ABORIGINAL HEALTH POLICY
Government of Ontario, 1994
EXECUTIVE SUMMARY
Introduction
The Aboriginal Health Policy will provide the First Nation/Aboriginal communities and Ministry of Health
with broad direction and guidelines for Aboriginal involvement in planning, design, implementation and
evaluation of programs and services directed at Aboriginal communities.
It will assist the Ministry of Health to address access inequities in First Nation/Aboriginal health programming,
respond to Aboriginal priorities, adjust existing programs to respond more effectively to needs, support the reallocation
of resources to Aboriginal initiatives and improve interaction and collaboration between ministry branches to support holistic
approaches to health.
For the First Nation/Aboriginal community, the policy is a vehicle by which barriers to Aboriginal participation in regional
and local health planning structures can be addressed and Aboriginal priorities in health care planning and delivery can be
communicated to the ministry.
Vision Statement
The Vision Statement originates from extensive consultations with Aboriginal people and communities:
Aboriginal health is holistic, and includes the physical, mental, emotional, spiritual and cultural aspects of life.
Through this understanding of self, a vision of wellness, which balances body, mind and spirit, is promoted through the
healing continuum.
Committed partnerships of First Nation/Aboriginal and non-Aboriginal people and governments will recognize and respect
the diversities in lifestyles and traditions of Aboriginal people regardless of residency and status.
The goal of the Aboriginal Health Policy is to improve the health of Aboriginal individuals, families,
communities and nations through equitable access to health care, First Nation/Aboriginal health care facilities,
improved standards of care, the provision of culturally appropriate health services and promotion of a healthy environment.
Self determination in health will be supported by appropriate levels of financial and human resources for Aboriginal-designed,
developed and delivered programs and services which respect and promote community responsibility, autonomy and local control.
- Nothing in this policy suggests either directly or by implication the consent of the
First Nation or Aboriginal communities to any amendment in the meaning and intent of their original
treaties or Aboriginal rights or to a measure that would constrain or prevent the full implementation
of their treaties or Aboriginal rights.
- A Holistic approach, through all developmental stages of life, will guide Aboriginal health programs and services.
- First Nation/Aboriginal people and communities have diverse needs pertaining to their cultures,
traditional ways, languages, lifestyles, geographic locations and status. Flexible policies, programs
and services are required to respect and address Aboriginal diversity.
- Traditional Aboriginal approaches to wellness, including the use of traditional
resources, traditional healers, medicine people, midwives and elders are recognized,
respected and protected from government regulation. They enhance and complement healing
as well as programs and services throughout the health system.
- Addressing Aboriginal health determinants in a holistic manner will require co-ordination
and collaboration between First Nation/Aboriginal communities and government ministries.
- First Nation Aboriginal people must have control of health planning and resource
management processes pertaining to Aboriginal policies, programs and services.
- To realize the goal of improving Aboriginal health, effective co-ordination of all
Health services are required.
- Access to and effectiveness of programs and services must be assured for all
Aboriginal people.
- Equitable access to provincial health services must be assured for all Aboriginal
people, regardless of residency.
- An Aboriginal person's choice of services will be acknowledged and respected.
- First nation/Aboriginal communities control of health needs assessment, planning,
design, development and delivery of community-based health programs and services are
essential to improving Aboriginal health. Aboriginal people will define and negotiate
the level of their participation in the governance of health programs and services available
to and accessed by their communities.
- Accountability processed require assessment of program effectiveness and
financial expenditures with annual report to Aboriginal people and governments.
- The interrelationship between the environment and individuals, families and communities, as well as protection of the environment is essential to the survival
of all Aboriginal people.
- Aboriginal people are distinct and not part of a multicultural mosaic.
- The Aboriginal communities and Ontario will continue their collaborative
relationship through a First Nation/Aboriginal communities' process which
will include joint and regular review and evaluation of the Aboriginal Health
Policy to ensure it continues to meet the needs of all Aboriginal communities.
An Aboriginal Framework for Holistic Health and Well-Being
The Aboriginal Health policy is guided by a conceptual framework for understanding Aboriginal health
and for facilitating the changes required to improve Aboriginal health.
The framework incorporates three interrelated concepts: the life cycle, holistic health, and continuum of care.
These are described briefly here.
The life cycle explains life through the passage of stages including infancy and childhood,
youth, adulthood and senior years. These stages of life are celebrated and correspond to the
four directions, seasons and gifts such as kindness, honesty, caring and strength within Aboriginal
culture, and the four elements of the environment: water, air, mineral and fire. The life cycle
incorporates all members of the community at difference phases in their lives. Each person has a
gift to bring and a role to play in the community, as explained in the teachings below. In a healthy
community each member is able to share his or here gifts and assumes responsibilities.
