Health Committee on April 21st, 2020

[The Chair, Liberal, Ron McKinnon]

I now call this meeting to order. I welcome everyone to meeting number 14 of the House of Commons Standing Committee on Health. Pursuant to the orders of reference of March 24, April 11 and April 20, 2020, the committee is meeting for the purpose of receiving evidence concerning matters related to the government's response to the COVID-19 pandemic.

Today's meeting is taking place by video conference, and the proceedings will be made available via the House of Commons website. As at the last meeting, the website will always show the person speaking rather than the entirety of the committee.

I will go through a bit of housekeeping in order to facilitate the work of our interpreters and ensure an orderly meeting.

I will outline a few rules. Certainly, interpretation in this video conference will work very much as in a regular committee meeting. You have the choice at the bottom of your screen of either floor, French or English. The bottom of the screen applies if you are using a personal computer; if you are on an iPad, it's slightly different.

Before speaking, please wait until I recognize you by name. When you are ready to speak, you can either click on the microphone icon to activate your mike, or you can hold down the space bar while you are speaking. When you release the bar, your mike will mute itself just like a walkie-talkie.

As a reminder, all comments by members and witnesses should be addressed through the chair. Should members need to request the floor outside their designated time for questions, they should activate their mike and state that they have a point of order.

If a member wishes to intervene on a point of order that has been raised by another member, they should use the “raise hand” function. This will signal to the chair your interest to speak. In order to do so, you should click on “participants” at the bottom of the screen if you have a PC. When the list pops up, you will see next to your name that you can click “raise hand”.

When speaking, speak slowly and clearly. When you're not speaking, your mike should be on mute.

The use of headsets is strongly encouraged. If you have a microphone on your headset that hangs down, please make sure it is not rubbing on your shirt during your questioning time.

Should any technical challenges arise, such as in relation to the interpretation, or if you are accidentally disconnected, please advise the chair or clerk immediately and the technical team will work to resolve the problem. Please note that we might need to suspend during these times as we need to ensure that all members are able to participate fully.

Before we get started, could everyone click on their screen, in the top right-hand corner, and ensure they are on gallery view? With this view, you should be able to see all the participants in a grid arrangement. It will ensure that all video participants can see one another.

During this meeting we will follow the same rules that usually apply to opening statements and questioning of witnesses during our regular meetings. Each witness will have 10 minutes for an opening statement, followed by the usual rounds of questions from members.

I would now like to welcome our witnesses.

From the Department of Indigenous Services, we have Ms. Valerie Gideon, senior assistant deputy minister of the first nations and Inuit health branch; Dr. Tom Wong, chief medical officer and director general of the office of population and public health; and Chad Westmacott, director general of the community infrastructure branch.

From the Inuit Tapiriit Kanatami, we have Natan Obed, president; and Aluki Kotierk, who is a member of the board and president of Nunavut Tunngavik Inc.

From the National Association of Friendship Centres, we have Christopher Sheppard-Buote, president; and Jocelyn Formsma, executive director.

Finally, from the Southern Chiefs' Organization Inc., we have Grand Chief Jerry Daniels.

Welcome, everyone. We will now commence with statements from the panel.

We'll start with the Department of Indigenous Services.

Ms. Gideon, please go ahead.

[Valerie Gideon, Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indigenous Services]

Thank you very much, Mr. Chair.

I would like to thank you all for inviting me to appear before this committee on the issue of COVID-19. I want to begin by acknowledging that I am on the traditional territory of the Algonquin people, and I am here today, along with my colleagues, to discuss the unique strengths and challenges faced by first nations, Inuit and Métis in preparing for and responding to COVID-19.

First nations, Inuit and Métis know their communities and their community members. They know what will work and what will not work. The effectiveness of the government's response to COVID-19 among indigenous peoples relies on our ability to listen and provide support, tools, resources and reliable and timely information communicated in a culturally informed way.

The challenges faced today by indigenous peoples are related to poor social determinants of health and higher rates of respiratory and chronic disease. These challenges are well documented in countless detailed studies, including the Royal Commission on Aboriginal Peoples, the Truth and Reconciliation Commission, and the missing and murdered indigenous women and girls inquiry. These challenges are highly relevant to the COVID-19 planning and response required.

Lessons learned from H1N1 demonstrate the importance of connecting health to the social determinants of health in pandemic planning. The establishment of Indigenous Services Canada has strengthened the government's ability to focus its efforts, aligning the public health response with supports in social programs, critical infrastructure and broader emergency management. Investing in pandemic planning capacity and readiness across communities was also an important lesson learned.

With budget 2019 resources of $79.9 million over five years, Indigenous Services Canada proactively invested in first nations' capacity at the regional, tribal council and community levels in health emergency preparedness. The department also established a public health emergency network made up of regional medical officers and regional coordinators, including in emergency management, environmental public health and communicable disease emergency coordinators, to advise and support first nations across provinces.

While this capacity provided an important foundation, the need for communities and the department to adapt broad pandemic plans to the unique context of COVID-19 requires additional support and resources. It is also equally important to recognize the need to expand the support to first nations in the territories, Inuit, Métis, self-governing nations, indigenous individuals living away from their communities and indigenous communities within urban centres.

