module 4 current array of aboriginal health services
Skip this Video
Download Presentation
Module 4 Current Array of Aboriginal Health Services

Loading in 2 Seconds...

play fullscreen
1 / 165

Module 4 Current Array of Aboriginal Health Services - PowerPoint PPT Presentation

  • Uploaded on

Module 4 Current Array of Aboriginal Health Services. Welcome to Current Array of Aboriginal Health Services. This course takes 45 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about ' Module 4 Current Array of Aboriginal Health Services' - elana

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Welcome to Current Array of Aboriginal Health Services.

This course takes 45 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module.

You can either have the volume turned on or off to complete this learning module.

Select the arrow keys at the bottom of your screen to move forward and move back, or to stop and start the learning module.


Course Learnings

By the time you complete this learning module, you will be able to identify:

Aboriginal self-determination in healthcare

Holistic health, and health status monitoring

Federal government programs

Provincial government programs

Current Array of Aboriginal Health Services

acronyms used in this learning module
Acronyms Used in This Learning Module
  • ACL: Aboriginal Cancer Lead
  • ADI: Aboriginal Diabetes Initiative
  • AHWS: Aboriginal Healing and Wellness Strategy
  • AHTF: Aboriginal Health Transition Fund
  • APN: Aboriginal Patient Navigator
  • CCO: Cancer Care Ontario
  • CPNP: Canada Prenatal Nutrition Program
  • DBL: Drug Benefit List
  • FNIHB: First Nations and Inuit Health Branch
  • FNIM: First Nations, Inuit, Métis
  • IHTP: Indian Health Transfer Policy
  • NCCAH: National Collaborating Centre for Aboriginal Health
  • NIHB: Non-Insured Health Benefits
  • RCPs: Regional Cancer Programs
  • RHA: Regional Health Authority

Holistic vs. Wholistic: We have used the more commonly seen spelling of Holistic (for non-Aboriginal Canadians) in this module vs. the Aboriginal spelling which refers to Aboriginal philosophy in which everything is related by virtue of shared origins.

This list can be printed if you want to refer to it throughout the module.

insert pre test quiz slide
Insert Pre-Test Quiz Slide

True or False

Q: The federal government is responsible for covering the health care needs of all Aboriginal people in Canada (First Nations, Inuit and Métis).

A:  True  False

Move forward to begin Chapter 1


Self-Determination – What does it mean?

The International Covenant on Civil and Political Rights, Article 1 states:

“All peoples “All peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development.”

Essentially this means that a group of people (usually a common ethnicity) living in a territory have the right to determine their own future.


What is Aboriginal Self-Determination in health? Being involved in the health services in response to needs the community has identified, including:

  • creation,
  • maintenance, and
  • control.

The federal government recognizes that Aboriginal governments and institutions require the authority to make decisions in a number of areas, including health, similar to self-government.

We will review a history of the change in Aboriginal government structure that led to the removal of self-government.


Traditional governments were characterized by the collective ownership of all lands, waterways, forests and wildlife, full participation and consensus in decision-making and non-coercive leadership.

Government policy was usually framed in the context of doing what was best for First Nations, Inuit and Métis people in the long term, but operated in the national interest.

An Overview of the Traditional Aboriginal Government Structure

decision making and responsibility
Decision Making and Responsibility

In Aboriginal culture- all people were considered equal – men, women and youth, and contributed equally to the success of the community.

All Leaders had to agree for a decision to pass that affected the whole community.

At the micro level, decisions were based on need, survival and family structure.

Developments evolved inside of the nation, band, community and the clan structure.

All members were expected to contribute to the benefit of the larger group.


HealthTraditional medicine and Aboriginal health and wellness are rooted in a holistic approach. The steps to the Aboriginal Path of Well-being include:

1. Health in balance: giving equal importance to all aspects of health

6. Joint and personal responsibility: health and well-being is the responsibility of the individual, family and community

2. Wellness: both emotional and spiritual

3. Active choice: one’s ownership for health decisions

4. Holistic approach: balance the mind, body, and spirit with community and environment

5. Understand root causes: past and present aspects that impact health


The Introduction of a New System

Post-European contact, a colonial-style government structure was implemented with significant changes to Aboriginal social and government structures.

In this new situation, the economies and belief systems of the two groups were increasingly incompatible.

Diminishing the Traditional System

During the 1800s and mid-1900s, the government exercised extreme measures to assimilate FNIM people into new society. Traditional ceremonies were made illegal:

  • Sun Dances
  • Giveaways/Potlatches (honouring births, weddings, or deaths)
  • Traditional medicines and healing

Spiritual leaders and healers were arrested when trying to perform traditional medicines and healing.


The displacement of the traditional system contributed greatly to the impoverishment of Aboriginal societies.

Poverty was non-existent during these times.

Removed was collective ownership and decision-making.

Impoverishment of Aboriginal Societies

These needs included health, work, and food.

The traditional government system ensured that the needs of the people were met.


First Nations leaders were nearly unanimous in their rejection.

One main reason was that they were not consulted during the creation of the paper, and it had major impacts to their lives.

In addition, special rights deriving from their unique and historical relationship with the government.

FNIM Response: Citizens Plus. More commonly known as the Red Paper.

Leaders maintained that their people were entitled to all the benefits of Canadian citizenship.

Leaders based their response on early legislation from 1763 and the intent of their treaties.


Some Key Developments Transfer of Control over Community Health Programs

The Government’s Re-evaluation of Aboriginal Self-Determination in Canada

Over the last few decades, governments recognized that the losses as a result of the policies and practices governments have placed on Aboriginal communities (i.e. assimilation, move to reserves, and removal of self-determination) had a detrimental impact to their well-being. This recognition has resulted in a concerted effort to increase the transfer of health accountability in some form back to Aboriginal communities.

some key developments transfer of control over community health programs 1970s and 1980s
Some Key Developments Transfer of Control over Community Health Programs: 1970s and 1980s

1979: Federal Indian Health Policy recognizes that FNIM people may assume responsibility for administering any or all aspects of their community health programs.

