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Monday, 20 February 2012

Aboriginal Health issues in Canada: A Collision of Collaboration, Multiple jurisdictions and the problem of too many cooks.

DrPHealth is material written for the audience of public health professionals in Canada.   Follow by subscribing, being a follower or following by email on the links at the very bottom of the blog.  You can also follow on Twitter @drphealth. 

Since the posting of the Smart Meter blog on February 3rd, there has been a significant shift in audience from Canadian viewers to the US. Clearly a hot topic on both sides of the border. 

Just an encouragement to continue to push the blog information to the Canadian public health community -   while all viewers are most welcome.  Sometime this week, the blog will exceed 5000 views – thanks for making it a valued contribution.

One of Canada’s greatest strengths is also its Achilles heel.   We are a “confederation”.  Originally a confederation of four provinces to which six provinces have been added and more formal recognition of the partnership of the 612 First Nations  (spread over 2,675 reserves of which some 120 are in urban settings), and three territories.  To this is added the governance structures of the Métis Nation settlements.   For a primer on Aboriginal Health issues specific issues see Aboriginal Health DrPHealth equity.  

The problem, while the original five governments (four provincial and one federal) might have functioned well under the concept of a confederation, theoretically change now requires agreement of all provinces (recognizing that Quebec retains a certain special status as well), and probably also the “vast majority” of First Nations and the territorial governments with acknowledgement of Métis structures. 

Put differently, it is amazing that we actually achieve anything in the country these days.  Of course the different levels of government have different responsibilities and our current federal government has demonstrated that it can act in a fashion not consistent with other governance levels, general public, or common sense.  Totally aside, kudos to the Ontario judge that refused to implement a mandatory sentence imposed by the Harper government because it was cruel punishment.

Where we trip over each other is when multiple jurisdictions may be involved in a similar issue.  First Nations Health is one of those collision sites.   Health is a provincial responsibility under the Constitution,  except of course on federal lands.  Reserves are one the federal lands.  Health transfer has shifted some resources and responsibilities for some of the First Nations to their self responsibility which means that Band and Council now are significant responsible parties as well.  Most provinces delegate some of their responsibilities to local health regions, retaining certain powers.   All of sudden you have a situations where federal, provincial, regional and band authorities may all be converging on an emergency health problem, this is a recipe for disaster. 

In fact, having six or seven agencies with similar responsibilities showing up to address an issue is not uncommon and more likely to occur into the future.   The ability to solve emergent challenges becomes the measure of our success, and Attawapiskat (Aattawapiskat and Social Justice DrPHealth)  might be a clear demonstration of this current lack of ability.   Conversely there are many examples of cross jurisdictional successes that are developing and will be the new models of the future. 

Local governance bodies, both First Nation and either local or regional government will likely become the foundational unit for success going forward. It is just the neighbourly thing to do, and isn’t that just so Canadian, eh?  This will require federal and provincial governments and agencies to devolve some of their historical roles and power  - that has the potential to be the major barrier to a smooth transition.  Power is sometimes equated with money, and decentralization is usually associated with a loss of efficiencies - hence conflicting values contribute to the policy change.  

We will need to learn and acknowledge the successes and experiences as this transition occurs and provide reassurances to others that local solutions will be the best solutions. And also learn at the local level, where centralization and efficiencies can be gained through collective/collaborative solutions. 

There are 1,172,785 registered Aboriginals in Canada. This  currently represents about 3.5% of the Canadian population.  Some 13% of the Canadian land mass is held as reserve lands. Aboriginal statistics in Canada on a BC website.  Learn more about our Aboriginal heritage and structures at Aboriginal affairs and northern development home page  

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