Government, Indigenous leaders herald health agreement that will dismantle ‘colonial’ system

Canada’s health minister, the province of Ontario and the Nishnawbe Aski Nation have signed a deal on health care, a “landmark” agreement they say will begin the process of decolonizing the provision of care in the province’s north.

The three governments agreed to a series of principles that any First Nation-led health-care system must adhere to, while vowing to pool money to better address poor health outcomes in Ontario’s northern and remote reserves.

It is the first step in a longer process of turning over health care in northern Ontario to First Nations themselves, and allowing them to decide how best to spend money, staff nursing stations and provide care for people in need, the health ministers said Monday. Currently, the delivery of health care for status Indians is largely the responsibility of the federal government.

The agreement comes after a particularly brutal spate of youth suicides on reserves in the far reaches of the province.

Alvin Fiddler, the grand chief of NAN, an organization that represents 49 reserves in northern Ontario, said First Nations used to have their own systems of care, and it worked well for generations.

“Because of the last 150 years, because of the colonial history of this country, many of [our systems] have been broken,” he said.

Fiddler on new Health charter1:06

“Despite the many tragic events that you hear about almost on a daily basis, there’s still a lot of good things in our communities that we can build upon,” he said, adding NAN already has control over some aspects of health care.

“The system as it’s constructed, the colonial health-care system, is not providing the access, equity and positive outcomes we would expect for any of us who are not First Nations, who are not Indigenous,” Ontario Health Minister Eric Hoskins said after the signing ceremony.

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Hoskins said there are a plethora of problems, from the absence of oxygen tanks for pregnant women giving birth, to the endemic rate of bacterial skin infections among young children.

The Ontario minister said all levels of government are working now to address this “untenable situation.”

‘A complete transformation’

“For the first time in Ontario’s history we’re talking about a complete transformation of the system to one that is under the guidance and leadership of NAN. It’s First Nations planned, developed and implemented,” he said. “It’s a pretty profound change.”

“The systems as they are functioning now were not designed in a way that is in the best interest of First Nations, and that’s exactly what we’ve acknowledged by saying we need a new approach, the system needs a transformation,” federal Liberal Health Minister Jane Philpott said.

Federal health minister Jane Philpott, together with Nishnawbe Aski Nation Grand Chief Alvin Fiddler and Ontario Health Minister Eric Hoskins sign the Charter of Relationship Principles Governing Health System Transformation in Nishnawbe Aski Nation Territory. (Sean Kilpatrick/Canadian Press)

The agreement signed Monday did not include details on any new spending, or how a move towards a First Nation-led health system would now proceed, but further negotiations are expected.

Hoskins pointed to the system currently in place in British Columbia, where the federal government, the province, and local First Nations signed a tripartite agreement that handed over control of health care to Indigenous people. The First Nations Health Authority assumed the programs, services, and responsibilities formerly handled by Health Canada’s First Nations Inuit Health Branch.

20 emergency mental health workers

Philpott said this medium-term plan to change the delivery of care is not meant to serve as a distraction from the current and pressing problems that many northern Ontario reserves face. She said the three levels of government are working on a Pikangikum action plan, named after a remote community located near the Manitoba border that has long struggled with a suicide crisis

Hoskins said Ontario will immediately send 20 new full-time mental health workers to Pikangikum First Nation — at a cost of about $1.6 million — and will remain as long as needed.

Ontario Health Minister Eric Hoskins said the province will immediately send 20 new full-time mental health workers to Pikangikum First Nation — at a cost of about $1.6 million — and will remain as long as needed. (Darryl Dyck/Canadian Press)

The investment comes after the province heard from the community about a serious need for trauma and mental health supports, including from about 380 people seeking counselling.

The move comes after doctors working in Ontario’s north sent a letter to the health ministers demanding a transformational approach to a broken system that often leads to mental health crises.

“While government bureaucracies maintain funding and health-system design, First Nations are left with the blame for health-system failure,” said the letter signed by some 20 doctors.

“They are also left with the results of health-system failure — more suicides, more disease morbidity and more broken families and communities.”

Health ministers on overhauling Indigenous health care system in wake of suicide crisis6:43