Good morning, Madam Chairperson and the committee.
I would like to say I appreciate the opportunity to talk with you about suicide among indigenous peoples and communities.
My name is Del Graff. I'm the child and youth advocate for the province of Alberta. I'm of Cree, Métis, and German ancestry, and I've been married to a woman who's Métis from northern Alberta for 30 years. We have raised three children and we have two wonderful grandchildren. I'm very honoured to have the opportunity to speak with you today.
I would also like to acknowledge that the land on which we gather is the traditional unceded territory of the Algonquin Anishinaabe people.
As an independent office of the Alberta legislature, we provide direct services to vulnerable people throughout the province. Our advocacy efforts focus on children and youth in the child welfare and youth justice systems.
I also have the authority to review the deaths and serious injuries of young people receiving child welfare services or who had received services within two years of their death.
Unfortunately, what I have observed in this role is extremely unsettling. Since I took on this responsibility in 2012, my office has received 40 reports of young people who have died by suicide or been seriously injured after attempting suicide. Twenty-six of those young people were indigenous.
I'll be referring to two reports that my office has released in the last year. Both reports can be found at our website under “Publications”.
In 2016, I released a report called “Voices for Change: Aboriginal Child Welfare in Alberta”, a special report on aboriginal child welfare in Alberta. We talked to indigenous young people, elders, parents, caregivers, and professionals about their experience in child welfare. They also talked to us about what they think would make it better. I raise this here because the report provides a snapshot of what has happened in Alberta.
When we looked at the overrepresentation of indigenous people, this is what we found. About 10% of the young people in Alberta are of indigenous ancestry, yet they account for almost 70% of the young people in government care. Of those who are involved with child welfare but not in care, 38% are indigenous young people. Of those who are in temporary care, 54% are indigenous young people. By the time they reach permanent care, three out of every four young people are indigenous. What that means is that the more intrusive government is, the more disproportionate the numbers are.
In Alberta on a per-1,000 basis, for every 1,000 non-indigenous children, three will be involved with child welfare. For every 1,000 Métis children, 18 will be involved with child welfare. For every 1,000 first nations children in Alberta, 94 will be involved with child welfare. What that means is Métis children are six times more likely to have child welfare involvement than their non-indigenous peers, and first nations children are more than 30 times more likely to have child welfare involvement than their non-indigenous peers.
This has to be considered unacceptable by anybody's standards.
In April 2016, we released a report called “Toward a Better Tomorrow: Addressing the Challenge of Aboriginal Youth Suicide”. In that report, we talk about the experiences of seven indigenous young people who died by suicide over an 18-month period from 2013 to 2014. The deaths of these seven youth put a face on these tragic circumstances.
Two of these young people were brothers aged 15 and 18 who died within four months of each other. I'm using pseudonyms, as our legislation prevents me from identifying youth who are receiving designated provincial services. The names are most often chosen by family members. Fifteen-year- old Sage was a shy boy who dreamed of becoming a famous violin player or a rap artist, while his 18-year-old brother Cedar was outspoken and the protector of his younger siblings. They grew up in a home where they were exposed to family violence, addictions, and neglect. Their mom was a single parent.
Because of these concerns, child welfare services became involved with their family shortly after Cedar was born, and support services were provided in the family home. The boys were taken into government care when Cedar was three years old and Sage was six months old. Over time, there were efforts to return the boys to their mother's care, but, sadly, they were unable to stay with her. The boys moved into foster care and group homes, but they yearned to be returned to their mother.
By the time Cedar and Sage reached adolescence, they were both using drugs and alcohol and had stopped attending school. Sage was a very sad child, and he expressed that he did not know why. He died by suicide when he was 15 years old. Just four months later, 18-year-old Cedar also died by suicide. Both boys' manner of suicide was the same, and they both died in their mother's home.
I had the privilege of meeting the mother of these two young men, and she feels that Cedar ended his life because he felt he was to blame for Sage's death. Her grief is beyond words. She's very worried about her remaining children, who have told her that they've contemplated suicide.
