Aboriginal maternal and child health should be on post-2014 health accord agenda: Linda Duncan

As debate on the future of a federal-provincial health accord that expires in 2014 begins, the federal government should take a look at aboriginal maternal and child health as part of the process, says an NDP MP.

“One thing that our party has certainly been calling for for as long as I’ve been elected is the need to kick start the dialogue with the public about what’s going to happen in the next health accord. One aspect that I have not heard discussed is there should be a whole separate train on dealing with this disparity on aboriginal health,” said Linda Duncan (Edmonton-Strathcona, Alta.), her party’s aboriginal affairs critic.

Ms. Duncan said that while the government continues to “deny their role in health care” by saying it’s a provincial jurisdiction, the federal government has 100 per cent jurisdiction when it comes to helping to improve lives of aboriginals.

“Given the fact that we already have numerous reports showing the disparity, whether it’s safe drinking water, whether it’s safe housing conditions, whether it’s children running amok because nobody’s keeping them in school and they’re getting into drugs or sniffing or whatever or whether it’s just straight maternal care, that’s federal responsibility,” she said.

“So, this should be a separate dialogue and a strategy needs to come forward.”

A new report by the Health Council of Canada is also calling for a strategy to reduce the health and social economic gaps between aboriginals and non-aboriginal Canadians. The report, Understanding and Improving Aboriginal Maternal and Child Health in Canada: Regional Sessions about Promising Practices Across Canada, stated that compared to the rest of Canadians, was released on Aug. 8. It showed that aboriginals “are much more likely to live in poor health and die prematurely,” “have a burden of chronic conditions and of infectious disease,” and “are more likely to live in poverty, which has a domino effect on other aspects of their lives.” In addition, “aboriginal children are more likely to die in the first year of life.” When it comes to education, “aboriginal people are less likely to graduate from high school, and more likely to be unemployed” than non-aboriginal Canadians.

Prime Minister Stephen Harper (Calgary Southwest, Alta.) co-chairs the UN commission on maternal and child health in the developing world. When chairing the G8 summit last year, Harper said that “Canada will champion a major initiative to improve the health of women and children in the world’s most vulnerable regions.”

In a speech to the World Economic Forum, he said, “It is therefore time to mobilize our friends and partners to do something for those who can do little for themselves, to replace grand good intentions with substantive acts of human good will.”

The Health Council of Canada noted in its report that because the government has placed an emphasis on maternal and child health already, aboriginals wanted the government to focus its attention on their economic and social situation in Canada. Speaking with First Nations, Inuit and Métis across the country for the report, the Health Council echoed aboriginals’ calls for the federal government to look at maternal and child health issues more seriously in Canada.

“Participants said they hoped this work would help to turn the spotlight onto Canadian issues, focusing the federal government’s attention on aboriginal mothers, their children, families and communities,” the report said. “Though we did not start out with this in mind, it is fair to say that the Health Council endorses their perspective.”

Liberal MP Carolyn Bennett (St. Paul’s, Ont.) agreed. She said if Mr. Harper is serious about child and maternal health globally, he should start addressing those problems at home in aboriginal communities. “If we go back to the [World Health Organization] WHO commission on the social determinants of health, the area on aboriginal health has always been a black mark for Canada. Too many of our First Nations, Inuit and Métis people are living in third world conditions and have health outcomes to match that,” she said. “I think that seeing that the Prime Minister decided to take on maternal and child health as a signature project, I think he should start at home. There is no question that First Nations, Inuit, Métis mothers and children are worthy of the attention of this government.”

Ms. Duncan said she’s heard from aboriginal groups that were “bitter” about Mr. Harper’s decision to take on maternal and child health globally but not at home.

“I know there was a lot of bitterness and consternation in the aboriginal community and there was a lot of people who’ve commented about that, when Harper made that announcement, and said he would take the lead on that,” she said. “What about here at home? So, it’s a valid question. Lead by example.”

In response to the report, Health Canada spokesperson Stéphane Shank, told The Hill Times that the government is continuing “to work collaboratively” with aboriginal leaders “to ensure access to quality health programs for infants, children and families in First Nations and Inuit communities.” Mr. Shank said in an email that Health Canada provides multiple programs and services to address maternal and child health in aboriginal populations.

