Health
Learn how the Government of Canada is responding to the Truth and Reconciliation Commission's Calls to Action 18 to 24.
Based on data provided August 2021.
18. We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.
What's happening?
The Government of Canada acknowledges that the current state of Indigenous health is a direct result of the shameful colonialist policies and interventions against the well-being of Indigenous peoples and communities, including residential schools, the Sixties Scoop and other harmful practices whose impacts are still felt today. The intergenerational impacts of residential schools are well documented in international and national evidence cited in Government of Canada publications and specifically recognized in partnership agreements with Indigenous governments and representatives. The Government of Canada has publicly acknowledged the impact of colonization on health care at recent forums including the third virtual national dialogue on anti-Indigenous racism in health care held in June 2021.
Canada has committed to working to co-develop distinctions-based Indigenous health legislation with First Nations, Inuit and the Métis Nation to improve access to high-quality and culturally relevant services. The Government of Canada will recognize and protect the health of Indigenous peoples on an equitable basis and support greater Indigenous control over the design and delivery of health services. This approach will be backed with the investments needed to deliver high quality health care for all Indigenous peoples.
Engagement will be broad-based and seek to support the inclusion of diverse and intersectional perspectives. It will serve to inform the co-development of a legislative approach that supports the vision expressed through various federal commitments, including the Truth and Reconciliation Commission's Calls to Action, the United Nations Declaration on the Rights of Indigenous Peoples, the National Inquiry into Missing and Murdered Indigenous Women and Girls' Calls to Justice and the Federal Pathway to Address Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ People, the Government of Canada's contributions to the 2021 Missing and Murdered Indigenous Women, Girls, and 2SLGBTQQIA+ People National Action Plan: Ending Violence Against Indigenous Women, Girls, and 2SLGBTQQIA+ People and that sets the stage for high-quality, culturally relevant health care for all Indigenous peoples, backed with needed investments.
With the support of Health Canada (HC) and Crown-Indigenous Relations and Northern Affairs (CIRNAC), Indigenous Services Canada (ISC) has been leading the planning and coordination of national dialogues on addressing racism experienced by Indigenous peoples in Canada's health care systems. Central to this work is the promotion and support of Indigenous healing approaches. National dialogues held in October 2020, January 2021 and June 2021 have brought together participants from National Indigenous Organizations, Indigenous health professional organizations, provincial and territorial governments, and other stakeholders. Immediate steps will be acknowledged and taken, in collaboration with Indigenous peoples, to address anti-Indigenous racism in order to achieve patient and cultural safety across health systems and improve the quality of care for Indigenous peoples. Work and engagement will continue through 2021 and beyond.
The Minister of Indigenous Services publically launched the engagement process on Indigenous health legislation on January 28, 2021, during the second virtual national dialogue on anti-Indigenous racism in health care.
Recent budget investments
The 2020 Fall Economic Statement announced an initial investment of $15.6 million over 2 years, starting in 2021 to 2022 to support the co-development of distinctions-based health legislation with First Nations, Inuit and the Métis Nation.
Budget 2021 is providing $1.4 billion over 5 years, beginning in 2021 to 2022, and $40.6 million ongoing, to maintain essential health care services for First Nations and Inuit, continue work to transform First Nations health systems, and respond to the health impacts of climate change. This includes:
- $107.1 million over 3 years, beginning in 2021 to 2022, to continue efforts to transform how health care services are designed and delivered by First Nations communities, building on the government's commitment to improve access to high-quality and culturally relevant health care for Indigenous peoples
- $354 million over 5 years, beginning in 2021 to 2022, to increase the number of nurses and other medical professionals in remote and isolated First Nations communities
- $774.6 million over 5 years, beginning in 2021 to 2022, to ensure continued high-quality care through the Non-Insured Health Benefits Program, which supports First Nations and Inuit with medically necessary services not otherwise covered, such as mental health services, medical travel, medications and more
In addition, Budget 2021 is providing $478.1 million to continue to support the ongoing public health response to COVID-19 in Indigenous communities, including support to hire nurses, help at-risk people to isolate, and distribute personal protective equipment.
Recent progress
In recognition of the right to self-determination, First Nations, Inuit, and Métis Nation partners will lead engagement with the constituents they represent. ISC is complementing First Nations, Inuit, and Métis Nation-led processes and supporting the engagement of representative Indigenous organizations, including women, youth, 2SLGBTQQIA+, urban based service delivery networks and other Indigenous groups. ISC is also facilitating direct engagement with provinces, territories and other federal departments. The Federal Pathway to Address Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ People reaffirms the Government of Canada's commitment to transforming health service delivery to an Indigenous-led model, to address anti-Indigenous racism in the health care system, improve cultural safety across the various stages of health service delivery, support the advancement of Joyce's Principle and to convene partners on a continued national dialogue on accountability and change.
In addition, $2 million was committed to the Atikamekw Nation and Manawan First Nation to advance their advocacy for the implementation of the federal aspects of Joyce's Principle across Canada.
Since 2016, the Government of Canada has approved more than 911,000 requests for products and services under Jordan's Principle and in 2019 to 2020 provided coverage of health benefits to over 857,000 First Nations and Inuit peoples.
Next steps
Continue working with First Nations, Inuit, and Métis Nation partners to establish a coordinated engagement approach for the co-development of distinctions-based Indigenous health legislation including the development of engagement materials. Engagement with provinces and territories continues to establish a collaborative working relationship and prepare for future discussions.
19. We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long-term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.
What's happening?
