Indigenous and Northern Affairs Committee on May 10th, 2022

[The Chair, Liberal, Marc Garneau]

Good afternoon.

Welcome to meeting number 19 of the Standing Committee on Indigenous and Northern Affairs.

We are gathered here today on the unceded territory of the Algonquin Anishinabe nation. We have just a couple of housekeeping matters to take care of before we start the panels.

The clerk distributed to everyone the budget for our fourth study, and I would like to see if we have the committee's approval for this budget. What does the committee say? Do we have approval?

[Some hon. members]

Agreed.

[The Chair, Liberal, Marc Garneau]

Very good. That's approved. Thank you very much.

I remind everyone that the lists for the first 12 witnesses for the study are due by noon this Friday, May 13. That's six witnesses for the Liberals, four for the Conservatives, one witness for the NDP and one witness for the Bloc. The rest of the witness lists are due at noon on May 20. This is to give the clerk the ability to book witnesses in advance since we'll be coming up soon, after our May break week, on the study.

Today, we are continuing our third study, which focuses on the administration of the non-insured—

[Marilène Gill, Bloc, Manicouagan, QC]

Sorry to interrupt you, Mr. Chair.

My understanding was that the Bloc Québécois and the NDP were each allowed to invite two witnesses. If I'm not mistaken, that was Ms. Idlout's understanding as well.

[The Chair, Liberal, Marc Garneau]

That would mean we would have more than 12 witnesses.

It's six, four, one and one.

We are continuing our study on the administration of the non-insured health benefits, or NIHB, program and its accessibility to indigenous people.

Before I introduce our first panel, I have a few notes.

Please wait until I recognize you by name before speaking, and if you are on the video conference, please click on the microphone icon to unmute yourself. For those in the room, your microphone will be controlled as normal by the proceedings and verification officer. When speaking, please speak slowly and clearly, and when you are not speaking, your microphone should be on mute. I remind you that all comments should be addressed through the chair.

Today's committee meeting is like all committee meetings. We will introduce our guests and they will have five minutes each to speak, after which we'll proceed with a question period.

I would like to introduce our three witnesses today: Mr. Lee Thom, elected official of the Kikino Metis Settlement; Frances Chartrand, minister of health and wellness of the Manitoba Métis Federation; and, finally, from the Métis Nation of Saskatchewan, Marg Friesen, minister of health, and Adel Panahi, director of health.

I would like to start the testimony of the witnesses. We'll begin with Mr. Lee Thom.

Mr. Thom, you will have five minutes for your presentation. Go ahead.

[Lee Thom, Elected Official, Kikino Metis Settlement]

Thank you, sir. It's an honour to be here.

I'll make this quick. I have some really good notes, and hopefully I can stay focused. It took me a while to get here, but I'm here.

First of all, my name is Lee Thom, and I'm from the Kikino Metis Settlement. Kikino is in northern Alberta. It is two hours north of Edmonton. I'll give you a quick history on the settlement, and then I'll go into my three topics that I've elected to talk about today.

The Metis Settlements of Alberta in 1990 were given the Metis Settlement Accord from the province of the day. That gave 1.2 million acres of fee-simple land, which brought us the land base. We were then given some funding to build our infrastructure and our communities. That was the accord.

With the accord ending in 2011, there was short-term interim funding, which led, in 2013, to the LTA, and now we're at the end of the LTA. The LTA was put in and designed for us to continue our future funding, with schedule J being one part of the LTA that was to give us beneficial ownership of mines and minerals, which didn't happen.

Long story short, and it's a very long story that I'm making short here, in 2017 the Metis Settlements signed an MOU with the federal government and Minister Bennett. A piece of that was to protect our lands through section 35 rights.

A 2018 framework brought a framework agreement with a bunch of items, the main one being health. There are 10 of them, but I won't go through that, as I'm cutting into my time here on my topics, but health was one of the most important ones. Right now the Metis Settlements are in discussion with the province, and always have been, about three main topics: senior services, mental health and addiction.

On senior services, in our community we have right now anywhere from 80 to 100 seniors who have no access to dental or vision support. A lot of barriers come up with transportation, education and training for our local workers and people to supply services. We're told at Metis Settlements that the services are at arm's length, and the hope is that some day we can have facilities that can house the services that are so important to our community as a small municipality.

I'm right off my notes now. I know what I'm talking about. I don't like to be scripted, so I'm just going to continue as Lee Thom.

Mental health and addictions are big contributors to rural crime, senior abuse and problems we have in our community now with youth lacking participation. Program funding for youth to access sports is huge. Creating campaigns that are anti-drug and alcohol.... I really think that health ties to the home: healthier homes, healthier people.

