You have asked why we are not offering detailed definitions of the components in a holistic approach. Our document provides a framework that contains fundamental components. The framework is based on an evaluation of programs that have been the most successful in our communities.
It must be recognized that, at the community level, there are currently many administrative obstacles related to program management. There is a diabetes program, the Aboriginal Head Start Program, etc. There is little flexibility allowing for the transfer of resources, the identification of priorities or the determination of the need for recruiting additional skilled personnel. We don’t necessarily have the resources to accomplish these tasks. The bureaucratic system currently imposes many limits.
When provinces receive transfers to finance health programs, they do not face the same bureaucratic constraints we do. We must comply with a myriad of details and definitions, program by program, and produce reports for the government which take much time and restrict our ability to implement such a holistic approach. That is one of the recommendations we made when we met with the First Ministers. Governments want sufficient transfers, with a reasonable rate of growth, every year. We also want the required flexibility to identify our priorities and the strategies that will work in our communities. As Mark was saying, “one-size-fits-all” solutions don’t work.
In fact, we should be able to adopt a public health approach that is in better harmony with recommendations made by international organizations since the 1970s.
Our document shows that there are links with housing and education but our budgets are not flexible enough for all sectors to really work hand in hand. Communities are structured like the federal government and we know that doesn’t work. There is no communication between sectors. It would therefore be very important to recognize that fact and to facilitate a holistic approach. Of course, we must not be too rigid otherwise we will find ourselves in the same situation as we are now, i.e. being forced to dedicate our resources to one or two components of a program, in which case nothing would get done.