Aboriginal Canada Revisited

THE COMMISSION ON THE FUTURE OF HEALTH CARE IN CANADA: A CASE STUDY OF ABORIGINAL HEALTH

Falko Brede THE COMMISSION ON THE FUTURE OF HEALTH CARE IN CANADA: A CASE STUDY OF ABORIGINAL HEALTH1 S u> INTRODUCTION ince the beginning of the 19808; Canadian lawmakers have come under increasing pressure to reform the country's national health-care system. Because many Canadians greatlyvalue their medicare system, it has been very difficult for them to agree on a way of instituting structural reforms. As such, in 2001the federal government appointed Roy Romanow to head the Commission on the Future of Health Care in Canada (hereafter CFHCC). Romanowwas asked to study the medicare system and recommend ways in which it could be improved. In his final report, issued in 2002, Romanow, among other things, addressed the health status of Aboriginal people in Canada (First Nations, Metis and Inuit peoples). His recommendations, and their implications for Aboriginal people in Canada, are the subject of this paper. I will argue that Romanow s proposals were neglected by all levels of government because Aboriginal people, on the whole, did not embrace his concept ofAboriginal 50 Health Partnerships. Indeed, since the tabling of this report; no structural changes to health care, as it relates to Aboriginal People, have taken place. In order to understand whyRomanowmade the recommendations that he did, it is first necessary to highlight the particular health issues and problems that face Aboriginal-Canadians. Then, after having analysed the reform proposals ofthe CFHCC, Iwill discuss what has happened since Romanow tabled his report andwhymost ofthe recommendations relatingtoAboriginal health have not (yet) been implemented. In the final section, I will argue that the reform proposals of the CFHCC failed to attract sufficient support, because there was no agent of change who demanded an implementation of the recommendations ; moreover, the concept of the Aboriginal Health Partnerships, although very innovative, was not sufficiently rooted in the existing system of health service provision for Aboriginal peoples. THE STATUS OF ABORIGINAL HEALTH IN CANADA The average life expectancy of Aboriginal peoples in Canada has improved significantly in the past fifty years. Nevertheless, significant disparities still do exist: in 2000, the average life expectancy for Canadian males was 7.4 years higher than that of the Status Indian male population; for women, it was 5.2 years higher than that of the Status Indian female population (CFHCC 2002, 218).The severity of the problems in the provision of health services to Aboriginal peoples in Canada was repeatedly stressed by reports of advisory bodies in the recent past. For example, in 1996 the Royal Commission on Aboriginal Peoples proposed a broad agenda for structural changes in the provision of health services for Aboriginal Peoples (RCAP 1996). One of the biggest health problems in Aboriginal communities is diabetes. Among First Nations and Metis, the prevalence of diabetes is three to five times the national average. These groups also have diabetes complications more often and at an earlier age compared to the national average (CFHCC 2002,220). Since diabetes is a chronic disease, this is along-term problem that requires a long-term solution. First Nations also face tuberculosis rates ten 51 ABORIGINAL HEALTH FALKO BREDE times higher than that of other Canadians (Health Canada 1999, 3). Socioeconomic factors like poor housing standards and homelessness contribute to the comparatively high rate of new tuberculosis infections. Other risk factors are HIV, substance abuse (including alcoholism) and diabetes (Health Canada 1999,46). A huge and growing health problem among Aboriginal people is HIV/ AIDS. While the annual number of new HIV cases in Canada has levelled off, the number of HIV cases among Aboriginal people has increased steadily over the last decade. Citizens ofAboriginal descent make up around 3percent of the total population in Canada, but in 2002, 250to 450Aboriginal people were newlyinfected with HIv (6 to 12 percent ofallnew HIV casesin Canada). Therefore, one can speak of an HIV epidemic among Aboriginal people in Canada (Public Health Agency of Canada 2004,4). There are severalreasons why the number of new HIV cases amongAboriginal Canadians is rising. For example, Aboriginal people are over-represented in high-risk groups, such as injecting drug users.Aswell, the high mobility ofAboriginalpeople between urban and rural areas leads to an "export" ofthe disease from cities to remote communities (Health Canada 2003, 39). .Another problem is that most studies analyzing Aboriginal health issues concentrate onpeoples living on-reserve,but Aboriginalpeoplewho areliving off-reserve alsosuffer from apoorhealthstatus (Tjepkema 2002).According to Chief Dwight Dorey (National...