Mr. Chair, members of the committee, thank you for inviting Health Canada's first nations and Inuit health branch for this briefing on first nations and Inuit health programs.
Health Canada is committed to ensuring that first nations and Inuit communities and individuals are receiving a range of health programs and services that are responsive to their needs. The overall objective is to improve health status.
As you may know, first nations and Inuit communities are facing major health challenges. Compared to Canadians as a whole, they have shorter life expectancies, higher rates of chronic illness and infectious disease, and higher mortality and suicide rates.
They are also faced with greater challenges in relation to the social determinants of health, such as high unemployment rates, lower education levels and higher rates of overcrowding in homes.
In addition, first nations and Inuit face historical legacies, such as colonialism, the disconnection of culture, and the intergenerational impacts of Indian residential schools.
The health care system for first nations and Inuit is complex. Provinces and territories deliver hospital, physician, and public health programs to all Canadians, including first nations and Inuit, but do not operate health systems on reserve for most. In order to support first nations and Inuit in reaching an overall level of health that is comparable to that of other Canadians, Health Canada funds or provides a range of health programs and services in first nations and Inuit communities.
Within this context, Health Canada works with first nations, Inuit, provincial, and territorial partners to provide effective, sustainable, and culturally appropriate programs and services to improve health outcomes and support greater control of the health system by first nations and Inuit.
As part of this effort, Health Canada invests more than $2.5 billion annually in first nations and Inuit health to supplement programs and services provided by provinces and territories. This includes over $840 million for primary health care and public health on reserve, and $1 billion for health benefits. It also includes over $440 million this year for the British Columbia tripartite initiative, an innovative, precedent-setting development in first nations health, which took effect in October 2011, when B.C. first nations, the Province of British Columbia, and Health Canada signed the British Columbia tripartite framework agreement on first nation health governance.
Spending also includes $240 million for health infrastructure support, which promotes first nations and Inuit capacity to design, manage, and deliver their health programs and services, while supporting health service innovation, integration, and partnerships.
There are five key elements funded by Health Canada to support first nations and Inuit health: health promotion and disease prevention programs, public protection programs, primary care services, supplemental health benefits, and health infrastructure support.
In the area of health promotion and disease prevention, Health Canada provides funding to support community-based health promotion and disease prevention programs to support mental wellness, healthy child development, and healthy living.
Services related to mental health promotion, addiction support, suicide prevention, and counselling are funded under a range of programs, such as the national native alcohol and drug abuse program, Brighter Futures, Building Healthy Communities, and the national aboriginal youth suicide prevention strategy. In the area of healthy child development, it supports children to have the best start in life through programs such as aboriginal head start, the Canada prenatal nutrition program, and maternal child health.
As part of the Indian residential school settlement agreement, Health Canada also funds and provides health support services to former Indian residential school students and their families so that they can safely address a broad spectrum of wellness issues related to the impacts of these schools.
In the area of health protection, the department delivers public health protection programs, including communicable disease control, monitoring of drinking water and waste water, and environmental public health inspections of facilities and housing on reserve. In this area, services are provided by a combination of Health Canada and first nations-employed workers.
In the area of primary health care, Health Canada supports access to primary health care services in 80 remote and isolated first nations communities where access to provincial services is limited. Efforts are ongoing to enhance the inter-professional team approach, increase the number of Health Canada nurses, including nurse practitioners, and increase access to physician services.
Health Canada delivers primary care in 52 first nations communities, while in the remaining locations these services are totally under the control of first nations.
Through home and community care programs, Health Canada supports home care nursing, respite care, client assessments, and personal care or home support in over 500 first nations and Inuit communities. Most of these services are delivered by first nations community-employed health workers.
As indicated before, Health Canada also provides supplemental health benefits. Health Canada supports one of the largest health benefit programs in the country and provides coverage for medically necessary goods and services to over 824,000 eligible first nations and Inuit.
NIHB provides program coverage in different benefit areas to supplement those that are usually available through provinces, territories, and private insurers. This includes coverage for prescription and over-the-counter drugs, dental services, medical transportation, medical supplies and equipment, vision care, and mental health counselling.
The NIHB program does not require co-payments or deductibles and encourages health service providers to bill the program directly so that clients do not face out-of-pocket expenses.
The NIHB program provides important coverage for medical transportation to health care services. Approximately 125,000 clients accessed medical transportation benefits in 2014-15, accounting for over 300,000 medical-related trips. Medical transportation coverage includes emergency transportation and transportation to access medical care, such as appointments with physicians; hospital care; diagnostic tests; medical treatments; alcohol, solvent, drug abuse, and detox treatments; traditional healers; vision and dental appointments; and mental health counselling.
Specific to dental care, the NIHB program provides eligible first nations and Inuit with coverage for diagnostic, preventive, restorative, endodontic, periodontal, removable prosthodontics, oral surgery, and orthodontic services.
Health Canada also provides support for the infrastructure of 700 health care institutions across Canada. This supports the delivery of services and helps first nations with health services accreditation, the adoption of cyber health technologies, human resources in Aboriginal health care, and service integration.
Health Canada does not do this alone. First nations and Inuit also take on various degrees of responsibility for directing, managing and providing a multitude of health services funded by the federal government.
Efforts to assist first nations and Inuit in their desire to influence, manage and control health programs and services that affect them continue to be essential for improving health outcomes and expanding access to the health services and programs they need. This approach has been motivated not only by the desire to give first nations and Inuit greater autonomy in matters that could improve their health, but also by the evidence that better control can improve health outcomes and make public health activities more effective and respectful of the culture.
A majority of health programs have been transferred to over 400 first nations communities, to varying degrees. Some first nations communities receive funding to design and deliver autonomous health services that meet their needs, while others work with Health Canada to develop community health plans in order to model the programs to their health services needs. And in some communities, Health Canada personnel deliver health services jointly with local health teams.
We have made significant progress in health services integration in the last ten years. In many regions, we see examples where there are more doctors in the communities or the continuum of health services provided within and outside the community has improved through collaboration agreements. These efforts have resulted in better outcomes and made it possible to implement a more patient-focused approach, in spite of the complexity of the system.
The national organizations are consulted regularly and the two main national organizations representing first nations and Inuit sit at the management table of the First Nations and Inuit Health Branch. There are co-management tables and tripartite tables in most regions of Canada for holding official discussions with the provincial and territorial partners and the first nations and Inuit partners, in order to advance common priorities and resolve systemic issues.
I would like to speak briefly about some of the priorities with which we are concerned.
As you know, first nations and Inuit are more likely to experience complex mental health and substance abuse issues. We have been working with the Assembly of First Nations over the last few years to develop the first nations mental wellness continuum framework. This framework was endorsed and released by the Assembly of First Nations in January 2015, and implementation is under way with first nations partners at the regional and national levels.
Health Canada will also participate in the whole-of-government approach to address the call for action of the Truth and Reconciliation Commission. We are also working jointly with the Assembly of First Nations on a joint review of the non-insured health benefit program. This is a benefit-by-benefit review with the AFN to discuss improvement of the health programs and services.
I want to thank this committee for giving us an opportunity to be with you today, and we will be pleased to answer your questions.