I really believe that addressing mould in our communities and dealing with inefficient housing in the days of climate change now and the movement towards energy efficiency in their homes have a big impact on health. Our homes are inefficient. We're in dire need of funding that supports housing. Housing is tied to health.

We need funding that supports policing. Policing is tied to reduction in rural crime and everything that comes with mental health and addictions and senior abuse. There's so much we can talk about.

I had my scripted notes, and I may have missed a few things here but, as you can tell, I like to speak from my heart, and I like to come as a Métis person from a Métis settlement and make the government understand that we signed two agreements in the past. The 2018 framework agreement identified 10 things again. I want to make that point clear. Since then, we haven't had the traction that we would hope to have that would identify line-item dollars for the Metis Settlements specifically. We tend to be budgeted as Métis communities, and there are a lot of Métis communities, but Alberta is unique. It's the only province that has land-based Métis, and the only province that has land-based Métis with infrastructure, with roads, with staff, administration and elected people.

Good governance is a huge part of our system. Without good governance, programs that we offer to our members, such as 50-50 repair programs, where people can access dollars to repair their homes, to gain medical travel.... Some of the programs that we have in our communities are very important to our members.

[The Chair, Liberal, Marc Garneau]

Mr. Thom, we're past the five minutes.

Could you wrap up, please?

[Lee Thom]

Yes. I'll wrap up quickly. I'm sorry.

I think we need to follow the obligations that were identified in the 2018 framework agreement. We're on health today. I understand that, and I did give some things on health.

The signing with Minister Bennett was the day when there was supposed to be reconciliation from that time, but I haven't seen the traction. Being elected now, I haven't seen the movement. I think the federal budget needs to acknowledge the Metis Settlements directly, with flow-through funding to address all issues.

Thank you very much.

It's an honour to be here. Thanks for your time.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Thom.

We'll now go to Frances Chartrand.

Ms. Chartrand, you have five minutes.

[Frances Chartrand, Minister of Health and Wellness, Manitoba Métis Federation]

Good afternoon, everyone.

I would like to thank you for allowing the Manitoba Métis Federation to speak here today. We are looking forward to this study on indigenous peoples' access to the non-insured benefits program and are excited to start a conversation on improving the health of our Red River Métis citizens.

Before I start the discussion, I would like to provide a few definitions and a little information about our identity.

The Manitoba Métis Federation is the indigenous collective that was historically known as the Red River Métis. We are Canada’s negotiating partners in Confederation and the founders of the great Province of Manitoba. Our collective or community goes beyond borders, and our citizens are today located within what is now Manitoba, as well as elsewhere inside and outside of Canada.

With our July 2021 Manitoba Métis Self-Government Recognition and Implementation Agreement, the MMF is the federally recognized government of the Red River Métis, also known as the Manitoba Métis, a distinct indigenous people whose rights are recognized and affirmed as protected by section 35 of the Constitution Act, 1982.

The Manitoba Métis Federation has undertaken substantial health research based on samples of over 70,000 of our citizens. While MMF citizens are not covered under non-insured health benefits, the 2010 Métis atlas and subsequent studies have shown that overall health and life expectancy of Métis are poorer when compared to the rest of Manitobans. Social determinants of health, including socio-economic status and access to services, factor largely in this. The findings of our research indicate that the rate of chronic illness is extremely high in our communities. Heart disease is 40% higher than in the general Canadian population; arthritis is 22% higher; diabetes is 34% higher, and diabetes-related lower limb amputations are 49% higher.

In order to provide equitable and culturally appropriate services, Métis citizens in Manitoba require health and social programs and services that are developed and delivered by Métis citizens and Métis people.

In 2017, a prescription drug program was developed by the Manitoba Métis Federation and introduced to assist Métis seniors in need to ensure they were not out of pocket for medication expenses. To date, our prescription drug program has been funded solely by the Manitoba Métis Federation, despite our attempts to work with Canada to develop a partnership.

The PDP covers a comprehensive range of prescription drugs and over-the-counter medications listed on the Manitoba pharmacare formulary. In addition, a small range of medical supplies and equipment items are covered by the program. At present, for the PDP supports, you have to maintain a current and valid MMF citizenship card; you have to be 55 or older; you have to have an annual income of $25,000 or less; you have to be enrolled in the Manitoba pharmacare program; and you have to agree to use MEDOCare Pharmacy as the sole dispensary.

The utilization rate of the program among eligible Métis seniors and older adults continues to rise. It has doubled from 2019-20 to the 2021-22 fiscal year. The program utilization is projected to climb, as seniors are known to have a higher prevalence of certain chronic conditions compared to younger Canadians, as well as lower incomes on pension plans.