This is why the Government of Canada invested $305 million in the distinctions-based indigenous community support fund. These funds are provided to communities while maximizing their flexibility to respond to the immediate needs of their members. They include an urban and regional indigenous organization envelope of $15 million. Some of the needs being addressed through the community support fund are food subsidies for households; supports to control non-essential travel in communities; surge capacity costs for staff, critical equipment and supplies; and mental health supports.

In addition to the indigenous community support fund, the department is working with other federal colleagues to ensure that first nations, Inuit and Métis individuals can access the broader COVID-19 economic response plan benefits available to workers, families and businesses. Ten million dollars will be provided to Indigenous Services Canada's existing network of 46 emergency shelters, located on reserve and in Yukon, to support indigenous women and children fleeing violence. Approximately 329 first nations communities have been served by Indigenous Services Canada's funded emergency shelters.

On April 18, the Government of Canada announced up to $306.8 million in funding to help small and medium-sized indigenous businesses and to support aboriginal financial institutions that offer financing to these businesses. These measures will help 6,000 indigenous-owned businesses get through these difficult times and play a key role in the country's economic recovery.

Economic prosperity is an important determinant of health, particularly when you consider the younger age distribution among indigenous peoples.

In terms of my department's specific public health measures, I wish to highlight some of the core elements and activities of the response to date. While the exposure and number of confirmed cases among first nations and Inuit to date have been relatively limited, 0.01% of the total first nations on-reserve population compared to 0.09% for the rest of the population, vigilance is essential as the numbers are gradually increasing.

Communications and protocols have been critical, with multiple visual and social media channels being utilized and a heavy emphasis on adapting national public health guidance to target community priorities, including physical distancing, limits to non-essential travel, personal protective equipment, home and community care, long-term care and nursing homes on reserve, non-insured health benefits medical transportation, self-screening of health providers and visitors, access to testing and funerals.

As an example, we are supporting indigenous communities to implement adapted culturally relevant public health measures to promote physical distancing on the land. Translation of materials in indigenous languages will also continue.

At a national level, weekly briefings are taking place with the Assembly of First Nations chiefs committee on health, the Inuit public health task group and representatives of the Métis Nation. We are working closely with indigenous, federal, provincial and territorial partners through the public health working group on remote and isolated communities to ensure that the unique needs of these communities are met and that adequate preparedness, supplies and response levels are in place.

Weekly "touch bases" have also taken place with the National Association of Friendship Centres and the First Nations Health Managers Association. The department is also keeping apprised members of the indigenous women's well-being advisory committee, co-chaired by the National Aboriginal Council of Midwives and Pauktuutit.

At a regional level, our regional officials have either daily or multiple weekly calls with indigenous partners and work on a daily basis with provincial and territorial colleagues. As you know, health care is a shared jurisdiction, which raises the significance of coordination and collaboration among first nations, Inuit or Métis-led services with those of Indigenous Services Canada, other federal departments, provincial or territorial governments and their public health authorities.

During this pandemic, clarity of roles and responsibilities can remain a challenge, but thankfully, regional offices have spent recent years strengthening trilateral partnership tables. Relationships are well established and a strong asset in this COVID-19 response.

Indigenous Services Canada plays a more direct role for primary health care in 79 remote first nations communities and for public health among first nations on reserve across provinces, with the exception of British Columbia where the department acts as a funding and governance partner with the B.C. First Nations Health Authority.

Specifically, the department has mobilized its national health emergency network and regional command centres to actively support communities in updating testing and activating their pandemic or their all-hazards emergency plans. It has assessed more than 550 requests to the department stockpile for personal protective equipment and hand sanitizer, within 24 hours, intended for first nations health care workers. It has set up emergency contracts for surge nursing and paramedic capacity available to first nations health and long-term care facilities across provinces and identified additional physicians for the Society of Rural Physicians of Canada. It has worked with the Public Health Agency of Canada on the availability of swab tests, where these cannot be provided by provinces, and point-of-care testing in and/or near indigenous communities when those become available.

With fewer commercial flights and travel restrictions in place, the department has secured stable means to transport health professionals and needed supplies to remote first nations communities. Finally, we have directly purchased or funded alternative infrastructure for medical purposes or for accommodation. With a focus on remote communities, retooling existing space in schools, band offices or hotels is the preferred and fastest option. However, where this has been deemed impossible, 41 mobile medical units and 17 multi-purpose mobile trailers have been secured so far.

I understand the committee has been provided a copy of a dashboard we developed to provide to the committee some key information as it relates to COVID-19 and indigenous communities.

Indigenous Services Canada is also ensuring that additional supports are available through the emergency management assistance program, income assistance, non-insured health benefits, Jordan's principle, the Inuit child first initiative, and first nations child and family services.

When Indigenous Services Canada is made aware of COVID-19 tested positive cases, we work in collaboration with key partners to ensure appropriate health care is available for affected individuals; to implement immediate measures to reduce further community spread including contact tracing; and to identify any additional support that may be required. The health and safety of community members is a top priority, as is the need to respect the privacy of those who are sick with COVID-19.

With flood and fire season approaching, I want to assure you that the department is working closely with first nation communities to prevent any additional challenges that seasonal flooding and other natural disaster emergency situations may present in the midst of responding to the COVID-19 pandemic.

We are working to ensure that emergency seasonal evacuations continue to happen within the context of COVID-19. Confirmed and presumptive cases of COVID-19 will be assessed and treated using appropriate public health and primary care measures. Infection prevention and control measures are put into place to ensure that community members who are being evacuated are protected from being exposed to COVID-19.

