Speech for The Honourable Jane Philpott, Minister of Indigenous Services - Partners in Reconciliation: Recognizing and Respecting Indigenous Health
Public Policy Forum
Partners in Reconciliation: Recognizing and Respecting Indigenous Health
September 26, 2017
National Arts Centre
Thank you very much. It is a real honour to be here with you in this beautiful venue on the traditional lands of the Algonquin people. Thank you for the invitation to be here. I’m always happy to be in a room of policy geeks, great to have the occasion, my first formal speech as Minister of Indigenous Services.
When you invited me to attend this event, I was the federal Minister of Health and as was mentioned, I was just sworn in as Minster of Indigenous Services a month ago, the first person to act in this capacity. I am thrilled that the Prime Minister appointed Ginette Petitpas Taylor as the new federal Minister of Health. I cannot wait to work with her and continue our common commitment to improve the lives of Canadians.
Let’s start with a story, a story about a young woman named Eileen Cooney Lucy. Eileen died in this city in January of this year. She was 15 years old. She was from a small community of (indigenous language) in Nunavut. She had been ill for at least two years but it was not until just a few hours before her death that she received a diagnosis, a diagnosis of tuberculosis.
In 2017 in the city of Ottawa a 15 year old girl died from tuberculosis, a treatable infectious disease but the bacterial infection wasn’t the only problem. Eileen’s story is also the story of nursing shortages, language barriers, medical evacuations, weather delays, delayed diagnoses and an epidemic that has persisted among the Inuit of Canada for more than one century.
I dedicate today’s talk to Eileen and countless other indigenous youth in our country who suffer and die needlessly. They are why we need to be here talking about this today to prevent other young Canadians from meeting a similar unnecessary fate. According to your promotional materials for your event today this conference is to focus on reconciliation and strategies for implementing the Truth and Reconciliation Commission health related calls to action.
I’m going to take a look at one specific call to action as a framework for my comments today. It’s call to action number 18. I don’t know whether any of you have them memorized but I will read it for you in case you’re not familiar with that one. It says “we call upon the federal, provincial, territorial and aboriginal governments to acknowledge that the current state of aboriginal health in Canada is a direct result of previous Canadian government policies including residential schools and to recognize and implement the healthcare rights of aboriginal people as identified in international law, constitutional law and under the treaties.”
There are three points in that call to action that I want to speak to. One, the current state of aboriginal health in Canada, two, the role of previous government policies and three, the recognition of rights. The full report of the Truth and Reconciliation Commission I expect you know speaks a great deal about health. It speaks specifically to gaps that exist in health outcomes between indigenous and non-indigenous Canadians.
I’m sure if we had time I could get you all to outline to me the health outcome gaps that you’re particularly concerned about but here are some of the ones that I think about: infant mortality rates for First Nations and Inuit children are two to three times higher than non-indigenous rates. Diabetes rates among First Nations are three to four times higher than non-indigenous rates. The tuberculosis rate among Inuit is 270 times higher than the rate in the Canadian born non-indigenous population.
I could go on and list many other gaps in health outcomes. You could spend the whole day today in your conference talking about why those gaps in health outcomes exist. It would involve talking about the social determinants of health: education, employment, housing etc. It would involve talking about the effects of intergenerational trauma. It would involve an admission of racial discrimination that exists even today in health systems in our country.
Perhaps the most succinct way to explain how these appalling gaps have developed is written in that call to action by the Truth and Reconciliation Commission. These troubling statistics have their roots in laws, policies and practices of our country including residential schools, forced mass resettlement and intentional cultural oppression.
It is high time that we put an end to this entrenched discrimination, not only because it is the right thing to do, but because our country will never develop its full potential until these injustices have been addressed and all Canadians have a fair and real opportunity to prosper. I am proud to be part of a government that is prioritizing a renewed relationship with the Indigenous Peoples, one based on the recognition of rights, respect, cooperation and partnership.
Last year the Prime Minister made an important decision to establish a working group of Ministers for the review of laws, policies and operational practices at the federal level. I’m very thankful to be part of that working group. We meet with indigenous leaders, academics and policy experts to study the laws and policies that need to be changed in order to reconcile our relationship with indigenous peoples and ultimately to close the socio-economic gaps that exist. As it relates to health what does one discover when one reviews the laws and policies of our country?