ISC and the Public Health Agency of Canada have initiated work with Indigenous organizations including the First Nations Information Governance Centre and the Inuit Tapiriit Kanatami. These organizations, together with their regions, are currently exploring the development of an information strategy, as well as a set of appropriate indicators that will identify gaps in health outcomes and that can be routinely reported. The development of indicators will draw on and include data from the Regional Health Survey and National Inuit Health Survey. Through the Pan-Canadian Health Inequalities Reporting Initiative, the Government of Canada has released baseline measures of health inequalities between First Nations (on- and off-reserve), Inuit (within and outside Inuit Nunangat), Métis and up to 13 additional socio-demographic groups. An online Health Inequalities Data Tool was also released that explores data using different measures of inequality by topic and population of interest.
The Federal Pathway to Address Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ People (Federal Pathway), released in June 2021, recognizes and affirms Indigenous worldviews and ways of knowing, seeing, doing and being are based in a holistic understanding of health and well-being, recognizing elements of spiritual, social, physical and mental health and wellness within Indigenous individuals, families and communities. Health and safety are very much intertwined, as health is linked to the prevention of danger and harm to others, to the health of children and families and to all aspects of physical and mental wellness. The Government of Canada commits to measures to address gaps in health outcomes between Indigenous and non-Indigenous communities in a holistic way.
The national dialogues and engagement with partners on anti-Indigenous racism in health care have provided an opportunity for federal government, provincial and territorial governments and health system partners to hear about the lived experiences of racism in health systems which is a key aspect of gaps identification.
Sport for Social Development in Indigenous Communities program
In addition to the sport-specific Calls to Action, Sport Canada delivers the Sport for Social Development in Indigenous Communities program Initiative that aims to achieve 4 intended outcomes for Indigenous peoples:
- improved health
- improved educational outcomes
- reduction of at-risk behaviours
- improved employability
Recent budget investments
Budget 2021 is providing $478.1 million to continue to support the ongoing public health response to COVID-19 in Indigenous communities, including support to hire nurses, help at-risk people to isolate and distribute personal protective equipment. It also proposed $354 million over 5 years, beginning in 2021 to 2022, to increase the number of nurses and other medical professionals in remote and isolated First Nations communities.
In the Federal Pathway, the government outlined the commitment to a partnership approach to data development that respects co-development and addresses the need for national standards to ensure the information collected is relevant and meets the needs and priorities of Indigenous peoples. The government recognizes the importance of Indigenous data sovereignty as a key principle of the proposed partnership approach and in supporting Indigenous self-determination. Indigenous data sovereignty is about ensuring Indigenous peoples have the opportunity to design and manage the data needed to tell their stories and to ensure that high quality, culturally relevant, distinctions-based data are available to support reporting on the 2021 Missing and Murdered Indigenous Women, Girls, and 2SLGBTQQIA+ People National Action Plan: Ending Violence Against Indigenous Women, Girls, and 2SLGBTQQIA+ People.
Budget 2021 investments linked with the Federal Pathway include:
- $73.5 million over 3 years for the First Nation Data governance strategy
- $8 million over 3 years for the Inuit data baseline capacity and development of Inuit data strategy
- $172 million over 5 years, $36.3 million ongoing for the Disaggregated Data Action Plan
- $6.7 million over 5 years, $1.4 million ongoing to the Department of Justice and Statistics Canada overrepresentation of Indigenous peoples in justice system
- $20.3 million over 5 years to ensure appropriate monitoring mechanisms are in place to measure progress and to keep the government accountable, including support for Indigenous-led data initiatives
Budget 2021 included $126.7 million to address anti-Indigenous racism in health systems. $37.8 million was provided, within this envelope, to improve supports and accountability that will allow Indigenous patients to more safely navigate federal, provincial and territorial health systems. This includes funding to support targeted data collection.
Sport for Social Development in Indigenous Communities program
The Sport for Social Development in Indigenous Communities was launched to respond to the Calls to Action through Budget 2018 as a component of the Sport Support Program: an ongoing investment of $9.5 million per year. Projects began in Spring 2019.
The program is delivered in 2 streams:
- Stream 1 provides annual funding (up to $5.3 million) to the 13 Provincial and Territorial Aboriginal Sport Bodies and the Aboriginal Sport Circle for sport for social development projects in Indigenous communities in each of the provinces and territories
- Stream 2 provides funding (up to $3.6 million) to Indigenous governments, communities and organizations, including delivery organizations working in collaboration with Indigenous communities
Recent progress
Collaborations with Statistics Canada on improved estimates of life expectancy for Indigenous populations have progressed substantially and efforts in measuring infant mortality continue. Progress has been affected due to COVID-19, as community lockdowns have interrupted engagements and Indigenous organizations have refocused their resources to pandemic response. Identifying outcome measures that are inclusive and reflective of Indigenous perspectives in partnership is essential. Given anticipated vaccination timelines for the Canadian population, work is not expected to resume until late 2021. The First Nations Information Governance Centre and national Indigenous organizations have been invited to be part of the Pan-Canadian Health Inequalities Working Group, to help guide data analysis and knowledge mobilization plans for the second cycle of Pan-Canadian Health Inequalities Reporting Initiative.
Budget 2019 committed $50 million over 10 years, with $5 million per year ongoing, to support Inuit Tapiriit Kanatami's Inuit-specific approach through the Strategy to address deaths by suicide in Inuit communities.
Also through Budget 2019, the Government of Canada, together with contributions from the Government of Nunavut and Inuit partners, announced its commitment to support the construction and ongoing operation of a treatment centre in Nunavut. The Government of Canada committed $47.5 million over 5 years to support the construction and operations of the treatment centre, and $9.7 million ongoing in support of treatment centre operations.
Budget 2021 proposes to provide $597.6 million over 3 years, starting in 2021 to 2022, for a distinctions-based mental health and wellness strategy with First Nations, Inuit and the Métis Nation. The strategy will renew funding for the Indian Residential Schools Health Supports Program and Crisis Line, which provide healing supports for survivors of childhood trauma and residential schools. It will could also enhance community-based supports and capacity, increase substance use treatment and prevention, and support workforce development.