We are learning and adapting quickly as the COVID-19 pandemic evolves. Currently, we are focused on enhancing our response efforts in key areas. We are partnering with indigenous organizations to ramp up and tailor communications to their needs, including youth, urban-based and northern populations.

We are working collaboratively with first nations on ensuring access to mental health resources, including virtual counselling, crisis lines surge capacity and strategies to cope with alcohol, opioid and methamphetamine addictions.

[The Chair, Liberal, Ron McKinnon]

Ms. Gideon, could you please wrap it up? You're at 13 minutes.

[Valerie Gideon]

Okay.

Lastly, recognizing the large number of indigenous individuals residing in urban centres, we will continue to do outreach and collaborate with indigenous organizations, provinces and territories to offer extra support.

I want to assure you that we are taking this matter very seriously to ensure that no indigenous person or community is left behind.

I would be pleased to take your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Gideon.

Next on my list is ITK. However, Mr. Obed is having trouble connecting. We will therefore go to our next group and get back to ITK shortly.

The next group is the National Association of Friendship Centres.

You have 10 minutes, please.

[Jocelyn Formsma, Executive Director, National Association of Friendship Centres]

Good afternoon, everyone. I am going to do the first five minutes and then I'm going to hand it off to our president, Mr. Sheppard-Buote.

My name is Jocelyn Formsma. I am the executive director of the National Association of Friendship Centres, NAFC. I am originally from northern Ontario. My family is from Moose Cree first nation, and I grew up in the surrounding area in my territory.

Friendship centres have been on the front lines of the COVID-19 response since the first day. I will give some examples of what they have been doing. They have been responding to increased service demands, delivering food to families, young people and elders. They have been responding to calls for assistance and support, and we've found that there are additional calls around sexual assault and family violence. They have also been providing mental health and cultural supports for urban indigenous community members. They have been asked to lead task forces or have just started them on their own, responding to the needs in urban settings. They have been asked by mainstream agencies to help deliver supports. They've been emptying their food stores, cooking food for community members and picking up and delivering food and traditional medicines.

We've even had an example of a friendship centre that went to a family home to deliver food, and they found out that the family's stove had broken down. They purchased a stove and arranged for it to be delivered to the home. In another instance, we found that they were delivering food to a family and that the father was very ill. They convinced him to go to the hospital so that he could seek medical attention. He thought that, whatever he was dealing with, he was safer at home than going to the hospital to deal with that medical issue. Although it wasn't COVID-related specifically, there are so many things that friendship centres have been doing to step up in this space.

The NAFC represents 107 local friendship centres and provincial and territorial associations, operating in every province and territory in Canada except Prince Edward Island. The services offered are as diverse as the communities in which they are located. They key point is that they are all culturally informed and culturally appropriate.

The NAFC received word from Indigenous Services yesterday that we will be receiving $3.75 million from the indigenous community fund, and that was representative of 100 different organizations, including the NAFC, six provincial and territorial associations and 93 local friendship centres. We certainly appreciate the support, but we know that these funds will not last long, and we welcome the opportunity to work with the government to seek additional supports for friendship centres.

Friendship centres are experts in urban indigenous service delivery. Since the 1950s, we've been working in a wide variety of our communities from Inuvik to Montreal to Labrador, Vancouver Island and everywhere in between.

Indigenous people, as we know, are diverse. A diversity of approaches and partners are needed to respond appropriately to this COVID-19 pandemic. We know that friendship centres are already providing services, food, supplies and staffing. We need support for creating safer spaces now and in the future. We need support for equipment and information technology, software, hardware and protective equipment for our staff, volunteers and community members.

The distinctions-based approach has affected urban indigenous pandemic responses. In echoing the words from the MMIWG inquiry report, we believe and would advocate that distinctions ought to be defined with an intersectional lens, not just including first nations, Métis and Inuit, but also considering the residence of indigenous people, the province or territory that they're in, whether they're remote or northern residents, their physical and mental abilities and their sex, gender identity and sexual orientation. We believe that, by including an intersectional lens to distinctions, we will be better positioned to provide wider and greater supports for urban indigenous community members.

I will provide the committee with a bit of context. In the early weeks, we found that jurisdictional wrangling had an effect on our ability to respond. As a national association, we immediately went to Indigenous Services and received word that the provinces and territories would have been expected to step in within the urban spaces for indigenous people, but when our provincial and territorial associations went to the provinces and territories for support, they were saying that we should be going to the federal government for financial support. This led to a lot of running around for friendship centres and nobody taking full responsibility.

We know that first nations, Métis and Inuit are a priority group for testing. They're a community of concern for the virus. We want to ensure that urban indigenous voices are considered and that our communities are considered in whatever approaches are taken to respond to this pandemic.

I'll hand it off to President Sheppard-Buote to wrap up our comments.

[Christopher Sheppard-Buote, President, National Association of Friendship Centres]

I'm going to take a bit of a different frame. What I am really concerned about, more than the timing and everything else, is that the Government of Canada continues to frame urban indigenous communities as somehow different or separate from our relatives who continue to live in their respective historical or current territories.

Since the 1950s, friendship centres have been the direct result of indigenous self-determination, designed to be a support foundation for indigenous people in cities, who for many reasons, ended up there. Friendship centres provided a safe haven that was fabricated from indigenous ways of knowing, outside and beyond historical government-determined boundaries. Current data shows that indigenous people will continue to move to urban centres and the numbers will continue to increase in urban centres. Systems, programs, pandemic planning and public policy are still crafted from a perspective that does not appropriately reflect where indigenous people live.

