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4.3 Summary
from Indigenous health in federal, provincial, and territorial health policies and systems
by NCCIH-CCNSA
Finally, some agreements have also gone on to incorporate, or are in the process of establishing, Indigenous-led and governed health care authorities responsible for the administration and delivery of health care services and programs for their signatory community. Some notable examples include, although are not limited to: the Cree Board of Health and Social Services of James Bay, of the James Bay and Northern Quebec Agreement; the Nunavik Regional Board of Health and Social Services, of the Nunavik Inuit Land Claims Agreement; the Nisga’a Valley Health Authority, of the Nisga’a Final Agreement; and the Tłįchǫ Community Services Agency, of the Tłįchǫ Land Claims and SelfGovernment Agreement.16
A few agreements embed unique provisions to direct how health care is to be managed for signatory communities. For example, the Sioux Valley Dakota Nation Self-Government Agreement (2014) establishes Sioux Valley Dakota Nation jurisdiction in matters of health and health care services; however, it asserts that laws made under this authority must align with the principles and program criteria established under the Canada Health Act (1984). Thus, this is the only self-government agreement to draw on all five principles of public administration, comprehensiveness, universality, accessibility, and portability in its consideration for health care delivery. Portability is of significant importance when considering issues surrounding coordination of care and the need for actions such as Jordan’s Principle (see Section 3.2). Furthermore, the Délınę - Sahtu Dene and Metis - SelfGovernment Agreement (2016) is the only self-government agreement to include provisions that aim to establish and regulate an ongoing intergovernmental and data sharing relationship between all signatory parties. Within this relationship, each party must meet at least once every two years to discuss the delivery of health care programs in the Délınę District, as well as health care priorities and other matters related to the agreement. Each party must also consistently share information relevant to the delivery of health programs in the Délınę District. Barriers and limitations to data sharing in health care is a significant issue that currently impacts the continuity of care in many northern Indigenous communities (Kyoon-Achan et al., 2021). Thus, the provision to ensure information sharing between parties is particularly promising in its capacity to improve and sustain delivery of quality health care.
4.3 Summary
Historic and modern treaties and self-government agreements continue to influence the administration, financial management, and delivery of health care services in and by Indigenous communities today. Treaty 6 is the only historic treaty to include health care provisions in its treaty text, with Treaties 1-5 and 7-11 having implied and oral commitments, and
16 Other Indigenous governed health agencies are also discussed in detail in Halseth & Murdock (2020).
Treaty 7 being later interpreted in the Alberta provincial court on similar grounds as Treaty 6, based on verbal promises made at the time of negotiations. In terms of modern treaties and self-government agreements, this report identifies 32 completed agreements, 28 of which include provisions related to health care. Several agreements share similarities in their provisions granting First Nations, Inuit, and Métis communities authority in law-making and other regulatory activities in health care, while others have gone so far as to establish Indigenous-led and governed health authorities. Each agreement is an opportunity to advance Indigenous health care, fill service gaps, and ensure equitable and safe delivery of culturally appropriate care. Agreements may also serve as informative tools for new and ongoing negotiations for all levels and types of government involved, especially to inform and investigate the use of unique provisions such as ensuring portability of health services (Sioux Valley Dakota Nation SelfGovernment Agreement) and ongoing data sharing to improve the continuity of care (Délınę - Sahtu Dene and Metis - SelfGovernment Agreement).
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