Region saves money while patients' needs go unmet

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In the same week that Grand Chief Chris McCormick of the Association of Iroquois and Allied Indians told the United Nations that First Nations health in Canada is in pitiful condition, a British Columbia chief told Windspeaker that money allotted to First Nations health concerns was not distributed in the last fiscal year.

"They sent money back this year and I'm really pissed off about that," said Sowalie First Nation Chief Doug Kelly on May 18. "Pacific region had a $2 million surplus on dental. They budget about $20 million and they only spent about $18 million. And a little bird who would know these things told me Health Canada nationally lapsed money."

In other words, millions of dollars set aside for healthcare for First Nations people was not spent, despite the desperate need.

Kelly and Assembly of First Nations (AFN) National Chief Phil Fontaine met with Ian Green, the deputy minister of Health Canada, on April 27. Kelly reports he told the department's top bureaucrat during the hour-long meeting how he felt about that situation.

"I brought up the fact that federal bureaucrats get their bonuses whether they earn them or not and I told Ian Green he should have been paying us. I told him I expect a much better performance," Kelly said. "What's happened here is a reason to cut the pay of government officials, not give them bonuses. They should be disciplined."

Federal officials receive what's called "at risk" pay of up to 25 per cent of their salaries each year. Although it's supposed to be an incentive that's earned for good performance, Conservative Party of Canada government spending watchdog John Reynolds has said that very few bureaucrats don't receive the extra pay.

Ottawa sources say Green issued an edict to the regional directors general at the beginning of the last fiscal year that no deficits would be allowed. Whereas in the past Health Canada headquarters kept some money in reserve in case of emergencies or unexpected over-runs, Green's order caused increased conservatism within the First Nation and Inuit Health Branch [FNIHB] of the department.

Kelly said he has uncovered two major problems with the provision of health care by the federal bureaucracy.

"The program is underfunded. And there are winners and losers in the way Ottawa allocates the money," he said.

A Native person's chances of receiving approval for expensive orthodontic care depends on which bureaucrat that person deals with.

"It seems there's an angel who approves orthodontic care if there's a legitimate need, and a devil. If you get the latter, no matter how bad off you are, you won't get it," he said. "There should only be one standard."

The Stolo Nation chief said it's obvious that the First Nations and Inuit Health Branch of Health Canada is severely underfunded.

"How do I know it's underfunded? It's broke every year. And there have been cuts every year and they're cutting into the bone. There may have been some fat there at one point, but it's long gone. Very clearly there's a problem there," he said.

Cuts to non-insured health benefits have been steady for the last number of years. Levels of dental care have been lowered and generic drugs are covered while more expensive drugs are not. Few areas have escaped funding cuts of one sort or another. Some programs have seen their funding levels frozen since 1996 even though the Native population is the youngest and fastest-growing in Canada.

Kelly said the underfunding makes it difficult for bureaucrats to cope.

Chris McCormick sees the same thing. In Ontario, the FNIHB is $9.7 million in the red with a forecasted deficit for 2004-2005 of $11 million.

Al Garman, the regional director general [RDG], announced cuts to a variety of programs to make up that deficit.

Some of the cuts were announced, McCormick said, but the funding was reinstated when the chiefs scheduled a press conference to express their outrage.

McCormick old the UN Permanent Forum on Indigenous Issues that Canada may rank 8th on the human development index but First Nations rank 63rd.

"We are essentially a Third World society living in one of the top 10 countries in the world," he said. He told the international body that First Nations people have a suicide rate that is five to eight times higher than Canadian averages, five times more diabetes, 10 to 12 times as many communicable diseases and an infant mortality rate that is one-and-a-half times as great as Canadian norms. He said poor housing, poor water and sewage systems and the harm created by the residential school system are among the reasons why Native people are not as well off as Canadians in general. He also told the permanent forum about the cuts that were announced to programs aimed at improving the health of children and then withdrawn. McCormick quoted from a letter written by the Ontario RDG.

