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LECTURE OBJECTIVES

LECTURE OBJECTIVES. Gain awareness and understanding of Aboriginal health legislation and policy framework. ABORIGINAL HEALTH POLICY. Canadian health system: complex (policies, legislation and relationships) Multiple authorities: federal provincial/territorial, municipal governments

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LECTURE OBJECTIVES

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  1. LECTURE OBJECTIVES • Gain awareness and understanding of Aboriginal health legislation and policy framework

  2. ABORIGINAL HEALTH POLICY • Canadian health system: complex (policies, legislation and relationships) • Multiple authorities: federal provincial/territorial, municipal governments • Aboriginal authorities • Private sector

  3. ABORIGINAL HEALTH LEGISLATION CONTEXT • 1867 – British North America Act (BNA) • Defined • health services as a provincial jurisdiction • Indian affairs as federal jurisdiction • 1876 – Indian Act • Health related provision (unclear) • 1939 – Federal responsibility for Inuit • not health specific

  4. FEDERAL ROLE • FIRST NATIONS AND INUIT HEALTH BRANCH (FNIHB) • Services: • status Indians living on-reserve • Inuit living in their traditional territories • NIHB: prescription drugs, dental, vision (all status/registered Indians/Inuit but not Métis)

  5. ABORIGINAL LEGISLATION & HEALTH POLICY FRAMEWORK • Complex and diverse health service provision across provinces and territories • Fails to address the healthcare needs of: • Métis • First Nations, non-registered, not living on-reserve • Inuit, not living on traditional territories • Resulted in jurisdictional debating about who should pay for health services • 1966: Hawthorne report • 2002: Romanow report

  6. TRANSFORMATIVE CHANGE • 40 – years= transformation in provision of health services and programs • Increase involvement of First Nations and Inuit peoples in control and delivery of community –based health services • Widely acknowledged: Aboriginal people can identify and manage their own health priorities and healthcare IN their communities

  7. HEALTH TRANSFER • 1979 – Indian Health Policy: recognition of First Nations and Inuit ability for administering their own health programs • 1989 – Health Transfer Policy Framework • Benefits of Transfer: • Increased community awareness of health issues • More culturally sensitive health car delivery • Improved employment opportunities for community members • A sense of empowerment and self-determination

  8. INTEGRATED AGREEMENTS • 1994 – smaller communities: mechanism for community control • 176 communities as of 2003

  9. POLICIES & LEGISLATION IN P/Ts • Provincial/Territorial legislation: specific provisions that clarify the responsibilities of government in Aboriginal health. (Limited & focused on jurisdiction) • Self-government agreements: define jurisdiction • Embedded provisions related to healing and ceremonial practices (Yukon: respects traditional healing practices)

  10. DIVERSITY IN P/T LEGISLATION • 1990 – Aboriginal Health and Wellness Strategy • Ontario Ministry of Health, Aboriginal Health Policy’ – governing policy • Assist MOH in accessing inequities in programming • Responding to Aboriginal priorities • Adjusting existing programs to be more responsive • Support reallocation of resources • Improving interaction and collaboration between ministry branches to support holistic approaches to health

  11. Decentralization/Regionalization • Regional Health Authorities: priority setting, planning and delivery of health services • Increase public participation - engagement

  12. EMERGING MODELS • Coordination models: • bridge jurisdictional gaps • Enhance Aboriginal participation • Indentify health priorities • Designing strategies • Coordinating approaches to improve Aboriginal health • Cross-jurisdictional coordination models and • Intergovernmental health authorities

  13. CROSS-JURISDICTIONAL • Goal is to bride jurisdictional gaps • Committee based • Include stakeholders in Aboriginal health • Most comprehensive: Aboriginal Health and Wellness Strategy (AHWS) • BC ‘Tripartite First Nations policy framework’

  14. INTERGOVERNMENTAL HEALTH AUTHORITIES • Formal organizations • Federal/Provincial partnerships • Self-government agreements • Extensions of the provincial health care system but are co-funded by the F/P governments

  15. MODERN TREATIES & SELF-GOVERNMENT ACTIVITIES • Opportunities for Aboriginal engagement in health policy and service delivery • Nunavut Land Claims Settlement Agreement • Métis Settlement Agreement

  16. The path ahead….national umbrella Aboriginal health policy • Significant inequities in health status and access to health services • Significant gaps in service and jurisdictional ambiguities • Greater coordination needed! • Equitable funding for and access to health service • Focus on SDOH • Inclusive P/T health legislation and policy frameworks

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