Indigenous and Northern Affairs Committee on April 29th, 2022

[The Chair, Liberal, Marc Garneau]

Good afternoon, everyone.

I call the meeting to order.

Welcome to the 16th meeting of the Standing Committee on Indigenous and Northern Affairs.

We are gathered here today on the unceded territory of the Algonquin Anishinabe nation.

Today we are starting our third study, which is on the administration and accessibility of indigenous peoples to the non‑insured health benefits program.

We will have three witnesses today. One of them is not yet online, but we're going to start the meeting with the hope that he will join us. At two o'clock, we'll proceed to our in camera meeting to discuss committee business.

I would like to remind you to respect the requirements of the Board of Internal Economy regarding physical distancing and wearing masks.

I would also like to outline a few rules to follow in our interactions.

Members or witnesses may speak in the official language of their choice. Interpretation services in English, French and Inuktitut are available for the first part of today's meeting. Please be patient with the interpretation. There may be a delay, especially since the Inuktitut has to be translated into English first before it can be translated into French, and vice versa. The interpretation button is found at the bottom of your screen with the choice of English, French or Inuktitut. If interpretation is lost, please inform us, and we'll stop the meeting until we can rectify the problem.

Before speaking, please wait until I recognize you by name, and if you are on the video conference, please click on the microphone icon to unmute yourself. When speaking, please speak slowly and clearly, and when you're not speaking, your mike should be on mute. I remind everyone that all comments should be addressed through the chair.

We're going to start with each of the witnesses speaking for five minutes.

Today, we have Vice-Chief David Pratt, Federation of Sovereign Indigenous Nations, appearing on behalf of the Assembly of First Nations. Vice-Chief Pratt is not yet online. We also have Natan Obed, president of the Inuit Tapiriit Kanatami, accompanied by Pierre Lecomte, senior policy adviser of the ITK. Finally, we have Cassidy Caron, president, Métis National Council.

Given that Vice-Chief Pratt is not here yet, I would ask Mr. Obed, if he is ready, to kick us off with a five-minute presentation.

Mr. Obed, please go ahead.

[Natan Obed, President, Inuit Tapiriit Kanatami]

Nakurmiik, Mr. Chair. It's great to be here talking about such an important topic.

I'm Natan Obed. I'm the president of Inuit Tapiriit Kanatami, which is the national representational organization for Canada's 65,000 Inuit.

The majority of Inuit live in Inuit Nunangat, which is our homeland that encompasses 51 communities across the Inuvialuit Settlement Region in the Northwest Territories, the entirety of Nunavut, Nunavik in northern Quebec and the Nunatsiavut region in northern Labrador.

Many Inuit also live in southern centres. When it comes to the considerations for non-insured health benefits, those Inuit who live out of jurisdiction are still indigenous peoples and still have the ability to access non-insured health benefits but in very different ways.

There are three points I hope you take from my presentation.

First, the majority of Inuit rely on non-insured health benefits and access a range of medically necessary health care products and services that are not otherwise provided through provincial and territorial health programs, social programs or private insurance plans. Inuit are not a part of the Indian Act, so the jurisdiction and the service delivery flow primarily through provinces and territories or through Inuit self-governing mechanisms, which are emerging and will continue to evolve as we are successful in achieving self-determination over the health care system.

My second point is in relation to Inuit beneficiaries facing barriers in accessing and receiving NIHB program benefits due to the existing program structure, its restrictive policies and administrative processes.

Finally, there's a clear need for the development and implementation of Inuit-specific goals and objectives to address barriers to care and to provide timely, responsive and equitable access to NIHB by Inuit, no matter where they reside.

The NIHB program plays a key role in health care access and delivery in Inuit Nunangat, from medical transportation, pharmaceuticals, dental care, vision care, medical supplies and equipment, and other services. These health care products are administered and delivered to Inuit by the NIHB program and they directly impact our health outcomes. Given the state of Inuit health and the challenges of health care delivery across Inuit Nunangat, it's fundamentally important that the NIHB program provides timely and accessible health care products and services to fully support the health care needs of Inuit.

To this end, the program must be properly resourced, offer unique and adaptable administrative processes and be accountable to the goal of timely access to care. The things we are hoping for from any improvements to the NIHB program are a recognition and commitment that demonstrate the government's willingness and leadership to better meet the needs of Inuit, to be truly responsive to Inuit-specific circumstances and realities, and to provide a firm commitment on improving timely access to care.

