3.5 Summary

Table 1 demonstrates that the policy recommendations of each national report (RCAP, Kelowna Accord, TRC, NIMMIWG, Forced and Coerced Sterilization of Persons in Canada) share several similarities and are often repeated from one report to the next. Much of the health-related policy recommendations provided in the RCAP in 1996 are directly recycled to subsequent reports, notably: to improve health outcomes and address Indigenous determinants of health (noted in the RCAP, Kelowna Accord, TRC); improve access to care through community-based and Indigenous-led approaches (RCAP, Kelowna Accord, TRC, NIMMIWG, Forced and Coerced Sterilization of Persons in Canada); promote and integrate traditional healing practices in western bio-medicine (RCAP, TRC); implement supportive measures to increase the number of Indigenous Peoples in health care professional roles and education, and improve access to cultural safety and competency training for both practitioners and students (RCAP, TRC, NIMMIWG, Forced and Coerced Sterilization of Persons in Canada); and modify post-secondary education and professional development programs in health care to integrate and promote Indigenous knowledges and practices (RCAP, TRC). Boyer et al. (2021) review the implementation of key health-focused RCAP recommendations in the last 20 years, finding some progress in areas of Indigenous recruitment and retention in health care provider roles, as well as in improving access to culturally safe and trauma-informed care. However, minimal progress was found in areas of supporting self-determination in health care (or more so self-administration) for all Indigenous Peoples, and in adequately funding and promoting the integration of traditional healing practices into Western models of care (Boyer et al., 2021). Regardless of the incremental progress, the mere pattern of repeated health policy recommendations suggests more work needs to be done to effectively and meaningfully respond to the careful work of each national report. As a complete evaluation of each report’s progress is beyond the scope of this report, further work is recommended.

3.5 Summary

The Government of Canada has a fiduciary relationship with and responsibility to First Nations, Inuit, and Métis peoples, bound by federal legislation and Supreme Court of Canada interpretations (Constitution Act, 1867; Supreme Court of Canada, 1939; Daniels v. Canada, 2016). Yet, in terms of health care provision, the Government of Canada continues to regard this relationship to be one with status First Nations and Inuit living in traditional territories only, and to be a “matter of policy and not through any legal obligation” (Boyer, 2014, p. 150). The absence of federal acknowledgement of legal responsibilities, coupled with provincial and territorial resistance to fill health service gaps, fosters jurisdictional confusion and disputes that perpetuate inequitable access to care for First Nations, Inuit, and Métis peoples. Current discussions on the proposed distinctions-based Indigenous health legislation may address these issues, by way of articulating and holding the federal government accountable to its legal obligations to Indigenous health care and instilling a communicative mechanism between jurisdictions that will effectively fill health service gaps according to the priority issues as identified by distinct Indigenous groups. Until that time comes, policy programs such as Jordan’s Principle and the Inuit Child First Initiative work to fill health service gaps for status First Nations and Inuit children; yet, in terms of Jordan’s Principle, many shortcomings remain (Sinha, et al. 2022).

Furthermore, despite administrative and financial barriers, many First Nation communities across Canada continue to assert inherent rights to self-government in health care, through local policy grounded in public health and

health protection, as well as by reclaiming authority over the administration and delivery of on-reserve health services (Heiltsuk Indian Band, 2020; Mashford-Pringle, 2013; Snuneymuxw First Nation, 2020). Federal policies such as the Indian Health Policy, Health Transfer Policy, Medical Transportation Policy, and the Traditional Healer Services Travel Policy also continue to play significant roles in the structure and delivery of First Nations and Inuit health care; however, administrative barriers, heavy federal oversight, and the exclusion of Métis and non-status First Nations create further obstacles and inequities in managing the delivery of and accessing culturally safe and Indigenous-led care.

As the federal government continues to embark on a path towards reconciliation with Indigenous Peoples to redress historic and current legacies of harmful colonial policies and discriminatory practices in health care, documents such as the RCAP, Kelowna Accord, TRC, NIMMIWG, Forced and Coerced Sterilization of Persons in Canada, and UNDRIP must be at the forefront of all next steps. There is much promise in new federal developments, such as the United Nations Declaration on the Rights of Indigenous Peoples Act (2021) and current co-developments for a new distinctions-based Indigenous health legislation (ISC, 2022d). However, accountability structures are needed, and policy gaps must be filled to ensure inclusion of all First Nations, Inuit, and Métis peoples.

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