Health

Anti-Indigenous Racism in Health Systems

Canada is committed to ending anti-Indigenous racism in our health systems in a way that is informed by the lived experiences of Indigenous Peoples and based on the recognition of rights of Indigenous Peoples, respect and co-operation. With the support of Health Canada and Crown-Indigenous Relations and Northern Affairs, Indigenous Services Canada led the planning and coordination of national dialogues on addressing racism experienced by Indigenous Peoples in Canada's health systems from October 2020 to January 2023. The Government of Canada publicly acknowledged the impact of colonization on Indigenous health at forums including the third virtual national dialogue on anti-Indigenous racism in health care held in June 2021.

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 health systems, 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.

Indigenous Health Legislation

The Government of Canada is working to co-develop distinctions-based+ Indigenous health legislation with First Nations, Inuit, Métis and Intersectional partners to improve access to high-quality and culturally relevant services. The Minister of Indigenous Services publicly 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. The engagement process wrapped up in fall 2022, and a national summary report, What We Heard: Visions for Distinctions-based Indigenous Health Legislation, is now publicly available.

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

Jordan's Principle

Jordan's Principle is a legal obligation, described by the Canadian Human Rights Commission, that ensures all First Nations children living in Canada can access the products, services and supports they need. Jordan's Principle helps to ensure that all First Nations children can access the health, social, and educational services they need.

Recent budget investments

Budget 2022 provided $4 billion over 6 years, starting in 2021 to 2022, to ensure First Nations children continue to receive the support they need through Jordan's Principle. Budget 2023 provided an additional $171 million in 2022 to 2023 to ensure First Nations children continue to receive the support they need through Jordan's Principle.

Budget 2023 also reaffirmed the Government of Canada commitment to invest $2 billion over 10 years through a new Indigenous Health Equity Fund to address unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. Funding will be provided to First Nations, Inuit, and Métis on a distinctions basis.

Recent progress

During the Indigenous Health Legislation engagement process, partners highlighted that Indigenous health legislation is a chance to acknowledge how settler-colonialism creates ongoing health inequities and ensure Indigenous Peoples' right to access safe health services, free of racism and discrimination. This is something that will be further explored with Indigenous partners during the co-development of legislative options.

Indigenous Services Canada received 42 engagement reports from First Nations, Inuit, Métis and Intersectional partners from across the country. These partners also participated in a co-analysis working group to jointly summarize engagement reports. As part of this process, multiple drafts of the report were shared with Indigenous partners for feedback, resulting in the publication of a national summary report, What We Heard: Visions for Distinctions-based Indigenous Health Legislation, that summarizes the input received to date from Indigenous Peoples. The report, as well as individual engagement reports, will assist in identifying possible legislative options for discussion through the co-development phase.

Jordan's Principle has had a reach^{Footnote 1} of more than 2.69 million approved products and services for First Nations Children betw, illness and injury incidence, and the availability of appropriate health First Initiative has had a reach of had a reach of 85,280 products and services for Inuit children under the Inuit Child First Initiative and in 2019 to 2020 provided coverage of health benefits to over 857,000 First Nations and Inuit peoples.

Additional information and the most up-to-date numbers regarding products and services can be found at Jordan's Principle. In February 2022, Indigenous Services Canada announced a partnership with the Federation of Sovereign Indigenous Nations in Saskatchewan to establish the first ever First Nations Health Ombudsperson's Office. The initiative will ensure First Nations have a point of contact where they feel safe to be able to report incidents of discrimination when accessing health care service in the province. The office will also assist in determining options to resolve conflicts or concerns for overall system change improvements.

Next steps

Indigenous Services Canada will continue working with First Nations, Inuit, Métis, and Intersectional partners to co-develop legislative options through distinctions-based+ tables, with the intention of tabling legislation in winter 2024. The perspectives of provincial and territorial governments will also be important in ensuring that the proposed legislative options are comprehensive and reflective of differing provincial or territorial contexts, and jurisdictional or legal landscapes.

Recent budget investments

Budget 2022 provided $227.6 million over 2 years, starting in 2022 to 2023, to maintain trauma-informed, culturally-appropriate, Indigenous led services to improve mental wellness, and to support efforts initiated through Budget 2021 to co-develop distinctions-based mental health and wellness strategies. In addition, the 2022 Fall Economic Statement announced $225 million over 5 years, starting in 2022 to 2023 to support recruitment and retention of health professionals on reserve.

