My perspectives herein apply primarily to First Nations, where I have spent the majority of my years as a dental and health-care provider, before being appointed to the Senate. As the history of access to health care is markedly different for the Métis and the Inuit, it would be unrepresentative to place all three Indigenous peoples within one narrative.
As a dental health professional I have been involved in different elements of the health system since 1973, amassing more than 40 years of in-depth, firsthand experience.
Over this period, I have seen very little positive change for health care to First Nations in terms of physician care, nursing care, and mental health care. Inadequacies surrounding legal services, housing, education, food, and violence must be viewed as built-in barriers to access.
The prevalence of the health gap for Indigenous peoples in Canada has been acknowledged by government, academics, and health advocates, each of which have proposed different ways of closing this gap. Despite this, the rate of illness and disease continues to increase as access to care for insured services and the Non-Insured Health Benefits Program keeps facing these barriers.
In order to close the health gap, due consideration must be given to the factors that continue to determine access to care for Indigenous peoples based on their geographical regions, whether isolated, urban, or rural. Socio-politico-economic fragmentation of health plans promotes different clinical cultures with practices being linked to the resource constraints faced by these segments of the population. The disparity created by this fragmentation exists in the delivery of health benefits for First Nations and is rooted in historic and contemporary inequities. This issue has evolved in different ways through inefficient management of health programs; predetermination by Ottawa; standing offer agreements; and other mechanisms.
The education and training of health professionals limits the way they practise their care. “Fee for service” is one of the main components of the provision of health services to First Nations. Within this, delivery of care is structured for a health-care professional to see as many patients as possible, in which the “symptom” becomes the priority, not the patient.
The health-care professional does not look at the holistic care of the patient or the possible damage caused by social determinants of health. Here, the presence of epidemics (housing shortages, infectious diseases, unemployment, substance abuse, etc.) in a physically degraded and enclosed environment contributes to community disintegration, which permits easier spread of illness and diseases in these communities.
In the districts of The Pas and Opaskwayak Cree Nation (OCN) in northern Manitoba, both groups of people accessed health care by the same medical doctors. However, one group was healthy while the other faces heightened illness and disease. As a result, OCN started its own medical and health programs and is finding positive results already.
As stated in the Royal Commission on Aboriginal Peoples report, “Indeed, we have concluded that the business-as-usual approach to services perpetuates ill health and social distress among Aboriginal people. However much good a particular health or social program may do in the narrow sphere it addresses, it does not shift the overall picture of Aboriginal disadvantage—the pattern of poverty, powerlessness, and despair—that determines health and illness.”
It goes further to state: “The commission proposes that new Aboriginal health and healing systems should embody four essential characteristics: pursuit of equity in access to health and healing services and in health status outcomes; holism in approaches to problems and their treatment and prevention; Aboriginal authority over health systems and, where feasible, community control over services; and diversity in the design of systems and services to accommodate differences in culture and community realities.”
The question now is: where do we start?
Dr. Mary Jane McCallum is a senator from Manitoba and a social justice advocate. Of Cree heritage, she has provided dental care to First Nations communities across Manitoba.
This article appeared in the April 18 edition of The Hill Times.