1988: Final Transfer Agreement transfers responsibility for Universal Health Programs to the Government of the Northwest Territories (NWT). NWT would continue to have access to any new federal programs for FNIM people

1988-1989: Cabinet and Treasury Board approves the health Transfer south of the Territories: policy framework, financial authorities and resources for transferring control of community-based health programs to FNIM communities.

some key developments transfer of control over community health programs 1990s
Some Key Developments Transfer of Control over Community Health Programs: 1990s

1995: Inherent Right to Self-Government Policy recognizes that the inherent right to self-government is an existing Aboriginal right under section 35 of the Constitution substantive information with respect to FNIM control of health services.

April 1999: Nunavut Territory is created with the conditions of the 1988 Northwest Territories Final Transfer Agreement applying to the Government of Nunavut.

some key developments transfer of control over community health programs 2000s onward
Some Key Developments Transfer of Control over Community Health Programs: 2000s onward

Oct. 2013: The Government of Canada hands over full health care services control to the newly formed First Nations Health Authority (100% First Nations community-run) in British Columbia, a first for a province in Canada.

2013: Health Canada\'s Health Services Integration Fund is a five-year, $80 million initiative supporting collaborative planning and multi-year projects aimed at better meeting the health care needs of FNIM Canadians.

2014: Canada Health Transfer (CHT) is the largest major transfer to provinces and territories. It provides long-term predictable funding for health care.


The Federal Indian Health Policy is based on four pillars of public health from which the federal government and FNIM communities can build upon to increase the level of health in FNIM communities:


Why Self-Determination is Important to Aboriginal Health

The removal of Aboriginal self-determination had detrimental effects to the health and well-being of FNIM people.

current statistical inequalities in fnim health in canada fnim people
Current Statistical Inequalities in FNIM Health in Canada:FNIM people:

Are much more likely to have poor health and die prematurely.

Have a higher burden of chronic conditions and infectious disease.

Are more likely to live in poverty affecting aspects of their lives.

Children are more likely to die in the first year of life.

For example: go hungry, or suffer from poor nutrition and obesity.


Lessons from Aboriginal Self-DeterminationIt is well documented that when initiatives are developed, led, and managed by First Nations and Inuit, there is the greatest potential for success in improving health care for their people.

  • They have the flexibility to tailor care to meet community-specific needs within the:
  • local
  • social,
  • cultural, and
  • geographic context.
  • The government’s transfer of health ownership has been proven to yield positive results as studies have demonstrated.

Pictured: MnaamodzawinHealth Services in Little Current, Ontario


Two Case Studies: Merits of Aboriginal Self-Determination

1. Community Crisis Teams in Northern Ontario

In response to a rising suicide rate amongst First Nations youth in Northern Ontario, the NishnawbeAski Nation (NAN) reached out and received funding to create crisis teams in the communities.

First Nations communities have considerable flexibility on crisis team spending decisions.

The program is administered by a First Nations organization (the NAN), which is accountable to Aboriginal Healing and Wellness Strategy.

This is an almost pure example of Aboriginal self-determination.

2. British Columbia Tripartite First Nations Health Plan

Oct.1, 2013, the federal government transferred its role in the


management, and

delivery of

First Nations health programming in British Columbia to the new First Nations Health Authority.

Under the system, First Nations work closely with government and health agencies for better coordination of health programs and services.

The government funds the program and acts as a governance partner, but do not deliver or define services.

insert quiz slide quiz for chapter 1
Insert Quiz slide: Quiz for Chapter 1

There is one question for this chapter.

Q: Name two reasons that self-determination is important to Aboriginal health as defined in the chapter.

A: _______________________________________


Emerging ModelsFNIM leaders and federal and provincial governments collaborate to improve relationships to develop new models in Aboriginal health programming and service delivery.


Charting a new course: Protocol agreements and what they mean

What are protocol agreements?Protocol agreements establish and formalize relationships with FNIM people. They provide a framework for collaboration and outline processes for engagement with the FNIM nations regarding a contemplated project or activity that may have adverse effects on established rights.

the ministry of aboriginal affairs recognizes protocol agreements as an agreement that
The Ministry of Aboriginal Affairs recognizes protocol agreements as an agreement that:

While protecting and promoting the distinct culture, identity and heritage of FNIM people.

Fosters partnership opportunities that respect FNIM traditions.

Recognizes the unique history and ways of life of FNIM communities in Ontario.

Is intended to improve the well-being of FNIM people and communities.

Sets a collaborative relationship with the government and FNIM people.

Protocol agreements establish and formalize relationships with FNIM people. They provide a framework for collaboration and outline processes for consultation with an FNIMgroup regarding a contemplated project or activity that may have adverse effects on established rights.


Federal and Provincial DirectivesIn 2005, the Blueprint to Aboriginal Health was created as the result of collaborative efforts by federal, provincial and territorial governments and representatives of FNIM people.


The Blueprint charted a 10 year course of action.

  • We will first review Federal Directives: Consultation and then Provincial Directives

Federal consultation directives are specific to First Nations people and Inuit. There are no federal level provisions for Métis people.

Consultation Directive #1During the planning or implementation of a federal proposed activity: If information becomes available about potential adverse impacts on rights exercised by a First Nations or Inuit group, officials must undertake the appropriate consultations.
  • For example, decisions with respect to:
  • a pipeline that may affect wildlife, movement, supply and access;
  • decisions with respect to pollution from construction; or
  • use that may affect flora or animal populations.

Consultation Directive #2Departments and agencies must assess their activities, policies and programs that may adversely impact potential or established Aboriginal or Treaty rights and related interests.

Based on this review, federal officials will ensure that appropriate consultation activities with FNIM groups are carried out.

Consultation Directive #3Federal officials must be able to demonstrate in decision making processes that FNIM concerns have been addressed or incorporated into the planning of proposed federal activities.

As such, early discussions with the FNIM groups who may be adversely impacted by a federal activity are crucial.


Consultation Directive #4The Government of Canada and its officials are required to carry out a fair and reasonable process for consultations.

A meaningful consultation process is characterized by good faith and an attempt by parties to understand each other’s concerns, and move to address them.


Consultation Directive #5To manage FNIM consultation and accommodation, the Government of Canada will facilitate efficient and effective cooperation among and within federal departments and agencies via senior federal official governance structures which will assign a lead in a consultation process where the lead is not clear.