Sport for Social Development in Indigenous Communities program
The Sport for Social Development in Indigenous Communities program is in high demand, supporting its value to Indigenous communities and contribution to achieving the Calls to Action.
For the 2019 to 2021 program period, 225 communities benefitted from the Sport for Social Development in Indigenous Communities projects, including those supported through funding to the 13 Provincial and Territorial Aboriginal Sport Bodies.
Next steps
Planned activities for 2021 to 2022 include continuing work on the second cycle of Pan-Canadian Health Inequalities Reporting Initiative to add new and updated data points and monitor changes over time in health inequalities in Canada. This cycle will capture updated health indicators for First Nations (on- and off-reserve), Inuit (inside and outside Inuit Nunangat), and Métis (in rural and urban environments).
On September 14, 2020, the Government of Canada launched the second intake of applications for the Sport for Social Development in Indigenous Communities program component and is being used to fund activities in the 2021 to 2022 and 2022 to 2023 fiscal years.
20. In order to address the jurisdictional disputes concerning Aboriginal people who do not reside on reserves, we call upon the federal government to recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples.
What's happening?
COVID-19 pandemic response
The health, safety and well-being of all people in Canada, including First Nations, Inuit and Métis is and will remain a top priority for all. The Government of Canada recognizes that First Nations, Inuit and Métis are among the most at risk and that during this crisis, in particular, those in remote and fly-in only parts of the country are uniquely vulnerable. Indigenous communities are incredibly resilient and full of solutions and innovative ideas. This is why we must support distinctions-based measures to improve public health response for Indigenous communities and provide them with the flexibility they need to address the specific needs identified by communities and their members. COVID-19 funding is provided through the Indigenous Community Support Fund and Public Health funding. ISC will work with communities to help address their COVID-19 response needs.
What's happening?
The Government of Canada recognizes that First Nations, Inuit, Métis and urban Indigenous peoples experience a disproportionate burden of ill health, which is rooted in Canada's colonial policies and existing health and social services that fail to adequately meet needs. This is exacerbated for people with disabilities. There are significant challenges that Indigenous peoples face when interacting with health systems, including anti-Indigenous racism, a lack of cultural safety and a lack of understanding and acceptance of Indigenous health and healing models.
ISC plays a key role in addressing the COVID-19 public health needs of First Nations and Inuit. At the onset of the COVID-19 pandemic, ISC immediately mobilized to work with Indigenous communities to support the public health response. First Nations communities and organizations, delivering community-based services in response to COVID-19 public health needs, are eligible for funding to support community-led pandemic responses, and increase primary health care resources for First Nations communities. In case of outbreaks, this public health funding can also be accessed for surge capacity and additional support for similar services in First Nations, Inuit and Métis communities.
The government also launched the Indigenous Community Support Fund that, among other streams of support, targets the distinct COVID-19 response needs of First Nations living off-reserve, Inuit, Métis as well as urban Indigenous peoples.
As the scope of ISC's support for COVID-19 public health measures for Indigenous communities and groups may overlap with assistance provided through provincial or territorial jurisdictions, ISC continues to work with federal (Public Health Agency of Canada), national (e.g. Assembly of First Nations and Inuit Tapiriit Kanatami) and regional Indigenous partners, as well as provinces and territories. This work ensures that appropriate funding is coordinated and targeted to address pandemic-related public health gaps and needs in Indigenous communities and Indigenous populations.
Anti-Indigenous racism in healthcare arose as an urgent issue during the pandemic. The virtual national dialogues on anti-Indigenous racism in health care included organizations that represent Métis, Inuit and off-reserve First Nations in order to better understand not only common barriers that all Indigenous peoples face, but also distinct perspectives and lived experiences. The engagement to address anti-Indigenous racism will continue to be inclusive and will continue to ensure that all distinct First Nations, Métis and Inuit perspectives are taken into account.
Recent budget investments
In the 2020 Fall Economic Statement and various government announcements made throughout 2020 to 2021, the Government of Canada committed and invested:
- $926.7 million to support the ongoing public health response to COVID-19 in Indigenous communities
- approximately $1.1 billion delivered through the Indigenous Community Support Fund with approximately $235 million allocated to regional, urban and off-reserve Indigenous organizations to support a variety of measures, including food security, elder supports, educational supports, and more
In Budget 2021, the Government of Canada is providing an additional $1.2 billion in 2021 to 2022 to continue supporting the COVID-19 response in Indigenous communities:
- an additional $760.8 million for the Indigenous Community Support Fund to help First Nations, Inuit, Métis Nation communities, and urban and off-reserve Indigenous organizations serving Indigenous peoples meet the unique needs of their populations during the COVID-19 pandemic. This funding includes a specific set-aside of $150 million to support the distinct COVID-19 response and recovery needs of Indigenous peoples living in urban centres and members of First Nations living off reserve
- $478.1 million to continue to support the ongoing public health response to COVID-19 in Indigenous communities, including support to hire nurses, help at-risk people to isolate, and distribute personal protective equipment
Budget 2021 included $126.7 million to address anti-Indigenous racism in health systems. There are measures in the budget that will be available to First Nations (on and off-reserve), Inuit and Métis.
Recent progress
The government worked in partnership with First Nations, Inuit, Métis leaders, as well as urban Indigenous organizations, to support pandemic preparedness and response in Indigenous communities, including COVID-19 public health funding for Indigenous communities. There was successful control of the spread of COVID-19 during the first wave in the spring of 2020.
