Thank you, Mr. Chair.
Good afternoon, everyone.
[Witness spoke in Ojibwa]
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—