This can be most easily seen during this current health crisis. The majority of the support fund did not require a request for proposal process, whereas urban people were required to create a proposal. In most instances, it required our national association to intervene in the work they were doing on the ground, to ask questions to make sure we were getting the appropriate data to complete an application to get support for our organizations on the ground.

While friendship centres historically have been designed as wraparound civil society organizations, we have been fighting this notion that across the spectrum of program design within federal systems, there is very little space for urban people. This current situation is highlighting and compounding other problematic realities.

When you look at historically ineligible items to support your community, such as food security, in a time when food security is one of the biggest barriers in our communities, and our organizations know it's not typically an eligible expense, it takes a lot of written confirmation before they will be comfortable spending those resources. They have a huge fear of being told that what they're doing is ineligible.

I'll finish with this. It may seem unusual to a lot of people right now that you go to work every day fighting to keep people alive, but this is a normal occurrence in our organizations all the time. COVID-19 and keeping people alive is not strange territory for us. When you have urban people who are borderline invisible and not quite distinct enough, it takes an incredible amount of work, energy and response to make sure they have the best health outcomes every day. So it's very normal for our organizations not to even consider closing and to keep working, because this is their everyday life.

As we move forward, my hope is that policy responses to a health crisis like we're in right now represent the reality for urban people and for indigenous people in this country. Out of $305 million, $15 million is set aside for where the majority of us live.

Thank you.

[The Chair, Liberal, Ron McKinnon]

We'll go now to the Southern Chiefs' Organization, with Grand Chief Jerry Daniels.

Grand Chief, please go ahead for 10 minutes.

[Grand Chief Jerry Daniels, Southern Chiefs' Organization Inc.]

Thank you.

I would like to start by acknowledging that although we may not be together in the same place for this meeting, we are all on Turtle Island. Indigenous peoples have been on this land since the first sunrise.

I want to take a moment to acknowledge our elders, who are the keepers of our knowledge and culture and who are at increased risk during this health pandemic. I want to acknowledge all the people who are working hard on the front lines and behind the scenes to keep indigenous nations and Canada safe from COVID-19.

I would like to acknowledge the leaders and community members on the ground who are putting themselves at risk to ensure operations are maintained and families are taken care of. Whether it is running errands for others, delivering supplies such as groceries, water or medicine, or standing for hours at the road checks to help flatten the curve, I want to say chi-meegwetch, thank you from the bottom of my heart for doing that work and being the backbone of this country right now.

I thank the committee for the work you are doing and for inviting me to speak today about Canada’s response to the COVID-19 pandemic. I will speak about how the pandemic is impacting indigenous Anishinabe and Dakota people in what is now southern Manitoba.

I hope that this meeting will be fruitful and further inform the way forward. In my presentation I am going to focus on four key determinants of first nations health, how they are impacted by the COVID-19 pandemic and what is needed to effectively support our communities. At the heart of the determinants of health are inequities in the health system, inequities with federal funding, and ongoing inequities the communities are facing that make our elders and our youth so vulnerable.

I begin by focusing on health inequities that first nations people face in Canada. When it comes to accessing health care services and professionals, indigenous peoples are the most marginalized in the country, with the poorest health outcomes. As just one example, a joint study released last year by the First Nations Health and Social Secretariat of Manitoba and the Manitoba Centre for Health Policy demonstrated that decades of poor health outcomes have resulted in a gap in life expectancy between status first nations and all other Manitobans that now sits at 11 years. Shockingly, this 11-year gap is growing.

This lack of access to health care was allowed to develop over decades and many administrations. First nations reserves are often remote and far from major cities in which there is better access to health care. It is important to remember that displacement of Anishinabe and Dakota nations made way for those cities, such as Winnipeg and Brandon, with large health hubs and resources. I am concerned about our fly-in communities such as Poplar River, Pauingassi and Little Grand Rapids, which are particularly vulnerable in this pandemic. When the rest of the country comes to a halt or adjusts its production, transportation and distribution schedules, the impact hits our remote communities hard. They rely on supplies and health professionals from outside of their communities. For first nations living off reserve, we need only think of the death of Brian Sinclair to know that racism and stereotypes can be deadly in our cities as well.

As we continually check in with our communities, we hear their concerns. I can tell you that as of yesterday, Little Grand Rapids is experiencing a shortage of liquid baby formula at their Northern store. We ask that the systemic inequalities be addressed once and for all, with increased access to health care on reserve, with special consideration for remote communities.

Sadly, the inequities continue with the response to COVID-19. While we applaud the initial steps of this government with the indigenous community support fund, and are encouraged by the aid announced over the weekend for indigenous businesses suffering COVID-19 losses, there is a monumental financial shortfall that will cause hardship. This past Friday, CBC’s Power & Politics host Rosemary Barton estimated that an unprecedented $113 billion has been allocated to help Canada thus far with the pandemic. Only $621 million is earmarked for indigenous communities. The 2016 Canadian census reported that indigenous people account for 4.9% of the national population, yet indigenous people are receiving just over half of 1% of the relief funds allocated by Ottawa. This is clearly disproportionate, and first nations are still left to manage in poverty.