Consultation Directive #6The Government of Canada, in carrying out consultation processes, must act in accordance with its existing commitments and processes (e.g. Treaties, Treaty land entitlement agreements, settlements and consultation agreements).


Consultation Directive #7The Government of Canada and its officials can rely on FNIM groups, industry and provinces and territories, to carry out procedural aspects of a consultation process (e.g. information sessions or consultations with FNIM groups). The information collected during can be used by the Government of Canada and its officials in meeting its consultation obligations.

Consultation Directive #8A whole of government approach for FNIM consultation will be used in the regulatory review process for major natural resource projects. Consultation will be integrated into environmental assessment and regulatory approval processes.

insert pop up quiz box
Insert pop up quiz box
  • [Add in a pop-up: This is a non-scoring quiz:

True or False

Consultation directives were developed to identify potentially adverse impacts of federal activities on Aboriginal or Treaty rights and interests and find ways to avoid or minimize them.

  • Answer: True False

Provincial DirectivesIn 2004, the provincial government collaborated with FNIM leaders and communities to determine a new approach for FNIM health care.


The collaborative approach to FNIM health care was to realize progress towards goals.

The strategy that was developed was called Ontario’s New Approach to Aboriginal Affairs.

FNIM leaders stressed the need for more control over a range of matters that affect their communities.

Provincial Directives


FNIM leaders also stressed the importance of improved relationships with Ontario

One of the key goals that emerged was to improve the coordination of provincial and federal programs.

An approach to consultation on matters related to:
  • constitutionally protected rights
  • Métis harvesting regimes
  • justice and tobacco strategies

These were considered important elements of Ontario\'s New Approach to Aboriginal Affairs.

Consultation Directives

The federal government’s duty to consult applies to provincial and territorial governments.

Ontario, has a legal obligation to consult with FNIM people when it contemplates decisions or actions that may adversely impact asserted or established Aboriginal or treaty rights.

consultation directives generally involve
Consultation directives generally involve:

Giving timely and accessible information to FNIM communities on initiatives.

Obtaining information on any potentially affected rights.

Listening to any concerns raised by the community, and determining how to address them.

Attempting to avoid, minimize and/or mitigate adverse impacts on Aboriginal or treaty rights.

For initiatives involving federal, provincial and territorial governments, opportunities to coordinate efforts between jurisdictions should be pursued to the maximum extent possible.


The Need for Improved Health Services and AccessWhile First Nations, Inuit and Métis are all recognized as Aboriginal under the Canadian Constitution Act of 1982, policies are not applied consistently across the groups and therefore, each group faces its own unique set of challenges in navigating the Canadian health care system.

insert pop up quiz box1
Insert pop up quiz box
  • [Add in a pop-up: This is a non-scoring quiz: Do you know if a First Nations mother living in downtown Toronto is covered by the National Insured Health Benefits (NIHB) program?]
  • Answer: Yes No I’m Not Sure

The system is based on public policies that have created jurisdictional gaps that are underscored by a continued debate between federal, provincial and FNIM governments as to who is responsible for the delivery of health care to FNIM people. Higher morbidity and mortality rates among FNIM people have partially been attributed to the uncoordinated health care service delivery system.

Source: British Columbia Provincial Health Officer, 2009

Let’s look at Jordan River Anderson’s story as an example of deficiencies in the current health system for FNIM people

Jordan River Anderson, a young child from Manitoba’s Norway House Cree Nation, was born in 1999 with a rare neuromuscular disorder.

  • It required him to receive care from multiple service providers.
  • He spent his entire life living in an institutional hospital setting.

The reason was not medical but because of a jurisdictional dispute between federal and provincial governments over who should pay for his home care.

Source: The Aboriginal Health Legislation and Policy Framework in Canada, 2011 National Collaborating Centre for Aboriginal Health


Jurisdictional Responsibilities for FNIM Healthcare Service DeliveryFNIM health policy in Canada is made up of a complicated mix of policies, legislation and agreements that delegate responsibility between federal, provincial, municipal and Aboriginal governments in different ways in different parts of the country.

Source: National Collaborating Centre for Aboriginal Health (NCCAH), 2011

FNIHB administers several programs, including community-based programming for health promotion and disease prevention; primary health care centres and nursing stations in about 200 remote communities.

They additionally fund public health programs focused on prevention of communicable disease, safe drinking water, and other public health issues; and non-insured health benefits, which covers expenses not typically covered by provincial health care plans, including dental and vision care, prescription drugs, medical supplies and equipment, transportation and other services.

Source: FNIHB, 2008

Multiple levels of authority are involved in the provision of services to FNIM communities.

The tendency is to delegate responsibility to local levels.

In the absence of a clear national FNIM health policy:

jurisdictional gaps and inconsistent levels of funding continue to create barriers for many FNIM communities

Sources: NCCAH, 2011; Lavoie, Forget, & O’Neil, 2007


Stating the minister may enter into an agreement with Canada and/or First Nations for the delivery of health services.

Legislation and Policy in Ontario

FNIM health Provisions in Ontario:

  • Related to existing modern treaties.
  • That recognize FNIM traditional healers should be exempted from control specified under the Code of Professions.
  • In tobacco control legislation stating that the legislation does not apply to the use of tobacco for ceremonial purposes.
First Nations and Inuit Governments

First Nations and Inuit communities have taken on various levels of responsibility to direct, manage, and deliver a range of federally funded health services.

Over the past three decades, First Nations and Inuit communities have assumed an increasingly prominent role in the design and delivery of a wide range of community health services.

This was done through a series of transfer arrangements and contribution agreements with the federal government.


Delivery of services is administered from direct delivery of services by the First Nations and Inuit Health Branch, transferred health services, or where communities have full control and responsibility for all aspects of providing services, such as the First Nations Health Authority in British Columbia.


Aboriginal Affairs and Northern Development Canada (AANDC)The AANDC funds an Assisted Living Program that provides non-medical social support services and an Income Assistance Program for First Nation seniors’ on-reserve in all provinces and the Yukon Territory.

The table illustrates the services and variations by the individual’s legal status, as defined by the Constitution, and place of residence.
Let’s review jurisdictional responsibilities for cancer research and surveillance as an example of the jurisdictional divides.