On February 7, 2023, the federal government announced new investments to improve health care for all Canadians, including Indigenous Peoples, and is working with provinces, territories, and Indigenous partners to help advance our shared health priorities. Bilateral agreements with provinces and territories will be supported by key principles, including a commitment to reconciliation with Indigenous Peoples and recognizing their right to fair and equal access to health services, free from racism and discrimination anywhere in Canada. This includes seamless service delivery across jurisdictions and meaningful engagement with Indigenous organizations and governments.

As part of the federal government's plan to strengthen Canada's health system, the government is investing $2 billion in additional funding over 10 years for a distinctions-based Indigenous Health Equity Fund. This fund will address the unique challenges Indigenous Peoples face when accessing health care services, and support immediate and long-term Indigenous health priorities.

More recently, Budget 2023 proposed to introduce additional measures to maintain essential health services for Indigenous Peoples. Specifically, the Government of Canada is providing $810.6 million over 5 years, beginning in 2023 to 2024, to support medical travel and to maintain medically necessary services through the Non-Insured Health Benefits Program including mental health services, dental care, vision care and medications. The Government of Canada is also providing $16.2 million over 3 years, beginning in 2023 to 2024, for interventions to reduce rates of tuberculosis in Inuit communities.

PHAC has provided $200,000 to the First Nations Information Governance Centre (FNIGC) to support work until the end of 2025 on the development of a new report on mental wellness inequalities experienced by First Nations Peoples living on reserve and in northern communities.

Recent progress

Indigenous Services Canada continues to collaborate with Statistics Canada, the Public Health Agency of Canada and Indigenous organizations such as the First Nations Information Governance Centre and Inuit Tapiriit Kanatami on establishing health indicators that can identify gaps and be routinely reported. Although delayed by COVID-19, the First Nations Information Governance Centre is currently finalizing a scan and review of health frameworks and indicators developed by Indigenous academics and organizations that will form the basis on which an informed decision can be made in the selection of Call to Action 19 indicators. This work is essential to the identification of outcome measures that are inclusive and reflective of Indigenous perspectives. It is anticipated that indicators currently existing in the Regional Health Survey and Qanuippitaa. National Inuit Health Survey will provide many of the outcome measures for Call to Action 19. At the same time, the Pan-Canadian Health Inequalities Reporting Initiative measures health inequalities between First Nations (on- and off-reserve), Inuit (within and outside Inuit Nunangat), Métis, and up to 13 additional sociodemographic groups. A health inequalities data tool was created using data from this joint initiative between the Public Health Agency of Canada, the Pan-Canadian Public Health Network, Statistics Canada and the Canadian Institute for Health Information.

The first major refresh of the health inequalities data tool was completed in 2022. The tool now includes inequalities results sorted by First Nations, Inuit or Métis identity for 81 new and updated indicators of health outcomes and determinants of health. New indicators focus on priority public health areas such safe and stable housing, mental health, and access to care. Core HIRI partners, including FNIGC, National Indigenous Organizations and other members of HIRI's Pan-Canadian Health Inequalities Working Group were also consulted for feedback on this update.

PHAC continues to work with FNIGC to improve our understanding of the drivers of health inequalities in Canada and how they have changed over time. To highlight the various approaches to mental health and wellness, including Indigenous perspectives, enhanced reports that include both qualitative and quantitative evidence are currently being developed.

The first enhanced HIRI report will focus on the topic of social determinants of mental health inequalities in Canada. These can include, but are not limited to:

• socio-economic conditions
• stigma and discrimination
• access
• quality and use of services
• social isolation and community belonging
• intergenerational violence and trauma

In addition to this narrative report, a data tool will be created with a focus on trends in mental health and well-being outcomes. These outcomes will be categorized by Indigenous identity where sample sizes allow.

PHAC has also partnered with ISC and FNIGC to support the development of complementary assessments that measure, monitor, and report on mental wellness inequalities experienced by First Nations Peoples living on reserve and in northern communities. This report is expected by 2025.

