An Open Dialogue on Indigenous Health Legislation: Summary report

Restoring the balance to do honour to all people.

Table of contents

Introduction

Guided by the Elders Advisory Circle, on February 23, 2022, Indigenous Services Canada hosted a one day virtual event, "An Open Dialogue on Indigenous Health Legislation: Restoring the Balance to do Honour to all people". The event aimed to hear from Indigenous academics, traditional knowledge keepers, students and other partners committed to improving Indigenous wellness and provided participants with an opportunity to share wisdom to inform Indigenous health legislation. It was one part of a larger engagement process underway across the traditional territories of Canada to solicit input from Indigenous peoples, health professionals, health system partners and provinces and territories to inform legislative options. Prior to the event, a pipe ceremony was held with the Elder's Advisory Circle to open the avenue for dialogue in a good way.

There were 5 dialogue sessions held throughout the day, each one guided by the Elders:

Elder Leroy Little Bear also offered a keynote address called "Interrupting Toxic Stress", where he spoke in detail about the impact of colonialism on the physical and mental health of Indigenous peoples.

We would like to thank all those who contributed to the dialogue, including but not limited to the speakers, participants, facilitators, graphic recorder, organizers and the Elder's Advisory Circle. Thank you for sharing your knowledge and wisdom with us, and for gathering with us in the spirit of health.

We are pleased to share this summary of the dialogue, which represents what was heard from participants throughout the Open Dialogue. It is available in English, French, Ojibway, Mi'kmaq, Plains Cree, Inuktitut and Michif, and is organized as follows:

You can request copies of the report, including graphic recordings drawn live during the sessions, by emailing lsa-ihl@sac-isc.gc.ca. Please note that session-specific graphic summaries are only available in English and French.

Guiding principles of the dialogue

Overall graphic summary of the dialogue

Open Dialogue on Indigenous Health Legislation
Text description: Open Dialogue on Indigenous Health Legislation

This graphic summary is an artistic representation of the Open Dialogue on Indigenous Health Legislation, held on February 23, 2022. It uses both artistic imagery and text to represent the discussion.

At the centre of the image, a circle of diverse people with interlocking arms surround the words "Open Dialogue on Indigenous Health Legislation". The circle of people are all very different. Some can be seen wearing traditional clothing, one is wearing an orange shirt that says "every child matters" and another with a Métis sash across their waist. The individuals that make up the circle are welcoming others to step in and join the circle. A silhouetted gathering of more people is represented in the distance displaying the phrase "invite all voices" and "relationship at the centre" to encompass the intent behind the graphic. Three of the people approaching to join the circle have speech bubbles, reading:

  • "It will take honest, consistent dialogue."
  • "Involve and hear youth."
  • "We all carry a sacred fire."

The circle of people are surrounded by a painted golden ring that bears the words "We are doing this for our families" and then lists:

  • The United Nations Declaration on the Rights of Indigenous Peoples
  • The Truth and Reconciliation Commission
  • Missing and murdered Indigenous women and girls
  • Jordan's Principle
  • Joyce's Principle

Outside the painted golden ring containing the diverse group of people with interlocking arms inviting others to join are four quadrants that each contain a different illustration:

  1. To the top-left of the circle, there is a mountain landscape with a river, trees and a couple of houses. Illustrated in the distance, a city is displayed with several tall buildings. Above the whole illustration are two hands shaking, with the words "we entered into a relationship with the Crown, but did not relinquish our sovereignty".

    Below, several people paddle a canoe down the river that reads "Indigenous people must lead the way". Below the river, an elderly Inuk woman lights a qulliq with a young person. The words "reframe who is an expert" are written above them and "Indigenous models of care" are written below them.