Research and Surveillance

Shared responsibilities between federal and provincial/ territorial levels of government.

  • Cancer Incidence and Mortality Surveillance
  • Responsibility of provincial and territorial cancer registries, which collect data that are included in a national database.
  • The registries do not generally contain ethnic identifiers making it very difficult to conduct cancer surveillance specific to FNIM people.

Cancer Research in FNIM People

Funded through the usual sources: governments, universities, hospitals, health charities and private foundations and corporations.


Key Gaps Based on Jurisdictional IssuesJurisdictional fragmentation has caused gaps that have created issues to appropriate health care services.


Key Gaps Based on Jurisdictional IssuesJurisdictional fragmentation has caused gaps that have created issues to appropriate health care services.


Key Gaps Based on Jurisdictional IssuesJurisdictional fragmentation has caused gaps that have created issues to appropriate health care services.


Key Gaps Based on Jurisdictional IssuesJurisdictional fragmentation has caused gaps that have created issues to appropriate health care services.

insert pop up exercise box
Insert pop up exercise box
  • [Add in a pop-up: This is a non-scoring exercise: Write down one way that you could help a FNIM patient try to navigate the health care system for cancer treatment in a different region]
  • Answer: Yes No I’m Not Sure
first we will review funding and then review coordination of services
First we will review funding and then review coordination of services.

Gaps Due to Jurisdictional Divides The two main issues with the jurisdictional divides are funding and barriers to coordination of services.


Funding levels often depend on the participation of provincial governments in the support of:

FNIM services, and

the availability of FNIM health experts to lobby for support.

This leads to discrepancies, e.g. some off-reserve FNIM community services have to rely solely on fundraising.

  • There is an important role for governments to play in:
  • Improving community infrastructure and capacity.
  • Helping communities sustain their services.
  • At the end of the learning module, there is a resource to help determine how to straddle between federal and provincial funding.
Barriers to Coordination and Collaboration

There are inter-governmental barriers and cross-jurisdictional barriers that affect the coordination of health services. We have discussed some of them earlier in this chapter.

  • Taking on responsibility for community health care is complicated for many communities.
  • It required him to receive care from multiple service providers.
  • It is not uncommon for a community to be located across two or more regional health authorities - each with its own way of doing business.
  • There are First Nations communities that cross regional health authority boundaries and provincial boundaries.
At the Community Level

Legislated definitions have created divisions among FNIM people, e.g.:

Since 1985 First Nations people have been defined pursuant to the Indian Act as status, non-status, and reinstated Indians.

Jurisdictional distinctions divide the FNIM community against itself:

Reserve governments are separate from organizations representing off-reserve people.

Métis organizations compete for the recognition of Métis people.

Inuit organizations seek action on problems in the North.

Developing Improved Coordination Processes

FNIM stakeholders, health care providers and government agencies across regions develop core health strategies for coordination processes with the hope of bridging gaps.

Recently, cross-jurisdictional mechanisms have emerged in a few provinces.

One example:

The Saskatchewan Northern Health Strategy (ended in 2010) that brought together First Nations, Métis, northern municipalities, Regional Health Authorities (RHAs), and federal and provincial authorities.


These methods are steps in the right direction; however their effectiveness in addressing cross-jurisdictional issues is constrained by existing legislation, policies and budgets that are decided at the national and provincial levels.


Cross-Jurisdictional Mechanisms

There are several FNIM specific health policy-frameworks that provide for cross-jurisdictional coordination mechanisms to try to bridge jurisdictional gaps in health service delivery.

The frameworks usually consist of a collaborative committee comprised of stakeholders from FNIM organizations and federal and provincial governments.

They try to reduce the roadblocks to appropriate access to services and/or funding.

Ontario’s Aboriginal Health and Wellness Strategy (AHWS), developed in 1994 is considered to be one of the most comprehensive in the country.

In 2010, the Ontario government worked with its Aboriginal partners to develop a renewed Aboriginal Healing and Wellness Strategy. Five Ontario government ministries fund the strategy.

Source:, Mar 2014


Intergovernmental Health Authorities

These are formal organizations created either through federal-provincial partnerships or self-government agreements. An example is the Sioux Lookout First Nations Health Authority (SLFNHA) created in 1993 and serving 31 First Nations communities in northern Ontario.

The SLFNHA is partnership between Sioux Lookout Zone First Nations, the Town of Sioux Lookout and the governments of Canada and Ontario.

It has a funding agreement with the provincial and federal governments to provide health services for First Nations people and the residents of Sioux Lookout.

In 2013: Health Canada\'s Health Services Integration Fund (HSIF) is a five-year, $80 million initiative supporting collaborative planning and multi-year projects aimed at better meeting the health care needs of FNIM people. HSIF builds on the lessons learned and partnerships developed under the Aboriginal Health Transition Fund.

aboriginal patient navigators


Erie St. Clair


Hamilton Niagara Haldimand Brant

Central East



North Simcoe Muskoka


Aboriginal Patient Navigators

Toronto Central

Network of 10 in regions with higher FNIM population to provide support to FNIM patients with cancer and their families

aboriginal patient navigators1
Aboriginal Patient Navigators

Jeannie Simon, NW Navigator

Leah Bergstrome, NSM Navigator

Audrey Logan, ESC Navigator

Chantel Antone, SW Navigator

Deena Klodt, HNHB Navigator

Recruitment Underway, TC Navigator

Verna Stevens, Champlain Navigator

Sherri Baker, NE Navigator

Lynn Brant, SE Navigator

Kathy MacLeod-Beaver, CE Navigator


“Hospitals are an entirely alien environment for the average FNIM person—and even for me. However, my experience at the Windsor Regional Hospital has been nothing but positive. The hospital is fully vested and open to our communities”

Audrey Logan, ESC Aboriginal Patient Navigator

regional aboriginal cancer leads

North Simcoe Muskoka




Hamilton Niagara Haldimand Brant

Erie St. Clair

Toronto Central

Regional Aboriginal Cancer Leads

The role of the Regional Aboriginal Cancer Leads is to provide leadership on FNIM cancer care in the region and champion the Aboriginal Cancer Strategy.