Next steps

The Government of Canada is engaged in a multi-year joint review of the Non-Insured Health Benefits program in partnership with the Assembly of First Nations. The objectives of the review are to:

• identify and implement actions that enhance client access to health benefits
• identify gaps in benefits
• streamline service delivery to be more responsive to client needs

Many changes and improvements have been made by the Non-Insured Health Benefits program throughout the joint review, including the addition of new and expanded benefit coverage, new types of health professionals who can prescribe benefits, and new client services.

Planned activities for 2023 to 2024 include:

• continuing work with FNIGC on the mental health report
• expanding HIRI's data tool with new and updated data points
• monitoring changes over time in health inequalities in Canada

These activities will help capture updated health indicators for First Nations (on- and off-reserve), Inuit (inside and outside Inuit Nunangat), and Métis (in rural and urban environments).

COVID-19 pandemic response

The Government of Canada recognizes that First Nations, Inuit, Métis, regardless of where they live within Canada, 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. The Canadian health system is a complex patchwork of jurisdictions, policies, legislation, and relationships. Coordinated approaches to address the health needs of First Nations, Inuit, and Métis Peoples and health care delivery amongst all levels of government, including Indigenous governments, remain an ongoing challenge. Additionally, 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.

Throughout the COVID-19 pandemic, the Indigenous Community Support Fund was, among other streams of support, available to respond to the distinct COVID-19 response needs of urban First Nations, Inuit, and Métis Peoples.

This fund provided Indigenous leadership and organizations with the flexibility needed to design and implement community-based solutions to prevent, prepare and respond to the spread of COVID-19 within their communities. Since March 2020, approximately $2.1 billion has been provided through the Indigenous Community Support Fund. As of March 31, 2023, $1.2 billion in direct allocations have been provided to First Nations, Inuit, and Métis communities, and $851 million in needs-based funding. In addition to the Indigenous Community Support Fund, the Government of Canada invested $1.67 billion in COVID-19 Public Health Funding since the start of the pandemic. This funding was provided to First Nations communities and organizations that delivered public health services in response to COVID-19, using a needs-based approach.

The urgency of addressing anti-Indigenous racism in the health systems also arose during the pandemic. The virtual national dialogues on anti-Indigenous racism in health systems included organizations that represent First Nations, Métis, Inuit, in urban and non-urban contexts, 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.

The Government of Canada is working to co-develop distinctions-based+ Indigenous health legislation with First Nations, Inuit, Métis and Intersectional partners to improve access to high-quality and culturally relevant services. The Minister of Indigenous Services publicly launched the distinctions-based+ engagement process on Indigenous health legislation on January 28, 2021. The engagement process wrapped up in fall 2022, and a national summary report, What We Heard: Visions for Distinctions-based Indigenous Health Legislation, is now publicly available.

The report will assist in identifying possible legislative options for discussion through the co-development phase which is now underway with First Nations, Inuit, Métis, and Intersectional peoples, including those within urban contexts. Co-developed distinctions-based+ Indigenous health legislation, and implementation backed with investments has the potential to support the delivery of high-quality, stable, timely, culturally relevant health care for all Indigenous peoples. This includes a patient-centered approach to health service delivery, as well as 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.

Additionally, work continues on Jordan's Principle and the Inuit Child First Initiative. These Initiatives ensure that First Nations and Inuit children have access to the products, services and supports they need, 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

Between March 2020 and March 2023, the Indigenous Community Support Fund provided approximately $2.1 billion to Indigenous communities and organizations to prevent, prepare and respond to the spread of COVID-19. As of March 31, 2023, $1.2 billion in direct allocations have been provided to First Nations, Inuit, and Métis communities, and $851 million in needs-based funding. Similarly, the Government of Canada invested $1.67 billion in COVID-19 Public Health Funding since the start of the pandemic. This funding was provided to First Nations communities and organizations that delivered public health services in response to COVID-19, using a needs-based approach.

Budget 2022 provided $4 billion over 6 years, starting in 2021 to 2022, to ensure First Nations children continue to receive the support they need through Jordan's Principle. Budget 2023 provided an additional $171 million in 2022 to 2023 to ensure First Nations children continue to receive the support they need through Jordan's Principle.

Budget 2023 also reaffirmed the Government of Canada commitment to invest $2 billion over 10 years through a new Indigenous Health Equity Fund to address unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. Funding will be provided to First Nations, Inuit, and Métis on a distinctions basis.

