A step back — not forward — for Indigenous health care

Hey there, time traveller!
This article was published 30/01/2021 (1906 days ago), so information in it may no longer be current.

In 2019, on the campaign trail during the federal election, the Liberals promised to develop “distinctions-based” health-care legislation for First Nations, Inuit and Métis communities in Canada.

This journey began Thursday, when federal officials announced nearly $16 million will be spent over two years for an “engagement process” to develop the legislation, designed to deliver “high quality” health care for these communities.

While the promise was years coming, the legislation has been sped up following the death of 37-year-old Atikamekw woman Joyce Echaquan in a Québec hospital, and other ongoing evidence of racism in Canada’s health-care system.

Proof was in the fact Echaquan and her community were mentioned several times throughout the announcement. The first words were: “Systemic racism remains embedded in our country’s health-care systems, with catastrophic effects for First Nations, Inuit and Métis communities. Indigenous peoples are entitled to receive first-class medical care, without fear of discrimination or maltreatment.”

The solution, the government suggests, is to develop “distinctions-based” policy.

“Distinctions-based” has become the federal government motto for all things Indigenous, emerging from the 10 principles the Liberals adopted in 2018, framing its “new” relationship with Indigenous peoples.

“The Government of Canada recognizes that a distinctions-based approach is needed to ensure that the unique rights, interests and circumstances of the First Nations, the Métis Nation and Inuit are acknowledged, affirmed, and implemented,” the 10th principle states.

Since then, the Liberals have promised “distinctions-based community infrastructure plans by 2030,” a “distinctions-based approach to Indigenous language revitalization,” even making all funding for COVID-19 responses “distinctions-based.”

While the term “distinctions-based” is a Liberal catch-all phrase, definitions are harder to come by.

The best definition the Liberals have provided is in the 10th principle that states: “First Nations, the Métis Nation and Inuit” are “distinct, rights-bearing communities with their own histories,” and the federal government’s “work of forming renewed relationships based on the recognition of rights, respect, co-operation and partnership must reflect the unique interests, priorities and circumstances of each people.”

If “distinctions-based” means that First Nations, Inuit and Métis must be considered differently (never mind the fact that there are thousands of political, cultural and social differences in those groups), the problem is the federal government has never worked this way. The constitution doesn’t operate this way either, and neither does much of federal law.

The Indian Act, for instance, is a one-size, single set of rules for all Indigenous peoples and it’s as firmly entrenched as ever. And while the federal government seeks to replace it with an “Indigenous rights framework” based on the United Nations Declaration on the Rights of Indigenous Peoples, anything that replaces it will definitively be generalized, national and certainly not localized, specific or “distinctions-based.”

This means the government is working almost backwards, trying to hammer a sense of diversity and complexity into a singular model of governing Indigenous peoples.

It’s like trying to make a set of rules for a house with exceptions for every room — one wonders what’s the point of singular rules if they’re always changing.

What this “new” Indigenous health-care legislation will no doubt resemble (yes, I’m predicting it now), is Bill C-92, the federal government’s approach to Indigenous child welfare.

Beginning this year, First Nations can agree to administrate their own child-welfare systems and make certain culturally specific changes, as long as they follow guidelines set by Canada and in aligning with standards set by provinces, which previously governed the majority of Indigenous child welfare.

Time will tell if C-92 will change the egregious proportion of Indigenous children removed from their families, but the bill basically turns First Nations, Inuit and Métis into fourth levels of Canadian government. The bill also hasn’t come with increased funding to support changes, potentially leaving some First Nations to repeat a broken system because they have no means to overhaul it.

Without a major constitutional discussion about the way Canada frames Indigenous jurisdiction (are those screams I hear?), it’s like trying to hammer thousands of round pegs in a single, square hole. While this path has never been tried, it certainly appears frustrating.

Is Indigenous independence so threatening that this country is going to waste years on a backwards, barely incremental and frustrating process that is sure to prove naysayers right?

What if the jurisdictions of Indigenous communities to establish their own health-care systems were recognized without strings and demands? What if land, governing and funding agreements were put in place where First Nations, Inuit and Métis governments established their own laws and facilities, and Canada operated in a (gasp) co-governing capacity?

What if there was no need for a “distinctions-based approach” because distinctions were inherent in Canada’s relationship with Indigenous peoples?

Sounds like a cure for racism to me. 

niigaan.sinclair@freepress.mb.ca