These changes have to be made to improve the program's approach and delivery in order to support the needs of Inuit across Inuit Nunangat. There must be clear and specific priorities that are delivered in a timely and distinctions-based way. They must also allow for considerations of Inuit positions in the way in which these services are considered and delivered.

In conclusion, we urge the standing committee to seriously consider the importance of providing inclusive and Inuit-specific goals and objectives as part of its review of the NIHB program's administration and accessibility objectives and, further, to truly demonstrate a clear commitment to eliminate barriers to timely access and develop responsive processes to better meet the needs of Inuit.

Thank you for the opportunity.

[The Chair, Liberal, Marc Garneau]

Thank you, President Obed.

I will now give the floor to the president of the Métis National Council.

Go ahead, Ms. Caron. You have five minutes.

[Cassidy Caron, President, Métis National Council]

Tanshi. Thank you.

Good afternoon, Chair and committee members. Thank you for the opportunity to participate in your hearing today.

I am here as the president of the Métis National Council to speak to you on the administration and accessibility of non-insured health benefits for Métis people. This has been identified as a top health priority for the Métis Nation's citizens.

On April 13, 2017, the Canada-Métis Nation Accord was signed by the Métis National Council, its governing members and the Prime Minister on behalf of Canada. It recognizes the Métis Nation as a distinct indigenous nation with inherent rights and formalized the nation-to-nation, government-to-government relationship between the Métis Nation and the Government of Canada.

The Métis Nation, with its own collective identity, language and way of life, continues to advance its right to self-determination, including self-government in Canada, through democratically elected governance structures and registries. Each governing member is mandated to represent its citizens. As a constitutionally recognized indigenous people, Métis must have the same opportunity as first nations and Inuit to contribute to the achievement of an overall health status comparable to the Canadian population, and shift the focus of health service delivery from an illness model to a prevention, wellness and health promotion model.

Métis people do not have poor health outcomes because they are Métis. Poor health outcomes are a result of oppressive policies that have effectively sought to erase or assimilate the Métis. Health is not merely the absence of disease. For the Métis Nation, it is a state of balanced and interconnected relationship between physical, mental, social, spiritual, environmental and cultural well-being.

A self-determined Métis version of the non-insured health benefits will work toward improved health and well-being for Métis citizens, families and communities now and for future generations. It is increasingly clear that these health inequities arise from disparities in Métis social determinants of health and the processes of colonization, forced assimilation and social exclusion.

In 2013, the Health Council of Canada reported that despite significant investment to address inequities in the health status and health outcomes of aboriginal peoples, the impact of these initiatives is unclear. None of the noted federal health services available to other indigenous people are currently available, nor have they ever been available, to Métis people. Provincial supports and services are also not meeting the needs of Métis citizens.

However, a positive example can be found in the territories. The Government of the Northwest Territories' Métis health benefits program provides Métis with access to a range of benefits not covered by standard hospital and medical care insurance, including eligible prescription drugs, dental services, vision care, medical supplies and equipment, and medical transport and accommodation. Benefits of this nature should be available to Métis citizens across the homeland.

Métis non-insured health benefits should be financially sustained by federal financial resources and coordinated with provincial authorities and private insurance providers. With secured resources, the MNC's governing members are ready to action the exploration of operational and financial models responsible for the needs of Métis citizens. These actions will include feasibility analyses of benefit plans, coverage, cost-benefit analysis, burden of disease, health and economic impact assessments.

Everyone in Canada has the right to health. This right is defined and protected by international human rights treaties that Canada has ratified. The International Covenant on Economic, Social and Cultural Rights affirms the right to enjoy the highest attainable standard of physical and mental health.

In the Canadian context, the preamble to the Canada Health Act states:

—that continued access to quality health care without financial or other barriers will be critical to maintaining and improving the health and well-being of Canadians;

Specific to indigenous peoples, the Truth and Reconciliation Commission's call to action number 20 calls upon the federal government to “recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples.”

These rights mean that all indigenous people should be able to access the health and wellness programs, services and non-insured health benefits they need, when and where they need them, without suffering financial hardship or encountering anti-indigenous racism. Many Métis cannot realize the right to health as it currently stands.

In the current system, Métis are underserved and marginalized, resulting in poorer health outcomes and vulnerability. The Canadian federal, provincial and territorial governments have an obligation to support the opportunity for barrier-free, high-quality, culturally safe and equitable health programs, services and benefits for Métis citizens.

