‘We are nickel and dimed to death’
Assembly of First Nations seeks strategy to address policy gaps in Indigenous health care
First Nations leaders are wrestling with what the future of Indigenous health care should look like as they piece together legislation meant to deal with multiple health crises, as well as the legacy of colonialism and racism.
The Assembly of First Nations (AFN) held a national health legislation forum in Toronto this week where discussions revolved around new health legislation for First Nations, the cause of polarizing debate.
Conversations ranging from whether or not First Nations health should become enshrined into Canadian law, how new health legislation would parallel recent child welfare legislation, and how new legislation may address health crises in Indigenous communities coast to coast.
One case mentioned multiple times was that of Joyce Echaquan, a 37-year-old Atikamekw mother of seven, who on Sept. 28, 2021, died of heart failure in a Quebec hospital. She initially entered the hospital with stomach pains, but according to her last words in a Facebook livestream days later, and spoken in her Atikamekw language, “they are overdosing me on drugs.”
With discriminatory taunts against Joyce from hospital staff heard in the background of her livestream, the coroner investigating concluded that racism was a contributing factor in Echaquan’s death.
However, it’s not just racism in hospitals that’s driving the conversation. Vice Chief David Pratt of the Federation of Sovereign Indigenous Nations (FSIN), who also sits on the AFN leadership table, said there are too many issues to address that are at crises status in First Nations communities across Canada.
In opening remarks, Pratt pointed out how the long-standing alcohol crisis in Indigenous communities has now escalated into a crystalmeth crisis. “Communities are forced to fund their own crystal meth recovery programs using their limited source revenue, and it’s a situation that should not be the case,” he said.
He also explained how an existing “status quo” currently guides conversations and decisions on First Nations health matters, and that it must end. In reference to those who believe health legislation might compromise Treaty and Inherent Right to Health, Pratt said, “in reality we have to work in this colonial structure that we call Canada.”
Some leaders are skeptical about introducing new federal health legislation and believe there has been a lack of consultation during the preliminary meetings with the federal government.
Chiefs of varying nations in attendance made it known they completely reject proposed new legislation, while some have not made up their minds. Piikani Nation Chief Troy Knowlton stood up during a Q&A and said, “The comments made today clearly show the difference between some who are ready and some who are not.”
“As chief, I have to make sure that anything that I sign onto, all the boxes are checked,” he said, and that “it comes down to trust that First Nations have with the federal government.”
Multiple leaders said they felt the process was rushed, which is one reason why they remained skeptical, with Knowlton describing it as a “forced timeline.”
“Look at the support (Prime Minster Justin) Trudeau is giving to Ukraine, but if you look at the First Nations, we are nickel and dimed to death.”
Discussions also included finding middle ground between Indigenous law and Canadian law — a hybridization — in an attempt to bridge policy gaps in health care for First Nations.
Pratt worried, “there’s no time left.”
However, the situation is different in British Columbia, where chief operating officer Richard Jock of the First Nations Health Authority highlights over 10 years of experience in a unique approach to First Nations health care, working closely with the province.
Critics at the gathering also highlighted how current funding models for First Nations health are no longer sustainable. Despite the allocation of funds, significant challenges remain, prompting the need for reevaluation and reform.
As the discussions continued, the question that emerged was: could implementing federal “Distinctions-Based Indigenous Health Legislation” be the key to addressing the existing gaps in health-care policies? With no compromises made and some communities feeling pressured, finding a solution that satisfies all stakeholders remains a challenge.
Josée Lavoie, professor and director of Ongomiizwin Research Indigenous Institute of Healing and Health at the University of Manitoba, clarified contemporary legislative and policy considerations in a presentation where she discussed the Treaty Right to Health and the legacy of the Indian Health Policy of 1979.
Lavoie said First Nations in Canada can look to New Zealand, which has a responsibility to work with Indigenous Peoples, but the difference in Canada is that provincial boundaries don’t align with Indigenous boundaries.
Dr. Greg Frazer from Six Nations of the Grand River said in a Q&A how his nation is one of the largest in Canada with close to 30,000 members, and only has “three and a half doctors.”
He pointed to a lack of consultation.
“We’re not into that, co-analysis or co-development.” He said Six Nations of the Grand River “does not approve this legislation.”
“Everyone thinks were rich,” he continued, “we have the same problems whether you’re from Cross Lake (or) Shamattawa, and we have the same (health) problems.”
Frazer said for Six Nations members, doctors take up to 45 minutes to examine, while non-Indigenous patients will get examined for 15 minutes. “It’s not built into the system, that system was built for somebody else,” he says.
Minister of Indigenous Services Patty Hajdu shared some words through video call to the forum following an Indigenous Services Canada panel. “I can fully understand the frustrations and the mistrust. This is not a new problem,” she empathized.
“I recognize that the gaps are still gaping and that there are still huge inequities for First Nations peoples, even for people living in urban and rural centres, to close infrastructure gaps, and indeed continue the transformation.”