Let’s start - before I go into answering that question to remind you of a statement that I take from the TRC report. It says that healthcare is a right enshrined in international and constitutional law as well as in treaties. The UN Declaration on the Rights of Indigenous Peoples recognizes that indigenous peoples have the right to physical and mental integrity as well as the right to equal enjoyment of the highest attainable standard of physical and mental health.
It is in the context of these rights when we look to the laws of this land that we discover the absence of any clear legislative framework specifically referencing health or healthcare for First Nations, Inuit and Metis. Instead this has been dealt with by way of evolving departmental policies administered by different federal institutions, first in the early 1900’s by the Department of Indian Affairs and since the 1940’s by what is now known as Health Canada.
The mandate of the First Nations Inuit Health Branch of Canada was established under a document. The document is called the 1979 Indian Health Policy. It was announced not with a signing agreement but a fax, a fax that was sent to what was then the Indian Brotherhood. It has never been updated since. In addition to the legislative vagueness and decades old policy guidance, there is the fact that indigenous peoples have not been sufficiently involved in the governance, leadership, design, delivery and control of their own health services.
Funding has been inadequate, unstable and unpredictable. This has resulted in ad hoc budget decisions most often made without indigenous engagement. Chronic funding shortfalls have led to short term crisis management rather than longer term investments in health promotion and disease prevention. Ambiguities in federal, provincial and territorial roles and responsibilities have meant that all too often indigenous peoples have fallen through the cracks, victims of jurisdictional squabbles about who should pay for what.
I believe that Alika referred to some of those kinds of stories of people who had tragically fallen between the cracks. To top off the challenges indigenous peoples often feel unsafe, misunderstood and stigmatized in health systems that are largely staffed and organized by non-indigenous providers who do not understand and may not respect indigenous knowledge and practices. It’s certainly clear why the TRC called for an acknowledgment that the current state of indigenous health in Canada is a direct result of previous Canadian government policies.
Of course I have only spoken about the fragile web of government policies that relate directly to healthcare. I could go on at some length about other government policies associated with the social determinants of health, policies related to housing, education, public safety and virtually every department of government which have arguably an even greater impact on health and quality of life. I want to focus on some positive things as well.
I want to provide you with some reason to believe there is hope for a better future when we all work together. The Ministers’ working group on the review of laws and policies adopted a set of ten principles. They’re called the principles respecting the government of Canada’s relationship with indigenous peoples. They express a fundamental shift from relationships based on a denial of rights to those based on a recognition of rights.
I encourage you to look at those principles and absorb them. The first principle is that all relations with indigenous peoples need to be based on the recognition and implementation of rights including the right to self-determination and the right to self-government. This concept of the recognition of rights goes back to that TRC call to action number 18 which asks specifically for recognizing and implementing healthcare rights.
The TRC was not the first report in our lifetime that has called for the recognition of rights as a key to reconciliation. It was just over 20 years ago that the Royal Commission on Aboriginal Peoples stated that rights recognition is an imperative. The Royal Commission on Aboriginal Peoples or ARCAP sounds very similar to those TRC calls to action. For example if you look to ARCAP and I strongly encourage you to read at least the highlights, it says this.
Aboriginal people do not want pity or handouts. They want recognition that these problems are largely the result of loss of their lands and resources, destruction of their economies and social institutions and denial of their nationhood. They seek a range of remedies for these injustices but most of all they seek control of their own lives. The Royal Commission on Aboriginal Peoples clearly indicated that the Indigenous Peoples need new structures.
One of the structural changes recommended by the Royal Commission was to eliminate the Department of Indigenous and Northern Affairs. To replace this Department, the Royal Commission recommended creating two new departments: a Department of Indigenous Relations and a Department of Indigenous Services. This is exactly what we did four weeks ago.
As Minister of Indigenous Services, my job will be to collaborate with Minister Bennett and Minister Petitpas Taylor and all my Cabinet colleagues along with an entire array of other partners to see to it that the services provided are standardized and of the highest quality, and that they improve the quality of the daily lives of First Nations, the Inuit and the Métis Nation.