The Regional Aboriginal Cancer Leads are located in the 10 Regional Cancer Programs with higher FNIM population to provide support to FNIM patients with cancer and their families

regional aboriginal cancer leads1
Regional Aboriginal Cancer Leads

Dr. Shannon Wesley, NW Lead

Dr. Andrea East, HNHB Lead

Dana Strength, NSM Lead

Bernice Downey, TC Lead

Recruitment Underway, Champlain Lead

Dr. Jason Pennington, CE Lead

Dr. Hugh Langley, SE Lead

Dr.Mike Vreugdenhil, SW Lead

Dr. Mark Tomen, ESC Lead

Dr. AnnelindWakegijig, NE Lead

the aboriginal cancer lead role
The Aboriginal Cancer Lead Role

Engage and collaborate with primary care providers

Champion the strategic vision with Regional Cancer Program staff

Lead strategic planning and program design

Conduct peer education and training


“It’s all about building trust. I have always done my best in this regard with my patients and it’s time for the healthcare system to do the same. Respect certainly goes a long way in healing.”

Dr. Mark Tomen, Regional Aboriginal Cancer Lead, Erie-St. Clair Region

Move forward to begin the quiz for this chapter

insert quiz slide quiz for chapter 2
Insert Quiz slide: Quiz for Chapter 2

The quiz for this chapter is comprised of one multiple choice question. Select all responses that you think are accurate for the statement.

Health legislation and policy applicable to Ontario include:

  • Provisions stating that the minister may enter into an agreement with Canada and/or First Nations for the delivery of health services.
  • Provision clarifying the application of legislation on Métis settlements
  • Provisions related to existing modern treaties
  • Territory/province-wide Aboriginal health framework
  • Health legislation recognizing the need to respect traditional healing practices
  • Provisions that recognize that Aboriginal traditional healers should be exempted from control specified under the Code of Professions
  • Provisions in tobacco control legislation stating that the legislation does not apply to the use of tobacco for ceremonial purposes
federal government s role
Federal Government’s Role

Source: British Columbia Provincial Health Officer, 2009.


Canada Health Act (1984)

The Canada Health Act (CHA), which established national standards for health care service delivery.

Persons insured under the CHA are defined as residents of the province, other than:

  • Members of the Canadian Forces or
  • Members of Royal Canadian Mounted Police,
  • Federal inmates, or
  • Residents of the province who have not completed a minimum period of residence

The coverage of Status and/or Treaty Indians is not stated.

Source: Department of Justice, 2010

Federal Programs

The Federal government agreed that culturally relevant heath care programs and traditional healing traditions that address the whole person are key to reducing FNIM health disparities.

This led to the development of a variety of programming throughout the last few decades.

Understanding offerings at the federal level can help support your decisions when making recommendations to FNIM patients.

Source: Health Canada, 2003


Federal government offered the IHTP to transfer control of health program resources over to the community.

Giving communities flexibility to allocate funds according to community priorities.

One main reason was the lack of improvement in FNIM health status after years of federal spending.

The transfer required specific mandatory public health programs to be provided.

1989: The

Indian Health Transfer Policy (IHTP)

First Nations and Inuit Home and Community Care programs for over 600 communities.

Instead of increasing funding, they determined that increased input by FNIM people would be more effective.


This freezes inequities between communities, e.g. to keep competent health care professionals in isolated communities, it is often necessary to offer better wages and bonuses than elsewhere, but it is not financially possible.

Meet identified needs: It claims to support the revitalization of indigenous healing practices, with no funds available for this. It does not provide for population growth.

Cover the environment, housing, infrastructure because they do not fall under the umbrella of health care, even though they very much do affect health.

There is a no enrichment clause resulting in major differences between First Nations in the number and quality of services available.

Negative Aspects FNIM have reported that funding does not:

Take into account off-reserve and non-status users. The funding formula has created issues of funding gaps in jurisdictional responsibility.

Aboriginal Health Transition FundThe Aboriginal Health Transition Fund (AHTF) ran from 2006 to 2011, and supported:

At its completion date, the AHT Fund funded 311 Aboriginal health-related projects across the country. The projects piloted different approaches to better coordinate and adapt health services including e- and tele-health, substance abuse, child and youth care, mental health, chronic disease, public health, home care and governance.


Family Health Programs

Families play an important role in encouraging and maintaining healthy lifestyles in Aboriginal communities. Health Canada established programs to support the health of First Nations and Inuit families, including:

Health Canada

Several initiatives under Health Canada’s First Nations and Inuit Health Division are aimed to support and promote better health for status First Nations people and Inuit living on reserve or in the territories.


Aboriginal Diabetes InitiativeEstablished in 1999, the Aboriginal Diabetes Initiative (ADI) was developed to reduce type 2 diabetes among FNIM people (a key health risk factor). It supports health promotion and primary prevention activities and services delivered by trained community diabetes workers and health service providers. The ADI is comprised of four main components.


Primary Prevention and Health Promotion: Community-led and culturally relevant health promotion and prevention activities to promote:

Diabetes awareness, healthy eating and physical activity as part of healthy lifestyles.

The quality of diabetes healthcare, and for evaluation studies and program monitoring of programming at the local, provincial and national levels.

Screening and Treatment: For increased and regular screening for the early diagnosis of diabetes complications. It provides education and support for people living with diabetes and their family members.

Research, Surveillance, Evaluation, Monitoring: Establish partnerships with research agencies / organizations to jointly fund priority research, support to determine:

Four Main Components of the ADI

Capacity Building and Training:

Offers training and continued education for community diabetes workers.

Aboriginal Head Start

Founded in the 1990s, there are two types of Aboriginal Head Start programs in Canada:

  • Aboriginal Head Start On-Reserve for First Nations children on-reserve, and
  • Aboriginal Head Start in Urban and Northern Communities for FNIM children living in urban and northern communities.
  • The programs’ goal is to provide FNIM children with a positive sense of themselves and desire for learning.
  • Both support the spiritual, emotional, intellectual and physical development of FNIM children, while also supporting their parents and guardians as their primary teachers.

Source: Health Canada, 2003

insert pop up exercise box1
Insert pop up exercise box
  • [Add in a pop-up: This is a non-scoring exercise: write down a short strategy (no more than 2 sentences) of the services you can offer an Inuit senior with limited English or French speaking capabilities to receive culturally appropriate palliative care in their community.]