We are working alongside the government and having conversations, and we hope to propose a self-determined Métis non-insured health benefits plan. The Métis Nation is committed to working with all levels of government as an equal partner to make this happen. We look forward to actioning a Métis non-insured health benefits program.

Thank you again for the opportunity to articulate the immediate health priority of the Métis Nation and express the voice of Métis citizens.

We welcome any questions you may have. Marci.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Caron.

Vice-Chief David Pratt is now with us.

Vice-Chief Pratt, you have five minutes to make your initial presentation.

[Vice-Chief David Pratt, First Vice-Chief, Federation of Sovereign Indigenous Nations, Assembly of First Nations]

Thank you, Mr. Chair.

Good afternoon, everyone.

[Witness spoke in Ojibwa as follows:]

Aaniin chigwaa daan siikiwaa.

[Ojibwa text translated as follows:]

Hello to everyone.

[English]

First of all, I want to acknowledge the Treaty 6 territory that I am calling from today.

I want to greet the members of the Standing Committee on Indigenous and Northern Affairs who are gathered here, and you, Chair Garneau. It is my pleasure to appear before you to speak on the non-insured health benefits program.

I am joining this committee presentation today from Treaty 6, as I stated previously. I am David Pratt, vice-chief of the Federation of Sovereign Indigenous Nations in Saskatchewan. I am the Saskatchewan representation on the chiefs committee on health at the Assembly of First Nations.

I am presenting today on behalf of the Assembly of First Nations. I would like to thank this committee for taking the time to explore this matter of great importance to first nations communities, and that is the non-insured health benefits program. It has consistently been identified as an irritant for first nations and a high priority area for AFN advocacy and transformation.

The NIHB program is perhaps the most frequently cited grievance related to federal health programs and has many factors, including inadequate coverage, lack of timely access, inconsistent adjudication of claims and burdensome administrative cases.

The AFN notes that the NIHB program remains primarily concerned with cost containment rather than providing adequate and timely medical benefits and services to first nations. As you are likely aware, there is an AFN-FNIHB joint review of the NIHB program. The pandemic has stalled some of the progress of this important work, but we look forward to continuing to move forward with this review to make meaningful changes together.

For our first nations, NIHB can be seen as a bureaucratic and intimidating entity. Our NIHB navigators work tirelessly in every region and are a source of immense support, and we thank them for their service. They are on the front lines working with families to navigate the overwhelming system, dealing with the consequences of national policies and guidelines at the grassroots level, and this work can be challenging, to be sure.

It is critical to note that first nations are very clear that the NIHB program is funded in the federal fiduciary responsibility based on guarantees through treaty. Our elders teach us that treaties between the first nations and the Crown are an articulation of the Creator's gifts and wisdom. In addition, they are sacred. The treaties articulate relationships and ongoing legal obligations.

In the case of health, treaties reaffirm first nations' jurisdiction over their own health care systems and establish the positive obligation on the Crown to provide medicines and protection. Crown treaty obligations are founded both in verbal commitments and in the text of the treaties. To be clear, AFN is not a rights holder. Individual first nations and citizens holds these rights; however, AFN does play an important role in advocating with first nations for these rights to be upheld.

We know from lived experience that the health status of first nations is far below our national potential, given the financial resources and health system capacity in Canada. In essence, it means that we interact with the health care system more frequently throughout our lifespan than other Canadians.

Numerous national and regional reports from RCAP in 1996, the TRC calls to action in 2015 and the MMIWG calls to justice in 2019 have confirmed that the mental, physical and spiritual health of first nations are severely compromised by policy obstacles and constraints, disjointed jurisdiction, proximity to services and overt racism in the health care and justice systems.

NIHB was constructed to be the payer of last resort, but for many first nations this is their only option. For that reason, we must offer remedies that address the operational and systemic deficits within this program. From what we see and hear, the administrative challenges with the NIHB program have been cumbersome, with the burden carried by our citizens. Reimbursements from NIHB to service providers is rife with delay and denials. Service providers are dropping out of the NIHB program at an alarming rate. For first nations who may already have trouble finding a service provider, it becomes even more of a challenge to find care when dentists and optometrists refuse to deal with NIHB anymore.