The community where this family lives has been tremendously impacted by suicide, and this is not unlike other communities in Alberta or across Canada. The other five indigenous young people whose experiences we describe in our report came from different communities. Some lived in cities, some on reserve, some off reserve, and some in small towns. There were three girls and four boys, ranging in age from 14 to 18 years old. Some grew up in government care, while some were primarily raised by parents or relatives.
What did they have in common? It was family disruption and the legacy of residential schools; early childhood trauma from exposure to family violence, neglect, or abuse; and parents or caregivers who had addictions or mental health problems. Many experienced the death of a family member by suicide.
My report identified three areas where we think action should be taken for improvement.
First, we must pursue community-led strategies to address indigenous youth suicide. We cannot apply a one-size-fits-all approach to this issue. Each community is unique and has different circumstances and conditions. As a result, it's imperative that each community develop local strategies and solutions that are community led. I believe that government is best positioned to provide resources and to use its policies and financial levers to support community-led strategies.
Second, it is important that we address indigenous youth suicide holistically. What does this mean? It means that we need to demonstrate an understanding that youth at risk for suicide must be assisted physically, mentally, emotionally, and spiritually. It means that communities need to engage families, community leaders, service providers, and key professionals to collaborate in the development and implementation of their community-led strategies. It means that those strategies should include efforts and responses across a continuum of suicide, including prevention, intervention, and aftercare.
Finally, our report calls for building and supporting protective factors for young people. When we talk about protective factors, we're specifically referring to conditions that promote the social, physical, emotional, psychological, and spiritual health and well-being of children. We know with certainty that investing in protective factors greatly enhances a child's healthy development and prevents suicide. For example, a strong connection for indigenous youth with their traditions and culture can enhance their sense of belonging, of identity, of purpose and meaning for their lives, which will act as protective factors for them. Protective factors can be found at the individual, relational, social, and community levels. Individual protective factors like good physical and mental health, good coping skills, along with relational factors such as having positive role models and strong and healthy relationships with extended families and elders can make a huge difference.
Hope comes from protective factors. Dr. Chris Lalonde, who's a professor of psychology at the University of Victoria, was an expert committee member on our report. He speaks about resilience and protective factors in his work. He points out that there are a number of healthy indigenous communities across Canada that have very low concerns related to suicide. He suggests groups can look at the protective factors in those communities to see what's working well.
If you take those protective factors and work with communities to implement them, you'll likely see positive change. Risks can never be fully eliminated, but young people can be empowered with the skills they need to successfully navigate and cope with risks they encounter. Having this resiliency can help young people from turning to suicide.
It's my sincere hope that my presence here today moves governments, communities, and community leaders to act on the issues related to indigenous youth suicide. Further, I hope that as we move forward, we will find ways for young people to build on and celebrate their strengths, and that when they face adversity, they do so with a clear sense of who they are and where they come from, a sense that they are surrounded by people who love and support them and that they feel a sense of belonging to a healthy and caring community. That is what I think we all want.
I was told a long time ago that when you are really struggling with challenges in life, you need to go where you're loved. Every young person in this country needs to know where they can go for the love, comfort, and support that they need.
Thank you very much, Madam Chair, and I'll be happy to answer any questions once the other presenters finish.
Good morning. I too recognize the unceded territories of the Algonquin people.
My name is Cindy Blackstock. I'm the executive director of the Caring Society. I am also a professor at McGill University.
Faced with the tragic headlines of repeated deaths of first nations children and young people across the country, too often Canada's historical reflex has been to cite what it has done and to promise to do better. We say that first nations children and young people should be patient with the government, that we should all be patient while progress is done.
The word “patience” means to suffer without complaint, and I think this country is far better than asking children to suffer without complaint.