During the second and third waves, it was evident that the evolving COVID-19 situation was having a much more significant impact on Indigenous communities, compared to the first wave. The COVID-19 pandemic has continued to evolve as well as the government's response. To support Indigenous leadership to manage responses and prevent further outbreaks, funding measures were announced by the government throughout 2020 and in Budget 2021. Through the Indigenous Community Support Fund, support provided continues to be flexible to the needs identified by Indigenous organizations and communities, including urban and off-reserve ones. Over this period, the Indigenous Community Support Fund provided assistance to Indigenous organizations and communities in responding to various outbreaks located in off-reserve areas, including in Northern Ontario and Alberta, as well as providing funding to support urban-based vaccination activities and clinics in Manitoba, Ontario and across the country.
Next steps
Regional variations in the COVID-19 pandemic continue to necessitate different levels of response and investment. The emergence of a number of COVID-19 variants in the country and in some Indigenous communities and the third wave of the pandemic also necessitate continued close collaboration between ISC and provincial and territorial partners, including medical officers of health, to monitor the outbreak and take appropriate evidence-informed actions. With the recent funding announced in Budget 2021 through the Indigenous Community Support Fund for 2021 to 2022, ISC will continue to work with and support First Nation, Inuit, Métis and urban Indigenous communities and organizations in designing and implementing community-based solutions to help respond to the COVID-19 pandemic.
Health legislation
With respect to health care for First Nations, Inuit and Métis Nation, the federal, provincial, and territorial levels share some degree of jurisdiction. The Canadian health system is a complex patchwork of policies, legislation, and relationships. Coordinated approaches to address the health needs of First Nations, Inuit, and Métis and health care delivery amongst all levels of government including Indigenous governments, remain an ongoing challenge. Improved clarity and a shared understanding of the role of various levels of government is needed, including for off-reserve First Nations and urban populations of Inuit and Métis.
What's happening?
The Government of Canada is working to co-develop distinctions-based Indigenous health legislation with First Nations, Inuit, and the Métis Nation to improve access to high-quality and culturally relevant services. The Minister of Indigenous Services publically launched the engagement process on Indigenous health legislation on January 28, 2021, during the second virtual meeting on anti-Indigenous racism in health care.
The co-development of distinctions-based Indigenous health legislation is an opportunity to:
- establish overarching principles as the foundation of health services for Indigenous peoples
- support the transformation of health service delivery through collaboration with Indigenous organizations in the development, provision and improvement of services to increase Indigenous-led health service delivery
- continue to advance the Government of Canada's commitment to reconciliation and a renewed nation-to-nation, Inuit-Crown and government-to-government relationship with Indigenous peoples based on the recognition and implementation of rights, respect, co-operation and partnership
The Federal Pathway to Address Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ People, builds upon this work, announcing in June 2021, the Government of Canada's commitment to actions that will contribute to the creation of health systems free of racism and discrimination and better health outcomes for Indigenous peoples, including Indigenous women, girls and 2SLGBTQQIA+ people. This includes distinctions-based Indigenous health legislation and implementation co-developed with First Nations, Inuit and the Métis Nation, backed with the investments needed to deliver high-quality health care for all Indigenous peoples, access to high quality, timely, stable and culturally relevant distinctions-based services, including a patient-centred approach to health service delivery, and preparedness and response services enhanced to address public health emergencies in a way that aligns with Indigenous priorities, builds local capacity and is responsive and sustainable.
Recent budget investments
The 2020 Fall Economic Statement announced an initial investment of $15.6 million over 2 years, starting in 2021 to 2022 to support the co-development of distinctions-based health legislation with First Nations, Inuit and the Métis Nation.
Recent progress
Work is underway with national and regional First Nations, Inuit and Métis Nation partners, as well as other federal government departments, to establish a coordinated approach for engagement.
Next steps
Continue working with First Nations, Inuit, and Métis Nation partners on a coordinated engagement approach, for the co-development of distinctions-based Indigenous health legislation including the development of engagement materials. Engage with provinces and territories in the co-development of distinctions-based Indigenous health legislation to establish a collaborative working relationship and prepare for future discussions, including opportunities for improved coordination by federal, provincial, territorial governments and Indigenous organizations in addressing the health needs and priorities of First Nations, Inuit, and Métis.
Jordan's Principle and Inuit Child First Initiative
Jordan's Principle and Inuit Child First Initiative are designed to ensure First Nation and Inuit children are able to access the services they need immediately and avoid delays, disruption and denials that would be cause by jurisdictional disputes.
What's happening?
Jordan's Principle and the Inuit Child First Initiative ensure that First Nations and Inuit have access to the products, services and supports they need, when they need them, regardless of where they live in Canada. This includes First Nations children living on or off-reserve and Inuit children living inside and outside Inuit Nunangat. The Government of Canada works with organizations such as friendship centres to support urban populations. These initiatives can help with a wide range of health, social and educational needs.
Recent budget investments
Since 2016, the Government of Canada has committed almost $2.36 billion toward meeting the needs of First Nations children through Jordan's Principle. More than 911,000 products, services and supports were approved between July 2016 and March 31, 2021.
The Government of Canada committed $220 million over 5 years, beginning in 2019 to address the immediate needs of Inuit children and to continue working with Inuit partners to improve local capacity to deliver services. Between April 1, 2019, and March 31, 2021, more than 30,000 products, services and supports were approved under the Inuit Child First Initiative. In 2019 to 2020, coverage of health benefits was provided to over 857,000 First Nations and Inuit peoples and 344 communities were supported through 63 community-led wellness teams.
In 2020 to 2021, the Government of Canada allocated $47.5 million to support mental health programming to address the wide range of health and social needs.
Recent progress
Delivery of Jordan's Principle and Inuit Child First Initiative supports have been shifted due to the COVID-19 pandemic. Some regions saw decreased expenditures for certain services (such as respite care) due to the travel restrictions in the context of COVID-19, while other services saw an increase in expenditures (such as education supports).