Recent progress

The Government of Canada worked in close partnership with First Nations, Inuit, Métis leaders, as well as urban Indigenous organizations, throughout the COVID-19 pandemic to support pandemic preparedness and response in Indigenous communities.

Through the Indigenous Community Support Fund, Canada provided flexible funding to Indigenous organizations and communities, including those in urban and off-reserve settings, to address their unique needs. 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, in activities related to food security, for example, food hampers, community freezers, vaccination administration, personal protective equipment, and isolation accommodations and others.

With respect to Indigenous health legislation, Indigenous Services Canada received 42 engagement reports from First Nations, Inuit, Métis and Intersectional partners from across the country during the engagement process. These partners also participated in a co-analysis working group to jointly summarize engagement reports. As part of this process, multiple drafts of the report were shared with Indigenous partners for feedback. During engagement, certain partners highlighted that jurisdictional issues perpetuate and worsen the disadvantages experienced by Indigenous Peoples living off-reserve, specifically regarding access to health programs and services. Partners also emphasized the need for government accountability regarding its responsibilities to non-status and off-reserve populations. The distinct needs of off-reserve Indigenous Peoples will be further explored with Indigenous partners during the co-development of legislative options.

The Government of Canada is now moving into the co-development phase with partners. This stage is about translating what we've heard into proposed legislative options by working together at co-development tables. Co-development is distinctions-based+, with provincial and territorial participation where relevant.

Next steps

Indigenous Services Canada will continue working with First Nations, Inuit, Métis, and Intersectional partners to co-develop legislative options through distinctions-based+ tables, with the intention of tabling legislation in winter 2024. The perspectives of provincial and territorial governments will also be important in ensuring that the proposed legislative options are comprehensive, and reflective of differing provincial or territorial contexts and jurisdictional or legal landscapes.

The Government of Canada continues to work in partnership with First Nations and Inuit organizations to co-develop long term policy options for Jordan's Principle and the Inuit Child First Initiative and engage with relevant stakeholders to seek their views regarding access to the services and supports to meet the needs of First Nations and Inuit children.

Recent budget investments

Through Budget 2019, the Government of Canada committed $47.5 million over 5 years to support the design and construction of the Nunavut Recovery Centre and $9.7 million ongoing in support of treatment centre operations. To date, approximately $2 million has been provided to the Government of Nunavut to support the design and construction as per the contribution agreement signed and endorsed in late August of 2021.

Budget 2021 provided $597.6 million over 3 years, starting in 2021 to 2022, to support distinctions-based mental health and wellness strategies with First Nations, Inuit and Métis Peoples. This included the renewal of Trauma-Informed Health and Cultural Support Programs. It will support enhanced community-based supports and capacity and increased substance use treatment and prevention. Budget 2022 provided an additional $227.6 million over 2 years, starting in 2021 to 2022, to maintain expanded access to trauma-informed, culturally-appropriate, Indigenous-led services to improve mental wellness and further support distinctions-based mental health and wellness strategies.

In November 2022, Prime Minister Trudeau announced a $42.5 million investment over 6 years and $4.5 million ongoing to construct a new wellness centre in James Smith Cree Nation, refurbish the existing treatment centre, fund wraparound services and transitional supports. This investment will support healing, mental health, and well-being of community members impacted by a mass stabbing in September 2022.

In May 2021, Tk'emlúps te Secwépemc First Nation announced that ground-penetrating radar had detected remains of 215 children who died at the former Kamloops Indian Residential School. The confirmations of unmarked burials at residential schools has accelerated the need for cultural and emotional supports for survivors, family members, and those affected by the intergenerational trauma of residential schools. In March 2023, the Government of Canada announced that Tk'emlúps te Secwépemc First Nation would receive $12.5 million in federal funding, directed through the First Nations Health Authority, towards the construction of a healing centre for the community. The healing centre is intended to deliver traditional healing activities and equine therapy, bringing much needed traditional healing to members of the community.

Recent progress

On October 2, 2020, Indigenous Services Canada 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 Government of Canada (through Indigenous Services Canada) continues to meet regularly with the Government of Nunavut and Nunavut Tunngavik Incorporated, and construction is scheduled to begin early fall 2023 and is expected to be completed in August 2025.

