Visions for Distinctions-based Indigenous Health Legislation: Executive summary
What we heard from the Indigenous health legislation engagement
Full report
The full report, What we heard: Visions for Distinctions-based Indigenous Health Legislation, is available on request. If you would like a copy, please email lsa-ihl@sac-isc.gc.ca.
On this page:
Introduction
This report, What we heard: Visions for Distinctions-based Indigenous Health Legislation, summarizes the input the Government of Canada has received to date from Indigenous Peoples about:
- the state of Indigenous health in Canada
- their vision for what to include in distinctions-based+ Indigenous health legislation to improve access to high-quality, culturally-relevant, and safe health services
From the winter of 2021 to fall 2022, regional and national First Nations, Inuit, Métis, and Intersectional Partners led numerous engagements within their communities. The Government of Canada has now received most of the input from Indigenous partners and is pleased to present it in this summary report.
This report will help inform the upcoming discussions between the Government of Canada, Indigenous partners, and provinces and territories, where relevant, as we develop options for distinctions-based+ Indigenous health legislation.
To help guide the drafting of this report, officials from Indigenous Services Canada worked with:
- an Elders Advisory Circle
- youth
- representatives from across distinctions+
Together, we summarized what we heard from the various engagements, and shared drafts of this report with partners for their review and input.
From engagement, 9 goals emerged as themes:
- Indigenous Peoples treated and respected as equals and systems transformed to remove settler-colonial policies and discriminatory practices
- Indigenous Peoples can exercise their sovereignty and right to self-determination freely
- Holistic approaches to health that encompass Indigenous ways of knowing and being and the social determinants of health
- Health systems, health professionals and governments take responsibility for action and strengthen their accountability to Indigenous Peoples
- Respectful relationships between Indigenous Peoples and the Government of Canada
- Equitable, adequate, sustainable, inclusive and flexible funding is available to Indigenous Peoples
- Indigenous Peoples control their data and information is available to support wellness
- Critical health service needs are met
- Supporting and building capacity in health human resources
This executive summary shows common, recurring and notable messages that we heard across distinctions+. It doesn't speak for any one Indigenous community or organization. In the full report, each theme is presented in detail using the language provided by First Nations, Inuit, Métis, and Intersectional Peoples.
Quotes from the Elders Advisory Circle
"The journey to well-being is on-going and is a complex but simple weaving of many components. Like the Métis sash, policy and legislation are part of the rich design and pattern that are unique to each community and tell the story of our ancestors, our culture and traditions, and all the determinants of well-being through First Nations, Inuit, and Metis perspectives and visions."
"I believe that our ancestors left us the knowledge and tools for the time after the great disruption. We have now arrived at this place and will respectfully use their knowledge and pick up the tools they left us as we move forward to reclaim our inalienable and inherent rights to good health and strong lives."
"l pray that we have created a path that works for everybody and everyone towards wellness and reconciliation for Indigenous and non Indigenous Peoples on this land called Mother Earth which the Creator has graciously given us."
Artistic summary
Text description for the artistic summary
This graphic is an artistic summary of the input the Government of Canada received from First Nation, Inuit, Métis, and Intersectional Partners on Indigenous Health Legislation.
Across the top section of the graphic, different landscapes are presented. On the left upon a mountainous background, there are rural homes as well as a city skyline. In the center upon a prairie landscape, there are tipis and a Métis cart being pulled by a horse toward another cityscape in the distance. On the right hand side, a northern landscape is presented with snowy terrain and a snowmobile pulling a kamutik, a long sled.
The title "Indigenous Health Legislation" is displayed underneath.
Emerging from the different landscapes, various streams of water merge into a single river that grows in size as it winds toward the foreground of the graphic. The silhouette of a group of 5 people, differing in size and shape, walk along the river, where the phrases "Things will be done differently", "This is a new day: We are using the Calls to Action and Justice", and "Indigenous People are Indispensable to the Future of Canada" are written.
To the left of the winding river, the words "Treated and Respected as Equals" and "Respectful Indigenous & Federal Relationships" and "Treaty" are written.
To the right of the winding river, the words "Freely Exercise Sovereignty and Right to Self-determination" are written.
Also, in this section to the right of the winding river, there are 3 circles with images within them. The first image is a hospital encircled by the words "Health System". The second is a group of people encircled by the words "Health Professionals". The third is parliament hill encircled by the words "Canadian Government". Above these images, the words "Take Responsibility for Action & Strengthen Accountability" are written. There is also an image of a checklist titled "Accountability Measures".
The winding river expands in size and fills the foreground of the graphic. Along the right side of the page, the profiles of seven people's faces are featured, of different ages and genders. One person is wearing a shirt with a progress pride flag on the back. Extending to the left from their profiles and blending into the winding river graphic are mounds of colorful, rolling shapes that highlight different concepts.