Over 3,500 requests for items and products, services and supports related to COVID-19 were approved for a total of $9.5 million under Jordan's Principle between March 20, 2020 and May 2021. For the Inuit Child First Initiative, over 140 requests for items and products, services and supports related to COVID-19 were approved for approximately $685,000.
The Government of Canada continues to work with the Assembly of First Nations through mechanisms such as the Jordan's Principle Operating Committee and the Jordan's Principle Advisory Table, to improve the current implementation model and develop a long-term approach for Jordan's Principle.
Next steps
We continue to provide support to First Nations and Inuit children through Jordan's Principle and the Inuit Child First Initiative and we are working with First Nations and Inuit partners, provinces and territories to develop longer-term approaches to help better address the unique health, social, and education needs of First Nations and Inuit children.
21. We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.
What's happening?
It is understood that addressing the need for a comprehensive, system-wide approach to substance use and trauma treatment in Nunavut is in response to the Qikiqtani Truth Commission's recommendation #2; Truth and Reconciliation Commission's Call to Action #21. In collaboration with the Government of Nunavut and Nunavut Tunngavik Incorporated, the Minister of Indigenous Services has provided funding to support the construction and operation of the Nunavut Recovery Centre, as part of a Three Pillar Approach, designed through a consultative process as per Article 32 of the Nunavut Agreement, to improve addiction and trauma treatment in the territory. ISC funding supports Pillar 2 of the Three Pillar Approach: the construction of a recovery centre in Iqaluit that will offer services that are Inuit-led and build on cultural strengths. Pillar 1 is Enhanced Community Based Programming offering on-the-land healing camps and other in-community supports. Pillar 3 is the development of an Inuit workforce that can staff both on-the-land healing camps as well as the Nunavut Recovery Centre. As part of this work, the Government of Nunavut and Nunavut Tunngavik Incorporated have been in discussion with the Arctic College and others to enhance Inuit counsellor-training programs. ISC continues to support the Government of the Northwest Territories and Indigenous organizations in initiatives and programming that address healing and trauma caused by residential schools.
In July 2018, the Government of Canada, the province of British Columbia and the First Nations Health Council signed a Memorandum of Understanding on Mental Health and Wellness recognizing new flexible funding models and approaches are required to support nation-based approaches to healing and wellness. A cost-shared $30 million fund was created to support strength-based, family-focused and community-driven approaches to planning so that First Nations can design, deliver and re-align services along across the continuum of mental health and wellness needs.
Recent budget investments
Through Budget 2019, the Government of Canada committed $47.5 million over 5 years to support the construction and operations of the Nunavut Recovery Centre and $9.7 million ongoing in support of treatment centre operations. To date, $502,000 has been provided to the Government of Nunavut with the balance of $41.7 million to support the construction of the Centre expected to be provided over the next 5 years following the signing and endorsement of the contribution agreement in late August, 2021. The Federal Pathway to Address Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ People (Federal Pathway), released in June 2021, outlines investments to be made in Indigenous-led community safety planning to improve the safety and well-being of Indigenous peoples, specifically, women, girls and 2SLGBTQQIA+ people, including through the Aboriginal Community Safety Planning Initiative and the new Pathways to Safe Indigenous Communities Initiative to develop more holistic community-based safety and wellness models. The Government of Canada will also conduct a review of resources at the Correctional Service of Canada healing lodge for Indigenous women with a view to identifying the capacity required to effectively address rehabilitation and intervention needs.
Through Budget 2021, the federal government is providing $597.6 million over 3 years, starting in 2021 to 2022, for a distinctions-based mental health and wellness strategy with First Nations, Inuit and the Métis Nation. The strategy will renew funding for the Indian Residential Schools Health Supports Program and Crisis Line, which provide healing supports for survivors of childhood trauma and residential schools. It will also enhance community-based supports and capacity, increase substance use treatment and prevention, and support workforce development. The Federal Pathway affirms this commitment supporting healthy and safe Indigenous communities free from racism and discrimination where Indigenous peoples are respected and safe and where access to culturally relevant mental health and wellness services is improved.
Recent progress
With regards to Nunavut and the construction of the Nunavut Recovery Centre, addressing Call to Action #21, on October 2, 2020, ISC signed a Memorandum of Understanding with the Government of Nunavut and Nunavut Tunngavik Incorporated that outlines roles, responsibilities and governance between the parties for both the construction period and ongoing operations of the Nunavut Recovery Centre (post the federal 5 year capital funding commitment).
The Federal Pathway, released in June 2021, affirms the commitments to be made in Indigenous-led community safety planning to improve the safety and well-being of Indigenous peoples, specifically, women, girls and 2SLGBTQQIA+ people, including through the Aboriginal Community Safety Planning Initiative, and the new Pathways to Safe Indigenous Communities Initiative to develop more holistic community-based safety and wellness models. The Government of Canada will also conduct a review of resources at the Correctional Service of Canada healing lodge for Indigenous women with a view to identifying the capacity required to effectively address rehabilitation and intervention needs.
Indigenous Services Canada's First Nations and Inuit Health Branch Saskatchewan Region has committed to work collaboratively with the Lac La Ronge Indian Band in the development of their Wellness Centre's operational and program plan and budget for the facility with an estimated opening date of February, 2022. A working group with representatives from Lac La Ronge Indian Band was formed and began meeting in July, 2021. Lac La Ronge Indian Band is developing a work plan that identifies the nature and scope of mental health and addictions services that they will be delivering at the 22-bed facility.
Since 2018-2019, Indigenous Services Canada has invested $6.5 million into the construction of a new healing center in Kuujjuaq, Nunavik. The new Isuarsivik Regional Recovery Center will provide culturally appropriate addiction treatment services, including services for families in the healing process to lessen the impact of substance abuse on couples, pregnant women, and families with children. Due to the pandemic, construction has been delayed but the opening is still scheduled for 2022 or 2023.