  • Nurses work in First Nations communities south of the territories in rural, remote or isolated communities.
  • Nurses are often the communities\' main point of contact with the health care system.
  • In about half of these health facilities, registered nurses are employed by Health Canada, part of the Federal Government.
  • In the other communities, nurses are employed by the Band Council as these communities have responsibility for health care services through a transfer agreement.

Health Care ServicesHealth Canada hires over 800 nurses to work directly in First Nations and Inuit communities across the country, and home care workers to take care of the needs of community members in their homes. They provide electronic health services and provide electronic devices for nurses and doctors to see and talk to one another across Canada.

nurses provide primary health care in remote and culturally diverse communities to
Nurses provide primary health care in remote and culturally diverse communities to:

Visit new parents, facilitating new baby care

Encourage physical activity



Facilitate community education sessions

Provide primary care services

Attend to emergency needs


Environmental Public Health Program

The program works to identify and prevent environmental public health risks that could adversely impact the health of community residents. Programming includes:

  • public health inspections,
  • monitoring environmental conditions such as drinking water quality,
  • delivering training and raising awareness about potential environmental public health risks and the steps people can take to protect themselves and their families.

In the territories, responsibility for environmental public health programming has been devolved to territorial governments or First Nations and Inuit control as part of land-claims settlements.


In 2002, Health Canada launched the Early Childhood Development Strategy.

That are language appropriate, and support the family unit and community dynamic.

It’s goal was to improve and expand early childhood development programs for First Nations and Inuit children.

They combine traditional and modern healing practices, nutritional and education services.

The Canada Prenatal Nutrition Program (CPNP)

98 % of communities report that CPNP provides a unique service in their community.

Instead of increasing funding, they determined that increased input by FNIM people would be more effective.


Health Canada’s Non-Insured Health Benefits (NIHB) Program

Provinces and territories are responsible for delivering health care services, guided by the provisions of the Canada Health Act.

However, there are some health-related goods and services that are not insured by provinces and territories or other private insurance plans.

health benefits are considered for coverage under the nihb if
Health benefits are considered for coverage under the NIHB if:

It is on the NIHB benefit list.

Prior approval or predetermination is obtained.

It is for use in the home, other ambulatory setting.

It is not available through any other


It is prescribed by a physician, dental care provider, or other licenced health professional.

It is provided by a recognized provider.

Drugs Covered Under the NIHB

Specific range of drugs as outlined on the Drug Benefit List (DBL)

Exceptions  Items not on the DBL, but which may be considered on a case-by-case basis with written medical justification and prior approval

Exclusions Items not on DBL which don’t apply to the exception process

Open Benefits Drugs listed on DBL which are covered without the need to meet established coverage criteria

Limited Use BenefitsDrugs listed on DBL with specific criteria that must be met


Benefits Covered Under the NIHB

  • Dental care
  • Vision care
  • Medical supplies and equipment
  • Short-term crisis intervention
  • Medical transportation

Appeals Process

There is an appeals process if a benefit is denied.

An eligible client, their parent, legal guardian or representative may initiate the appeal process.

The appeals process differs for each of six benefits we just covered under the program. At a high level, the process includes:

Condition for which benefit is being requested

Justification for proposed treatment

Information requested

Diagnosis and prognosis (note alternatives tried)

Relevant diagnostic test results

We will review how the NIHB process works in Ontario

the nihb process in ontario
The NIHB Process in Ontario

There are more details about the NIHB program in the handouts available at the end of this learning module.


Canada on a Global Scale

The global political climate has influenced on the policy decisions of the Canadian federal government. For example, to gain credibility and avoid criticism from the United Nations (UN) factored into Canada’s extension of voting rights to Indians in 1960 and the 1969 White Paper’s proposal to abolish Indian Status (Cairns, 2000). In 2007, Canada voted against the UN Declaration on the Rights of Indigenous Peoples, stating that it was inconsistent with the Canadian Constitution Act of 1982 and the Canadian Charter of Rights and Freedoms (Indian and Northern Affairs Canada, 2009); however, in 2010, Canada officially endorsed the Declaration and reaffirmed the nation’s “commitment to promoting and protecting the rights of Indigenous peoples at home and abroad” (Indian and Northern Affairs Canada, 2010).


2013 First Nations Gain Support to Declare Canada’s Treatment of Aboriginal People Genocide

In 2013, former National Chief Phil Fontaine, elder Fred Kelly, businessman Dr. Michael Dan and human rights activist Bernie Farber sent a letter to a UN representative on the rights of indigenous peoples, detailing that specific crimes against aboriginal people in Canada qualify as genocide under the post-Second World War Convention on the Prevention and Punishment of the Crime of Genocide.


Article 2 of the Convention states that genocide means any of the following acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group, as such:

Causing serious bodily or mental harm to members of the group.

Forcibly transferring children of the group to another group.

Imposing measures intended to prevent births within the group.

Deliberately inflicting on the group conditions of life calculated to:

Killing members of the group.

Bring about its physical destruction in whole or in part.

There were three actions on the part of Canadian governments that were cited as constituting genocide under those rules.

Campaign Gains Local and Worldwide Attention

In August, 2013, the campaign gained local and worldwide attention, and brought to light several unresolved issues that needed to be addressed.

Moving forward, global policies and pressures will likely continue to shape the federal government’s position on public policy and FNIM health.

where canada ranks on a global scale
Where Canada Ranks on a Global Scale

The United Nations’ Human Development Index (HDI) ranks countries on the social and economic well-being of their people.

In 2010, the UN released a study that showed the ranking if countries were judged solely on the social and economic well-being of their FNIM people.


Results are based out of 174 nations.

  • The results are significantly worse as outlined in the chart.

The substantial difference in Canada’s HDI Rank overall vs. FNIM truly demonstrates the disparity between FNIM people and non-Aboriginal people.

insert quiz slide quiz for chapter 3
Insert Quiz slide: Quiz for Chapter 3

This chapter has one true or false question.

Q: The Aboriginal Head Start On Reserve Program is comprised of six components: education; health promotion; culture and language; nutrition; social support; and parental/family involvement.