In the blue shape, which occupies the upper right side of the foreground, the words "Critical Health Service Needs" are written along with various sub-concepts, including:
- urban services
- continuing care
- internet access, telemedicine, virtual technology
- midwifery, maternal, paternal and child health
- remote and rural services
- capital and infrastructure
- sexual health services
- gender-specific services
- mental health and wellness
- Non-Insured Health Benefits (NIHB)
- translation and languages services
- auxiliary services
In a purple shape, which occupies the upper left side of the foreground, an image shows various people pointing towards and listening to different forms of data that include graphs, charts and storytelling. The words "Story" and "Telling" appear above the people. Above this image, the words "Indigenous Peoples Control their Data and Information is Available" are written.
In a yellow shape directly below the purple shape, the words "Health Human Resources" are written. Within this shape, there are 2 images, one of a health professional using a stethoscope on a child who is being held by their parent. The other image shows a health professional attending to a patient's bedside.
In another blue shape along the bottom left of the foreground, the words "Equitable, Adequate, Sustainable and Flexible Funding is Available to Indigenous Peoples" are written, surrounded by images of paper money.
In the centre foreground, surrounded by all other shapes, there is a red shape with the words "Wholistic Health" written at the top centre. Under these words, there is a collection of images that include speech bubbles, a feather, an ulu and a wigwam. On the left side of the red shape, surrounding the words "Social Determinants of Health", is a collection of images that include a yellow hard hat, a hammer, an apple, carrots, a house, a fire and money. On the right of this same shape, surrounding the words "Indigenous Ways of Knowing and Being", is a collection of images including sweetgrass, burning sage, a blanket with the Métis symbol, and silhouettes of people holding hands in front of a mountain backdrop.
Along the bottom right of the foreground is an orange shape with the acronyms "TRC", "MMIWG" and "UNDRIP" written within it.Feedback by theme
1.Indigenous Peoples treated and respected as equals and systems transformed to remove settler-colonial policies and discriminatory practices
Indigenous Peoples avoid accessing health care services because of the racism and discriminatory practices that they experience. As described in article 24 of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), Indigenous Peoples have an equal right to the enjoyment of the highest attainable standard of physical and mental health.
Indigenous health legislation is a chance to:
- acknowledge how settler-colonialism creates ongoing health inequities
- ensure Indigenous Peoples' right to access safe health services, free of racism and discrimination
2. Indigenous Peoples can freely exercise their sovereignty and right to self-determination
Indigenous Nations are Sovereign Nations. They have an inherent right to self-determination and self-government. All levels of government must respect and recognize Indigenous jurisdiction and Treaty and Inherent rights. Indigenous Peoples have a right to Indigenous-led health care design, delivery and decision-making, as described in articles 3, 4, 23 and 24 of UNDRIP.
Indigenous health legislation is a chance to make sure Indigenous Peoples can exercise their right to self-determination by taking control of their health services. This will result in safer, innovative care that improves health outcomes.
3. Holistic approaches to health that encompass Indigenous ways of knowing and being and the social determinants of health
Health is holistic. Physical and mental health are affected by social, spiritual and emotional needs, as well as community and environmental well-being. Governments need to understand that communities are healthiest when all determinants of health are addressed.
Indigenous health legislation is a chance to:
- support health care systems grounded in Indigenous Culture, Traditions, Beliefs and Values
- recognize traditional health equitably with western health care and use both to improve health outcomes
- respect and support Elders and Knowledge Keepers who are key to connecting individuals and communities to traditional medicines and healing
4. Health systems, health professionals and governments take responsibility for actions and strengthen their accountability to Indigenous Peoples
Canadian health care systems lack accountability and transparency to Indigenous Peoples. Although promises and commitments have been made, Indigenous Peoples have seen little progress. The Government of Canada needs to take immediate action to address biases and issues impacting the health of Indigenous Peoples.
Indigenous health legislation is a chance to:
- identify standards of care
- support work at every level of government to create binding, Indigenous-led accountability mechanisms for improved health care, including ombudspeople
5. Respectful relationships between Indigenous Peoples and the Government of Canada
Relationships between Indigenous Peoples and the Government of Canada need to be on a distinctions+, Nation-to-Nation, Government-to-Government and Inuit-Crown basis.
Treaties in Canada are constitutionally recognized agreements between First Nations and the Crown. Their full spirit and intent must be honored and implemented, including the Treaty Right to Health.
Inuit emphasize the need for better relationships, respectful engagement, and the Government of Canada to listen to Inuit.
Métis Peoples noted that they are often left out of existing federal Indigenous specific health care policies and programs. Calls for recognition and inclusion, as well as funding and expansion of programming were highlighted.
Intersectional Peoples also call on the Government of Canada to expand Indigenous Services Canada's health programming to include the health needs of Intersectional and non-status Peoples. These needs have been overlooked in the past.