Next steps
ISC and the Government of Nunavut are finalizing a capital contribution agreement that will cover the period of construction. The Nunavut Partnership Table on Health is being updated regularly on progress.
22. We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.
What's happening?
Anti-Indigenous racism in health care
With the support of Health Canada and Crown-Indigenous Relations and Northern Affairs Canada, ISC has been leading the planning and coordination of national dialogues on addressing racism experienced by Indigenous peoples in Canada's health care systems. Central to this work is the promotion and support of Indigenous healing approaches. National Dialogues held in October 2020, January 2021 and June 2021 have brought together participants from National Indigenous Organizations, Indigenous health professional organizations, provincial and territorial governments and other stakeholders. Immediate steps will be acknowledged and taken in collaboration with Indigenous peoples to address anti-Indigenous racism to achieve patient and cultural safety across health systems and improve the quality of care for Indigenous peoples. Work and engagement will continue through 2021 and beyond.
In order to achieve real change and improve the health and wellness of Indigenous peoples in Canada, Indigenous, provincial, territorial and federal governments will work together to address the social determinants of health, including poverty, employment, education, social support networks, housing, physical environments and early child development. The solutions will be distinctions-based, partner-driven and respect the diversity of Indigenous peoples to meet their unique needs, no matter where they live, whether it be in urban, rural, remote or northern environments.
Recent budget investments
In January 2021, $2 million was committed to the Atikamekw Nation and Manawan First Nation to advance their advocacy for the implementation of the federal aspects of Joyce's Principle across Canada. Joyce's Principle aims to guarantee to all Indigenous peoples the right of equitable access to social and health services, as well as the right to enjoy the best possible physical, mental, emotional and spiritual health. The Federal Pathway to Address Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ People (Federal Pathway) affirms this commitment to Joyce's Principle to guarantee to all Indigenous peoples the right of equitable access, without any discrimination, to all social and health services, as well as the right to enjoy the best possible physical, mental, emotional and spiritual health.
Through Budget 2021, the federal government proposes to provide:
- $126.7 million over 3 years, beginning in 2021 to 2022, to take action to foster health systems free from racism and discrimination where Indigenous peoples are respected and safe. This funding will support patient advocates, health system navigators and cultural safety training for medical professionals
- $107.1 million over 3 years, beginning in 2021 to 2022, to continue efforts to transform how health care services are designed and delivered by First Nations communities
On June 29, 2021, the Minister of Indigenous Services announced detailed Budget 2021 investments including:
- $33.3 million to improve access to culturally safe services, with a focus on services for Indigenous women, 2SLGBTQQIA+ people, people with disabilities and other marginalized groups who may experience intersecting discrimination. More specifically, this will support the expansion of Indigenous midwives and doulas initiatives, strengthen funding for Indigenous women's organizations and regional and grassroots organizations and support youth sexual health networks
- $46.9 million to support the adaptation of health systems through the integration of cultural and patient safety at the local and systems levels. This work will be supported through ISC's Cultural Safety Partnership Fund and Health Canada's new Addressing Racism and Discrimination in Canada's Health Systems Program. This funding will also contribute to increased Indigenous representation in health professions through training and education programs
- $37.8 million will be provided to improve supports and accountability that will allow Indigenous patients to more safely navigate federal and provincial health systems. This includes funding for new Indigenous health system navigators and patient advocates as well as to support targeted data collection
- $8.7 million will be dedicated to support continued dialogue that leads to results. This includes convening national dialogues to advance concrete actions to address anti-Indigenous racism in Canada's health systems, and leading by example through the evaluation and improvement of ISC's programs and practices to ensure more culturally responsive and safe services
Budget 2021 also is providing $597.6 million over 3 years, starting in 2021 to 2022, for a distinctions-based mental health and wellness strategy with First Nations, Inuit and the Métis Nation. The strategy will renew funding for the Indian Residential Schools Health Supports Program and Crisis Line, which provide healing supports for survivors of childhood trauma and residential schools. It will also enhance community-based supports and capacity, increase substance use treatment and prevention and support workforce development.
Recent progress
Recent national dialogues on anti-Indigenous racism in health care, on October 16, 2020, January 27 to 28, 2021, and June 28 to 29, 2021 brought together participants from Indigenous health professional organizations, National Indigenous Organizations, provincial and territorial governments, Pan-Canadian Health Organizations, health experts, and other stakeholders. Partner organizations were invited to hold roundtable discussions and provide written submissions outlining their proposed next steps. Among the themes that emerged, education to health care providers on the history of Indigenous peoples in Canada was identified as a priority, as well as traditional approaches to healthcare.
On January 11, 2021, ISC helped to support a webinar by Indigenous Knowledge Keepers: "Setting the Foundation for Good Relations in our Homeland". The webinar was hosted by Turtle Lodge and addressed racism. The ISC Associate Deputy Minister co-moderated the event.
7 additional roundtables have been held to date: 2 by Indigenous Physicians Association of Canada, First Nations Health Managers Association and Healthcare Excellence Canada, 2 by Accreditation Canada and Health Standards Organization, the National Aboriginal Council of Midwives and the Atlantic Policy Congress.
The Government of Canada is committed to the co-development of distinctions-based health legislation and on June 29, 2021, the Minister of Indigenous Services affirmed that this legislation will be informed by the spirit and elements of Joyce's Principle.
Next steps
The Federal Pathway to Address Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ people reaffirms the Government of Canada's commitment to address anti-Indigenous racism in the health care system, to improve cultural safety across the various stages of health service delivery, to support the advancement of Joyce's Principle and to convene partners on a continued national dialogue on accountability and change. Another National Dialogue was held on June 28 and 29, 2021 and focused on collective measures related to post-secondary health education, cultural safety and humility training, traditional approaches and safe patient navigation.
