Certainly I think the point we've tried to bring forward to the committee is in the fact that we are facing a 3% cap on the overall health budget on April 1, 2007. There will be cutbacks and pressures, and budget resources will be oriented towards those critical services such as nursing and transportation, where if you don't provide them, people will die.
The emphasis on population health, health promotion, and disease prevention will be reduced even more significantly than it currently is. We would very much like the committee to recognize the need for that broader population health approach. We've developed a public health framework for first nations that includes a list of core and mandatory programs--which define public health with a big “P”, so to speak--that would empower first nations governments to really address the root non-medical and medical determinants of diseases.
I think this type of approach would give them the flexibility to look at the school environment, as you just mentioned, and to really invest in a capacity to be able to deliver effective programs. If we continue to fund very specific programs that are highly targeted, there are some benefits, in that some materials can be provided and some standards can be developed. But at the same time, the limitations are that those programs are not made universally accessible to communities. For instance, the head start program is still a pilot program, and it was created almost ten years ago now. So is diabetes prevention. These are still pilot programs. Obviously there needs to be some real rethinking about how resources are invested and how the system overall is organized and structured. I think there needs to be that flexibility and an annual growth rate in transfers to first nations, so they can take greater control over how their programs and services are delivered.
You still need the economies-of-scale supports at the regional or sub-regional level to provide some broader population health capacity and expertise such as in the area of public health surveillance. That's still something that would be agreeable to first nations. But ultimately, that flexibility and that holistic approach needs to be fostered in first nations communities.