"[E]ven though children's programs will be reinstated, this does not relieve the obligation to find a way to balance planned expenditures to the budget available."

Then continuing with his own remarks, McCormick said "This falls on the heels of program funding cuts to balance a deficit of approximately $9.7 million for the previous year. This is an example of the Canadian government's agenda. Cost containment, not improved health for First Nations."

McCormick, in a letter to Health Minister Pierre Pettigrew that was obtained by Windspeaker, questioned whether bureaucrats have the right to pay down deficits with program dollars.

"As we understand, Treasury Board allocates specific resources for specific program areas for [FNIHB]. As First Nations, we are constantly reminded by FNIHB staff that we [must] use resources for the exact purposes they are allocated for," he wrote. "If we do not, we are then considered in breach of our contribution agreement and these resources will then be recovered by Health Canada. If we as First Nations must follow sringent guidelines when spending funding, why then does the Canadian government, more specifically Health Canada [FNIHB], not have to follow these guidelines?"

Problems in health seem to exist in every region. Manitoba's Sandy Bay First Nation Chief Irvin McIvor said it's a problem that must be confronted immediately.

"Health is a very, very serious issue and it's not being addressed. Health has to go to the national level and we have to fight and we have to fight now," he said.

He told Windspeaker that only two dentists are accepting non-insured claims in Winnipeg, a city with perhaps the highest number of Native people in Canada.

"And there's 64 First Nations in Manitoba. How are these two dentists going to address the concerns of 64 First Nations? It's ludicrous how this government looks at First Nations. It's becoming more and more evident every day," he said.

One of the greatest scourges afflicting Indigenous peoples in Canada is given only token attention, he said.

"I think they gave us $5,000 last year to fight diabetes and it's ridiculous. It's hardly enough for one patient," he said.

AFN health technicians are excited about a remark made by the health minister at a health policy summit held in Toronto on April 19 and 20. Pettigrew was the keynote speaker on the second day.

In his speech, Pettigrew stated, "We have a profound duty to improve the health status of Aboriginal people. That is one of the reasons why the prime minister hosted a [Canada-Aboriginal roundtable] on Aboriginal issues yesterday...We know we must do more to achieve better outcomes for Aboriginal men, women and children."

AFN health renewal policy analyst Cynthia Stirbys then asked him, "In your address, you mention involving new partners. Mr. Minister, can you then outline how you see First Nations people and First Nations leaders involved in achieving better outcomes in health status?"

Pettigrew answered, "It is a good question and a timely one because of th [roundtable] held in Ottawa yesterday. The government has a fiduciary responsibility [to Aboriginals], as you know."

The minister also mentioned he toured the country in January and was able to see first hand the special challenges in Aboriginal communities.

Nice words, said Kelly, but they do not reflect the actions of officials in the minister's department.

"The government of Canada seems to hear it when the provinces get up and raise hell about health funding but there's this refusal to hear when First Nations say FNIHB is underfunded," he said. "I've been telling them the funding has to be needs based. All I've been saying seems to be falling on deaf ears."

He said the word is going to have to filter down through the bureaucracy if Native people are going to believe all the promises made by the prime minister in recent months.

"I hear the Right Honorable Prime Minister Paul Martin tell me and all the other First Nation citizens he wants to make a difference, and I believe him. The problem we've got is the people he's got working for him aren't listening," Kelly said.

He said Pettigrew has not been an active and effective minister.

"He's been ducking me. I'm hopeful the Liberals get a majority government and that the prime minister will then give the job to somebody who wants it."

Kelly believes Pettigrew's other responsibility as intergovernmental affairs minister is receiving most of the minister's attention.

Kelly was outraged to learn that two senior Health Canada officials, Assistant Deputy Minister Ian Potter and Pacific Region RDG Dr. Jay Wortman, attended health conferences in Australia and New Zealand recently.

"They can find the money to send two people on this trip but they can't find money to treat Native kids and adults who sorely need it," he said. "They should all be at home manning their posts."

He noted that B.C.'s provincial health minister was actively lobbying for increases in health funding and suggested FNIHB