While the argument may be that first nations are eligible for some of the billions in aid available to regular Canadians, for example, the increase in GST rebates or child tax credit, that will not be close to the extent that would close the gap between $621 million and the $113 billion. We ask that the funding for the indigenous community support fund be increased to equitably reflect the first nations population and realities, realities created by many consecutive Canadian governments. We ask that any proposal processes move quickly to the approval stage due to the state of emergency we find ourselves in.

Another area of concern is off-reserve members of our communities. Approximately half of first nations populations now live off reserve and in urban centres, yet we are not funded to care of our off-reserve members.

Chiefs are receiving calls every single day asking for help. With just $15 million of the indigenous community support fund allocated for urban indigenous peoples and divided among first nations, Inuit and Métis organizations across the country, it is simply not enough.

We ask that the funding for off-reserve services be increased to appropriately reflect population dynamics in urban centres.

I will now take a moment to highlight other inequalities that impact first nations, specifically food security and infrastructure deficits.

When it comes to food security, indigenous peoples have been in precarious and vulnerable situations since the disruption of our agricultural and hunting economies. Because so many of our families are already experiencing food scarcity, this crisis has made this situation so much worse.

We rely on strong partnerships, like the one with the Breakfast Club of Canada. Our 34 communities applied to the COVID-19 emergency fund, with a low barrier application and fast response. A big meegwetch to the Breakfast Club of Canada for their strong support.

As first nations, we have always hunted, fished and trapped to survive and feed our families. In this time of crisis, with restricted movement to the surrounding cities and municipalities, we are trying to return to traditional food sources and harvesting to increase our food security.

We ask for financial help to support the implementing of community food security projects.

The COVID-19 pandemic has reinforced that there is a lack of housing and a poor quality of existing infrastructure on reserve.

Where do you isolate in a community when there are chronic housing shortages and more than a dozen people in one home? There is a lack of on-reserve facilities and resources for community members struggling with addictions.

While we applaud the $50-million allocation for women's shelters and sexual assault centres, which includes up to $10 million for facilities on reserve and in indigenous communities, more is needed. There are only 46 shelters funded by Indigenous Services Canada across the entire country.

We ask for more investment in first nations' infrastructure for housing facilities and shelters.

Lastly, I would like to speak about the well-being of our elders and our youth.

From conversations with our chiefs and members, we know that many are concerned about the safety of our elders from the virus that disproportionately kills older people.

Elders are sacred in our communities. Not only are they much loved members of our families, but they carry our culture and knowledge, languages, our histories and traditions.

If the disease hits our communities and the personal care homes like it has in other provinces, it would deal a heavy blow to the intergenerational knowledge systems of our people. We need our elders close and cared for. We need more homes on reserves because our elders are not always treated well in personal care homes off reserve. We have just two personal care homes for elders in all of our 34 communities.

I want to acknowledge and thank the hard work and dedication of the Manitoba first nations personal care home network, our leaders of the on-reserve care homes in Manitoba.

Our communities are also worried about our youth, especially those in post-secondary education. The economic fallout poses a real risk, with no summer job prospects this year and no child care to support single parents. Attending post-secondary programs this fall may not be possible.

Indigenous youth have some of the highest rates of suicide and self-harm in the country, and are overrepresented in the child welfare system. Mental health supports and resources to keep youth engaged during this time of isolation are critical.

We ask for a measurable increase in mental health supports and a new commitment to address addictions on reserve.

We ask for an investment of four additional personal care homes that can serve Anishinabe and Dakota elders in our communities.

I have spoken of the current health inequalities and of the inequitable response to COVID-19. I have spoken of the food security and infrastructure challenges exacerbated by the pandemic.

As I conclude, I want to leave you with a new vision of health transformation.

First nations do not want to inherit a broken health system, but to create a wellness model with our governance and our values, a new and groundbreaking health system for all southern first nations communities that will begin to close the gaps.

We are days away from signing a memorandum of understanding with Canada to make this happen. I should not die a decade before you because I am an Anishinabe man, and my son should not die a decade before your child because he is an Anishinabe.

Let's work towards the Truth and Reconciliation Commission of Canada's call to action 19 and identify and close the gaps in health care outcomes. Reconciliation can mean letting go of the structures and the faulty dynamics that have plagued our relationship for generations.

Statistics and reports document the legacy of systemic neglect and negligence in the health care system for first nations, but together we can build a new future founded on true partnership as the treaties intended.

Chi-meegwetch.

[The Chair, Liberal, Ron McKinnon]

Thank you, Chief.

I see that Mr. Obed has been able to join us. I'm sorry for the connectivity issues.

We go now to Inuit Tapiriit Kanatami and Mr. Obed.

[Natan Obed, President, Inuit Tapiriit Kanatami]

Nakurmiik. Thank you. I'm glad that I was able to get on the call.

Inuit Tapiriit Kanatami is the national organization representing 65,000 Inuit in Canada, the majority of whom live in Inuit Nunangat, our homeland, and that encompasses 51 communities over possibly a third of Canada's land mass. All but two of those communities are fly-in, fly-out communities exclusively during the winter months and only a handful of those communities are serviced by marine ferry during the summer.

ITK is governed by the elected leaders of the Inuvialuit Regional Corporation, Nunavut Tunngavik, Makivik Corporation and Nunatsiavut Government. These four representational organizations and governments are Inuit rights holders under section 35 of the Constitution, having negotiated comprehensive Inuit-Crown land claim agreements between 1975 and 2005.