  2. To the bottom left of the circle, a dark cloud represents "systemic racism and hate". Next to the dark cloud are two hands cradling the words "protect against racism and hate" as well as separate blue circles, each representing different concepts:

    • Midwives
    • 24-hour Indigenous liaison
    • Ombudspeople
    • Address jurisdiction
    • Indigenous care products
    • Revitalize language

    A speech bubble pointing toward the cradled hands reads "hold racists criminally accountable"

  3. To the bottom right of the circle, there is an outline of the geography of Canada, with the words "Access to services: what, where, when anywhere in Canada". Three birds are seen flying in the distance, a country/rural home surrounded by trees and tall grass is drawn on the bottom right-hand side of the illustration. To the left of the illustration, tall buildings and townhomes in a urban/suburban landscape are displayed.

  4. To the upper right of the circle there is another mountain landscape featuring a river. The sky is labelled "air", the mountain is labelled "land", and the river is labelled "water". On the other side of the river it reads "everything is medicine".

    A Métis sash and a baby wrapped in a cradleboard appear in a swirl that contains the words "access to ceremonies, Indigenous medicines and knowledge is a determinant of health".

    In the foreground, a non-binary person stands smiling in front of the river. A green spiral wraps around and above them, broadening over their head to the words "whole person health" in prominent writing. Beside these words appear an eagle feather, and two traditional dwellings (a teepee and a wigwam). At the feet and to the left of the person, the word "biomedical" appears above drawings of a microscope, a pill bottle, a syringe and a bandage. At the feet and to the right of the person, the word "traditional" appears above drawings of a sweet grass braid and burning sage, one of many purifying ceremonies held by Indigenous groups. At the feet and directly in front of the person is the phrase "Social Determinants of Health" which incorporates both aspects of western and traditional life, displaying various images including a bus, a cob of corn and an apple, a document, a small house with trees behind it and a laptop.

Summary of the suggestions shared to inform legislative options and approach

Taken from Elders, youth and speakers at the event. Quotations were captured and paraphrased as accurately as possible.

Suggestions related to the content of the legislation

Whole person health: Take a holistic, culturally-based approach that is inclusive of the social determinants of wellness as defined by Indigenous Peoples

