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British Columbia

The federal government has in the past defined involvement in Indigenous health at the federal or provincial/territorial level: “The federal government provides some health services to First Nations on reserve and Inuit, including public health activities, health promotion and the detection and mitigation of hazards to health in the environment” (Health Canada, 2005, p.3).

“The majority of health services available to Inuit, Métis, non-status Indians and status Indians living away from communities are provided by the provinces and territories in the same manner that services are available to all citizens. Some provinces/territories provide innovative, culturally-specific programs and services to meet the particular health needs of First Nations, Inuit and Métis” (Health Canada, 2005, p.7).

In 2017, the federal government embarked on an important restructuration. Indigenous Services Canada was co-created with Crown-Indigenous Relations and Northern Affairs Canada from what was formerly Indigenous and Northern Affairs Canada and the First Nations and Inuit Health Branch of Health Canada. It collaborates with partners in linking First Nations, Inuit and Metis with high quality services (Indigenous Services Canada, 2013, 2018, 2019). As of 2019, the process of transitioning previous programs to Indigenous Services Canada is in progress.

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Provincial
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Within the Ministry of Health, the Office of Indigenous Health “provides an Indigenous lens to strategic priorities, legislation, policy and program development in the Ministry of Health, as well as other ministries where appropriate. The Office works collaboratively with the First Nations Health Authority [FNHA], the regional health authorities, and the Provincial Health Services Authority [PHSA] to address the needs of Indigenous peoples during service planning, policy development and to promote culturally safe and appropriate service delivery. The Office also collaborates with key Indigenous partners and organizations such as Métis Nation BC and the BC Association of Aboriginal Friendship Centres” (B.C. - Ministry of Health, n.d.).

In turn, “[t]he PHSA must develop and maintain effective and efficient working relationships with the Regional Health Authorities, the First Nations Health Authority, and other key service partners to ensure an effective, integrated and well-coordinated system of health care for the citizens of BC. In partnership with First Nations Health Authority PHSA must support the Indigenous Health approach, services and wellness objectives” (Provincial Health Services Authority, 2018).

Many accords have been signed over the past years that have important transformative impact for public health in British Columbia.

In 2005, the “Transformative Change Accord and the First Nations Health Plan form[ed] the Tripartite First Nations policy that aims to close the disparities that exist between First Nations and other British Columbians in the areas of health, education and housing. The policy document also intends to clarify issues surrounding Aboriginal title and jurisdiction. It explicitly applies to First Nations, and does not address the needs of other Aboriginal groups in British Columbia” (First Nations Leadership Council, Government of Canada, & Government of British Columbia, 2006; National Collaborating Centre for Aboriginal Health, 2011, p. 29).

In 2007, the Tripartite First Nations Health Plan was signed. “The Health Plan provides for a new governance structure for First Nations health services in B.C. consisting of a First Nations Health Governing Body (to design and oversee implementation of a new governance structure), a First Nations Health Council (serving as an advocacy voice for First Nations in health-related matters), a tripartite First Nations Health Advisory committee (to review and monitor health plans and health outcomes, and recommend actions on closing health gaps), and an association of health directors and other professionals to create and implement a First Nations capacity development plan” (First Nations Leadership Council, Government of Canada, & Government of British Columbia, 2007; National Collaborating Centre for Aboriginal Health, 2011, p. 31).

“In  2011, BC First Nations Chiefs and leaders came together to take a historic decision – to adopt the BC Tripartite Framework Agreement on First Nation Health Governance and.” (First Nations Health Council & First Nations Health Authority, 2013). “The signing of the, changed the course of First Nations health in BC with the creation of a new First Nations Health Governance Structure that will enable First Nations in BC to participate fully in the design and delivery of these services.” (First Nations Health Authority, n.d. b).

As a result, the First Nations Health Authority (FNHA) was implemented in 2013. “The FNHA is the first province-wide health authority of its kind in Canada. In 2013, the FNHA assumed the programs, services, and responsibilities formerly handled by Health Canada's First Nations Inuit Health Branch – Pacific Region. The FNHA is responsible for planning, management, service delivery and funding of health programs, in partnership with First Nations communities in BC.” (First Nations Health Authority, n.d. a). Given the federal restructuration highlighted above, Indigenous Services Canada now provides the funding formerly provided by Health Canada, while the FNHA aims towards a better integrated health system (First Nations Health Authority, n.d. b).

The B.C. Centre for Disease Control (BCCDC) also administers Indigenous health programs, notably:

  • the Chee Mamuk Program which “provides innovative and culturally appropriate training, educational resources and wise practice models in STIs, hepatitis and HIV” (B.C. Centre for Disease Control, n.d.-a)
  • the TB Services for Aboriginal Communities program which provides TB consulting services for healthcare professionals, the management of the majority of active TB cases, and “testing, diagnosis and treatment to marginalized individuals exposed to TB in urban and rural or remote areas” (B.C. Centre for Disease Control, n.d.-b)
  • as well as “low-barrier, culturally safe services for diverse communities around the prevention, testing, diagnosis and treatment of sexually transmitted infections” (B.C. Centre for Disease Control, n.d.-c).
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Regional
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Indigenous health programs are developed and delivered by the five regional health authorities. “Each of the health authorities in British Columbia has an Indigenous health team that leads the work for the health authority in developing and implementing its Indigenous Health Plan” (B. C. Ministry of Health, n.d.).