The issue linking the inequalities that first nations children experience in health care and the deaths of these children is not a new story in Canada. In 1907, 110 years ago, Dr. Peter Henderson Bryce, Canada's chief medical health officer, raised the concern about the inequitable health services provided to first nations children in residential schools and their preventable deaths from tuberculosis. A leading medical doctor at the time, president of the American Public Health Association and founder of the Canadian Public Health Association, Dr. Bryce said that medical science knew how to save these children, who he stated were dying at a rate of 24% a year or 48% over three years. He believed it would have cost Canada $10,000 to $15,000, but the Canadian government said it was too expensive and that it would take one step at a time. The children continued to die.
In 1908, one of the leading lawyers of the time and co-founder of Blakes law firm, Samuel Hume Blake, said in response that if Canada failed to obviate these preventable causes of death, it would bring itself “into unpleasant nearness with manslaughter”. People of that period found Canada's failure to respond to the health inequities faced by first nations children to be immoral and possibly illegal.
There are a number of reports that span the decades, pointing out to the federal government the inequalities experienced by first nations children. The deaths and indeed the harms done to first nations children are too numerous to recount in this short period of time, but I will take your attention to 1946, when the Canadian Welfare Council and the Canadian Association of Social Workers did a joint presentation noting the inequities in services to the Royal Commission on Aboriginal Peoples in 1996; to the report by Dr. Patrick Johnston in 1983; and, of course, to the numerous reports done jointly with the Department of Indian Affairs in 2000 and 2005.
January 26 of last year provided a new moment of hope for this country. It ended a 10-year legal battle filed by the Caring Society and the Assembly of First Nations on Canada's inequitable treatment of first nations children in child welfare and its failure to implement something called Jordan's principle.
Jordan's principle is to ensure that first nations children receive equitable access across a whole range of public services on the same terms as other children, without delay. It was filed in 2007. The Canadian government fought it tooth and nail, but the tribunal substantiated the complaint and—relevant to this matter—cited significant evidence before it in the hearings that Canada was aware that mental health services were desperately required by first nations children due to the multi-generational impacts of residential schools. In Ontario specifically it was required by the Ontario Child and Family Services Act, yet federal officials testifying before the tribunal confirmed that yes, they were aware of that statutory provision, but no, Canada did not fund those services.
No, Canada does not fund those services, and kids were dying. The tribunal orders make specific mention of this in numerous paragraphs of the decision handed down on January 26, substantiating the racial discrimination by the Government of Canada and ordering Canada to immediately cease its discriminatory action. Specifically, it says paragraph 392:
||...the application of the 1965 Agreement in Ontario also results in denials of services and adverse effects for First Nations children and families. For instance, ...the agreement has not been updated for quite some time, it does not account for changes...over the years to provincial legislation for such things as mental health and other prevention services. This is further compounded by a lack of coordination amongst federal programs in dealing with health and social services that affect children and families in need, despite those types of programs being synchronized under [the provincial child welfare act in Ontario].
Canada did nothing to respond to that particular section of the order. In fact the tribunal, in its April non-compliance order against Canada, cites the failure of it to immediately provide mental health services again. In July we get this announcement from the federal government that they're providing up to $382 million for Jordan's principle. It was a breath of relief for those of us who hoped that those poor kids in Ontario would finally get the mental health services they require, not only in Ontario but across the country, but that did not happen.
In September the tribunal makes another non-compliance order and specifically mentions Canada's failure to provide mental health services and asks for further details. It recognizes the $382 million announcement and the further announcement of $60 million on mental health, but it doesn't know what it means for children. They said those are nice numbers to hear in the air, but what does it mean for children and Canada's compliance with this order? All of that remains unclear.
Canada starts to clarify that on October 31, 2016, when it finally says that INAC is working with the Province of Ontario and first nations to discuss the provision of mental health services.
I want to make it clear here that the tribunal did not order Canada to discuss how to provide mental health services; it ordered it to immediately provide those mental health services. That's Canada's own document of October 31, 2016.
