Incorporating First Nations’ cultural knowledge, beliefs, values, and models of healing into health care could make a significant difference for the wellbeing of indigenous people of British Columbia. A recent agreement to transfer the decision-making for indigenous health care from the BC Ministry of Health to the First Nations Health Authority is designed to do just that. This October, the federal and provincial government signed an agreement with the BC First Nations Health Society and the BC First Nations Health Council to give Aboriginal communities a more direct hand in their health care.
“This agreement means that First Nations will have a strong voice in identifying their healthcare needs, and the power to address those needs as they see best,” says federal Minister of Aboriginal Affairs and Northern Development John Duncan.
The health authorities in BC will continue to provide the most acute health services, but BC First Nations groups will handle the other levels of care. This vision will first be realized as onreserve programs beginning at primary care, mental-health services, addiction services, and child health initiatives.
According to Provincial Health Officer Perry Kendall, First Nations groups often have a mistrust of health-care providers, leading many to avoid aid until their health problems becomes acute. He believes the new agreement should help remove this barrier of mistrust.
Many First Nations leaders have also praised the initiative, with the belief that control of health care will assist in communities’ self-healing. "We cannot be passive observers in our own lives and the lives of our families and communities,” states the Assembly of First Nations National Chief Shawn A-in-chut Atleo. “This agreement enables First Nations to take a step forward in taking back responsibility for our own lives and for our own communities and nations."
“The difference I want to see is that every First Nations citizen in British Columbia 20 years from now accepts responsibility for their own health and their own wellbeing,” says Grand Chief Doug Kelly, chair of the First Nations Health Council.
The initiative, formally known as The British Columbia Tripartite Framework Agreement on First Nation Health Governance, arose from negotiations that began in 2006. “This agreement is a result of years of work by BC First Nations to bring forward a First Nation vision of health care,” explains Chief Atleo.
It is projected to take two years for the parties involved to mature into their new roles. This transition involves the federal government passing the management of responsibilities and finances to the BC First Nations Health Authority. The federal government has invested $17 million into the transferring process. Currently, the federal government spends about $380 million per year, a cost expected to continue yearly under the new program. As the program expands to account for population growth and other factors, the cost will likely go up. The BC government has committed $83.5 million.
Although unique in its exact nature, the new health care agreement does mirror the previous transference of education and protection of First Nations children in BC into the hands of Native agencies. A decision rooted in valuing indigenous culture, the actual execution was problematic, some critics alleged, due to some Aboriginal children excelling while others fall through the cracks. The new governance structure was developed under a more collaborative process than the hand-over of child protection services, notes BC Health Minister Mike de Jong. The new authority will face the struggle of elevating health care costs, but has some measure of security in annual funding.
Federal Minister of Health Leona Aglukkaq says, "This will streamline administration, encourage the integration of the federally and provincially funded health services, and allow health care decisions to be made closer to home. We're proud to partner with B.C. First Nations and the Province of British Columbia on this important initiative." The first of its kind, the new health care policy is “an important and historic milestone for the Harper government, B.C. First Nations and the Province of British Columbia,” said Aglukkaq.
“BC First Nations are demonstrating incredible leadership,” said Grand Chief Kelly. “We will be the first in Canada to take over province-wide health service delivery from the federal government and will work closely with the provincial health system to enable it to better meet First Nations health needs and priorities. Through this new health governance approach, we will see remarkable improvements in the health and wellbeing of First Nations people in BC within one generation, and contribute to the health services accessed by all British Columbians.”
// Illustration by Stefan Tosheff
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