It is therefore appropriate that the Crown engaged Inuit rights holders in the COVID-19 response. ITK has helped facilitate regional engagement with the Government of Canada throughout this process through our national governance structures. There's a very large gap between Inuit and non-Inuit Canadians on key measures of importance to health such as housing, income, food security and access to medical care.

A few key examples in relation to COVID-19 are that 52% of Inuit in Inuit Nunangat live in overcrowded homes whereas only 9% of non-indigenous people in Inuit Nunangat do. The median income level for Inuit in Inuit Nunangat is $23,000 whereas the median income for non-indigenous people in our homeland is $92,000, which is about four times greater. In many of our communities, individuals are often multiple flights and days away from emergency or intensive care, as we have health centres instead of hospitals in the majority of our communities.

COVID-19 poses a particularly high risk to the health and well-being of Inuit living in Inuit Nunangat and also in urban centres. It's crucial to understand the unique and considerable vulnerabilities that create these negative outcomes in both illness and disruption in service in Inuit communities. We have been working with the federal government throughout the last six to eight weeks in regards to an Inuit-specific distinctions-based response.

There are three considerations that I'd like to discuss today. The first is in relation to public health measures to prevent the circulation of COVID-19 in our communities, and it starts with testing. We struggled with the limited availability of testing and the long turnaround times. This has also been our experience in our TB epidemic. There are significant negative consequences in not having immediate results or results within a short period of time.

The quick identification of the presence of COVID-19 in our communities would then be key to our response, as it is in any community in the country. There were daily flights prior to the restrictions that have been put in place in our regions due to COVID-19, but now there aren't regular flights. People might get tested but there might not be a flight for a number of days and then that test also waits in a queue once it gets to a southern centre for processing.

The rate of active cases and the data that we use to respond to this crisis depend on rapid access testing. We commend the federal government for moving quickly to acquire point-of-care and near-care tests and also prioritizing remote communities for the placement of these tests. We understand that Inuit communities are a key consideration in this national response, and that the federal government understands that there is an urgent need for these point-of-care and near-care tests.

Also, with respect to Inuit-specific public health guidance, we've done really well so far to minimize COVID-19 and its entry into Inuit Nunangat communities. Two regions, Nunavut and Nunatsiavut, have not registered a confirmed case yet, and there are just a handful of cases in Nunavik and a couple in Inuvialuit region.

We need to ensure that we are working as closely as we possibly can with provinces, territories, our public health and data systems, and the federal government all the way through. We have an Inuit public health task group that facilitates this work.

We commend all parties, from the Public Health Agency of Canada to Health Canada to Indigenous Services Canada, and the provinces and territories in which Inuit live as they try to work through a number of challenges that are grey areas of governance. Sometimes there are processes that don't require Inuit participation through legislation, but we are living in a time of reconciliation, and the more information and open communication there is between Inuit rights holders and public governments, the better, in relation to this crisis. We see that through the shared health promotion strategies that we want to invest in and help deliver for our communities.

Inuit communities are known to have high rates of risk factors for poor outcomes in relation to COVID-19 based on things like our smoking rate, poor nutrition, poverty and the active cases of tuberculosis in our communities. The support for programs that contribute to a reduction in smoking rates and improve food security and nutrition is key to protecting Inuit from COVID-19. The ongoing shared ambition between Inuit and the Government of Canada to eliminate tuberculosis by 2030 also comes into play when we're dealing with COVID-19. There are many different synergies in the types of responses, especially in consideration of things like housing.

We'll continue to work with the federal government to provide funding to Inuit representation organizations that allows them to implement strategies to improve food security, enhance hygiene and promote physical distancing in Inuit communities, including on the land programs, elder support and increased access to water service and cleaning supplies.

The second point is in relation to health systems. It is a necessity that our health systems continue to function with COVID-19. We need to ensure that the connections remain strong between Inuit communities and the service agreements that jurisdictions have with southern care facilities in relation to COVID-19. We would work directly with the federal government for any immediate point-of-care considerations for COVID-19 responses if there were many cases in our communities. We have talked with the federal government about possibly employing federal resources and military or navy resources in relation to a response. Hopefully we can continue to have those strong connections between the care provided to us in the south and that provided in regional centres in Inuit Nunangat and in other communities in the COVID-19 response.

We're also concerned about the shortage of drugs, supplies and staff. There are many different HR considerations, especially considering that many of our communities are staffed by only one or two nurses at a time and that there is a huge push for resources in the health care response in the south. That consideration is top of mind. There are also things like drugs for tuberculosis, such as the BCG vaccine, and worldwide shortages in relation to that. There are a number of different considerations there that we continue to work with the federal government on in relation to the COVID-19 response.

The third point is in relation to air transportation. ITK has made it clear that we see air transportation as an essential service. There are no other ways to get to our communities at this time of year, and the way our health care system and all essential services flow in and out of our communities depends upon our air carriers. In other parts of the year we will have major considerations for sea-lift resupply and cargo traffic, but at this time it cannot be overstated how important air links are. Federal support for those air links across Inuit Nunangat should remain intact.

The last thing we want is for any of our existing airlines to not be able to continue to operate. That would place a massive and considerable risk on those populations in our communities over and above the already difficult challenges that we face.

We'll continue to work with the Inuit Public Health Task Group and the Government of Canada, but any of the work we do, whether it's with you in this committee or anywhere else, will be focused on an evidence-based globally informed and Inuit-specific response.