With nearly 200 participants, the dialogue included breakout sessions where Indigenous partners, provincial and territorial governments and health system partners focused on concrete actions they can undertake collaboratively to drive substantive and immediate change.
ISC will continue to take a leadership role in addressing anti-Indigenous racism in health systems by continuing to coordinate with Indigenous partners, professional bodies and provinces and territories to avoid duplication of efforts and ensure national alignment. ISC will also convene regionalized discussions with provincial and territorial government partners to develop distinctions-based work plans to address anti-Indigenous racism in health systems.
The Budget 2021 investments announced by the Minister of Indigenous Services on June 29, 2021, respond to many of the key recommendations from reports and partners at the national dialogues and lay the groundwork for the development of a more comprehensive approach in the coming years. The way forward needs to be rooted in cultural safety and humility, to be guided and informed by Indigenous peoples and the ongoing impacts of colonialization, as well as the contributions that Indigenous peoples bring to Canada's health systems.
Non-Insured Health Benefits (NIHB) traditional healers support
What's happening?
Traditional healer services for mental health counselling for Non-Insured Health Benefits clients are being offered through projects by First Nations and Inuit partners that respect their unique cultural contexts. Resources and services are being delivered by community-based First Nations and Inuit recipient organizations. The recipient organizations have the flexibility to determine appropriate providers of traditional healing services in support of mental wellness, to compensate them in a manner that is culturally appropriate and to define the types of activities that traditional healers may undertake.
Recent progress
The First Nations and Inuit Health Branch is currently engaged with the Assembly of First Nations in a Joint Review of the Non-Insured Health Benefits Program. A review of the mental health counselling benefit resulted in a recommendation to develop a process and criteria for coverage of mental health counselling services provided to Non-Insured Health Benefits clients by traditional healers and Elders.
The Indigenous Community Support Fund (ICSF) was introduced in March 2020 to provide funding to Indigenous communities and organizations to prevent, prepare for and respond to the COVID-19 pandemic. Throughout fiscal year 2020 to 2021, the Government of Canada allocated $1.095 billion to the ICSF, which provided funding to Indigenous leadership and organizations, including approximately $700 million to First Nations on-reserve, to design and implement community-based solutions to address the specific needs identified by communities and their members. Budget 2021 allocated an additional $760.7 million to the ICSF, including $472 million in direct allocations or needs-based funding for First Nations on-reserve, resulting in a total Government of Canada funding allocation of over $1.855 billion during the past 2 fiscal years (2020 to 2021 and 2021 to 2022). Land-based activities and cultural supports are eligible activities under the ICSF and have been historically funded. Youth winter lodges, on-land sweat lodges adapted to COVID-19 capacity restrictions, traditional food provided to elders and teaching traditional harvesting techniques are examples of previously funded land-based activities.
Indigenous midwifery
What's happening?
As part of Budget 2017, ISC invested $6 million over 5 years, including $2.1 million ongoing to support Indigenous midwifery demonstration and development projects to improve culturally safe access to midwifery services, bringing birthing closer to First Nations and Inuit communities and ensuring essential cultural knowledge around women's health and childbirth are preserved and transferred to new families.
Demonstration projects are focused on:
- returning birthing to the community
- establishing new community-based, self-determined midwifery practices responsive to community needs
- integrating Indigenous traditions and ways of knowing with modern medicine
- building partnerships which help to create, sustain and support innovation to bring birthing closer to, or in, community
They are also helping to create an evidence base for best practices for re-establishing Indigenous midwifery.
ISC is working closely with partners, including the National Aboriginal Council of Midwives and National Indigenous Women's Organizations, through the Advisory Committee on Indigenous Women's Wellbeing, to improve culturally safe access to midwifery services.
Recent progress
3 demonstration projects are currently underway in First Nation communities in Alberta, Saskatchewan and Manitoba and have focused to date on:
- cultural teachings
- training for doulas
- provincial advocacy for more training opportunities for midwives.
A fourth project is planned for Inuit Nunangat. Development projects are also underway in Atlantic, Ontario, Quebec and Northern regions.
Next steps
In 2021 to 2022, ISC will continue to support Indigenous midwifery demonstration and development projects and work closely with partners to improve culturally safe access to Indigenous midwifery.
23. We call upon all levels of government to:
- Increase the number of Aboriginal professionals working in the health-care field.
- Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
- Provide cultural competency training for all healthcare professionals.
What's happening?
Health legislation
Access to health care is widely acknowledged as a social determinant of health. Research has shown that access to care in Canada is not equal, nor equitable. For Indigenous peoples, there are several contributing factors that impact access to care, including, but not limited to, the lack of Indigenous presence in health systems, or Indigenous health human resources.
What's happening?
Canada is working to co-develop distinctions-based Indigenous health legislation with First Nations, Inuit, and the Métis Nation to improve access to high-quality and culturally relevant services. The Minister of Indigenous Services Canada publically launched the engagement process on Indigenous health legislation on January 28, 2021, during the second virtual meeting on anti-Indigenous racism in health care.
The co-development of distinctions-based Indigenous health legislation is an opportunity to:
- establish overarching principles as the foundation of health services for Indigenous peoples
- support the transformation of health service delivery through collaboration with Indigenous organizations in the development, provision and improvement of services to increase Indigenous-led health service delivery
- continue to advance the Government of Canada's commitment to reconciliation and a renewed nation-to-nation, Inuit-Crown and government-to-government relationship with Indigenous peoples based on the recognition and implementation of rights, respect, co-operation and partnership
The Federal Pathway builds upon this work. In June 2021 the Government of Canada announced commitment to actions that will contribute to the creation of health systems free of racism and discrimination and better health outcomes for Indigenous peoples, including Indigenous women, girls and 2SLGBTQQIA+ people. This includes distinctions-based Indigenous health legislation and implementation co-developed with First Nations, Inuit, and the Métis Nation, backed with the investments needed to deliver high-quality health care for all Indigenous peoples, access to high quality, timely, stable and culturally relevant distinctions-based services, including a patient-centered approach to health service delivery, and preparedness and response services enhanced to address public health emergencies in a way that aligns with Indigenous priorities, builds local capacity and is responsive and sustainable.
