Financing a First Nations and Inuit Integrated Health System
- A Discussion
Overview
For all First Nations and Inuit, a primary goal of health services
reform is the improvement of individual and community health status.
This can be addressed through two complementary, but distinct,
objectives: achieving equity in access to health services and secondly,
improving the effectiveness and cost-efficiency of the health services
system. Contemporary approaches to health service reform have fundamentally
realigned the health system, by placing control closer to the community
and by instituting allocation mechanisms which are responsive to
local needs. Among First Nations and Inuit, the progression to
community control of health services can be seen through the first
contribution agreements, to integrated community-based service
agreements and today's transfer agreements.
The purpose of this paper is to stimulate discussion on an integrated
funding approach for First Nations and Inuit health services whereby
health resources from both federal and provincial sources can be
seamlessly combined at the community level. Many First Nations
and Inuit have successfully embraced Health Canada's Health
Transfer initiative and have or are presently designing health
systems which are more reflective of Aboriginal needs, both individually
and at a community level. These innovations, however, have been
impeded by the lack of integration and harmony among the complete
spectrum of health programs and services, as funds and/or services
are received by different government departments independently.
Health Transfer has established a track record and a foundation
for communities who wish to develop a more integrated health system,
one which is holistic and compatible with the Aboriginal goal of
self-determination. As one mental health worker eloquently expressed
at a workshop on suicide:
People think the government can do something
about it, or the hospital, or the doctors and nurses. But I think
it has to come from within us as communities. . . We have to take
responsibilities and control for what's happening in our
communities. We can no longer blame the government, or Ottawa,
or anybody else.(Note 1: Quotation appeared in Minore, B., Boone,
M., Katt, M., and Kinch, P. 1991. "Looking in looking out:
Coping with adolescent suicide in the Cree and Ojibway communities
of northern Ontario." Canadian Journal of Native Studies.
11:1-24.)
The Royal Commission on Aboriginal Peoples (RCAP), in its lengthy
deliberations on the past, present and future of Aboriginal people
in Canada, has provided a new paradigm for Aboriginal peoples' health.
The following four guidelines for action were developed after the
most extensive and comprehensive consultation in the history of
indigenous peoples.
- Equity of health and social welfare outcomes
- Holism in the diagnosis of problems, their treatment and prevention
- Aboriginal peoples' control over health systems
- Diversity in the design of systems and services.(Note 2: Royal
Commission on Aboriginal Peoples. 1996. Report of the Royal Commission
on Aboriginal Peoples: Volume 3; Gathering Strength.
Canada Communications Group: Ottawa.)
RCAP's guidelines provide a framework to create and evaluate
a new financing model for First Nations and Inuit. Regarding the
first point, the allocation of resources should be designed to
facilitate equitable health status, both compared with non-Aboriginal
populations, and within the different Aboriginal peoples. Addressing
equity means a focus on the financing of health needs, not services.
Holism is reflective of Aboriginal peoples concepts of health
and well-being, which are very similar to a socially determined
wellness model based on broad determinants of health. Holism means
that optimally social and health services should be integrated.
At the very least health and health-related services should be
coordinated in a holistic manner, which respects physical, mental,
emotional and spiritual outcomes.
Control over health systems relate to the self-determination aspirations
of Aboriginal people, but in a broader sense, it is confirmed by
research which shows that persons with control over their life
events will have better health and will live longer. RCAP argues
forcefully that a piece-meal approach to health programs and services
by policy-makers is counterproductive to self-government development
among communities and nations.
Diversity in the design of systems and services is a recognition
of the different cultural approaches to health and healing that
exist among different Aboriginal groups, such as First Nations,
Inuit and Métis. Diversity also means a co-existence of
traditional approaches to healing with the western model now used
as the basic health services structure in First Nation and Inuit
communities.
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