A:  True  False


Historical Overview

  • The Ontario government launched an Aboriginal Healing and Wellness Strategy (AHWS) with an overarching policy in 1994.
  • The strategy’s aim was to help improve Aboriginal health through community-based programs and services for people living on-reserve and in urban and rural communities.
  • The AHWS is a partnership of the Ministries of Health and Long-Term Care, Community and Social Services, Aboriginal Affairs, Children and Youth Services, the Ontario Women’s Directorate, and 14 FNIM organizations.
  • It combines traditional and mainstream community-based programs and services for FNIM people in Ontario, regardless of location.

September 2004: the AHWS’ mandate to combine traditional and contemporary services was revised to include a four-pronged approach as seen above:

Improve FNIM health

Support family healing

Promote networking

Facilitate community development and integration

the nurses provide primary health care in remote and culturally diverse communities including
The nurses provide primary health care in remote and culturally diverse communities including:

Encouraging physical activity

Visiting new parents, facilitating new baby care

Providing immunization

Providing primary care services during scheduled clinics

Attending to emergency needs

Facilitating community education sessions

2005: the government leveraged their work and incorporated a new approach to FNIM affairs guided by six principles:
2005: the government leveraged their work and incorporated a new approach to FNIM affairs guided by six principles:
mid 2000s present
Mid 2000s-Present

2006-2011: From the Aboriginal Health Transition Fund (AHTF), Ontario received funding for:

  • 11 integration projects, and
  • 31 adaptation projects.

One of the key achievements of the AHTF initiatives in Ontario was the development of an Ontario First Nation Tripartite Public Health Relationship Framework.

The framework uses an integrated approach to on-reserve public health and facilitates collaborations among governments and First Nations people.

mid 2000s present1
Mid 2000s-Present

2011: Ontario established the Trilateral First Nations Health Senior Officials Committee in partnership with the federal government and the Chiefs of Ontario.

The committee focuses on four priority areas identified by the Chiefs of Ontario:

  • mental health and addictions (with particular attention to prescription drug abuse),
  • public health,
  • diabetes, and
  • data management.

2013: diabetes was expanded to include chronic disease prevention with a focus on diabetes and cancer.

mid 2000s present2
Mid 2000s-Present


Cancer Care Ontario (CCO) developed the Aboriginal Cancer Strategy II in collaboration with:

  • FNIM leaders, and
  • FNIM organizations.

The strategy aims to help FNIM people decrease cancer incidence and mortality rates and better navigate the cancer care system.

Aboriginal Patient Navigators and Regional Aboriginal Cancer Leads in four regions were appointed in December 2012.


Mid 2000s-Present

2012, Métis Nation of Ontario released the findings from its study on chronic diseases in Ontario’s Métis population

  • These findings show the disparities in health status and healthcare utilization between the Métis and the general population in Ontario.
  • The report details the Métis’ higher rates of chronic diseases, such as heart attacks, congestive heart failure, and diabetes, and states that Métis people are less likely to receive specialized care for diabetes.
  • To address these issues, the Central East and South East Local Health Integration Networks are funding the Métis Nation of Ontario to conduct a health needs assessment.

Ontario Federation of Indian Friendship Centres (OFIFC)

Received a grant to analyze and use health data from Our Health Counts and administrative databases held by the Institute of Clinical and Evaluative Sciences.

different programs offered in ontario
Different Programs Offered in Ontario

More information about the programs discussed in this section of the chapter is available at the end of this learning module.

  • Ontario offers culturally appropriate regional and community health services to support FNIM people.
  • Understanding these programs and policies can help support your decisions when making recommendations to FNIM patients.

Pictured: M\'Chigeeng First Nation in West Bay Ontario

The 14 Regional Cancer Programs (RCPs) located across the province in the Local Health Integration Network regions are Cancer Care Ontario’s (CCOs) most important partners.
Each RCP is led by a CCO Regional Vice President.Pictured: Dr. Mark Hartman, RVP, Regional Cancer Services, Northeast (Sudbury)
fourteen regional cancer programs in ontario
Fourteen Regional Cancer Programs in Ontario

Located at Sunnybrook Health Sciences Centre and Princess Margaret Hospital

Toronto Central Regional Cancer Programs (Two programs)

Champlain Regional Cancer Program

Erie St. Clair Regional Cancer Program

Mississauga Halton Central West Regional Cancer Program

Central Regional Cancer Program

South West Regional Cancer Program

Waterloo Wellington Regional Cancer Program

Central East Regional Cancer Program

North Simcoe Muskoka Regional Cancer Program

Hamilton Niagara Haldimand Brant Regional Cancer Program

North West Regional Cancer Program

North East Regional Cancer Program

South East Regional Cancer Program


Health Agencies and Organizations

The Ontario government funds a network of 10 Aboriginal Health Access Centres and three Aboriginal Community Health Centres.

These are FNIM community-led, primary health care organizations that provide primary care, health promotion /prevention activities, and services offered by traditional healers and elders.


Aboriginal Health Access Centres (AHACs)

AHACs are community-led, primary health care organizations that provide a combination of services to FNIM people in all locations.

This includes:

  • traditional healing
  • primary care
  • cultural programs
  • health promotion programs
  • community development initiatives
  • social support services
  • social support services
  • tele-health
  • nutrition
  • mental health
  • diabetes education
  • seniors care

There are ten locations across Ontario.

Aboriginal Health Access Centres

In 1989, the federal government offered the Indian Health Transfer Policy to transfer control of health program resources over to the community.

One of the main reasons for this change stemmed from the lack of improvement in Aboriginal health status after years of federal spending.

So instead of increasing funding, they determined that increased input by FNIM peoples would be more effective.


The assumption was that the community could better respond to the local needs better than a centrally managed program could.

The transfer required specific mandatory public health programs to be provided, giving communities flexibility to allocate funds according to community priorities, and limits funding, by way of a non-enrichment clause, to health care delivery costs at the time of transfer.


MenoYaWin" in the Anishinaabe language means "health, wellness, well-being", and refers to holistic healing and wellness, the "whole self being in a state of complete wellness".

MenoYa Win Health Centre, Sioux Lookout

A 60-bed hospital and 20-bed Extended Care facility that services all residents within Sioux Lookout and the surrounding area, including the Nishnawbe-Aski communities north of Sioux Lookout, the Treaty #3 community of Lac Seul First Nation, Hudson, Pickle Lake and Savant Lake.