In January of 2016 we get a legal submission from the Government of Canada. We find out how much they've spent of the $382 million, and it turns out they've spent $5 million of that. That's 1.3% of that allotted money, and 91% of the claims are in Manitoba and in Saskatchewan, leaving only 9% for the remaining jurisdictions.
There are further non-compliance orders against Canada. We have cross-examined Canada's witnesses, and those transcripts will be made available publicly. When that evidence comes out, I think it would be well worthwhile for everyone who is on this committee to read it very carefully.
I want to back up and look at the consequences. Remember Blake's statement that Canada brings itself into “unpleasant nearness with manslaughter”. We like to think we learn from residential schools. I'm not sure that we always have. While Canada was failing to comply with the order, Wapekeka first nation sends an urgent mental health proposal to Health Canada dated July of 2016, right after the first non-compliance order handed down by the tribunal. It makes a plea for the immediate provision of mental health services, citing a suicide pact among the girls. Canada doesn't reply for some months. Then says it will discuss the provision of mental health services.
On January 10, 2017, Chantel Fox dies by suicide at the age of 12. Two days earlier, Jolynn Winter, 12 years old, died. We don't know if those little girls would have died had Canada implemented the order, but I think we can all agree around this table that it would have given them a fighting chance.
It's inexcusable to me that we can offer any justification for Canada's non-compliance. People have said to me that we can't afford to implement the entire order, to which I ask, what are first nations children losing to? The Canadian government is spending half a billion dollars on the birthday party. You're renovating Parliament. Is that more important than any of these kids?
Racial discrimination and inequity have been known to this country for many decades and years. Equity for first nations children need not be done a teaspoon at a time. A great nation and a great people and great leaders don't make excuses for inequality. They move with dispatch, because children's lives are on the line, and as Dr. Michael Kirlew, the physician at Sioux Lookout in charge of Wapekeka, says, these deaths are preventable.
You can talk about codifying this as a personal problem for first nations or for the kids or for what you're going to do for services, but as the World Health Organization has said, “social injustice...is killing on a grand scale”, and the one thing you can do in this committee is ensure that the federal government fully complies with that Canadian human rights order and with Jordan's principle.
, Madam Chair.
I thank both of our witnesses this morning. In my view, any child and youth advocate deserves the highest of respect. Thanks to both of you for your work.
I have a couple of questions, but I don't think I'll be able to ask them in the short period of time I have.
First of all, Cindy, I think you talked about patience. In my experience over 35 years in this business, a lot of people have always talked about the complexity of the issues that we face as indigenous peoples. That's one side of it, but however complex and difficult issues are, if there is no political will to work on them or to resolve them, then we're not moving ahead. Thank you for that.
Here's one of the questions that I would like to ask you. I commend you for the work that you've been doing over the years for children. I think Canada owes you a lot. On behalf of Canada, I want to say “thank you” to you this morning.
One of the things that always bothered me in this discussion is the fact that for a very long time, and in fact for the last 150 years since Confederation, indigenous rights have been viewed as constitutional rights, rarely as human rights. Everybody endorses the UN Declaration on the Rights of Indigenous Peoples. Also, the present government said that they would implement all 94 of the Truth and Reconciliation Commission's calls to action. I'd like you to speak to that aspect of these kids having human rights: the human right to clean water, the human right to a roof over our heads, and the human right to be who we are as indigenous peoples and indigenous kids.
I'd like you to address that, because it's never been talked about in that sense. Then I want to come back to the Human Rights Tribunal decision and orders, but first of all, it's about human rights.
Good morning. I'm James Irvine. I'm the medical health officer for three northern health authorities in Saskatchewan, roughly the northern half of the province. David Watts and Denise Legebokoff work with Mamawetan Churchill River Health Region. We're on Treaty 6 territory here in northern Saskatchewan. Thank you very much for the opportunity to present to you.
The northern half of Saskatchewan has roughly 40,000 people. It has some of the highest proportions of indigenous people in Canada, with about 87% being self-identified as indigenous and about 49% of those living on reserve. We have 12 first nations living in multiple communities, all of which have had health transfers, and we work in partnership with them.