Unlike non-insured health benefits medical coverage for first nations individuals, the PDP does not cover diagnostic services such as examinations, radiographs, audiology services, preventative services, orthotics, dental care and medical transportation and accommodation, to name a few. MMF is working on expanding the program to cover the services stated above to alleviate financial burdens on low-income Métis older adults. There is a demand for more and broader range of services. The Métis can work in complementarity with Manitoba and Canada.

The Manitoba Métis have the right to self-determination as recognized in the United Nations Declaration on the Rights of Indigenous Peoples, and the inherent right to self-government recognized and affirmed by section 35. The right to self-determination includes the right to health in all its forms. This includes the administration and delivery of health care services, setting our own priorities, administering our own health care budgets and managing our own resources.

Provisions are needed to negotiate agreements or to promote the health, safety and welfare of Métis citizens within a defined area of pharmaceutical and medical services, and to enhance access.

[The Chair, Liberal, Marc Garneau]

Ms. Chartrand, I'll have to ask you to wrap up. We're over five minutes.

[Frances Chartrand]

Okay.

We are prepared to work with Canada at the technical level on the negotiation of agreements and participate in the development and promotion of health legislation that will ensure that our elders and vulnerable Métis citizens have the health services they require.

Thank you very much for having me here to present today.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Chartrand.

We'll now go to our next witnesses. We have Marg Friesen and Adel Panahi.

I'm not sure whether you're going to divide your time or have just one speaker, but you have five minutes.

Thank you.

[Marg Friesen, Minister of Health, Métis Nation-Saskatchewan]

Thank you.

Taanishi. Hello, everyone.

Good afternoon, Mr. Chair and committee members. Thank you for providing us this opportunity to participate in your hearing today.

I'm here as the minister of health with Métis Nation-Saskatchewan to speak to you about non-insured health benefits for our Métis citizens. They have identified it as a top health priority across our homeland.

You've heard from our president, Métis National Council president Cassidy Caron, recently. I'd like to provide further details on the health experiences of our people, and I want to specifically comment on the non-insured health benefits.

Métis Nation-Saskatchewan is one of the four governing members of the MNC. We represent the Métis citizens in Saskatchewan. Our Métis nation legislative assembly governs our people and also enacts legislation and regulations for the conduct of the Métis Nation-Saskatchewan.

Our people have a holistic understanding of health, shaped by larger social structures that include kinship ties, community, identity and culture, and especially connections to the land. These principles are foundational to any work that addresses health inequities faced by Métis people.

Colonization is an important social determinant of health that contributes to the health inequalities faced by Métis peoples to this day. Examples of colonial practices include residential schools, day schools and industrial schools. There's a large proportion of Métis children in care, which we'd like to address, and there is ongoing systemic racism in our health care institutions.

In the last several years, MN-S has carried out several engagement sessions across the province, across our 12 regions, and has reached out to over 800 citizens. They have expressed their top priority, which is non-insured health benefits, and would like to see that come to fruition in the future. I'd like to share some of their experiences with you today.

Regarding affordability of health care and medication, many citizens cannot afford to prioritize their health. For example, citizens may choose between their basic needs, such as shelter and food, and their medications and prescriptions. We've also heard stories across the homeland that some folks who are living on a fixed income, particularly elders and seniors in our communities, in order to ensure that people are getting the medications or the prescriptions, share prescriptions among their family members who take the same medication or with other community members, neighbours or friends. This is quite alarming to us as health care advocates. We'd like to address that.

High food costs and costs for testing equipment, such as diabetes implements and equipment, are barriers to good health for Métis citizens. This barrier is especially concerning among, as I mentioned, our seniors and elders. There's an urgent need to support the cost of prescription medication for seniors and to prioritize home care and long-term care in our local communities. Oftentimes our elders are shipped away because the long-term care facilities are outside their communities. We know, and learned from experience in listening to citizens, that this is often the case, and then they lose contact with their families and their connection to the land, and their community life as well. That is a concern for us.

We've also heard stories about cancer patients living hundreds of miles away from cancer centres and sleeping in their vehicles because they couldn't afford hotel accommodations after their treatment. It's too far for them to go home when they're not feeling well after a cancer treatment. That is concerning for us as well. It's very common for Métis families and communities to regularly host fundraisers to raise money so that families can afford to stay in a hotel and to ensure that their needs are met when they're going through cancer treatments.

During the pandemic, MN-S started a medical travel assistance program to support the costs of fuel, food and accommodations required by high-need and low-income people who have medical appointments and access that program. Since July 2020 we've supported 965 citizens to attend almost 4,000 medical appointments. The cost is just over $500,000. These numbers demonstrate the significant need for Métis-specific medical travel assistance, yet the program does not have sustainable funding.