Services include:

  • hospital programs,
  • the merging of traditional and modern healing practices through the Traditional Healing, Medicines, Foods & Supports Program.

They also offer an Aging at Home Elder Care Continuum program to improve the health and well-being of seniors in remote and isolated communities.


Tungasuvvingat Inuit Family Health Team Medical Centre and Family Resource and Health Promotion Centre

The Centre incorporates features unique to the Inuit population to provide high quality, culturally appropriate, interdisciplinary primary care for the community across the entire life cycle spectrum with a focus on identified Inuit population health priorities.


Weeneebayko Area Health Authority (WAHA), James Bay and Hudson Bay

WAHA is responsible for providing comprehensive health services and facilities serving six communities along Ontario’s James Bay and Hudson Bay coastal regions, Moose Factory, Fort Albany, Attawapiskat, Moosonee, Kashechewanand Peawanuck.

A charter aircraft provides services to Kingston for eligible First Nation patients requiring diagnostic tests such as CT scans and MRI’s and specialist care.

Services include:

  • acute and chronic care,
  • 24 hour emergency services,
  • mental health,
  • rehabilitation,
  • general surgery,
  • a traditional Healing Program with counselors and community endorsed Traditional Healers,
  • referral services and tertiary care.

Akwesasne Health provides home and long-term care to First Nations seniors in Cornwall, enabling them to stay in their communities with access to culturally relevant care.

The Erie-St. Clair CCAC has strategies to have direct engagement with FNIM communities to help plan health programs including support with cancer resources, financial aid, breast screening, and education.

Community Care Access Centres (CCACs) focus on removing barriers to access to care options and services including in FNIM communities.

Alzheimer Society London & Middlesex and the Oneida Nation of the Thames provides culturally safe information and support to First Nations people with dementia.

Other Health Services

Additionally, they adapted a residential treatment program specific for FNIM men. It is being extended to include a women’s program.

Centre for Addictions and Mental Health provides counselling to FNIM people experiencing homelessness, substance abuse and mental health issues.

Canadian Cancer Society offers support and information for people with cancer. This includes supporting information about services such as First Nations Healing.


Mamaweswen, the North Shore Tribal Council Collaborates with First Nations and the Indian Friendship Centre to improve primary health care services.

Their Chronic Disease Surveillance Project gathers Métis specific health data. One example is the March 2012 Cancer in the Métis Nation of Ontario Clinical Significance Report.

Ottawa Health Services Network Inc.

Coordinates specialist and tertiary health care for residents of the Baffin region while respecting the Inuit vision of wellness.

Métis Nation of Ontario Community Centres serves as cultural and service hubs that link Métis people to services and supports in their local areas across the province.

Other Health Services

Oneida Nation of the Thames

Offer programs to reduce the isolation of seniors by promoting social interaction and activities in southwestern Ontario.

The room contains Aboriginal medicines including sweet grass, sage, cedar and traditional tobacco.

Ontario Renal Network (ORN) organizes and manages the delivery of renal services. The ORN has established an FNIM resource room in London, ON.


Saint Elizabeth Health Care

Enhances and supports FNIM community capacity to understand and solve complex health care issues, improve access and address barriers to care.

Some activities include research, education and knowledge exchange.

It also provides links between hospital and communities to support discharge planning.

Tyendiaga Home and Community Care Program and the Community Wellbeing Centre

Supports integrated care, a single point of access, and a continuum of home care.

Supportive Care Oncology Networks Network of professionals that plan for supportive care services and advocate for equitable access to and delivery of these services.

Other Health Services

KeewaytinookOkimakanak - Knet Chief’s Council supports resources at the community level for the effective delivery and management of health services in Northwestern Ontario.

KeewaytinookOkimakanak Telemedicine Ontario delivers clinical, educational and administrative services via videoconferencing and advanced information communication technologies.

They provide cultural respectful services, to meet the needs of the FNIM population who make up one of the higher percentages of people seen.


Clearly states that the use of tobacco for ceremonial purposes will not be regulated under the terms of this legislation.

Where Ontario Ranks Compared to Other Provinces:

Some Milestones

insert quiz slide quiz for chapter 4
Insert Quiz slide: Quiz for Chapter 4

The quiz for this chapter is comprised of one short answer question.

Q: What program is available that coordinates cancer care for FNIM patients across local and regional healthcare providers, including coordinating care with hospitals, physicians, nurses, and pharmacists?


  • Aboriginal Cancer Strategy II, Cancer Care Ontario, November 2013
  • Aboriginal Consultation and Accommodation - Updated Guidelines for Federal Officials to Fulfill the Duty to Consult - March 2011
  • A Complex Environment for Aboriginal Health, Health Canada’s 2012 First Nations and Inuit Health Branch Strategic Plan, A Shared Path to Improved Health.
  • Fact Sheet: Aboriginal Self-Government, Government of Canada, Aboriginal Affairs and Northern Development Canada, 2013
  • Federal Aboriginal Health Policy, October 1999
  • First Nations, Inuit And Métis Action Plan On Cancer Control, Canadian Partnership Against Cancer, June 2011
  • Health Canada website
  • Indian Health Transfer Policy, Cancer Care Ontario Presentation, 2013
  • Jurisdictional Profiles On Health Care Renewal: An appendix to Progress Report 2013 – Ontario, Health Council of Canada, 2013
  • Ontario’s New Approach To Aboriginal Affairs, Prosperous and Healthy Aboriginal Communities Create a Better Future for Aboriginal Children and Youth, Summer 2005
  • Policy silences: why Canada needs a National First Nations, Inuit and Métis health policy, International Journal of Circumpolar Health, Vol 72, Josée Lavoie, 2013
  • The Aboriginal Health Legislation And Policy Framework In Canada, National Collaborating Centre for Aboriginal Health, 2011
  • Towards a New Era of Policy, The International Policy Journal, Miranda D. Kelly, University of British Columbia, May 2011

Thank you for your participation in this course. Please click this linkto download and save, or print your course handouts. If you have any questions not addressed in this course or comments, please contact [email protected], we will respond within three business days.