From preconception, the Aboriginal life cycle reflects the interrelationship and interdependency of individuals,
families and communities and their responsibilities to each other. People have different and evolving needs throughout
the life cycle, which must be addressed through appropriate health policies and programs.
Holistic health incorporates the physical, mental, emotional and spiritual needs of the individual, family and community.
The Continuum of care, or healing continuum, incorporates health, promotion, prevention treatment and curative programs
and services, and rehabilitation.
These three complementary concepts, life cycle, holistic health and the healing continuum, are interrelated.
Health is addressed throughout the life cycle of an individual, in a holistic way, within a continuum of care.
This forms a multidimensional matrix of Aboriginal health.
The illustration provides a pictorial, interpretation of these descriptions as well as the relationship
between the concepts.
The Strategic Directions: Overview
Thirteen major issues were identified during the First Nation/Aboriginal communities'
consultations and later grouped into three strategic directions. The first direction
is health status, which includes issues related to health promotion and wellness,
mental health and additions, disease and illness prevention, long terms care and disability.
The second direction is access to services, which includes languages and communications,
patient advocacy transportation, health facilities, training, co-ordination of services
and traditional healing. The third direction is planning and representation, which includes
health planning processes, representation and public appointments.
Each strategic direction consists of an issue statement a description of the barriers
identified by Aboriginal people, and proposed approaches to addressing the issue.
A series of recommendations categorized by program service, policy, legislative and resource
requirements is contained in the full report.
Strategic Direction 1: Health Status
Loss of identity, language, self-esteem and nurturing ways are some of the multiple
multigenerational losses, which have contributed to erosion of Aboriginal self-reliance
and collective responsibility for health. These losses are results of assimilation policies
and practices, removal of children through residential schools and adoptions, and implementation
of the Indian Act.
It is also acknowledged that inequities in education, employment, incarceration, housing and
infrastructure have had a negative impact on Aboriginal health.
Barriers
- poor community health
- lack of co-operation and co-ordination among First Nation/Aboriginal
communities and providers
- inequity of funding of health programs between communities
- overemphasis on treatment as opposed to wellness
Approaches:
Community Health
Healing and wellness will be guided by Aboriginal beliefs, values, customs, languages
and traditions that complement current and future health systems. These values and
beliefs must be respected and accepted in the design, development and delivery of health promotion,
prevention and treatment programs and services for Aboriginal people.
For health empowerment to occur, individuals, families and communities
must possess information and have the ability to influence choices and make
decisions that support wellness. A healthy lifestyle may help prevent or
reduce complications of diabetes, heart disease, some forms of cancer,
alcoholism, foetal alcohol syndrome, acquired immune deficiency syndrome,
hypertension and other conditions.
Health empowerment includes enabling individuals, families and communities
to understand all the factors that affect health and to recognize personal responsibility.
Strategies might address physical health and lifestyle as well as the mental, emotional and
spiritual aspects of health.
Flexibility is required in order to support Aboriginal approaches to community health.
The family unit is the pivotal point in the delivery of community health programs and services.
Co-operation and Co-ordination
Health care providers include healers, medicine people, elders, midwives,
community health workers, community support systems, external health and
other agencies. Removal of system barriers and rigid role definitions
will improve the ability of these providers to work together to support
the healing of First Nation/Aboriginal individuals, families and communities.
To promote physical, mental, emotional and spiritual healing and wellness,
all providers need to recognize, redirect and accept their roles and responsibilities
within a "healing network." The healing network cannot function without cross-cultural
respect, equality partnership, interdependent, practices and linkages.
Aboriginal people who are recognized, respected and accepted by their communities,
and, by health providers, are callable members of the health team with a role in planning,
design, develop and development delivery of health programs and services.
Equity
Equitable funding is required to support First Nation/Aboriginal communities' health programs
and services and will address community location, size, Aboriginal status, need the establishment
of community infrastructure, opportunities for education and economic development and other factors.
Emphasis on Treatment
Shifting the emphasis from treatment of ill health to prevention will require promotion,
education and an increased self-reliance regarding the appropriate use of health services.
Strategic Direction 2: Access to Services
The existing health system has legislative, policy, administrative and program barriers
that restrict the effective delivery of culturally appropriate programs and services to
Aboriginal people. A comprehensive identification of barriers, and their removal, will
improve Aboriginal access to health program, services and decision-making structures.
Health care services for Aboriginal people must be planned, designed and developed by
Aboriginal people must be planned, designed and developed by Aboriginal people and be
available in locations identified by First Nation/Aboriginal communities.
Barriers
- inadequate transportation services for health care
- inadequate and inappropriate facilities
- language, communication and culture
- lack of client advocacy, processes and supports
- lack of recruitment, retention and professional development of health care workers
- lack of recognition and acceptance of traditional healing
Approaches:
Transportation
The provincial government's medical transpiration program
must be reviewed. This assessment should result in recommendations
for equitable access to, and availability of, transpiration services
for all Aboriginal people.