We look forward to working with you under those terms to ensure that Inuit are not adversely affected even more than we already are in relation to the COVID-19 response.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We will start our rounds of questions at this point.

First, Chief Daniels, I just want to point out that when you were speaking we were picking up a fair bit of noise on your mike, so when you're answering, try to hold your mike away from your body, if you can.

Also, if anybody needs to leave to get a coffee, leave your video on because if you turn it off, your picture gets moved all over the screen and it's hard to keep track of where you are.

With that, I'd like to thank everyone for their statements and the excellent information.

We'll start with Mr. Vidal for our first round of questions.

Mr. Vidal, you have six minutes.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you, Mr. Chair.

I want to thank all of the witnesses for taking the time and making the effort to be with us today. It is appreciated.

My first question is for the National Association of Friendship Centres. I'll let the two of you decide who wants to answer.

As has been referenced a couple of times, $305 million was announced for the indigenous community support fund. Out of that $305 million, $15 million was allocated to urban indigenous organizations like yours. It was through an application-based process. My understanding, from a statistical basis, is that over 60% of indigenous people in Canada live in urban centres and that this funding represents about 5% of the funding for indigenous organizations.

You spoke to it a bit in your presentation, but perhaps you could elaborate on how maybe the underfunding of urban indigenous organizations during this pandemic puts indigenous people in urban centres at greater risk.

[Jocelyn Formsma]

Maybe I'll start on that and then ask President Sheppard-Buote to jump in.

It's been a challenge, because we don't want to be seen as throwing anybody under the bus. That's why, in my criticisms of the distinction-based, we're saying that there has to be a consideration for remoteness, for those who live in the north, for women and for a number of different intersections in terms of what makes up an indigenous person. We're trying to add a voice with regard to the urban. We say “urban”, but we have friendship centres in Inuvik and Happy Valley–Goose Bay. They're not the typical big, urban spaces. They are just off reserve, and typically not in Inuit Nunangat. Sometimes they are in Métis homelands but not part of Métis settlements. It could be in communities of over a thousand or five thousand, or in major metropolitan areas.

I think the piece we're trying to get across is the service component. As friendship centres, we look at people in terms of what they need and in terms of service delivery. Who they are in terms of how they identify is important to us, but we're also considering the factors that they need. We're trying to respond from a service point of view. We don't dictate who we get calls from. People who are living in urban spaces, if they need support and they know that there's an indigenous organization that might have a better understanding of who they are, will call that organization. They will call regardless of whether they're first nations, Métis or Inuit. They're there, they need something, and they need an organization that understands who they are.

We're finding that friendship centres have now been getting an increase in calls. The friendship centres in B.C. are not just at capacity; they're at overcapacity in terms of the services they're providing. The financial resources from any level of government have not materialized yet. As I said, we got notice yesterday that we will be getting funds from the indigenous community support fund in the amount of $3,750,000 across 100 different organizations. As the NAFC, we chose to write a proposal on behalf of all of our member friendship centres, because we did not want to have the burden put on the local friendship centres, who are in it every single day. I've had executive directors say that they've been sleeping overnight in the homeless shelter because of their lack of staffing. We've had people say that they had a 25% increase in requests at their food bank and ran out of food in an hour, or that they haven't been able to get access to some of the personal equipment. We've been getting stories from across Canada on just the service needs...and going from place to place to place, knocking on doors, trying to get some kind of financial support and some kind of financial recognition that we're there, we're doing the work every single day, and it has not materialized.

It has materialized in some of the local centres in some of the larger areas—for example, with the Vancouver Foundation and local foundations, where they've been able to get supports from some local centres—but until the federal funds start flowing from the federal government to us to the friendship centres.... The provinces have announced, to a certain extent, some indigenous funding. We don't know yet if that will go to friendship centres. Ontario seems to be the only province that has actually committed funds that friendship centres will be able to access. However, the work has been happening for the last six weeks. For six weeks the friendship centres have been doing this work without that financial support. I don't want to say that distinctions don't matter, but when you're in need and you're calling somebody for help, you want that help to show up. We've been doing our best.

I hope that answered your question. I was just trying to express the need that's there, the work we've been doing for the last six weeks and the support we're trying to get.

I will say one last thing. We've been hearing from a lot of first nations about the supports for their off-reserve, and we've been trying to meet those needs. A lot of our friendship centres do have good relationships with their local first nations. I think one of the best problems we will have is that our people will have not just enough, but too much; you know, I don't think it's going to be a problem.

I think that the more supports we can get out, the more supports we can make available for people and the more options they have to meet their needs, will only serve the people on the ground. I think we should be doing the best we can to make sure that we coordinate our efforts and resources, plan and work together, and ensure that there are no gaps and that we're not leaving anybody behind.

Thank you for that. I'll hand it off to President Sheppard-Buote.

[Christopher Sheppard-Buote]

Thank you.

To echo what Grand Chief Jerry Daniels said, it isn't enough money, period.

You start with a deficit from the very beginning, and from our perspective, to see that envelope of money and to know that we are now competing for $15 million across the country, knowing that there are 100 organizations to try to get resources to on the ground....

To me, the fact that there was a structure that was that underfunded and competitive was very disrespectful. You are asking people to say, “You're kind of indigenous, not indigenous enough to be trusted to be given resources to support people, so we're just going to make you dig really hard to get the data and report on it so that you can help people on the ground.”

