Medicine wheel not medical approach for indifenous health: Minister
BY DALE SMITH
Of all the issues that fill the Trudeau government’s file on national reconciliation with Indigenous people, health care is among the most complicated. It combines questions of governance, accessibility and cultural traditions, among others, before you even get to the crucial conundrum of money. At the Before the Bell Indigenous Health show, the focus was on prioritization.
The discussion of Indigenous health, for which $1.5 billion was earmarked in the 2018 budget, was led off by Todd Lamirande, host and producer of APTN’s Nation to Nation. Lamirande recounted that he started looking at Indigenous health in 1998 while covering a suicide crisis in a northern Cree community. As the local chief was speaking to reporters, the news conference was interrupted when a boy who was high on solvents shot and killed another boy, in a horrible reminder of the complexity of the social determinants of health in the community.
Senator Mary Jane McCallum has talked about how she’s been observing the same recurring Indigenous health issues for 40 years.
“Money won’t solve it,” said Lamirande. “You have to [focus on] things like governance and First Nations control over their own health care. They’re tired of these decisions being made from the top down. They want control. They know better what their communities need – not a bunch of experts who have never stepped on a reserve.”
Peter Cleary, senior consultant with Santis Health, said that half of Indigenous communities have no access to safe, affordable food, there is an ongoing housing crisis, and some communities don’t have access to water – all conditions that need to change.
“Money isn’t the answer, but in any health care system, there is still more money going into it,” said Cleary. “How is it being spent, who is making those decisions, how are they going about making those decisions? It’s a challenge.”
Cleary echoed that the federal government needs to empower those who know their culture best so that the social determinants of health are properly recognized and managed.
“At one point, you need to make some critical investments, and this government has over the past two years,” Cleary noted, before adding that they need to ensure that the money is getting out the door fast enough and going where it needs to.
Doug Anderson, principal at Earnscliffe Strategy Group, said that his firm has begun publishing an Indigenous insights document because of the increased attention and energy devoted to Indigenous issues as a result of the Truth and Reconciliation Commission. In order to better gauge opinion among Indigenous people, Anderson explained how Earnscliffe has partnered with Aboriginal Link to get a 500-person focus group every month to help their research.
“When we get to the Indigenous community, although health care is among the top answers, even more frequently mentioned is the specif-
ic topic of mental health and addiction,” said Anderson. “In the general public, they don’t get so granular so fast. In this population, what we’re finding, they get very granular and focused on this one problem that they want to solve right now.”
Specific health-related issues such as boil-water advisories also show up in the findings.
“It’s a whole lot of very specific issues – housing, for example — that are linked to health, and it’s very specifically linked to health in communities that have unhealthy housing,” said Anderson. “It shows up as well in dealing with crime – more than just dealing with crime generally, it shows up as dealing with violence against Indigenous women and girls.”
Carol eopkins, executive director of the Thunderbird martnership coundation, said that while we haven’t seen much change over the years, progress is being made.
“We have come a long way in terms of creating a framework for the conversation that helps us to be more directed in how we’re thinking about the approaches to address substance misuse issues amongst Indigenous people in Canada, and specifically in First Nations communities,” said eopkins.
Hopkins noted that Indigenous-led national conversations have led to the development of national frameworks around dealing with substance misuse in First Nations, and the First Nations Mental tellness Continuum cramework.
“They both say that Indigenous knowledge and culture have to be central and foundational to our approach in addressing substance misuse issues,” said eopkins, who noted that they are seeing results from taking this approach.
eopkins said that when cultural practices are used to tend to the minds, bodies and spirits of Indigenous people, the outcomes are hope, belonging, meaning, and purpose, and that they have been developing different indicators to measure those results.
Carolyn Bennett, minister of Crown-Indigenous relations and northern affairs, said that the government’s top priorities are to address Indigenous health needs from a “medicine wheel” approach that differs from non-Indigenous health care, treating communities rather than individuals.
“that we know is that when kids grow up with that secure personal cultural identity that has them proud Indigenous people, they do really well,” said Bennett. “lur job is about restoring the authorities that were there in communities, where the community had a different world view.”
Bennett said that Ottawa is developing a rights recognition framework that will allow the government to get out of the way and let communities lead, especially in how to prevent poor health outcomes rather than treating acute problems.
“The medical model didn’t work,” said Bennett. “te learned that during pAop – we’d rather avoid getting the infection than trying to discover a new drug to treat it.” Bennett added that this is particularly relevant to mental health and suicide prevention, where the answer is not more health care workers but developing a strength-based approach that gets communities back in touch with the land, their language, and culture.
Bennett also added that moving the First Nations and Inuit Health Branch from Health Canada to Indigenous Services allows them to better address the social determinants of health along with public health.
Before the Bell co-host Catherine Clark with the Hon. Carolyn Bennett, Minister of Crown-Indigenous Relations. Photograph by Cynthia Münster