The five regional health authorities have each signed partnership accords with First Nations Health Council Regional Caucuses to facilitate greater collaboration with the First Nations Health Council, the First Nations Health Authority and the local regional health authority. The First Nations Health Authority (FNHA) has given notice to cancel its service agreement with the Inter-Tribal Health Authority (ITHA) on Vancouver Island. The notice the agreement was to end on March 31, 2019. (First Nations Health Authority, 2019).

Self-government agreements have been signed in British Columbia and have included health services (National Collaborating Centre for Aboriginal Health, 2011, p. 6). For example, the Sechelt Indian Band Self-Government Act (1986) “granted authority to the Sechelt band to exercise delegated powers and negotiate agreements about specific issues” (National Collaborating Centre for Aboriginal Health, 2011, p. 46). “Article 14 states that the Council has, to the extent that it is authorized by the constitution of the Band to do so, the power to make laws in relation to health services on Sechelt lands” (Sechelt Indian Band Self-Government Act, 1986; National Collaborating Centre for Aboriginal Health, 2011, p. 46).
 
Of note, the Nisga'a Health Council is an independent health authority. The Nisga'a Final Agreement (1999) “granted authority to the Nisga'a Nation to exercise delegated powers and negotiate agreements about specific issues” (National Collaborating Centre for Aboriginal Health, 2011, p. 49). “Sections 82 to 86 of the Agreement pertain specifically to health services, and provide the Nisga'a Lisims Government the authority to make laws in respect of health services on Nisga'a Lands. At the request of any Party, the Parties will negotiate and attempt to reach agreements for Nisga'a Lisims Government delivery and administration of federal and provincial health services and programs for all individuals residing within Nisga'a Lands” (Nisga'a Nation, Government of Canada, & Government of British Columbia, 1999, p. 49; National Collaborating Centre for Aboriginal Health, 2011).

 

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References
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  1. B. C. Centre for Disease Control. (n.d.-a). Chee Mamuk. Retrieved from: http://www.bccdc.ca/our-services/programs/chee-mamuk

  2. B. C. Centre for Disease Control. (n.d.-b). TB Services. Retrieved from: http://www.bccdc.ca/our-services/programs/tb-services

  3. B. C. Centre for Disease Control. (n.d.-c). STI/HIV Services. Retrieved from: http://www.bccdc.ca/our-services/programs/sti-hiv-services

  4. B. C. Ministry of Health. (n.d.). Office of Indigenous Health. Retrieved from: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/aboriginal-health 

  5. First Nations Health Authority. (n.d. a). About the FNHA. Retrieved from: http://www.fnha.ca/about/fnha-overview

  6. First Nations Health Authority. (n.d. b). Governance and Accountability. Retrieved from: http://www.fnha.ca/about/governance-and-accountability

  7. First Nations Health Authority. (2019). FNHA Cancels Service Agreement with Inter-Tribal Health Authority. Retrieved from: http://www.fnha.ca/about/news-and-events/news/fnha-cancels-service-agreement-with-inter-tribal-health-authority 

  8. First Nations Health Council & First Nations Health Authority. (2013). A joint First Nations health Council and First Nations Health Authority newsletter. Transition update 01(03). Retrieved from: http://www.fnhc.ca/pdf/Transition_update-April_08.2013-FIN_.pdf

  9. First Nations Leadership Council, Government of Canada & Government of British Columbia. (2006). First Nations health plan. Memorandum of understanding. Retrieved from: http://www.health.gov.bc.ca/library/publications/year/2006/first_nations_mou.pdf

  10. First Nations Leadership Council, Government of Canada & Government of British Columbia. (2007). Tripartite First Nations health plan. Retrieved from: http://www.gov.bc.ca/arr/social/health/down/tripartite_health_plan_signed.pdf

  11. Health Canada. (2005). Blueprint on Aboriginal Health. A 10-year Transformative Plan. Retrieved from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/blueprint-aboriginal-health-10-year-transformative-plan.html

  12. Indigenous Services Canada. (2013). First Nations and Inuit Health Branch. Retrieved from: https://www.canada.ca/en/indigenous-services-canada/corporate/first-nations-inuit-health-branch.html

  13. Indigenous Services Canada. (2018). Indigenous Services Canada - Departmental Plan 2018-2019. Retrieved from: https://www.sac-isc.gc.ca/eng/1523374573623/1523904791460

  14. Indigenous Services Canada. (2019). Indigenous Services Canada. Retrieved from: https://www.canada.ca/en/indigenous-services-canada.html

  15. National Collaborating Centre for Aboriginal Health. (2011). Looking for Aboriginal health in legislation and policies, 1970 to2008: The policy synthesis project. Prince George, B.C. Retrieved from: http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/28/Looking%20for%20Aboriginal%20Health%20in%20Legislation%20and%20Polcies%20(English%20-%20Web).pdf

  16. Nisga'a Nation, Government of Canada & Government of British Columbia. (1999). Nisga'a Final Agreement. Retrieved from: http://www.nnkn.ca/files/u28/nis-eng.pdf

  17. Provincial Health Services Authority. (n.d.). Our Unique Role. Retrieved from: http://www.phsa.ca/about/who-we-are/our-unique-role

  18. Provincial Health Services Authority. (2018). Foundational Mandate. Retrieved from: http://www.phsa.ca/about-site/Documents/PHSA%20Foundational%20%20Mandate.pdf

  19. Sechelt Indian Band Self-Government Act, S.C. 1986. Retrieved from: https://laws-lois.justice.gc.ca/eng/acts/S-6.6/

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