Indigenous Services Canada has worked collaboratively with the Lac La Ronge Indian Band in the development of their Woodland Wellness Centre that provides one-of-a-kind programming where medicine co-exists with traditional and land-based healing. The 24-bed facility had its grand opening in June 2022 and is providing Indigenous-led health and wellness services to Indigenous Peoples in Northern Saskatchewan.

Since 2018, 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 substance use treatment services, including services for families in the healing process to lessen the impact of substance use on couples, pregnant women, and families with children. Due to the pandemic, construction has been delayed but the opening is still scheduled for 2023.

Next steps

Work on the design and construction of the Nunavut Recovery Centre is on schedule. The Government of Nunavut confirmed that the construction tender was closed and bids are currently being evaluated. The substantial completion date of the project has been pushed to August 2025, however site preparation and early stages of construction are slated to begin early summer and fall 2023, respectively.

Indigenous Services Canada is currently working with James Smith Cree Nation to initiate planning of the First Nation-led wellness centre and refurbished treatment centre that will enable the community to develop and design programs that best serve the needs of the community. The community-led design and implementation plan for these projects will help inform internal government processes required to access and deliver this important funding to the community.

Recent budget investments

The Government of Canada is currently investing over $200 million per year to support Trauma-Informed Health and Cultural Support Programs. This includes funding provided in Budget 2021 and Budget 2022 to support the Indian Residential Schools Resolution Health Support Program, the Indian Day Schools Health Support Program, and the Missing and Murdered Indigenous Women and Girls Health Support Program, as well as support for urban and Métis priorities.

Building on the early successes of the Budget 2017 midwifery demonstration projects, Budget 2021 provided an additional $33.3 million to improve access to culturally safe services, with a focus on services for Indigenous women, 2SLGBTQQIA+ people, persons with disabilities and other marginalized groups who may experience intersecting forms of discrimination. This includes $26.5 million to expand Indigenous midwifery and doula services, intended to help bring birthing back to, or closer to, home, through increased access to a continuum of culturally safe prenatal, birthing and postpartum care.

Since March 2020, approximately $2.1 billion has been allocated to the Indigenous Community Support Fund. As of March 31, 2023, $1.2 billion in direct allocations have been provided to First Nations, Inuit, and Métis communities, and $851 million in needs-based funding. In addition to the Indigenous Community Support Fund, the Government of Canada invested $1.67 billion in COVID-19 Public Health Funding since the start of the pandemic till March 31, 2023. This funding was provided to First Nations communities and organizations that delivered public health services in response to COVID-19, using a needs-based approach. Land-based activities and cultural supports were eligible activities under the Indigenous Community Support Fund and public health funding.

Recent progress

Recognizing there is a shortage of Indigenous midwives and that culturally safe birthing services are predicated on a sufficient work force, Budget 2021 investments are supporting the development of new community-based First Nations midwifery education and training programs in several regions including Labrador, Ontario, Quebec, and Nova Scotia. In addition, Budget 2021 is supporting expansion of the existing Six Nations First Nations training program.

• Sturgeon Lake First Nation, one of the original Budget 2017 demonstration projects, celebrated its first community midwife assisted birth in decades this past spring and has received additional Budget 2021 investments for construction of a new standalone birthing centre in the community, expected to break ground in the spring of 2023.
• Inuit Land Claim organizations have begun projects, including the Ungava Tulattavik Health Center (UTHC) in Kuujjuaq, Nunavik, to recruit additional trainees for their Inuulitsivik Midwifery Education Program, and allow the students to work alongside the existing four person midwifery team on a 24/7 basis.
• New Métis-specific midwifery and doula projects are set to begin implementation, including expansion of a Métis Doula mentorship program to train and mentor additional cohorts of Métis birth workers, expansion of pre-natal care and supports to a mobile clinic service, which travels to rural Métis communities to provide a wide range of primary care services, and planning for service delivery models and education and training on a long term strategy for culturally safe midwifery services in northern Métis communities.

Traditional healer services for mental health counselling for Non-Insured Health Benefits clients continue to be 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.

Next steps

Indigenous Services Canada will continue working with First Nations, Inuit, Métis, and Intersectional partners to co-develop legislative options through distinctions-based+ tables, with the intention of tabling legislation in winter 2024. The perspectives of provincial and territorial governments will also be important in ensuring that the proposed legislative options are comprehensive, and reflective of the differing provincial or territorial contexts, as well as jurisdictional and legal landscape.