We are dismantling old colonial structures, bureaucratic structures and creating a new department of Crown indigenous relations and northern affairs that will be focused on supporting indigenous peoples as they strengthen their distinct political, cultural, legal and economic institutions and assume autonomy over their own affairs including the recognition and implementation of self-government as an expression of self-determination.
At the same time we recognize that the federal government has a history of providing services to indigenous peoples and an ongoing role to play in that regard. This will be the work of the new Department of Indigenous Services. Over time programs and services will increasingly be delivered by indigenous peoples as part of their move toward true self-government. I understand that indigenous peoples and other Canadians are skeptical.
They’re skeptical as to whether our government is serious about reconciliation. I want to assure you today of our firm resolve. If words are to be matched by actions it requires among other things the resources to get the work done. I met this morning with the executive of the Assembly of First Nations and the elder there said words do not feed a table. I took that to heart.
We have to put the resources and determination behind the words in order to see action. I’m pleased to remind you as you probably know in budget 2016 we committed $8.4 billion over five years toward building a better future for indigenous peoples. Budget 2017 followed with an additional investment of $3.4 billion. It’s going to take funds of this magnitude to achieve our commitments including things like lifting all long term drinking water advisories, building better housing and ending inequities in child welfare systems.
In the area of health we have targeted funding to where the needs are most immediate. For example we supported the creation of 32 mental wellness teams so that the total now is 43 mental wellness teams across the country. This means there are almost quadruple the number of teams to build capacity and provide crisis response. In addition we funded things like the Hope for Wellness helpline which is now available and I hope you will help us to promote it, available 24/7 providing services in English, French, Cree, Ojibway and Inuktitut.
Budget 2017 also added over $200 million to increase support for First Nations and Inuit mental wellness services including access to mental health professionals and traditional healers. We’re filling service gaps through the full implementation of Jordan’s Principle. As of last month there are now 14,000 requests that have been approved and we are determined to make sure all children will get access to the care they need.
Closing these kinds of gaps in funding service delivery is essential to make a difference in the day to day lives of indigenous Canadians but it’s going to take more than that to see significant changes in health outcomes. It’s going to take bold transformation of the structures that are in place. It’s going to take what ARCAP called for, giving people control over their lives. This has to happen in every domain including health.
There are already good models of transformation for example in the British Columbia tripartite agreement on First Nations health governance. We have begun to work on similar initiatives and agreements, for example between the province of Ontario, our government and Anishnawbe Aski Nation as it relates to health. We’re not naïve about the enormity of the work ahead nor about the time it’s going to take to see a change in health outcomes.
Renewing relationships that have been damaged by generations of neglect and denial will not be completed in the four years of a government’s mandate. The restoration of justice and equity for indigenous peoples in Canada though requires much more than the work of just governments. It requires the commitment of all Canadians. It’s going to take collaboration of our provincial and territorial partners and in the area of healthcare it’s going to take the ideas and the engagement of Canada’s health professionals across this country.
A good example of this is the work that British Columbia First Nations Health Authority and others are doing to address cultural safety. I know there are many of you in the room who are addressing similar issues. I believe we will all need to show humility and determination and work hard to win the trust of Indigenous communities and their leaders so that they will see how seriously Canadians are taking reconciliation.
We cannot erase the wrongs of the past, but we can acknowledge them, learn from them and stop the discriminatory practices that still exist today. We cannot undo the injustices of the past, but we can take right action today. You know how much this matters. It matters because in 2017 teenagers like Eileen die from tuberculosis.
It matters because in 2017 indigenous children and teenagers die by suicide at disturbing rates. It matters because thousands of indigenous children are separated from their families as a result of child welfare systems that discriminate against them. The status quo is not an option. Our government is resolute. We are firmly committed to justice and equity for all Canadians including indigenous Canadians.
With all the humility, determination and hard work that this undertaking entails our government will remain firmly committed to the journey of reconciliation. I hope every one of you will join us in that journey. Merci beaucoup.
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