of how not to do things. That is why Minister Chartrand comes here and tells you we have to specific. Those are just program realities that occur.
The bad part is that somebody thinks they are dealing with the problem or the challenges of these young kids, where in fact the coverage is 5 per cent. It is ridiculous.
Senator Cook: What is the primary language of your people today? Do they have their own language, or is it a combination of languages? What language do the majority of Metis people speak?
Dr. Bartlett: I think the majority speak English now. If you look at some of the literature on languages, they are combinations of French language and an indigenous language in the form of what is called Michif. There has been a resurgence of that, but still only a small number speak that. Even in Manitoba, the number of people who speak French in their homes on a regular basis is decreasing. There has been significant language loss. That is continuing, and I expect it will continue unless there is a real focus on that.
When you think about the Michif language, there could be Michif language based in Cree, Ojibwa, English or French. Therefore, you have to say it is much localized. In some areas, they speak a Michif language that is very Ojibwa-based. In urban areas, they will be speaking the English language for the most part.
Senator Cook: My questions are unrelated, but they are the ones that come to me at the end of a long day.
The federal government has still not assumed constitutional responsibility for your people. Your health services primarily fall under the umbrella of provincial governments. Am I correct in understanding that?
Mr. LeClair: Yes. This is why we have taken the higher ground. This is a shared responsibility, and we cannot duck issues.
Senator Cook: Help me to understand so we know how to go forward to provide you with what we are trying to do. We must link it to the reality of governance.
Mr. LeClair: The constitutional government institutions have taken the approach that Metis are not a federal responsibility legally, but they will assist because Metis may not have special rights but have special problems. It is on that basis that they proceed.
On the other hand, it is the classic being caught between two stools. The province feels the Metis are a federal responsibility but does some things for them. We spent decades at the constitutional table in the 1980s with Prime Minister Mulroney and Prime Minister Martin. We came to the point at the end the argument where everybody is responsible. Let us just not kick back and forth and fall between two stools. Face the fact that there is one taxpayer, including us, and there are some emerging issues that, if not dealt with, will drive up utilization rates and put more pressure on a health care system that is already not sustainable in its present form.
We need to find the solutions to the health care system. Our solution, which we urge on this committee, is to say this is a shared responsibility. We need to build the capacity together to deal with Metis population health issues. They are not just health issues; they are, by and large, economic issues. We ought to work together to find a solution in which we can ensure that income levels go up and jobs increase and labour market participation gets better.
Senator Cook: If I understand, you have something to bring to the table. You have your spirituality and the way you approach life for the health of your people. I see that as a positive.
Dr. Bartlett: I think it is. My own study is looking at the meaning of health and well-being for Metis women, and certainly spirituality was an area people looked at. They practise a whole spectrum of spiritual symbolic approaches, right from a traditional ceremony to the church, and do not see a lot of problem in practising that spectrum.
I do think there is a lot of strength there in terms of people's emotional ability to cope. What came up as most difficult was the area of the physical. Of course, that was because the population is suffering from so many physical diseases. Much health promotion has been focused on the physical body as opposed to drawing on the strengths there. Why are people actually surviving and even thriving in some cases? We need to get more at the details of those kinds of things.
Also, in terms of what we bring as a Metis society, we have always been sort of the intermediaries between the indigenous cultures and the European cultures. I always say to people that I am not indigenous in that way. I am not a member of a First Nation, but I am not European, either. I am a Metis, and I am neither, but I am both. That allows, then, a level of creativity to draw on the best of both worlds and come up with solutions that might be quite different.
We need to do a lot more research on this, as I said in my presentation. There has been a fair amount of looking at historical perspectives, but where are we today? What is the lived experience of Metis lives today? We need not to get too caught up in what the historical past was, because people do live in contemporary societies. That is important.
I think it is also important that, as our children and youth develop, they see that we are a valued part of Canadian society. Every individual wants to be valued. It is not to say that we need services, but we have a lot to offer the health systems. In Manitoba, for sure, we are saying that medicine is medicine. You can deliver medicine; you can have cultural competency within the clinical delivery system. However, where we need to focus is on health promotion, on saying, ``Specifically, let us articulate what we mean by Metis.'' As I said, we are diffusely populated. Metis is very localized content. We need to work all the way through, from looking at how we help people to think about their lives, all the way through from individuals to local levels, and then be able to liaise with the systems to be able to say this is what you need to do. That is one of the major barriers. There has not been the infrastructure to do that.
There have not been community wellness development workers. Those are the types of people that I would say that we need. We need to be able to actually do that. That includes that whole community plan and not just simply focusing on the medical illnesses. They are the consequence, but they are not the root problem.
Senator Cochrane: Do you know Senator Chalifoux? She was a Metis senator here. She retired about five years ago, I think.
Mr. LeClair: Yes. I have worked extensively with her. I also knew Senator Marchand. I used to work in this building with Senator Marchand, and I worked on another project with Senator Pépin, on the Electoral Reform Commission. It was good to see her. As we drove up here, I knew all the parking spots where you would not get a ticket down the street here. It is very good of you to have us here, senator.
The Chairman: In that case, you will have no trouble finding dinner. We will continue this conversation tomorrow.
The committee adjourned.