BC First Nations take next step in health governance

History was made on May 26 when the vast majority of 167 B.C. Aboriginal leaders voted in favour of a resolution framework that promises to open the door to First Nations-controlled healthcare.

Close to 500 people attended the fourth annual Gathering Wisdom for a Shared Journey 2011 Forum on the Tripartite First Nations Health Plan in Richmond May 24 to May 26. Only band chiefs or their proxies were permitted to vote on the resolution, however.

The framework, which will guide the development of a First Nations health authority, was created by information gathered by the First Nations Health Council (FNHC). The FNHC was created in 2007 to provide leadership in the implementation of the Tripartite First Nation Health Plan.
The 10-year Health Plan, signed by Canada, British Columbia and the FNHC, was designed to improve the quality of health and wellbeing for First Nations, as well as close the gaps in health outcomes between First Nations and non-Natives. The FNHC is made up of 15 Aboriginal representatives from the four regions of BC: the North, Interior, Fraser and Vancouver Island.

Since 2008, input gathered from community-based engagement hubs and 120 regional and sub-regional caucus sessions has been documented in five regional summary reports and then crafted into one Consensus Paper which outlines collective principles, values and mandates of all First Nations in BC with respect to future health governance.

“In my view this is a great opportunity to start building and delivering the understanding of actually taking a part in self-governance,” said Cliff Atleo Sr, president of the Nuu-chah-nulth Tribal Council. He occupies one of three Vancouver Island regional seats on the First Nations Health Council.

Although still in the early stages of development, those who approved the resolution say its adoption is a major step forward and many credit the FNHC for their work in the process.

“I’ve been involved in this kind of work for over 30 years,” the FNHC co-chair, Grand Chief Doug Kelly, told conference participants. “This is by far the healthiest, strongest, wisest, most determined council that I’ve ever had the privilege to serve with,” he said.

Kelly said the only request he made prior to the resolution vote was that people would make educated decisions on how they cast their ballot.

“When you consider saying yes, we want you to know what it means when you say yes,” he said. “But if you say no, we want you to know what it means to say no,” he told conference participants.
Kelly also expressed the importance of coming together as a First Nations collective, saying there is strength in the unity of First Nations people and communities.

“I encourage people to stay united,” agreed Jim Roberts of the Northwest Portland Area Indian Health Board. “There are going to be a lot of processes of institutions that try to divide and conquer through obstacles and barriers to the process,” he warned. BC may be the first province to approach this kind of self-determination in health, but Roberts has been involved in the United States Indian self-governance movement for years. He says there are many benefits to self governance if communities remained focused.

“It’s a very dynamic process [and] it’s a very interesting time and it may seem daunting at times regarding the task before you,” he advised. “[But] when tribes or Indian people take management of their own programs and services from others...what you end up with is a much better system.”

“Unity is power,” echoed Ron Allen of the Jamestown S’Klallam Tribe in Washington State and chairman of the National Advisory Committee of Self Governance Tribes.
“If you’re not unified you don’t need an enemy. [Just] look across the table,” he said to applause.

Mark Point from the Skowkale band of the Stolo First Nation agreed.

“We’re only as strong as our weakest link,” he pointed out. “If we look good on the outside but we stink on the inside then we haven’t done very much,” he added.
But while some gave advice and acknowledged concerns regarding what the resolution means for BC communities, others maintained that the need for First Nations independence and authority over health care was well worth the risk.

“As far as we can get away from that red tape that Indian Affairs and the federal and provincial governments put us in, we want to move that way,” expressed Joan Manual, proxy for Chief Judy Wilson of the Neskonlith Indian Band in the BC Interior. “We don’t want to be dictated to forever. We want to have a say,” she said.
“I certainly support our chiefs and our nations in moving forward and making decisions for themselves,” agreed regional chief of the BC Assembly of First Nations Jody Wilson Raybould.

“I see the work of the Health Council and Society as being something enormous,” she said. However, the [vote] doesn’t mean the work is done. Having passed this resolution is not going to solve all the problems, but it is a start,” she continued. “It’s significant in terms of change and the way we approach things and work collectively,” she said, adding that First Nations community members throughout BC must be informed of the details regarding the resolution so as to have greater input as the process unfolds.
“Every single person in the community will have a chance to have their input [and] you can’t ask for better consultation, communication and accountability than that,” added James Wilson, a member of the Vancouver Island Regional Health Council and co-founder of the Inter Tribal Health Authority. “We’re fully engaged and supporting the process and we’re developing a system in which every community is going to have input,” he promised.

Michael Hilson of Health Canada’s First Nations and Inuit Health says the federal government backs the resolution.
“Health Canada fully supports it,” he added.

But while the framework will provide BC First Nations with control over health care decisions, it won’t mean the severing of government ties completely.

“It isn’t like we’re going to do it on our own,” Atleo ensures. “There are partnership agreements that are going to be created between the federal government and us and the provincial government and us,” he added.”

Although funding agreements with the government will be made, Chief Bob Chamberlin of Kwicksutaineuk-Ah-Kwaw-Ah-Mish First Nation (Gilford Island) has concerns. While in favor of the resolution, he called on the provincial government to ensure funding be allocated to needed resources, adding that the province needs to realize that more money is needed for the future work of First Nations community healthcare hubs.

“I’m assuming that we’re going to be putting another layer of responsibility and tasks on the convenient hubs that are waiting,” he said. “There needs to be adequate funding for hubs, province-wide,” he stressed.
“Everybody in the room knows damn well that the dollars and resources that we have for health needs are horribly inadequate. We also know that the policies, procedures and programs do not meet the needs of our people. What the status quo is today is not good enough,” he concluded.

Of the 167 chiefs and dignitaries at the forum, 146 voted in favour of the resolution [87 per cent]. Of those who voted against, most said that they support the self-governance principle overall but had reservations regarding the lack of information about the future process and framework implementation.

“It’s the province I don’t trust [and] it’s Canada I don’t trust,” said Chief Michael LeBourdais of the Whispering Pine/Clinton First Nation in the Shuswap.

“The devil is in the details [and] it’s those details I need to know about,” he said, adding that he voted against the resolution as it stood.

But Atleo said the details will come later.

“This is not about us knowing what that health authority is going to look like,” he said. “The framework clearly states that we are going to go in the direction of the people,” he said.
However, while some publicly embraced the resolution, other’s understood community apprehension regarding the change.

“There is a lot of anxiety and fear of change and a fear of independence,” said Chief John Frank of the Ahousaht First Nation.

“[But] we’ve lost control of our fishing industry, we’ve lost control of our forestry and everything that’s coming into our territory, so this is a new beginning for us on how we can pick up independence this way, in our healthcare, which is really important,” he explained, adding that he was in agreement with the resolution.
Calling the existing framework for First Nations healthcare “inhuman,” Frank said changes must be made.
“They don’t care that my Elders can’t afford to buy glasses, they don’t care that my Elders can’t buy their dentures, that’s really inhuman and I think that if we had this in our hands we’d try to figure out how can we help our Elders and how we can help our people make it right for them. And that’s what it’s all about,” he said.

“It’s going to take time to get to where we need to be,” he added. “But we’ve got to start somewhere.”

The resolution is a 10-year framework agreement. The FNHC has been directed to develop a work plan in consultation with regional caucuses which is to be presented back to the caucuses for review no later than Sept. 1.

The regional caucuses are expected to provide feedback by Dec. 2.

The FNHC has been directed to continue sharing information, engaging with and being accountable to their respective regional First Nations communities.
To get more information on the First Nations Health Council and to view the resolution, go to www.fnch.ca