“These initiatives support healthy pregnancies, healthy births and healthy childhood development and include mental health promotion and youth suicide prevention, addictions prevention and treatment, nutrition and physical activity promotion, early childhood development and school readiness, chronic and infectious disease prevention, injury prevention and oral health promotion,” he said. “The long term goal of the Maternal Child Health Program on reserve is to support pregnant First Nations women and families with infants and young children to reach their fullest developmental and lifetime potential.”

Health Council of Canada CEO John Abbott noted however that more needs to be done to reduce the disparities between aboriginals and non-aboriginal Canadians. “While there is considerable diversity among First Nations, Inuit and Métis populations, they share significantly worse health and living conditions than the rest of the Canadian population,” he said in a press release. “Breaking this cycle should be a policy imperative for governments given the much younger demographic profile of aboriginal communities and their higher birth rate.”

Among the problems highlighted in the report that needed to be addressed were adopting a “holistic view of health,” combating systemic issues such as poverty, and moving to less complicated funding models for programs and implementing long term “stable, multi-year funding.” The report noted that poverty is not the only roadblock to improved maternal and child health, but also the legacy of colonialism, racism and residential schools also play a negative role. When asked to speak about these issues preventing healthy children and mothers, participants “spoke frankly and with some frustration,” the report said. “Most of their comments were about the life circumstances of the mothers and children they see, rather than their health issues.” These issues included living in poor conditions, overcrowded housing, lack of affordable nutritious food, domestic violence, and addictions.

“Part of the focus of aboriginal healing efforts is to help people understand their own experiences in the broader context—that the pain they have suffered and may have passed on to their families is the result of these experiences. The devastating effect of residential schools has been compared to post-traumatic stress disorder (PTSD) that affects a whole culture, not just individuals,” the report said. One participant told researchers: “You must stress this in your report, said several participants. This is still in our minds and our souls and is being passed on through the generations. The healing is still going on.”

The report’s major recommendation is to get better funding for meaningful programs. The report noted that in the government’s 2008 apology to aboriginal peoples about residential schools, the prime minister said, “The burden of this experience has been on your shoulders for far too long. The burden is properly ours as a government, and as a country.” If the government means to “turn these words into the real-life experience of aboriginal families and communities is to provide more aboriginal children with a better start in life,” the report said. “If Canada’s goal is to reduce the unacceptable health disparities between aboriginal and non-aboriginal Canadians, a concrete way of doing this is to expand programs that work and provide stable, multi-year funding.”

Funding should also focus on prevention, the report said. According to Health Canada, the Maternal Child Health program receives $170-million over five years, starting in 2010 and ending in 2010-2015. In addition, last year, Health Canada invested more than $2.1-billion in health services and benefits for more than 830,000 First Nations and Inuit. Shank also said that the government expanded programs totally $730-million between 2010 and 2015. These included Aboriginal Diabetes Initiative, National Aboriginal Youth Suicide Prevention Initiative, Maternal and Child Health programs, the Aboriginal Health Human Resource Initiative and the Health Services Integration Fund. Further, Shank said, more than 9,000 First Nations and Inuit women each year receives funding from the Canada Prenatal Nutrition Program which has a budget of $14-million.

“Health Canada is also investing $16-million annually to prevent Fetal Alcohol Spectrum Disorder births and to improve outcomes for those affected by supporting First Nation and Inuit communities to develop culturally appropriate and evidence-based prevention and early intervention programs,” Shank said. Participants in the report told researchers however that “funding for these programs is inconsistent, and they need increased, stable and long term funding to allow programs to put down roots and to reach as many parents and children as possible.”

Both Ms. Duncan and Ms. Bennett said they would try to push to get these issues on the House Aboriginal Affairs Committee’s agenda, or possibly the Health Committee and Human Resources as the issues have multiple dimensions. “I think that there’s some very important lessons to be learned there, but overall we’ve still got a lot of work to do,” Ms. Duncan said. “It is a bit disappointing that the government, unless I missed it, I haven’t seen a government response to this and by bringing it to a Parliamentary committee, they would have no excuse but to respond.”

Originally published in The Hill Times, August 22, 2011.

By Bea Vongdouangchanh