Northern Saskatchewan faces, like many other northern or mid-northern areas, challenges related to social determinants. We've provided information on some of those determinants, such as the income levels and poverty.
Fifty per cent of the individuals in northern Saskatchewan live on 20% of the average income of the average Canadian. Crowding in northern Saskatchewan on average is more than six times that of crowding within other Canadian homes. All of those things are indicators that show the challenges related to some of the social determinants of health.
With regard to the longer-term incidence of suicides in northern Saskatchewan, since about the mid-1970s we've had rates two to three times the crude rates in Saskatchewan. On average across the north, with about 40,000 people, we have about 12 suicide deaths a year. Youth account for most of these deaths. This slid shows that across Canada, the highest group at risk of suicide are the middle-aged or elders, whereas in northern communities and many indigenous communities the rates are highest within youth. For data up until 2014, for males and females combined, in northern Saskatchewan the suicide rate for youths age 15 to 24 is almost seven times greater than the Canadian average.
Hospitalizations for self-harm tend to be greater among females. In the last 10 years, suicide deaths have been higher in males, while in the French version, you see that females have a higher rate of hospitalization for self-harm.
We've just experienced a cluster of suicides in the north that was somewhat different from what we had in the past. These suicides were predominantly young girls under the age of 15. There was a cluster. We've experienced clusters in the past, with one community experiencing this and then several years later there was another community. That tends to be the pattern. We've noticed over the last few years that those clusters have spread geographically, and it's thought that part of this may be because of social media.
Six deaths occurring within about a two-week period has had a tremendous impact, and that impact was sustained in the following several months, with fairly serious attempts and serious ideations. We've provided a graph showing the significant effect on emergency departments and other mental health teams.
We've also provided a breakdown of this last cluster of attempts and ideation following these deaths. It's hard to comprehend that girls between the ages of 12 and 14 would find themselves in this situation. I would be happy to respond to questions about this later.
Generally across the north, we've had the issue of suicides for decades, and this will continue unless really long-term supports and strategies are enhanced and sustained.
These events have been occurring on and off reserve, in Métis communities, and in first nation communities. In general, communities work closely together, and we do well at times of crisis, pulling together and responding and getting support from provincial and federal governments. It's really the longer, sustained, culturally based preventive strategies that need to be strengthened and resourced.
We also talk about the many faces of the issue. Suicide is one. Others are self-harm, assaults, injury, unresolved grief, previous trauma, bullying, substance abuse, and addictions. Social issues of poverty, intergenerational trauma, and cultural ties and loss are also important.
We also looked at risk factors. As you're very well aware, there are the individual factors and social factors, as well as community culture and continuity. In our circumstances, we find that it tends to be much more involved with the social and community and cultural perspectives and that it's often not an individual issue. It ends up being much more of a community issue, and it's often in clusters.
It's the same with the sense of protective factors. There's the sense of community cohesion, family cohesion, family communication, social supports, engagement in things like schools and sports, but there's also a lot of evidence in British Columbia and Alaska, and anecdotally around the country, that it's the community engagement in maintaining cultural continuity that's so important for that self-identity.
In general, we've put together a couple of recommendations that you see before you, but really, one of the areas is that big area of prevention and looking at those social determinants: poverty reduction, housing, early childhood intervention, indigenous language and cultural identity, and intergenerational knowledge sharing, and really learning what's working in other indigenous communities through rigorous evaluation, along with culturally based early childhood development, supporting parents, enhancing coping skills, and strengthening and supporting communities to strengthen the family and cultural identity.
In the area of more clinical connections, there is working together between the biomedical and indigenous systems, enhancing training of mental health workers and mental health professionals, increasing the availability of team approaches and multidisciplinary teams, and coordinating across jurisdictions. We have several first nation health authorities and several regional health authorities provincially, and it's so important to be working together there, as well as with social services, the RCMP, and education.