Recent budget investments
The 2020 Fall Economic Statement announced an initial investment of $15.6 million over 2 years, starting in 2021 to 2022 to support the co-development of distinctions-based health legislation with First Nations, Inuit and the Métis Nation.
Recent progress
Work is underway with national and regional First Nations, Inuit, and Métis Nation partners, as well as other federal government departments, to establish a coordinated approach for engagement.
Next steps
Continue working with First Nations, Inuit, and Métis Nation partners on a coordinated engagement approach, including the development of engagement materials. Engage provinces and territories in co-development of distinctions-based Indigenous health legislation to establish a collaborative working relationship and prepare for future discussions, including opportunities for improved coordination by federal/provincial/territorial governments and Indigenous organizations in addressing the health needs and priorities of First Nations, Inuit, and Métis.
National Consortium on Indigenous Medical Education
What's happening?
Since 2019, Health Canada has held engagement sessions with health system and Indigenous health partners to identify measures underway and potential areas for collaboration on cultural safety and humility. Engagement resulted in funding for an Indigenous physician-led National Consortium on Indigenous Medical Education.
Recent progress
In January 2021, Health Canada approved funding for a National Consortium on Indigenous Medical Education. The initiative is led by Indigenous physicians, in partnership with the Association of the Faculties of Medicine of Canada and will provide leadership and implement Indigenous-led projects that reform and update the education of physicians. The goal of the initiative is to create an improved medical education environment, tools and resources to ensure Indigenous populations have access to culturally safe health care.
ISC is supporting the National Collaborating Centre for Indigenous Health to host an online information session on cultural safety and anti-racism tools and resources that relate to health care in Canada.
With the support of Health Canada and Crown-Indigenous Relations and Northern Affairs Canada, ISC has been leading the planning and coordination of national discussions on addressing racism experienced by Indigenous peoples in Canada's health care systems. Central to this work is the promotion and support of Indigenous healing approaches. Work and engagement will continue through 2021 and beyond.
Next steps
Following its establishment in early 2021, the Consortium has identified the following priority areas and established working groups and workplans associated with each priority:
- assessment of Indigenous studies, cultural safety and anti-racism
- anti-racism, policies, processes, and implementation support
- Indigenous student admissions and transitions
- Indigenous faculty recruitment and retention
- improving cultural safety in curriculum
- Indigenous physician wellness and joy in work
Indigenous health care providers and cultural competency
What's happening?
The Office of Primary Health Care in ISC has undertaken various outreach initiatives to increase the awareness of nursing employment within First Nation communities, with concentrated efforts on increasing Indigenous representation in the delivery of healthcare services. Initiatives include job fairs, social media outreach, paid advertising and on-going engagement with educational institutions to support Indigenous students' access and participation in health-care programs.
Cultural competency training is part of the onboarding requirements for all First Nations and Inuit Health Branch nurses. Since January 2020, a new ISC - First Nations and Inuit Health Branch policy was introduced requiring ISC management and employees at all levels and to complete the equivalent of 2 days (15 hours) of Indigenous cultural competency learning on an annual basis. Further to the 15 hours of required annual training, each region may have additional regionally focused cultural competency training for their healthcare professionals.
ISC is supporting a proposal from the University of Saskatchewan, in collaboration with Saskatchewan Polytechnic and the Northern Inter-Tribal Health Authority, for the establishment of an accredited dental therapy program. The proposed ladder program (such as dental aide to dental assistant to dental therapist) will focus on Indigenous student recruitment and enrolment. The program will also support virtual learning and will partner with northern campuses for learning close to home (such as Northern College).
One of the main goals of the proposed dental therapy program is to have Indigenous graduates return to work in their communities.
Nursing Now-Canada
ISC has partnered with the Canadian Nurses Association and the Canadian Indigenous Nurses Association to raise the profile of Indigenous nurses across the country through several activities, namely:
- funding provided to the Canadian Association of Schools of Nursing to develop a 5-year survey to understand the current and future state of Indigenous faculty and students engaged in nursing programs
- an environmental scan was completed to understand the landscape of schools of nursing who have integrated and are offering cultural safety and humility training within their programming
- Canadian Indigenous Nurses Association is currently exploring a mechanism for an Indigenous Nurse Identifier. An Indigenous nurse identifier will assist stakeholders to better identify and recruit Indigenous staff for academic positions, determine employment and education gaps and build culturally safer and more responsive health care systems
- Canadian Indigenous Nurses Association and the National Aboriginal Council of Midwives are working together to develop activities and a work plan for the upcoming year
Recent budget investments
Budget 2021 is providing $354 million over 5 years, beginning in 2021 to 2022, to increase the number of nurses and other medical professionals in remote and isolated First Nations communities.
Budget 2021 is providing $126.7 million over 3 years, beginning in 2021 to 2022, to take action to foster health systems free from racism and discrimination where Indigenous peoples are respected and safe. This funding will support patient advocates, health system navigators and cultural safety training for medical professionals.
Recent progress
A contribution agreement has been put in place to provide funding to the University of Saskatchewan to undertake the necessary planning for the proposed dental therapy program.
Next steps
Additional resources will be provided in fiscal year 2021 to 2022 as part of the multi-year contribution agreement.
24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.
What's happening?
All medical and nursing schools in Canada are responsible for the response to Call to Action 24.