Thank you for that question.
I have worked with the public health system in Manitoba, because in part of my day job I am a provincial public health employee. I have a unique relationship, I think, with some of the different people, because I am a western-trained public health physician, but possibly because of my background and my interests and my previous research experience with first nations, I feel that I've developed a trust relationship with a number of the different representatives who have sat at our tables. Also, when I received the invitation to come here, I e-mailed them to ask them for any feedback I could represent on their behalf.
As far as the evaluation goes, the feedback I've had in the past and what I've witnessed myself is that there are many tables designed to provide a forum for communication. But on the first nations representation side, there has been a lot of frustration, because merely having the forum hasn't necessarily led to meaningful discussions or to resolutions of the issues. Things seem to have to come up again and again prior to there being any satisfactory resolution, if there is one.
What I've seen and heard more broadly from my own family members, friends, and community members indicates a significant lack of trust in the public health system as well.
Intuitively, I think we have had some wins. I mentioned one before: the aboriginal ancestry being recognized as a risk factor in Manitoba. So I think there would be positive findings also, but I think there was a lot that could have and should have gone better.
In terms of how an evaluation could be done, my suggestion would be that we consider an approach at arm's length from government. A professional organization such as ours would be willing and could consider leading some type of organization. The second most common specialty among physicians in our organization after family medicine is actually public health. We have a number of physicians who work in different federal and provincial public health systems with the requisite expertise as well as a number of very highly qualified researchers and appropriate international links that could help develop a really solid scientific methodology.
I think it could use a combination of standard epidemiological techniques, really getting to those rates, which would require open access to the data that PHAC and the provinces hold. It would also need to include other methodologies to collect information about the quality of working relationships, such as key informant interviews. Obviously a key factor would also be the organization of response structures and some feedback from the first nations on how they feel they were represented in those response structures, so that we could build better linkages and better representation among those.