1.1 Definitions in Context

1.1 Definitions in Context

The concepts of health policies and legislation merit further explanation and definition. Health within a neo-colonial policy context is narrowly defined, with a focus on prevention, treatment, and financial management of disease (Chenier, 2002; De Leeuw et al., 2014). Within this realm, ‘health’ in ‘health care policy’ focuses on “health care as the organised enterprise of curing or caring for disease, disability, and infirmity, and includes efforts at regulating and organising health care professions, pharmaceuticals, financing of the healthcare system, and access to healthcare facilities” (De Leeuw et al., 2014, p. 3). This understanding of health conflicts with First Nations, Inuit, and Métis diverse knowledges systems surrounding health and well-being, which together generally define health as holistic, considering physical, social, mental, and spiritual elements, and interconnected with a wide range of determinants (also known as the Indigenous determinants of health2) such as education, housing, environment, public systems, colonialism, racism, land, and spirituality (Greenwood et al., 2018; Loppie & Wien, 2022). Federal policy documents such as the Lalonde Report (1974) present broadened views on health to acknowledge socio-economic and environmental predictors and to understand health beyond solely the absence of disease (Lalonde, 1974). The Lalonde Report is thus considered foundational to the growth and recognition of public health and health promotion in health care policy development (Rutty et al., 2010). Governments responded to the report by forming new health promotion roles and expanding the scope of public health activities (i.e., immunization, environmental health, disease control, etc.) (Rutty et al., 2010). However, the neo-colonial approach to health care policy within jurisdictions’ Ministries of Health continues to focus on the management of disease (Chenier, 2002; De Leeuw et al., 2014), while broadened views of health promotion and public health are adopted by separate public health departments or organizations, with varying levels of coordination between health care and public health departments (Allin et al., 2018). This siloed and fragmented structure of health care poses structural barriers to operationalize more holistic understandings of health, as well as limitations to this report. As a search through all departmental policies and legislation is beyond the capacities of the current project, this report focuses on federal, provincial, and territorial Ministries of Health and health care policies (employing De Leeuw et al.’s [2014] definition explained above) and does not thoroughly investigate public health policies that address a wider scope of the Indigenous determinants of health. We therefore document and follow a robust methodology which may be adapted to support research on other government ministries and departments to then piece together and capture a more holistic view of Indigenous health in policies and legislation (see Section 2 for limitations of the report).

Defining the interrelated notions of policy and legislation is also important. Policy may be considered as an outcome of legislation and as a formal or informal means of achieving goals set out by laws, standards, and regulations – all aspects of legislation (De Leeuw et al., 2014). Alternatively, legislation may be understood as a type of instrument used to implement a policy (Bemelmans-Videc et al., 1998). Finally, both legislation and policy may also be considered as formal instruments used to achieve an overarching objective established by actors with authority to assign such objectives (Jenkins, 1978). In this report, we consider policy and legislation as formal or official documents that instruct how a system or structure

2 See Greenwood et al. (2018) for a detailed discussion on Indigenous determinants of health.