For those who do stay on, frustrated with the NIHB program delays, more and more service providers are expecting upfront payments from our people. This is an incredible burden on our citizens, particularly elders and others on a fixed or limited income. It can result in people having to decide between food, shelter or essential medical needs. This places them in danger of compromising their mental and physical health outcomes even more.

I would like to touch on related concerns regarding health care for first nations. The COVID-19 pandemic has aggravated existing health and social inequities, and today we see and hear of the multiple and concurrent gaps that affect people's ability to find culturally appropriate supports for their mental wellness and/or addiction issues.

Systemic racism is another issue that leads to our people receiving substandard care and sometimes to death, as was the case with Joyce Echaquan. Systemic racism leads to our people delaying seeking care from health service providers. Their health may then deteriorate to the point where mostly costly intervention is required and time away from home is extended.

Maternal and child health, along with reproductive health services, were placed under a microscope when news of the forced sterilization of indigenous women and girls was revealed. This criminal practice demonstrates the deeply embedded racist views of some medical professionals. Forced sterilization is yet another act of genocide against first nations. At present, NIHB does not cover costs associated with supports for these women, nor are their fertility needs calculated into the benefits.

Currently, the western health system is failing our people, and many are returning to traditional healing to add vigour to health regimes. Traditional and spiritual counsellors and healers need to be properly recognized and fairly compensated. It should not be up to federal civil servants to determine what eligible expenses are, when this should clearly be guided by first nations ourselves.

Moving forward, NIHB funding must be matched to health needs on an ongoing cycle to ensure sustainability of the program. A long-term strategy must be developed for funding, premised on realistic expenditures and utilization projections. This includes population growth, aging projections, inflation trends and an annual escalator attributable to utilization, new treatments, changes in the delivery of health services and geography, as well as other factors.

We also recommend that the Government of Canada support, through policy and funding, the formal inclusion of traditional healing in the NIHB program. This process, like all decisions, must be led by first nations for first nations. The systemic failures of the NIHB program continue to occur because there is very little accountability to first nations, and as such, we need reliable and credible data presented in a meaningful way, so we can assess the cumulative deficits and construct policy solutions.

We welcome continued engagement and encourage collaborative efforts to address concerns with the NIHB program. Together, we hope to reform and realign wellness programs and services according to first nations priorities that do not place continued restrictions on our health as the NIHB administration process seems to do. Our people deserve better.

As stated in the United Nations Declaration on the Rights of Indigenous Peoples in article 21—

[The Chair, Liberal, Marc Garneau]

Thank you, Vice-Chief. We have to wrap up now.

[Vice-Chief David Pratt]

—our people have the right to improved health outcomes.

Thank you, Mr. Chair.

[The Chair, Liberal, Marc Garneau]

Thank you, Vice-Chief Pratt.

We'll go to the first round of questions, each lasting six minutes.

We'll begin with Mr. Viersen.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Thank you, Mr. Chair.

I want to thank the witnesses for being here, many of whom I've gotten to know, particularly Natan. I've gotten to know him over the last few years for sure, so welcome.

This is an important study. I know that whenever the government is dealing with health care and the intrusion...not necessarily intrusion but the caretaking of individual lives, the government must tread carefully. As we have seen with the residential schools situation in the past, here we are again with a large government institution that is trying to manage the day-to-day lives of individuals. I want to thank the witnesses for their testimony on this important topic.

One of the things I know, coming from northern Alberta and representing 14 first nations, is that access to health care is a big challenge, and I want to commend the individual nations for.... They all have a system of transport.

I'll start with Natan, in particular. How does getting to health care facilities in his region work? Is that a challenge? Are there areas that need to be worked on around that?

I know [Technical difficulty—Editor] in northern Alberta, there are these big white Ford vans. The ones I'm thinking of, in particular, have “Driftpile medical transport” written on the side of the vans, and I see them regularly coming through Barrhead, my hometown, bringing folks to their health care appointments. It's not just to the hospital. They can get an ambulance for that, but the vans bring them to their everyday medical appointments.

Natan, I'm wondering if you could elaborate on how that works in your neck of the woods.

[Natan Obed]

Thank you, Mr. Viersen, for that question. It has been good to get to know you over the last six years on a lot to do with indigenous and Inuit issues.

This is a point of contention within the NIHB program for Inuit, and it's about the way in which decisions are made. Often decisions made in relation to medical transportation are not happening in real time, and sometimes people can experience weeks or months of delays in being approved for medical transportation or for escorts—people who can help the patient get to care. This is vitally important because of where the care happens.