  • When we are planning we are always thinking about how many different dimensions fit together and are connected, stand in relation and produce healthy and vibrant communities.
  • Indigenous health must encompass holistic perspectives… Health covers physical (which is the predominant one from the Western perspective), mental and emotional. But what about the spiritual? This legislation must incorporate the spiritual aspect. Have legislators looks at Indigenous Health Legislation through Indigenous worldviews, mental, emotional, physical and spiritual quantums, will take deep, consistent dialogue to bring both worldviews together.
  • We need to recognize Indigenous social determinants: employment, education, income. But also recognize it is greater than all of these things: land, language, environmental stewardship, culture, experiences of racism and discrimination.
  • In the North, I see Indigenous people turning to their language for wellness and finding strength in this.
  • Holistic models of care vs medical models of care, Indigenous Health Legislation needs to be inclusive of Indigenous ways of living (traditions, medicines, community-based approaches to care, etc.).
  • Need to acknowledge that Indigenous people have own ways of health; their own worldviews, traditional ways of life. Need to support resurgence of these ways wherever they are wanted. For example, support midwives, women and traditional people… roles that are essential.
  • Recognizing cultural safety, holistic ways of wellness. Contrast with the medical model and look towards a way to build our supports and values.
  • Coming into my studies, I began to acknowledge the social determinants of health and the role it plays in oral health. Oral health begins even before the conception of the child. Creating the environment for Indigenous people that will lead to improved oral health… Oral health inequities are more than just brushing and flossing… Need holistic approach to oral health. Need to look at the social determinants of health and the role that it plays with oral health, and how Indigenous people's overall environment and life affects their health.
  • Need Mother Earth to be healthy and this needs to be reflected in the legislation. This can include giving personhood rights to the trees, fish, birds, insects. Otherwise we aren't being responsible in our role for protecting seven generations forward.
  • The work in this area has to move across psychological, economic, social, cultural issues that affect our people.
  • Indigenous peoples turn to their language as a protective factor and they are rebuilding and revitalizing language.
  • The medicines of Indigenous cultures is also something that we rely on. The way of life and living and being on the land and embracing the teachings of our Elders on how to be on the land.
  • Lack of access to ceremonies and traditional health supports, these have been ghettoized. Indigenous health care and non-Indigenous health care should have the same level of funding.
  • One of the ways we can consider the development of Health Legislation is thinking about working through the First Nations Mental Health Continuum Framework. Mental wellness is really wellness. What we learned here was the complexity of our wellbeing. It is made up of a number of factors and indicators that help us understand what wellness is. The language must be around holistic concepts and not breaking apart.
  • The importance of culture as a foundation for wellbeing. How do we use this to guide our practices and services? It must be put first. people are seeking to return to cultural values as a way to get back to a sense of wellbeing. Spirit and spirituality are also important, in doing so we are coming back to a place with the Creator and Creation. Culture and Spirit are therefore extremely important and should be central to health legislation. Our people are also seeking to reconnect with identity. Identity is embedded within communities and Nations and are an essential part of health legislation.
  • Access to transit impacts health equities.
  • We have to look at health always together, the social determinants of health are beyond what we in the contemporary world determine to be health. We want health legislation to look like this rich tapestry, inclusive of all the discussions we are having today. Pulling different aspects and rich contributions together. Reflecting our ancestral knowledge and contemporary learnings.
  • We need a holistic model of care, not a medical model. This includes access to ceremonies and Indigenous medicines etc.
  • Need to recognize the various ways to look at health: more holistic view, balance. It is important to have our own traditional healing, it shouldn't be reliant on bio-medical care. The only way we will be healthy again is to have the option to return to our traditional healing.
  • We need a more integrated approach to delivering all health services from the ground up, starting to use our traditional ways of doing things, as a sacred way.
  • Social determinants of health have never been really included in Western medical practice. Although they are gaining prominence, colonialism has not been given them much weight. "The approach to Western medicine has been like your parts store for your car". It is narrowly defined, it doesn't take into consideration land, spirituality, animals, plants, water, sacred sites… "loss of all of my relations". Most Indigenous people point to it as a source of ill health when it's not there. I can't even go into the national parks, some of my sacred sites, I can't go to do my traditional ceremonies or pick my traditional plants… "denied my being".
  • Legislation has to incorporate social determinants, right now they don't.
  • Supporting/increasing access to Indigenous health professionals.
  • Seeing Indigenous peoples thriving in whatever aspects they chose [gives hope for the future], e.g. Indigenous dentist here today, seeing more Indigenous peoples in health system… showing role models in health fields.
  • Women are the heart of our communities, so in supporting them we are supporting entire Nations.
  • Need more Indigenous mental health professionals, especially psychologists in our communities… There are specific spots for Indigenous nurses and doctors, but there is a need to hold specific spots for First Nation, Inuit and Métis psychologists.
  • Need for dental professionals to work in the communities, improve informed consent and increase autonomy.
  • We need research that is led by us for us. Current norms are all Western based which limits our ability to diagnose.
  • But there are a number of providers who had to pivot to virtual. Manitoba providers had been going there, pivoted to providing services virtually. In Nunavut, providers have experienced many barriers in providing supports. The infrastructure in the North does not allow for remote supports… electronic medical records in Nunavut cannot speak to the system in Manitoba which means that patients seeing providers in both Nunavut and Manitoba have different medical records. Nunavut is trying to resolve these issues with 3 large provinces on behalf of patients who make up a small portion in these areas.
  • The focus on cultural competency and safety where health professionals have legal and moral obligations, based on informed consent, recognition of Indigenous forms of life (e.g. land, culture) but not in bits and pieces. Important to have discussions about holding healthcare professionals accountable for the racism.
  • Want to hold to account the training of nurses and doctors. The provincial organizations that regulate health care professionals must ensure their members are culturally safe, and have proper training in universities and colleges. There need to be incentives and support to ensure this is in place.