The fact that this design even existed in some way, shape or form tells me that there's a huge problem with how this response has gone for everyone in the indigenous space, especially when it's so obvious that you have a section of individuals who are treated so differently.

We don't know when that money is actually going to reach organizations. There are multiple non-indigenous, not-for-profit agencies and national organizations that did not have to apply for their allocations either because they're providing essential services or because they're providing something that's needed. I think, even when you look at it within that scope, there's a clear issue with how this has been developed and framed. Why is that?

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you, Chris.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Vidal.

We go now to Mr. Kelloway.

Mr. Kelloway, you have six minutes, please.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thanks so much, Mr. Chair.

Hello colleagues, and thank you to the witnesses for coming today.

Before I begin with my questions, I'd like to acknowledge that I'm speaking to you from Mi'kma'ki, the ancestral unceded territory of the Mi'kmaq people.

My first question—and I have two—is an open-ended question to anyone on the panel who would like to answer it.

As we know, COVID-19 can affect anyone, anywhere. We all know that all too well. Emerging research shows us that there are risk factors that make certain communities in our country especially vulnerable to this coronavirus, as the disease emerges with such speed, such cruelty. Due to consequences of systemic racism, geographic inaccessibility and historical injustices, many indigenous communities find themselves especially vulnerable in this pandemic.

Can you speak to two measures that you believe the government is doing well and two in particular that we need to change immediately? That would be very helpful. That would be my first question, Mr. Chair, and that's open to anyone and everyone on the panel.

[The Chair, Liberal, Ron McKinnon]

Go ahead, whoever would like to answer.

[Natan Obed]

Perhaps I'll start.

We've found that there's been a lot of communication, but also at the same time a lot of confusion. The way the Government of Canada has worked with Inuit in allocating $45 million of the $305 million for the indigenous community support fund was in line with the Inuit Nunangat policy approach, and then the ITK board of directors allocated those funds within the board process, so each of the regions had a specific allocation. Now there are a number of interventions that have already happened.

On the other hand, there have been challenges with responsibilities and participation in conversations about health care systems, data, personal protective equipment, and a number of the essential considerations for the flow of health services in response to COVID-19. It would have been great, and it still will be, and the thing we look forward to is participating in those conversations even if we as Inuit don't always deliver those [Inaudible—Editor] to our communities.

Perhaps President Kotierk could talk specifically about what Nunavut has done in relation to the implementation of COVID-19 funds.

[The Chair, Liberal, Ron McKinnon]

Go ahead, if you wish.

[Aluki Kotierk, Member of the Board and President of Nunavut Tunngavik Inc., Inuit Tapiriit Kanatami]

Thank you for the opportunity.

In terms of the resources that were allocated through the federal government, in Nunavut we were very quick to determine how we would allocate those funds across the vast territory. As you know, Nunavut makes up one-fifth of the geography of Canada. The Nunavut Tunngavik Inc. board members have been having daily calls to determine how best to allocate that money, and much of that money has already been allocated to provide financial support to elders so they can purchase food items, as well as cleaning supplies.

We have provided a substantial amount of resources to municipalities so they can ensure that there is water and sewer delivery on a daily basis. Particularly when there's the public messaging about washing hands, we think it's crucially important in overcrowded housing situations in Nunavut, which is very common and we know in this day and age we need at least 3,000 houses just to meet the current housing needs across our territory. The common mentality is to conserve water usage, and we don't want that in a time when we're having a global pandemic.

The other area we've put some resources into is to address food insecurity. In Nunavut, it's astounding that already seven out of 10 children go to bed hungry each night, and instead of their getting better, we know the statistics recently released have indicated that it is now actually eight out of 10 children that go to bed hungry each night. We know with the experience we have had with infectious diseases such as tuberculosis, both overcrowded housing circumstances and food insecurity have a big impact on how one is able to fight off infectious diseases.

While the approach we've been taking is very much focused on meeting the basic needs that, in our view, should be met even before we find ourselves in a global pandemic, the opportunity for us in this global pandemic has been that we've been able to have very open communication and decision-making amongst Inuit organizations and all government levels, including the territorial public government here in Nunavut, as well as the federal government.

Our position at Nunavut Tunngavik Inc. is that the federal government should invoke the Emergencies Act in Nunavut, because in our view, although we don't have a confirmed COVID-19 case yet, we know that our capacity financially and in terms of human resources is not what it needs to be in our territorial public government, and that has been crucial, even before COVID-19.

We need to look at, and the very terrifying public healthy crisis we are all under right now is an opportunity to highlight, the great needs that so many Canadians live under. This is an opportunity for you as members of Parliament to take a better look at the social inequities that Canadians face. Of course, I am advocating for Nunavummiut to say, please take a look at the social inequities faced by Nunavut Inuit.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

Is there anyone else who would like to respond to Mr. Kelloway's question? Otherwise, we'll go to our next questioner.

[Christopher Sheppard-Buote]

One of my biggest concerns, or things that are not being done well right now, is the framing and preparation of the disaggregated data that should be collected to really see what this looks like and what the outcome was for indigenous people across this country.

Not every region collects really good disaggregated indigenous health data, and it will be really important for us to know what the outcome was for our people across this country in every jurisdiction. I know that health is a provincial piece, but I think that for the Public Health Agency and Health Canada it will be very important to make sure that data is disaggregated so you can tell that story after the fact.