Then there's working closely and supporting indigenous approaches to wellness.
There are a couple of things as well that we've learned recently. One is the importance of having suicide cluster response plans, and having the surge capacity to deal with that. Learning to use some common assessment tools and training across jurisdictions have been found to be valuable as well. We also support the development of quality data systems for surveillance, very much led or incorporated with first nation and Métis collaboration.
Thank you very much, and we'll be happy to respond to questions.
Thank you very much for inviting me here today. Thank you for the comments that were just shared, and for the acknowledgement that it is unceded Algonquin territory on which these meetings are being held.
My name is Alika Lafontaine. I'm an Ojibwa-Cree anesthesiologist, currently practising in northern Alberta, Treaty 8 territory. I am the immediate past president of the Indigenous Physicians Association of Canada and I currently work with the Indigenous Health Alliance, which is a collaborative approach to health transformation, currently led by more than 150 first nations from the territories of Manitoba Keewatinowi Okimakanak, the Federation of Saskatchewan Indian Nations, and the Nishnawbe Aski Nation.
As I have reflected on the unique contribution that the IHA could provide to these hearings, I believe that connecting the suicide crisis with the current health system we exist in as indigenous peoples would likely have the greatest utility.
In these hearings, you've heard a lot of testimony about a broken system. I'd like to suggest that, based on what community has taught me over the past several years that I've been involved in this project, the system is actually not broken. It does exactly what it is designed to do, but it will never be able to respond appropriately to a suicide crisis in our communities, or any other crisis, until we transform our health system.
In order to understand what the status quo is, I would like to share a very brief story. It's a story about a system we're all trapped in, not because we can't change, but because we choose not to change. As with any story, there are three truths that I would like to suggest you accept.
The first is that our communities are in perpetual crisis, and that crisis is worsening. You can see from the suicide crisis that suicides have become suicide pacts, and suicide epidemics are now becoming pandemics. This is happening in real time in the Nishnawbe Aski Nation, the Manitoba Keewatinowi Okimakanak, and the Federation of Saskatchewan Indian Nations.
Our indigenous systems were originally designed for colonial outcomes. That's the second truth. Colonial outcomes mean that the rights of indigenous peoples to land and resources are eventually extinguished.
The third truth I suggest you accept is that indigenous people are at a place where we need to change. We have no option but to create a different type of system because of the morbidity and mortality affecting our communities.
We'll begin our story in what I'll call a crisis.
If you look at the crises that happened in La Loche, Attawapiskat, Cross Lake, or any of the other communities that have been affected by suicide and mental health crises across the country, you will see that these crises usually lead to a meeting.
I remember the meeting that happened in La Loche. The Prime Minister attended, along with several ministers. The provincial government was represented. The meeting was supposed to lead to solutions, and those solutions were supposed to lead to an expected impact, which was a decrease in the suicide crisis.
In a review of La Loche and the amount of federal government spending that has happened there over the past 12 years, we've seen from our data that over $500 million has been spent in that small community of about 4,000. The question we have asked ourselves is why that didn't have an effect. Where did all the money go?
From both federal and provincial levels, $650 million was allocated to Nishnawbe Aski Nation since it declared its suicide crisis last February. Why has there not been the expected impact?
I would like to suggest that what communities think is happening—crisis meetings, solutions, and impact—is not really what's happening. This is simply what our communities are led to believe. Between the crises and the meetings, there are side conversations that occur between governments at provincial and federal levels, as well as with outside agencies that suggest they can assist with the crisis.
These side conversations occurring between the meetings and the solutions lead to a pre-allocation of funding.
It's interesting that of the $650 million that was allocated to the Nishnawbe Aski Nation, most of it was spent before it ever actually made its way into the community.
As an example of how this was spent, for the crisis teams, the federal government assigned specific suicide task forces that came into the community at a cost of about $2 million for three months. Once that pre-allocation of funding dried up, those crisis teams disappeared.