Address racism and discrimination to ensure safe access to care

  • Legislation has to have some protective factors for the hate and racism that currently exists in the healthcare system.
  • We need more than distinctions based policy, we need legislative change that criminalizes what happened to Joyce Echaquan. At a bare minimum this can be done through license removal… This should be looked at in terms of real change to criminal code (referring to racism).
  • We need wide-spread policies for culturally safe environments, and serious consequences. It is important that we discuss the sovereign application of these policies.
  • We will continue to seek care in urban hubs and will interact with the healthcare system that exists, so we do need policy that asserts a safe environment for that to occur in.
  • All I wanted was accessibility to the hospital system for myself and my children and grandchildren when they want.
  • People are being paid to give us dismal health- this needs to be investigated and reviewed. We have to shift that dynamic and hold people accountable in moving forward. If you're an expert in public health, why are we paying you for failing Indigenous peoples?
  • At our local hospitals, there is a liaison that liaises with patients, when they go home, that's when some things can happen. Because not everyone can get injured or sick during daytime hours. Requested for the hospital to have 24 hour support.
  • Connections between coerced sterilization and colonialism, a reflection of broader systemic racism and dehumanization that underpins Canadian society. There is a connection between the lack of consent with sterilization and with what is happening with Indigenous lands.
  • We can't lose sight of the broader perspective, and more actively we can't let governments lose sight of this. Have to look at all of the pieces outside of Western medicine to solve these systemic issues, because they exist inside and outside of health legislation. Can't address racism without acknowledging the reasons systemic racism exists in the first place.
  • Legislation has to address systemic racism. Perhaps an ombudsman for the legislation so there is someone who can do something about the racism.