Supportive Facilities
This policy supports community-based initiatives such as hostels,
hospices and community health canters and the provision of appropriate
funding.
Language. Communication and Cultural Barriers
Cross-cultural training and awareness programs are required for all health care workers
within, and providing services to, the First Nation/Aboriginal community.
Funding and training are required for translation services, cultural interpreters
and appropriate communications materials.
Client Advocacy
Service providers and clients require education and information regarding client rights.
Advocacy services need to be recognized, identified and developed where necessary.
Recruitment, Retention and Professional Development of Health Care Workers
There is a crucial need to establish a strategy and Programs aimed at recruitment, training and retention of Aboriginal
health care workers.
Increased Consultation and professional development opportunities for health care providers in First Nation/Aboriginal
communities are required to enhance their effectiveness.
Traditional Healers and Midwives
Support is required for First Nation/Aboriginal communities' efforts to promote
and encourage traditional Aboriginal teachings of holistic health.
Health care providers require training and education to increase awareness
and sensitivity towards traditional healers and midwives in the health care system.
Co-ordination is required between the First Nation/Aboriginal and non-Aboriginal
communities to facilitate access to, and work with, traditional healers and midwives.
Strategic Direction 3: Planning and Representation
First Nation/Aboriginal communities lack participation, resource support, influence over
decision-making and involvement in health planning process. As a result, programs and,
services are not appropriate for Aboriginal people.
Barriers
District Health Councils (DHCS) are mandated to plan health services on a regional
basis and make recommendation to the Ministry of Health. The ability of DHCs to
respond effectively to the needs of the First Nations/Aboriginal community is
restricted by
- lack of recognition of Aboriginal priorities due to a relatively small target
population;
- cultural biases and attitudes, as well as a lack of respect for, and understanding
and acceptance of, the Aboriginal culture by the non-Aboriginal community,
resulting in lack of consideration and frequent rejection of Aboriginal proposals;
- lack of respect, understanding and acceptance of first Nation/Aboriginal
community consultation, communication, representation, decision making and
accountability processes;
- lack of awareness of programs, services and resources available in the First
Nation/Aboriginal community;
- lack of access to and participation in health governance structures.
It is acknowledged that hospitals and other health service agencies plan
activities at local and regional levels. In these processes Aboriginal people
experience similar barriers to those described earlier.
Approaches:
Planning Authorities
First Nation/Aboriginal-defined planning processes, with appropriate resources,
are necessary. These processes will involve the design, development and delivery
of strategies that will facilitate the achievement of a First Nation/Aboriginal
community health vision.
The First Nation/Aboriginal communities will develop structure and roles with
respect to planning, co-ordinating and funding. These processes must be recognized
by government as the proper structure for planning and allocating resources to
address Aboriginal health needs.
Representation
Aboriginal people must have a role in governance of health programs and service
agencies and institutions. Until First Nation/Aboriginal processes are created,
Aboriginal people must have a role in existing health planning bodies.
Government Relations
In terms of Aboriginal health there has never been a process for dialogue
regarding governments' roles and responsibilities. Lack of clarity has caused
significant confusion, gaps in programs and services, and concern for funding
responsibilities.
Barriers
- federal government off-loading and capping of program funding
- failure of federal and provincial governments to co-ordinate programs
- federal focus on status Indians who reside on reserve
- need for protection of federal programming
- narrow interpretations by the federal government of policy and program
Guidelines
- issues related to federal inmates
Recommendations
A process is required which will lead to clarification of the roles and
responsibilities of the federal, provincial and aboriginal governments.
The process to clarify governments' roles and responsibilities cannot be used
to hold up the implementation of provincial initiatives aimed at improving First
Nation/Aboriginal communities' health.
Formal processes are required through which commitments of the federal
government will be sought to continue to fund First Nation/Aboriginal communities'
health programs at current or enriched levels.
The Ministry of Health will support First Nation/Aboriginal communities in
advocating with the federal government for fulfilment of federal responsibilities.
Inconsistencies across and within provincial ministries with respect to funding
programs and services on reserve that are not cost-sharable with the federal
government must be resolved.
The First Nation/Aboriginal communities and the Ministry of Health will
mutually pursue a process to explore the co-ordination of federal and provincial
funding to support implementation of the Aboriginal health policy and achievement
of its vision.
Conclusion
Aboriginal people have experienced 500 years of colonization and the health effects
of ethno-cultural stress. A long-term commitment, over many generations, but the
Government of Ontario and First Nation/Aboriginal communities is required to
restore health and well-being within the Aboriginal population
