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.


The Ontario Indigenous Healing and Wellness Strategy (previously the Aboriginal Health and Wellness Strategy) was the first of its kind in the country. It was developed in 1990 and supported by an overarching Aboriginal Health Policy put in place in 1994 (Government of Ontario, 1994). These documents remain current today (Ministry of Health and Long-Term Care, 2018, p. 16): “[t]he Indigenous Healing and Wellness Strategy reflects a shared commitment between the Ontario government and First Nations, Métis, Inuit and urban Indigenous partners to reduce family violence and violence against Indigenous women and children, and improve Indigenous healing, health and wellness through culturally appropriate and Indigenous-led programs and services. Three Ontario government ministries fund the strategy:

  • Children, Community and Social Services (ministry lead)
  • Health and Long-Term Care
  • Indigenous Affairs” (Government of Ontario, 2019a).

Furthermore, as a result of the Aboriginal Health and Wellness Strategy and Aboriginal Health Policy, a network of Aboriginal Health Access Centres (AHACs) emerged across the province in 1995. AHACs “are Aboriginal community-led, primary health care organizations. They provide a combination of traditional healing, primary care, cultural programs, health promotion programs, community development initiatives, and social support services to First Nations, Métis and Inuit communities. There are currently ten AHACs in Ontario, providing services both on and off-reserve, in urban, rural and northern locations” (Alliance for Healthier Communities, 2019).

“First announced in 1995, AHACs were closely modelled after Ontario's Community Health Centres (CHCs), whose wide basket of services and supports had become the preferred mechanism to improve the health and well-being of communities in Ontario facing various barriers in accessing health care. In fact, two CHCs had already been established, one in Toronto and another in Timmins, with a mandate to apply this CHC model as the framework for services to local Aboriginal community members” (Alliance for Healthier Communities, 2019).

“Ontario's experience with CHCs, including these two Aboriginal CHCs — Anishnawbe Health Toronto CHC and Misiway Milopemahtesewin CHC in Timmins — provided strong evidence that such organizations could play a powerful role in improving the health and wellbeing of Aboriginal communities throughout Ontario. Currently there are three Aboriginal CHCs in Ontario: Anishnawbe Health Toronto, Misiway Milopemahtesewin in Timmins and Chigamik in Midland” (Alliance for Healthier Communities, 2019).
Ontario was also the first to commit substantial resources to Indigenous peoples living in urban environments. The Urban Indigenous Action Plan's “action areas set a minimum standard for how Ontario ministries engage with and support Indigenous communities, organizations and service providers” in a variety of mutually-agreed upon areas including equitable, accessible and culturally safe public health services delivery (Government of Ontario, 2018a).

In 2008, the Chiefs of Ontario (COO) strongly recommended the adoption of an Ontario-First Nations Health Accord. Following this, “a meeting was held on November 24, 2010, between the Chair of Ontario Chiefs Committee on Health (OCCOH) on behalf of the Chiefs of Ontario (COO), Deputy Ministers (DMs) of the Ontario Ministry of Health and Long-Term Care (MOHLTC), Ministry of Aboriginal Affairs (MAA), and Cabinet Office, Intergovernmental Affairs” (Chiefs of Ontario, 2019). These discussions have led to the establishment of a Trilateral First Nations Health Senior Officials Committee (TFNHSOC) to work collaboratively in identifying and implementing practical measures on specific priority areas including mental health and addictions, public health, chronic disease management, addressing service delivery gaps and service coordination, priority setting, and policy development. It was further agreed that the Federal government be engaged as an active participant given its historical and continuing role with First Nations. Health Canada, representing the Federal government is committed to participate in a trilateral process with Ontario First Nations and the provincial government to improve health outcomes for First Nations, in a manner that is guided by the honour of the Crown (Chiefs of Ontario, 2019).


Ontario's healthcare system is divided into fourteen Local Health Integration Networks (LHINs). “Through the Local Health System Integration Act, 2006, LHINs have a mandate to engage with First Nation, Inuit and Metis peoples to provide direction and input on the development and the delivery of health care services” (Ontario Local Health Integration Network, 2014).
In 2018, the Ministry of Health and Long-Term Care issued the Relationship with Indigenous Communities Guideline. “This guideline is intended to assist boards of health in implementing the requirements established in the Health Equity Standard and the requirement for boards of health to engage in multi-sectoral collaboration with municipalities, LHIN(s), and other relevant stakeholders in decreasing health inequities. The requirement further specifies that engagement shall include the fostering and the creation of meaningful relationships, starting with engagement through to collaborative partnerships with Indigenous communities and organizations, as well as with First Nations and Indigenous communities striving to reconcile jurisdictional issues.” (Ministry of Health and Long-Term Care, 2018).

In addition, under Section 50 of the Health Protection and Promotion Act (1990), a board of health for a public health unit and a local band council may enter into an agreement in writing under which the board agrees to provide health programs and services to the band, and the council of the band agrees to accept the responsibilities of a municipality within the public health unit (Health Protection and Promotion Act, 1990). Example of Section 50 agreements facilitating the delivery of public health program and services to First Nations on reserve include the agreement with Peterborough Health Unit and the Curve Lake and Hiawatha First Nations communities and Eastern Ontario Public Health Unit (Peterborough Public Health, 2018; see also Board of Health for Peterborough Public Health, 2018).

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