Indigenous health legislation could be a foundation for new agreements and relationships with First Nations, Inuit, Métis, and Intersectional Peoples. It is a chance to:
- learn lessons from past legislative processes
- meaningfully and respectfully engage in Nation-to-Nation co-development, in accordance with Articles 18 and 19 of the UNDRIP
- further implement and meet the standards set out in:
- the United Nations Declaration on the Rights of Indigenous Peoples
- the Truth and Reconciliation Commission's Calls to Action
- Jordan's Principle
- the National Inquiry into Missing and Murdered Indigenous Women and Girls' Calls for Justice
- the Royal Commission on Aboriginal Peoples
- Joyce's Principle
6. Equitable, adequate, sustainable, inclusive, and flexible funding is available to Indigenous Peoples
Current funding arrangements do not support Indigenous self-determination in health. They are seen as paternalistic, complex and burdensome. Indigenous groups want more direct funding models, fewer reporting burdens, and funding formulas that are holistic and needs-based.
Indigenous health legislation is a chance to:
- redesign existing Indigenous health funding models
- secure funding for Indigenous groups that is equitable, adequate, sustainable, inclusive and flexible
7. Indigenous Peoples control their data and information is available to support wellness
Poor coordination between provincial, territorial and federal health systems creates barriers to accessing and using data. Current data systems and approaches are western-based and often not culturally relevant. Indigenous communities and organizations highlight the importance of better data access to improve the development and delivery of health services.
Indigenous health legislation is a chance to:
- honour Indigenous Peoples' data sovereignty
- improve data management in accordance to ownership, control, access, possession (OCAP®) principles,
- invest in data capacity
- enable better sharing of health data administered by provinces, territories or the federal government back to Indigenous communities
8. Critical health service needs are met
First Nations, Inuit, Métis and Intersectional Peoples experience significant gaps in health services compared to non-Indigenous Canadians. Gaps exist regardless of whether people live in urban, rural or remote settings. Specific gaps raised include, but were not limited to:
- midwifery
- mental health care
- continuing care
- sexual health care
- virtual care and internet access
- auxiliary care
- gender-specific care
- Non-Insured Health Benefits
- infrastructure
- language translation
- transportation
- navigator and advocacy supports
Indigenous health legislation is a chance to take significant and immediate action to address critical health service needs.
9. Supporting and building capacity in health human resources
Health care workers must develop locally-based cultural competencies to provide person-centered care and build relationships between providers, clients and communities. Health care workers need mandatory training in:
- Indigenous cultural competency
- anti-racism
- anti-oppression
- trauma-informed care
In addition, Indigenous partners highlighted challenges with recruiting and retaining health professionals, particularly in remote areas and in the north.
Indigenous health legislation is a chance to:
- work with every level of government and professional colleges to make commitments on mandatory training
- support recruitment and retention strategies
- increase Indigenous representation within the health care system
Conclusion and next steps
Though First Nations, Inuit, Métis and Intersectional Peoples share some similar ideas about health legislation, the legislation needs to be flexible enough to honour the unique visions of health that distinct Indigenous Peoples have across Canada.
Overall, the input received during the engagement reflects hope and optimism that legislation will:
- support Indigenous-led approaches
- take steps toward upholding Indigenous sovereignty
- improve health equity
The next step is for the Government of Canada to co-develop legislative options with Indigenous partners and, where relevant, provinces and territories. This will be done on a distinctions basis. The goal of this next phase is to co-develop fully costed legislative options for the Minister of Indigenous Services to present to Cabinet colleagues for decision-making by spring 2023.
Glossary of terms
Co-analysis: Working together through a collaboration process to summarize Indigenous Partner input and ensure the summary respects and accurately reflects Partner worldviews, language, experiences and engagement.
Co-development: In the context of this report, "co-development" refers to Indigenous Partners and the Government of Canada working together through a collaboration process to reach mutual agreement on legislative options for proposed distinctions-based Indigenous health legislation.
Distinctions-based+: Acknowledges that each community has a unique culture, territory, history, and relationship with the Government of Canada, as well as unique strengths to build on and challenges to face. A distinction-based+ approach means working independently with First Nations Peoples, Inuit, Métis Peoples and Intersectional Peoples in recognition of their unique attributes.
Intersectional: How unique aspects of a person's identity intersect. In the context of this report, "intersectional" refers to how a person's Indigenous identity, gender identity, physical ability, socio-economic status or other personal aspects of identity may cause overlapping impacts of discrimination. This is inclusive of non-status and unaffiliated First Nations, Métis and Inuit individuals.
Legislative options: Fully costed options for proposed distinctions-based Indigenous health legislation. These will be recommended to the Minister of Indigenous Services, who will present them to Cabinet colleagues for decision-making.
Self-determination: Article 3 of UNDRIP states: "Indigenous peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development." In Canada, this also refers to the Government of Canada's recognition of Indigenous Peoples' right to self-determination, including the inherent right to self-government.
Settler-colonialism: An ongoing system of power in which Indigenous Peoples of a colonized area are displaced by settlers who permanently occupy lands and resources.