There are 51 Inuit Nunangat communities, and just about each one of these communities doesn't have access to roads to the south. Inuvik and Tuktoyaktuk in the Northwest Territories technically have southern road access, but medical care doesn't flow through that road access. It still flows through flights to Yellowknife and then to Edmonton, largely.

If people are in urgent need of care and need help to get to that care, the NIHB program can be a lifeline to ensure that culturally safe and immediate care happens, especially in the language of choice of the recipient of care.

Sometimes there are programs within the province or territory that interact with the NIHB program about medical transportation, but too often we are hearing complaints from Inuit about either not being given clear decisions or being denied either medical transportation or escorts within medical transportation. This really is at the crux of what we can—

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Natan, would you have a fairly specific recommendation around transportation?

[Natan Obed]

The specific recommendation would be that.... Within the delivery of NIHB...?

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Yes. The ability to take an escort along, is that really where the crux of the problem is?

[Natan Obed]

I think for the solution that we're looking for, it would be a model within NIHB that is Inuit-specific and distinctions-based and that also has particular timelines for decision-making and clear links to the service delivery provision within the region.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Ms. Caron, I'm not sure if you're still there. Your camera went off.

[Cassidy Caron]

I'm here. I just had to move.

[The Chair, Liberal, Marc Garneau]

You have 30 seconds, Mr. Viersen.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

In that case, I will just recognize some of the hard-working Métis people of northern Alberta and Saskatchewan. In particular, I just want to recognize how many of them work in the resource sector and the oil patch in my neck of the woods and are still frustrated by having to pay the carbon tax and travel to get to medical appointments, with the carbon tax adding an increased burden on that.

You can confirm that, but I've probably used up all of my time at this point already.

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Viersen.

We'll now go to Ms. Atwin.

Ms. Atwin, you have six minutes.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you, Mr. Chair.

Thank you to all of our witnesses.

Today I'm speaking to you on the unceded traditional territory of the Wolastoqiyik here in Fredericton, New Brunswick.

I wanted to begin, as well, by congratulating you, President Caron, for being the first woman to represent the Métis National Council and for bringing women's voices in general to this really important discussion.

With the signing of the 2017 Canada-Métis Nation Accord, I understand that NIHB has begun to transfer funding for distinctions-based, Métis-specific programming. How is this process going?

[Cassidy Caron]

We have a lot of work to do within the Métis National Council, and thank you for your kind comments.

We've rapidly progressed since signing the Canada-Métis Nation Accord. We were really left out of a lot of different processes. We didn't have any established mechanisms to negotiate different policies or programs with the federal [Technical difficulty—Editor].

We still struggle to implement these programs into our communities due to a lack of infrastructure and a lack of capacity. Just throwing money at us to all of a sudden deliver programs and services to our people is fantastic. However, we have, at the same time, had to develop our capacity and our infrastructure to be able to do so. We've been playing catch-up and delivering these services all at the same time.

The work of the governing members of our Métis governments is just absolutely incredible. They are up to the challenge in doing all of that work. However, [Technical difficulty—Editor] there was an established program specifically for Métis people.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you very much.

What would some key pillars be to the ideal model that would best serve your nation? It's kind of specific, but if you can give us some key themes, that would be really great.

[Cassidy Caron]

For sure.

We have already started having these different conversations and have actually just wrapped up developing the Métis Nation's vision for health. It's a health care framework that is largely the beginning of the process that the government is going to be doing in developing the distinctions-based health care legislation. We got to work in consulting with our communities to find out exactly what is needed for health care with Métis people.

The biggest thing we have is that it has to be holistic. Health care needs to encompass all of the social determinants of health. We make sure that we have conversations around even how climate change is affecting the health of our people. The biggest theme in our vision for health is ensuring that it is holistic and takes into consideration all of the different social determinants of health that are affecting our people.

[Jenica Atwin, Liberal, Fredericton, NB]

That's excellent.

I'll turn to Vice-Chief Pratt, if I could.

I understand there's an ongoing review of the benefits that is being co-led by the AFN. This has resulted in funding from budget 2017 that had coverage for mental health counselling provided by traditional healers.

What has this meant for communities? Are there other areas in health care where solutions like this could be implemented? Mental health is very close to my heart, so I'd love to hear how this is working.