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Monday, 10 October 2011

Aboriginal Health equity – remedying a century of wrongdoing

To have and to hold the same to Her Majesty the Queen/His Majesty the King, and Her/His successors forever”.   Is the wording used in the Treaties which define the integral part of Canadian heritage and established the foundation of the defining relationship between Aboriginal peoples and those that now share this land.  It is a contract and both parties are bound by the contents.  The reference to “successors” on the above line reflects the duties of non-Aboriginal persons in Canada as Her Majesty is/was the agent on behalf of the Canadian peoples.
Seven of the treaties were signed between 1871-1877.  Four more were signed up to 1921. There are a smattering of other agreements that were entered into over the years but do not carry the weight of the above treaties.  A full list can be found buried in the Aboriginal and Northern Affairs website Canadian treaty documents and history.   Most tribes of Central Ontario and the provinces to the east are not covered by formal agreements.  Much of BC not covered by the treaties though a more formal treaty process began in 1990’s, slightly earlier for the Nis’gaa who signed a formal treaty in 2000. The Inuit are not formally covered by treaty, nor are Metis peoples. 
In Treaty 6 there is an onus on “Her Majesty” to provide a “medicine chest”, whose purpose was likely originally intended to reflect the limited medical options available in 1876.    The interpretation and application of the medicine chest clause has become an important part of defining Aboriginal peoples in Canada and given the tremendous advancements in medical science in the last century, what constitutes the basket of services is open for debate. At no point should Aboriginal peoples be denied the same health benefits available to non-Aboriginal persons.
The additional health benefits provided certain indigenous people through interpretation of the Treaties are provided to all First Nations and Inuit peoples, but not Metis (the province of Manitoba has extended certain benefits to Metis peoples). The extent of, and the interpretation of what constitutes the medicine chest is the foundation for the multilayered, jurisdictionally complex and at times perverse national approach to Canada’s most embarrassing health inequity.  The inequity is confounded by the efforts of the Canadian government through the late 1800s and at least the first half of the 20th century to constrain Aboriginal identity.  The inequity is clearly identifiable in reviewing inequalities of determinants of health in issues such as through the limitation of movement of Aboriginal persons off reserve, Indian hospitals and residential schools. 
There are innumerable papers, documents, reports, theses, and dissertations which have described and dissected the health status of Aboriginal peoples.  I have selected one at random for currentness and national perspective.   National Collaborating Centre on Aboriginal Health - Inequalities and social determinants albeit that some of the data is dated.    Many provinces, territories or health regions have issued health status reports of Aboriginal populations.   No shock to anyone that they clearly describe the burden of additional death, disease and injury shouldered by Aboriginal peoples throughout Canada.
The good news is that gains are being made.   In only the eloquent language of the epidemiologist, “there is evidence that the inequity is being reduced”.   While both Aboriginal and non-Aboriginal populations are getting healthier, the rate of health improvement amongst Aboriginal peoples is faster.  At some point decades in the future, there is hope that the lines may finally meet.  Bolstering this improvement are the collective efforts to support First Nations and Aboriginal groups in repatriating ownership of responsibility and self-determination.  Not a downloading, but an honest attempt to recognize that self-empowerment is a critical element in personal and population health promotion and improvement.  
Perhaps amazingly, this is occurring despite the obstructive efforts of the reigning political ideologists.  Perhaps the concept of off-loading the problem may be appealing for other ideological reasons.  Empowerment is however integral to re-establishing the wellbeing of our traditional inhabitants. Irrespective, hats off to the Canadian government for supporting the move forward, kudos to many of the provincial governments who have recognized the future investment benefit, bravo to Aboriginal leaders who are willingly accepting the challenge, and thanks to public health workers at a local level across the country who are facilitators, catalysts, cheerleaders and change agents in this developing success.  It is not yet time to celebrate, but it is time to begin to recognize the selfless efforts of so many in a country to right the wrongs of a century. 
Thanksgiving has its roots in the neighbourly celebration of European settlers and Native Americans coming together.   May a reflection of our history and current efforts reignite that joint celebration of cultures.  Happy Thanksgiving to all.   (for non-Canadian readers, Thanksgiving is celebrated the second Monday of October rather than the American tradition of the fourth Monday of November – such is one plight of living in a colder climate)

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