Support Indigenous Peoples in reclaiming sovereignty and Indigenous-led models

  • What we are seeking is the assertion of sovereignty without fear of reprisal, attack or colonial violence.
  • The line between the reserve and urban space is the most impactful figment of our imagination… the intentionality is expressed in that, when we look at health sovereignty and food sovereignty it is against a series of practices that eroded that sovereignty and really thinking about this space, are we in the trajectory of extinctions or are we in the trajectory of reclamation and the assertion of sovereignty? We never ceded our rights to tell us what to eat, why are we stopping people from eating good healthy and traditional food? It is not about safety but an assertion of a particular type of lifestyle. There is limited right to Indigenous food, there are all those barriers for the wholesome Indigenous lifestyle in the urban context.
  • We need Indigenous control over as much as possible, including traditional medicines.
  • Research focused on self-determination and social justice for Indigenous peoples, this is what communities are interested in addressing.
  • Having Indigenous midwives can be important to be advocates for our clients, also providing care in a way that promotes the sovereignty of Indigenous peoples. From the moment of birth our babies are surrounded by Indigenous knowledge and peoples. The ceremony of birth can really ignite a fire in our communities… Midwifery supports sovereignty, from the moment of birth the child is surrounded by our peoples, helps to promote knowledge of our rights, bodies, self-determination.
  • There is an inability of the Crown to support innovative care models due to rigidity of health models. Transformative work is underway but it comes back to the Crown, the bureaucracy etc. We can see the intention at the elected officials level but we do not see this translated through the bureaucracy to First Nations and flexible models.
  • Transportability of those rights - rights to health care in treaties did not say you need to stay in your reserve. Those rights go with me not where I am. It becomes a question of discrimination for me. Non-Indigenous people aren't told they need to go back to where they are born to access health services. People need to access services, what they need, when they need them, where they are. It is also cost effective. We can have earlier interventions and focusing on preventions so we are not focusing on long term treatments.
  • Indigenous data sovereignty should be embedded in the legislation. It also has to be written into the Canada Health Act in order to compel provinces and prevent provinces from taking advantage if they aren't providing the services.
  • Through distinctions based legislation we are hoping for a greater focus on Métis as a unique group.
  • We were ready long ago to take control over our healthcare systems. Whatever happens has to give us control. We need an ideal Indigenous health system that respects and balances traditional medicines and bio-medicine. We have examples around the world, one in Alaska and Hawaii.
  • Legislation should be evolving around the needs and best practices that Indigenous people define. Whether it is smudging, Elders or whatever else can be included when providing services, this is what we need.
  • As women and mothers, we need to support our families, you need to put that oxygen mask on moms first so they can be there to support others. Not pulling individuals out and putting them back, we need a family model.
  • In developing distinctions-based health legislation, look for frameworks that already exist and that are working for Indigenous people.
  • Look to community to define what they need. Our communities know what they need, they take the biggest risks when entering a health care service, we need to listen to them.
  • In this legislation, we have to reclaim this land in urban centres.
  • Canada needs to come alongside us to support rather than tell us what to do. How can people step back into their bodies and self-manage, if we are told we are not good enough, if there is still a paternalistic way to manage us?
  • With this legislation and these discussions it is a time to think about doing sexual and reproductive health differently in our country. We are using incomplete data and research that isn't Indigenous led, this data is what we are using for solutions and it is not going to work this way. We need to think about changing the way we provide health care in this country so that we are highlighting the strengths in our communities and nations.
  • When we talk about legislation and the needs of First Nations, Métis, and Inuit, we need to think about more than meeting the needs of communities; we need to ground healthcare in our communities to meet their needs and promote their health and wellbeing… we have to ground the solutions in the communities and then respond to those needs.
  • When we practice in the traditional way, I have never had an appointment that is less than a half hour. We sit with family and we be with them. When we fast or go to longhouse, we invite our patients with us. When we looked at this model of care, a model our Elders have always told us about, you are the medicine, we found this is true. Every single person involved in this model witnessed our healing, navigating western and traditional ways and bringing this together is what they saw. That was what empowered them and made them feel ok. We are living in a country where it is not safe to inhabit an Indigenous body. How can you do this when it is not safe.
  • There is no way for me to come forward to say how do you fund us outside of the band system. The funding is paternalistic, you are giving the money to yourself. They have to go to the band for money which is another arm of the government.
  • Among my people, the Blackfoot, generally, but not always, we attribute the cause of illness to the absence of harmony and balance. Illness can be attributed to many causes, natural, supernatural and even taboo causes. Unlike modern medicine which is disease based and attributes illness to germs and viruses. The causes of illness are linked to the treatment. In the Blackfoot culture, we have our medicines and systems, some of which were pharmaceutical, spiritual, supernatural. Blackfoot society has medicine persons who had the knowledge and medicines to treat the patient.
  • There is a strength that I see in communities: grassroots mobilization around de-colonizing health, e.g. delivery models that are flexible, that are able to respond to what Indigenous peoples need in the communities, e.g. language, culture, land-based services.
  • Where we have delivery models in Nunavut that are flexible, these delivery models are able to respond to what Indigenous people need. Land based services starting to be offered in many different areas for health and wellness. All of these things are bounded within Indigenous control and gives us comfort to respond to the racism that we are seeing in the health systems.

