The Health Canada Policy Toolkit for Public Involvement in Decision
Making
Level 2 Case Study:
The Northern Secretariat Aboriginal Diabetes Initiative
Background
In February 1999, the federal Canadian Diabetes Prevention and
Control Strategy was announced in the federal Budget. The central
component to this strategy is the Aboriginal Diabetes Initiative
(ADI), which was developed in consultation with First Nation, Inuit
and Métis peoples across the country. The ADI focusses on four
specific areas:
- Direct care, treatment, and support programs
- Culturally appropriate education and training in diabetes care
and prevention
- Health information and surveillance initiatives, to ensure
Aboriginal needs are met
- Lifestyle supports to enhance community capacity to deal with
diabetes and its complications in a holistic approach
The Medical Services Branch (MSB) of Health Canada is responsible
for the ADI. The following case study relates directly to the consultations
facilitated jointly by the Northern Secretariat and the governments
of Nunavut and the Northwest Territories (NWT). It is an example
of how a federal initiative was used to get feedback during a pre-budgetary
process from a specific region on issues related to diabetes in
Aboriginal communities and to gain information and insight from
the public on a potential budget-related issue.
Why Seek Public Involvement?
MSB has a long history of involving First Nation and Inuit communities.
As a result, using a consultation approach has become a policy
of the branch. MSB is a highly decentralized, client-oriented organization
which is responsible for several programs, particularly around
providing health services to status Indians living on-reserve and
to Inuit peoples. The ADI emerged out of the fact that diabetes
has become a large problem in Canada, particularly in Aboriginal
communities.
The following statistics outline the emergence of diabetes as
an increasingly important issue in Canada:
- 1.2 to 2.2 million Canadians have diabetes
- about one third of diabetes cases are undiagnosed
- diabetes contributes to an estimated 25,000 deaths annually
- the total economic cost of diabetes is $9 billion per year.
High public expectations and strong media coverage on the growing
problem of diabetes prompted the federal government to take visible
action.
Who Was Involved?
The National Steering Committee (NSC), a committee with First
Nation, Inuit and Métis partners, oversaw the consultation process.
MSB and the governments of Nunavut and the NWT, in partnership
with Inuit and First Nation organizations, consulted with health
organizations, First Nation and Inuit organizations, NGOs (e.g.
NWT Medical Association and the NWT/Nunavut Health Care Association)
and other key stakeholders.
The consultations were focussed on four core questions to guide
discussions:
- Is diabetes among Aboriginal peoples important to your organization?
Why?
- What work (a) have you done in this area? (b) are you planning
on doing in this area?
- What roles do you see your organization taking in the following
areas prevention, education, care and support, research, and
surveillance)?
- What will your organization offer to the ADI when it is implemented?
Identify types of contributions; include linkages, coordination
and integration.
Description of the Process
Consultation sessions occurred in Iqaluit, Rankin Inlet, Yellowknife
and Cambridge Bay with approximately 15 to 20 participants per
session. Sessions ranged in length from three hours to three days.
People and communities which were to be involved in the process
were sent joint letters from the territorial governments and MSB,
while some stakeholders were contacted directly by a representative
of MSB.
A MSB representative travelled to the respective locations and
provided an overview of the ADI. Citizens and key participants
who were involved in the consultation were selected by the federal
and territorial governments based on their roles in the community
and/or their expertise. The majority of the time was devoted to
a roundtable discussion which related directly to the four core
questions.
The consultations were held jointly by the two territorial governments
and MSB. Tripartite sessions involving the national Aboriginal
organizations were held in Yellowknife and Cambridge Bay.
Resources
The Canadian Diabetes Prevention and Control Strategy as a whole
received $55 million over three years in the February 1999 federal
Budget. The specific amount that will be devoted to the ADI has
not yet been determined.
For the consultations within Nunavut and the NWT, MSB contributed
two full-time staff, of which one was committed to travel to the
two territories for the consultations. Accommodation, translation
and other base costs were also provided by MSB, resulting in a
total operating cost for the consultation of $21,000 (not including
salaries). Other federal departments and territorial governments
sometimes provided meeting rooms, while the Aboriginal communities
provided experts, citizens and other notables in the consultation
process. The overall approach to funding these consultations was
to contain costs in order to maximize existing funding.
Summary of the Outcomes
The main objective of the consultation process was to answer the
core questions and the organisers felt this was accomplished. Answers
and discussions were presented in a report which was circulated
among the meeting participants for validation. Instead of MSB sending
out the information to each participant, it was often sent to the
territorial coordinator, who was then responsible for circulating
it to the participants.
Future plans will involve MSB working with territorial partners
(both government and Aboriginal) on all budget announcements. The
prospect of joint relationships was improved because of the positive
experience in the two territories on this project. These consultations
demonstrated that MSB has the capability of continually improving
its consultation procedures in order to obtain the best results.
These consultations also enabled MSB to learn about diabetes programs
currently being undertaken in various communities.
Analysis
This consultative strategy was deemed effective, as answers to
all questions were obtained, and the joint consultation process
generally worked well.
Factors for Success
- The media were involved in some of the consultation sessions
which helped to increase the exposure of the initiative and raise
public awareness of Type II diabetes.
- It was an open and transparent process which was tailored to
the needs and nature of the specific community.
- Focussed questions and key strategies were clearly identified.
- People were pleased that their opinions were being sought and
considered and that they were included in follow-up documentation.
Barriers to Success
- No specific funding for the ADI could be disclosed to the communities.
- The time frame was very tight as the consultations had to be
completed by May 15, 1999.
- Partnership relationships between federal/territorial partners
and between the Aboriginal/federal partners were not well defined
and consolidated in advance of planning the sessions. If this
process were to be done again, more of an effort for joint consultations
would have to be made.
- Often, other federal departments or Health Canada branches
are interested in doing consultations in the same communities
about a wide variety of issues. As a result, the different sessions
often bring together the same key stakeholders. Therefore, those
considering consultations need to
be cautious of "over-consulting" with the same people. This can
be avoided by finding out what other consultations were done
and are being considered for the future in a particular community.
Policy Implications
While public involvement is a standard MSB approach, the success
of ADI in Nunavut and the NWT reinforces its validity and credibility.
The success also makes this approach a useful model for understanding
the consultation process.
The long-term impact of this model is, however, limited to some
extent. MSB and its partners must wait for Cabinet approval and
funding decisions to be made before they can report back to the
communities. Despite these obstacles, some programs have already been
initiated in communities building on existing programs.
Public Involvement Techniques Used
- Community Meetings
- Focus Groups
- Roundtable Discussions
Contact Information
Judith D. Ross
Senior Program Analyst and Coordinator
Northern Secretariat
First Nations and Inuit Health Branch
(613) 957-6579
judith_ross@hc-sc.gc.ca
|