Between the solutions and the impact, outside agencies are almost always tasked with providing the solutions for our community issues.
While communities are stuck in the middle of a cycle—remember, we look at crisis, meetings, solutions, and impact—there is an outside circle that's happening at the same time, where we have side conversations, pre-allocation of funds, and outside agencies providing all of the care that is required to solve our crises. What this leads to is a lack of accountability within our communities and to our communities, a lack of resource allocation that goes directly to our communities, and a lack of responsibility and no role in implementation when it comes to solving our crises.
The guaranteed outcomes of this system, which I'm going to call the status quo, are worsening crisis and escalation by indigenous people in the form of political pressure, media, litigation, and civil unrest. The current system of government response has grown to recognize these outcomes and respond in kind. By keeping indigenous peoples within the cycle of crisis, meetings, solutions, and impact, the systems we work in are able to utilize their resources to de-escalate indigenous people through meetings, round tables, MOUs, and joint action tables. However, most of these activities have very little impact on the community crisis.
For example, although there is a joint action table with the Nishnawbe Aski Nation that has been established for more than a year, there are minimal, if any, real resources that have been established on the ground. The joint action table, from our point of view, is simply a mechanism to de-escalate indigenous peoples' move towards political pressure, media, litigation, and civil unrest.
That's not to say that any of these things are desirable. No community wants to move here, but this is where we are forced to move with the status quo. Quite literally, there are insufficient resources left to prevent the worsening crisis, because the attention is instead spent on de-escalating the indigenous peoples' response.
If we compare this to crises that have happened historically, we see that the response of the mainstream system was much different. After we recognized the prevalence of iatric injury to patients—that's physician and health care provider injury to patients—in the late nineties, a quality crisis led to the creation of health quality councils across the country. When we look at the SARS crisis, we see that the effect it had was the creation of the Public Health Agency of Canada. The crises in safety that we had in the mainstream system led to new rules for regulatory and accreditation bodies.
If we want to get out of the suicide crisis, we need to recognize that we need to write a different story, like the one I just shared, and we have to acknowledge our shared truths that our communities are in perpetual crisis, whether or not we receive media coverage; that our system is designed to produce the outcomes of worsening crisis and escalation by communities in order to get a response; and that we must change what we are doing. We need to re-task our bureaucracies from doing the job of incremental change to broad system transformation. It has been said in the past that the electric light bulb was not the result of incremental improvement of the candle.
In the Indigenous Health Alliance, we take on this task wholeheartedly in trying to address the indigenous health system, and we observe that this task is taken on wholeheartedly in the mainstream medical system. Patient-centred care is a complete transformation of the physician-patient relationship. You're talking about a national pharmacare program, which would reconstruct the way every patient in this country accesses drugs. We are not a country of incremental health system improvement; we are a country of health system transformation.
Indigenous communities are trapped in a system where worsening crisis and escalation are inevitable outcomes. Last week, representatives from more than 150 first nations presented their plan for health transformation of the indigenous health system to the ministers of indigenous affairs and health. It's in order to address the crisis in our communities, which includes suicide and mental health.
The IHA will continue on regardless of the role of the government, but our first nation leadership has been told that the bureaucracy only has the tools for incremental improvement of the existing colonial system. To be very straightforward, bureaucracy has no tools, no process, and no plan for health transformation, and that's what we need to move ourselves out of these crises.
A question I am often asked by communities is how severe a crisis must get and how high escalation must proceed before investment in health transformation finally happens and we work our way out of the status quo. My only answer to them right now is, “I guess we'll have to see.”
I want to start by thanking both presenters here today. I appreciate all the work you've done on this issue and the attention you bring to this very serious issue we're experiencing in our communities.
I chair the northern caucus, and this is an issue that is very challenging for us to address. As we look across Canada at what the different provinces are doing with some success, it's mostly for the non-indigenous population. It's a great concern that this seems to be escalating only in the aboriginal communities. Quebec has done some good work for the general population, but not with the aboriginal population, and that seems to be happening right through Canada.