Ensure federal accountability and address jurisdictional issues

  • Legislation has to resolve the Jordan's and Joyce's Principles, otherwise we fall in between the cracks.
  • [Not intruding on provincial and territorial roles], this echoes a federal government who has never stated responsibility due to this jurisdictional separation, reflecting a number of past examples including Daniels decision which abrogates their responsibility for Métis. Legislation must address issues of jurisdiction, offering equity in health services and addressing the determinants of health. We may need to consider how Canada Health Act does overcome jurisdictional boundaries and how new legislation can do this to ensure accountability.
  • I don't buy the jurisdictional thing at all. It can impact on the provinces and it should.
  • How much time is also spent by communities to advocate on their behalf? This is such a waste of time and energy, especially for Nations already struggling. Legislation has to resolve these issues, define areas of responsibility, and stop this waste of time.
  • This legislation has to have teeth, has to be able to enforce/push governments to act when they don't want to and address jurisdictional gaps when needed.
  • The legislation may also give us the type of continuity that we need for funding and resources.
  • National standards. Implementation of Jordan's and Joyce's Principles. Need substantive equality to address chronic underfunding but also the jurisdictional back and forth gaps.
  • Explicit language on funding: who is funding what and how (C-92 dances around this). Canada didn't address this in C-92, and this was criticized by Québec court of appeal.
  • Accountability: e.g. agree with idea of ombudsperson as mentioned by Little Bear, including for provinces, especially with respect to issues where there has been chronic neglect, need a mechanism that Indigenous peoples can access to bring federal, provincial and territorial representatives to the table when they need to be held to account.
  • Must include mechanisms for accountability, levers for funding or sanctions… I expect to see high-level principles, as well as mechanisms to abide by those principles
  • The idea that there was never an implementation plan [for past processes such as the Royal Commission on Aboriginal Peoples], we need to be addressing that in this health legislation.
  • Moral courage is important but not easy, health legislation should reward and support this.
  • The skepticism has to be embedded in the process to hold people accountable. Accountability is important.

Suggestions related to the process and approach to developing the legislation

Indigenous Peoples must lead the way

  • In legislation, Indigenous people should lead the way. Starting that fire, there is a way that Indigenous peoples can lead the way with the model of care that works for us, and is adapted to how we need it.
  • Nothing about us without us. The most important piece is having a seat at the table, not being consulted and then left behind, but sitting at the table.
  • Truth is the voices of our Elders and youth do not have an authentic role in real decision making… it's actually time to give us some influence of what happens with our health and wellbeing.
  • As Indigenous people we have a lot to contribute to this dialogue and what health is at the provincial, territorial and federal level. We need to situate our knowledge in an influential way.
  • Our voices and abilities can contribute to this process, legislators can see the worldview from our lens.
  • Help youth to know what's going on, promoted, youth have experiences with health and if they know, they can share their experience and knowledge.

Focus on relationships and diversity

  • Judge Edwards ruled on our behalf; did that save Joyce Echaquan? Did it change the system? No, because it was law, it has to be a change of relationship. We are in the same place today, using legal ways instead of respectful relationships. We are looking again at legislation and the legal avenues to solve a human relationship issue. We all have a responsibility to the relationship, not the legislation, not the law.
  • We entered into a relationship with the Crown but did not relinquish our sovereignty. To jump to legislation before looking at our relationship through Treaties, no legislation will be able to include all of these unique relationships across Canada. We need to focus on the relationship which is at the centre and has not been developed.
  • My spirit and heart are full because we are talking of building relationships, with ourselves, our ancestors and our relations. There are stories being told to bring us forward. Our legislation needs to reflect the stories and have that spirit.
  • Health legislation should be guided by First Nations practices of coming together, hearing each other.
  • Legislation requires honest and consistent communication.
  • Talking about women's voices, children, 2-Spirit, we need these voices heard. When we talk about distinctions-based legislation, we're talking about gender distinction, age distinction, etc.
  • This will need to be a slower process.
  • Unite everyone, bring people together, listen to the youth, bring together ideas in unity to move forward in a positive manner, everyone's good at something and has something to offer and contribute.
  • Go to places where youth are, universities and colleges, put the word out.
  • We can't just talk to big organizations, or regional organizations. We need to go straight to the communities/lands they are hoping to address, rather than having the communities come to Ottawa. Indigenous people shouldn't have to leave their land, we should have government come to us.
  • Nation to Nation plus: where are the voices of those on the ground, who are doing the work?
  • I didn't hear enough from community, it's similar to other government consultation. Need to ignite that fire across Canada. But we need to hear more urban and in community voices. Whether you are a youth or an adult, or an Elder, senior, knowledge keeper; whether urban or on-reserve, recognizing the diversity of voices in communities. It cannot just be certain members or representatives. Otherwise we're pan-Indigenizing; that will hurt us more than help us.
  • Language teaches us about a thousand years of history and the way that people related to each other for countless generations and this is what we want to share with others.

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