(EDITOR’S NOTE: The following letter to Jane Philpott, the federal Minister of Health, was sent last week by the chiefs of the Cote, Keeseekoose and The Key First Nations.)
Dear Minister Philpott:
We write this letter having recently completed the Federation of Saskatchewan of Indian Nations Special Assembly on Health. As a result of our Assembly, we wish to direct your Ministry and Health Canada towards urgent and specific concerns we need resolved in a timely and thoughtful manner.
The Treaty right to health
As partners in Treaty, we have waited patiently for Health Canada to organize itself and its programs to support Saskatchewan First Nations towards equitable health outcomes compared to the other Treaty partners of the Canadian Federation. At our assembly we discussed - in detail - how health inequality is more than a matter of policy. It is a manner of Treaty Rights and Canadian law. Saskatchewan First Nations do not have access to a basic level of health care services. The health providers and programs Health Canada has designed only "lead to a higher burden of disease and more death."
This is a matter of fact. This is a matter of equality. This is a matter of health system design and focus. This is a matter of treaty. We have a treaty right to equal care, equal quality and. equal health outcomes. We cannot accept this any longer.
What is your Ministry plan to ensure that the Treaty Right to health - including equal
care, equal quality and equal health outcomes comparable to mainstream Canadian health care - is provided to Saskatchewan First Nations in a measurable, timely and reasonable way?
Public health versus primary care services
It has become clear the focus of Health Canada's programming has been on public health services. We acknowledge that public health is an important part of any healthcare system. Public health services however, do not provide the effective interventions our First Nation patients require to have equitable and functional health outcomes.
We do not have consistent access to essential primary care services. Essential primary care services must include (note this is not an exhaustive list): health care providers who can initiate, change and discontinue the full spectrum of medications needed by our First Nations patients; health care providers who can properly screen, diagnose and initiate treatment for basic surgical interventions, and a toolkit of medical and surgical intervention options. Health Canada programs are designed to have one problem and one solution, and continuity of care. Health Canada services should make a difference in the care decisions Indigenous patients make in the provincial health care system. Right now, most Health Canada services make little to no difference in the care decisions made in the provincial health care system. Why design a health system that has minimal impact on health decisions and outcomes?
There are many other items in this list, but for example, clarity and focus we only mention these.
Saskatchewan First Nations are adopting a process and tools to ensure that the primary care service needs of our communities are clear and prioritized. Using this process and tools, we will direct Health Canada to respond to the highest priority items in a meaningful and impactful way. If Health Canada will consent to our process and tools, we can also identify shared priorities to accelerate health system transformation. This will ensure that resources lead to improved functional health outcomes.
As was said in our conference, "it is time for us to leave the issue of jurisdictional ambiguity and return to the patient-centred issue of jurisdictional responsibility."
What is the Ministry plan to ensure that consistent access to essential primary care services - as outlined above and in more detail in further outcome-focused meetings - lead to improved functional health outcomes for Saskatchewan First Nations?
What is the Ministry plan to internally and publicly declare that the focus of Health Canada will shift from public health services - which have been proven mostly ineffective as the main focus of Indigenous health care services - to a focus on primary care services, which we know are effective based on mainstream Canadian health outcomes? This is not to say that public health services are not important, but that it should not be the main focus of Health Canada system design and intervention.
Will your Ministry consider adopting our process and tools to ensure that we move forward towards health system design and intervention transformation in a measurable, consistent and impactful way?
Racism, discrimination and bias:
Who does the health care system serve?
The mainstream Canadian health system is rapidly moving from a modelof top-down, system-defined care. Health care outcomes have been repeatedly shown to improve when relationship-based care and patient-centred care models are adopted.
There is a large and growing body of peer-reviewed research that First Nations peoples access a system that is aggressive, hostile and causespatient harm. Health Canada dictates the definition of our health problems. It dictates the solutions it will give our First Nations access. It dictates where, how, when and how often those solutions will be implemented.
The mainstream Canadian health care system serves Canadian patients. Throughout the Canadian Federation, patients are being included in health system design (problem and solution definition) and health system intervention. Where is our meaningful representation, both at an Indigenous leadership level but also at an Indigenous patient level?
We cannot continue this approach of Health Canada to dictate its terms and have us oppressively accept. That is an outdated model that has been proven ineffective through widening health disparities and death. It is time for Health Canada to move into the best-practices of health system design and intervention adopted by the mainstream Canadian health care system.
What is your Ministry plan to ensure that Saskatchewan First Nations receive relationship-based and patient-centred care that is culturally safe?
What is your Ministry plan to ensure that Saskatchewan First Nations meaningfully participate in defining our health problems?
What is your Ministry plan to ensure that Saskatchewan First Nations meaningfully participate in defining our health care solutions?
What is your Ministry plan to ensure that Saskatchewan First Nations meaningfully participate in implementing our health solutions - which include reasonable implementation for where, when, how and how often implementation occurs? What is your Ministry plan to ensure Saskatchewan First Nation political leadership and patients are included in this plan?
We look forward to meaningful and impactful discussion on these issues of grave importance. Future meetings must be focused on identifying clear steps to move forward and use agreed upon measures for progress and effectiveness. The Federation of Saskatchewan Indian Nations is committed to addressing these issues. Saskatchewan First Nations leadership are committed to addressing these issues.
It is time to deliver on the Treaty Right to Health, to focus on primary care services and to ensure relationship-based/patient-centred/culturally-safe care for Saskatchewan First Nation patients.
Any further delay is a clear denial of care. This is something no Canadian patient would accept. It is something the Federation of Saskatchewan Indian Nations and Saskatchewan First Nations are no longer willing to accept.
In Treaty partnership,
Chief A. Norman Whitehawk of Cote First Nation
Chief Lyndon Musqua, Keeseekoose First Nation
Chief D. David Cote, The Key Band
