Medicine wheel not med­i­cal ap­proach for in­dife­nous health: Min­is­ter

BY DALE SMITH

Policy - - Before The Bell | From The Editor - 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

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