Indigenous Services Canada will continue to support Indigenous midwifery projects and work 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 and sustain access to culturally safe reproductive health services.

Indigenous Services Canada will also continue to support access to health and cultural support services for eligible individuals through the Trauma-Informed Health and Cultural Support Programs.

Recent budget investments

Budget 2021 provided $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 also provided $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.

Indigenous Services Canada provided of $203,640 to the Canadian Association of Schools of Nursing to develop and launch an annual survey. The survey will monitor progress, among Canadian schools of nursing, on the number of self-identified Indigenous (First Nations, Inuit, and Métis) nursing faculty employed in Canada and on the enrollment of self-identified Indigenous nursing students.

More recently, through the 2022 Fall Economic Statement, the Government of Canada provided $250 million over 5 years to further support the recruitment and retention of health professionals on reserve. Finally, through Budget 2023, the Government of Canada reaffirmed plans to invest $2 billion over 10 years through the new Indigenous Health Equity Fund, to address unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. Funding will be provided to First Nations, Inuit, and Métis on a distinctions basis and support Indigenous health priorities.

Recent progress

A national summary report, What We Heard: Visions for Distinctions-based Indigenous Health Legislation, has been developed and summarizes the input the Government of Canada has received to date from First Nations, Inuit, Métis, and Intersectional Peoples. It describes their vision for what to include in distinctions-based+ Indigenous health legislation to improve access to high-quality, culturally-relevant, and safe health services. During engagement, First Nations, Inuit, Métis, and Intersectional partners highlighted the need for Indigenous-led education and cultural competency training for health care providers. Engagement reports also discussed the need for Indigenous health legislation to address the barriers that impact the recruitment and retention of Indigenous health care providers. These topics will be further explored with Indigenous partners during the co-development of legislative options.

With respect to primary care, Indigenous Services Canada 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 (which can advance students from 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.

Indigenous Services Canada also provides funding to Indigenous health professional organizations to build capacity and support the development of transformative measures that help eliminate anti-Indigenous racism in health systems:

• Indigenous Physicians Association of Canada continues to work as a national leader on addressing anti-Indigenous racism in health systems specifically in medical education. The association will also be creating and implementing a framework for accreditation changes needed to reduce anti-Indigenous racism in medical education.
• Indigenous Dental Association of Canada provides leadership in increasing awareness of anti-Indigenous racism in oral health care. The association is also supported to continue to provide expertise to the federal government on anti-racism in oral health care.
• Indigenous Pharmacy Professionals of Canada assists with the recruitment and retention of Indigenous students in pharmacy assistant, pharmacy technician, and PharmD programs across Canada. They also strive to provide leadership in the continuing professional development of all pharmacy professionals, curricular and accreditation guidance, cultural safety education, and scholarships.
• The First Nations Health Managers Association, in collaboration with First Peoples Wellness Circle and Thunderbird Partnership Foundation and NationTalk developed the Rise Above Racism campaign to raise awareness and provide resources to eliminate racism in health settings.

Next steps

Indigenous Services Canada will continue working with First Nations, Inuit, Métis, and Intersectional partners to co-develop legislative options through distinctions-based+ tables, with the intention of tabling legislation in winter 2024. The perspectives of provincial and territorial governments will also be important in ensuring that the proposed legislative options are comprehensive, and reflective of the differing provincial or territorial contexts, as well as jurisdictional and legal landscape.

Indigenous Services Canada is supporting the Saskatchewan Indian Institute of Technology to expand the first dedicated Indigenous Practical Nursing program in Canada, which is rooted in Indigenous worldviews and ways of knowing. Funding provided will be to increase the number of Indigenous Practical Nurses through increasing the overall number of available seats and to enhance the reach of the existing program to rural and remote areas of Saskatchewan through mobile training laboratories and outreach programming. Indigenous Services Canada is also a supporting partner in the establishment of the Saskatchewan Indian Institute of Technology's Virtual Health Hub. The Virtual Health Hub aims to improve health outcomes for Indigenous peoples living in rural, remote, and northern communities by utilizing technology to increase access to essential health care services and programs offered throughout Saskatchewan.

Indigenous Services Canada is supporting First Nations University of Canada in the development and enhancement of certificate level programs for Traditional Birth Support Workers, including 2 certificate extension programs.