In the north we don't have the same level of attention as the rest of the population seems to get. Of the hundreds of millions of dollars of funding announced for indigenous people, none of it goes to the north, and that's really shocking. This is only money for reserves. We don't have any treatment centres in the north. We don't have any programs for trauma, yet a good part of our aboriginal population went through residential schools and are experiencing lots of difficulties surviving in this new world we live in.
I tried to calculate how many people are committing suicide in the north, and we don't have all the information, but in the Yukon, Northwest Territories, and Nunavut, we are averaging about one suicide every eight days. Every weekend we have a suicide. Most of the people committing suicide are male. We have more attempts by the female population, but the people who are succeeding are male. That points out the seriousness of the situation. Since we embarked on our suicide study, over 50 people have committed suicide in the northern territories, so solutions are needed.
We know that we don't have the same quality of life. We've heard that from many witnesses who presented to us. We don't have the Canadian standards that everybody else enjoys. We live in crowded homes. Housing is a real challenge. We have people in some territories who are living in boxes or sleeping on couches, and some are just wandering around, which is escalating the crime and violence in our communities.
We also have a small population getting high school diplomas. Our education is a challenge, and as for food, I think everybody has seen what's being reported in the media.
The reality is that money is being invested where the media is paying attention, and that's not bringing it into the Northwest Territories, Nunavut, or the Yukon.
I want to ask a couple of things. First, what are your top three recommendations to deal with this issue across Canada?
I'm sorry to hear those stats. I'll say that first. As you said, I've known that the crises in the north, the far north, were obviously very severe, but even those numbers are worse than the studies that I've read.
Bill Tholl, president of HealthCareCAN, who has overhauled the health regions in Canada, of which I believe Yukon and Northwest Territories are members, said that the biggest problem in health delivery is a consolidation of accountability, resource allocation, and responsibility to the proper levels.
When you look at our status quo and the cycles that I mentioned, particularly looking at the side conversations that happen with government, which really is the largest funding agency in Canada for health, and the pre-allocation that happens to these outside agencies that are then supposed to go in and fix our problems as indigenous peoples, you see that the challenge we have in health is ensuring that those three things—accountability, resource allocation, and responsibility—are consolidated under the communities that have the issues.
We talk about this federal-provincial split in funding; in reality, the provinces and territories receive a per capita allocation for indigenous peoples. They are funded to provide care to indigenous peoples.
Though I appreciate the arguments from health ministers from our provinces that indigenous peoples tend to present with more advanced disease, sickness, or other things—yes, absolutely, that's shown in the research studies for all the reasons that you mentioned here, including things like food security, etc.—but before the money even gets to our communities, it's already spent. For every Health Canada program, they immediately take off 6%. That goes to government to allocate the money. Then there's another 15% or 20% that gets taken off the top to ensure that Health Canada is properly staffed to deal with our issues. If that money just went directly to our communities and there was infrastructure in place to ensure that it was properly monitored, and if there was follow-through on measurement, which doesn't even happen now with most of the programs that get administered in our communities, I believe you would see a big change.
That's what happens in the mainstream system. In the mainstream system, the health system does not sit there and take off a big chunk before the money and resources make their way to the communities that need the help. That's why the mainstream health system works: it's because there's an infrastructure there to ensure that accountability, resource allocations, and responsibility are consolidated at the proper levels. Is it as good as it could be? Absolutely not, but it's definitely a lot better than what's happening in our communities.
I think, from a broad system level, if we want to impact where resources flow and, more importantly, achieve the outcomes that we all want.... I know both government and indigenous communities are not happy with the results that we're getting right now with current levels of funding, despite being quite large in some areas. We have to look at accountability, which is who you answer to; we have to look at resource allocation, which is whose pocket the money goes into; and then we have to look at responsibility, at who is responsible for implementation. If we take those into our communities, we'll start seeing an impact.