The Northwest Territories is the only jurisdiction in Canada that sponsors non-insured health benefits for Métis citizens. The program is administered by Alberta Blue Cross, an external service provider, and covers eligible prescription drugs, dental services, vision care, medical supplies and implements or equipment, as well as medical travel benefits. This program provides a successful model that the MN-S can implement across the Métis homeland in Saskatchewan in collaboration with the federal and provincial governments.

MN-S and other MNC governing members—

[The Chair, Liberal, Marc Garneau]

Ms. Friesen, I'll have to ask you to wrap up, please.

[Marg Friesen]

Thank you.

They are ready and committed to develop a program that is financially sustainable to meet the health care needs and priorities for Métis citizens.

Thank you again for the opportunity to articulate the immediate health priority of the MN-S and express the voice of Métis citizens across Saskatchewan. We welcome any questions you may have.

Maarsii.

[The Chair, Liberal, Marc Garneau]

Thank you, Minister.

We'll now proceed to the questions.

Ms. Stubbs, I believe you're first up. You have six minutes.

[Shannon Stubbs, Conservative, Lakeland, AB]

Thank you, Mr. Chair.

Thank you to all the witnesses for being here today. I think probably all of us share the view that we only wish we had more time to hear from you and to have question exchanges.

I'm going to ask Lee some questions. He hails from my neck of the woods. I want to appreciate his pointing out the unique position of Métis settlements in Alberta. It's a point I'm trying to emphasize on behalf of Albertans repeatedly in this committee—indeed, in part because four of the eight Métis settlements are in Lakeland.

Lee, Minister Hajdu was here on Friday. She said, “we have begun to transfer funding for distinctions-based, Métis-specific programming to Métis governments.” You're an elected councillor of the Métis government in Kikino. I just want to clarify. Has Kikino received any funding from the federal government, or has anyone from the federal government reached out to the settlement?

[Lee Thom]

I'd be glad to answer that. It's pretty straightforward. We do not get any funding in Alberta through other Métis affiliates. We are stand-alone. We have been really advocating for our own voice to represent our own membership through our own governance and to speak for ourselves, basically.

Shannon, the answer to your question is no, no, no. We've never received any federal funding for this program.

[Shannon Stubbs, Conservative, Lakeland, AB]

Can you give us any sense of whether federal public servants, anyone from the department or any of the government offices have reached out to your governance council and to the settlement to work on helping to deliver Métis settlement needs with regard to health insurance and other services, given the 2016 Daniels decision about the federal government's duties?

[Lee Thom]

No. We've had no communication thus far. We've been trying to work on an agreement that would be tripartite with the province and the federal government and to take care of some of the obligations of the Daniels decision. With section 91(24), the Métis people are now considered Indian as far as the Indian Act goes. We've been advocating, since that decision of 2013, to get those rights and to secure our land base, I guess securing it in the Constitution of Canada and securing our section 35 rights.

Shannon, there's a long and a short answer. The short answer is, no, we've had no communication with the federal government. We need it. We are ready for it. The settlements are open for business. Health is a business. Housing is a business. They're all businesses, because at the end of the day, they're all going to identify a line item in your federal budget that says, “Metis Settlements General Council”.

[Shannon Stubbs, Conservative, Lakeland, AB]

Thanks, Lee. I think probably all Canadians want to see actions and outcomes matched with words and promises. I hope that the necessary work gets going in co-operation with the Métis settlements.

Lee, can I get you to expand on the innovative ways and what your community has had to do to provide for yourselves and for your people? You and other witnesses certainly did point out all of the different aspects of health outcomes and health determinants. Since you haven't received funding for services that other indigenous communities get—vision, dental, mental health supports, medication, medical transportation—could you expand on what your community has put in place to get your community members the treatments that they need?

[Lee Thom]

I can expand on that, for sure.

Right now, we have an agreement with the province. Our members have access to Alberta health care. These programs, like the non-insured health benefit program we're speaking about now, have never been offered to us, nor do we have access to them. Right now, the province supports our community with an RN who's been here for 17 years with our community. It's a provincial support.

Locally, we are very innovative in taking care of our elders who need assistance. We have budget line items in our budget that support our elders with $1,100 annually to assist them with medication and medical transportation issues. Also, our community comes together very often for fundraisers. I heard another lady mention fundraisers in her speech. It's key to understand that the Métis people, in a community that's somewhat at the lower end of earnings, can come together and bring their dollars to the table to assist our members. That's another very innovative one. It's very touching to see our community come together to support through fundraising.

Right now, in the budget we have, the $1,100 per senior is a medical fund. That's what we've been doing for now. Most of our programs are provincially supplied right now. There's nothing extra, nothing on top of that, including the program we're talking about now.

[Shannon Stubbs, Conservative, Lakeland, AB]

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Stubbs.

We'll now go to Mr. Powlowski. You have six minutes.