Good afternoon, everyone.
I call this meeting to order.
We are unfortunately starting a bit late, but we will try to stick to our agenda.
Welcome to meeting 22 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 will spend the first hour hearing from our last witnesses on the NIHB study and spend about 30 minutes on drafting instructions for that report. We'll also consider the second version of our draft housing report, which was circulated last week.
Last, but not least, we'll consider the travel budget for our Arctic sovereignty, security and emergency preparedness study for the fall. If we’re all in agreement, we'll instruct the clerk to submit that to the liaison committee.
Today, we are completing our third study on the administration and accessibility of indigenous peoples to the non-insured health benefits program.
On today’s panel, we are hearing from Lee Allison Clark, manager of policy and research at the Native Women’s Association of Canada, who is with us in person. Joy Idlout is here as an individual, as is Grand Chief Jerry Daniels of the Southern Chiefs’ Organization.
I would like to remind everyone to comply with the requirements established by the Board of Internal Economy concerning physical distancing and mask wearing.
To ensure an orderly meeting, I would like to outline a few rules to follow. 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 could be a bit of 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 for English, French or Inuktitut. If interpretation is lost, please let us know and we'll pause to try to fix the problem. The “raise hand” feature at the bottom of the screen can be used at any time if you wish to speak or alert the chair.
Before speaking, please wait until I recognize you by name. 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. When you are not speaking, your mike should be on mute. I would remind you that all comments should be addressed through the chair.
The way we do this is that each of the witnesses will be invited to speak for five minutes. I would ask you to respect those five minutes, after which we will have a question period.
Thank you to the witnesses who are appearing today. We will now proceed. I will begin by asking Ms. Clark to start.
Ms. Clark, you have five minutes.
Good afternoon, honourable members.
Thank you for the invitation to come here today on behalf of the Native Women's Association of Canada, to speak about the administration of and accessibility by indigenous peoples to the non-insured health benefits program.
I want to acknowledge that the land that I and others here today are on is the traditional and unceded territory of the Algonquin Anishinabe people.
As you all likely know, NWAC is a national indigenous organization representing indigenous women, girls, two-spirit, transgender and gender-diverse people in Canada. As we all know, accessibility, availability and acceptability of health services indirectly and directly impact indigenous people's health and health outcomes.
Although the NIHB program provides critical financial support for accessing services, more must be done to ensure that indigenous women, girls, two-spirit, transgender and gender-diverse people have access to essential health care services that are acceptable, culturally and gender sensitive, and trauma-informed.
The NIHB program represents a lifeline for indigenous people. Indigenous women utilize the NIHB at higher rates than indigenous men. Previous amendments to the Indian Act have meant that a greater number of individuals can claim or restore their status. Bill , the Gender Equity in Indian Registration Act, and Bill aimed to eliminate known sex-based inequities in registration. Because of this, many people became entitled to register under the Indian Act.
Understanding that the population with access to NIHB has grown significantly in the past years, with a vast amount of the growth occurring in small and remote communities, NWAC really welcomes discussions on ways to better this. Today I will highlight several scenarios that underscore where the NIHB falls short, and I will welcome discussion throughout the hour to provide tangible solutions to these shortcomings. The examples I will present in the next few minutes represent just the tip of the iceberg.
In nearly every sharing circle, focus group or engagement session focusing on health care experiences that NWAC has held with indigenous women, girls, two-spirit and gender-diverse people, difficulty in accessing services, availability of services, quality of services and experiences of discrimination, racism and sexism are raised. Whether due to straightforward racism or discrimination embedded in institutions, health care services are often inaccessible to the folks who need them the most.
As with many other countries worldwide, women typically have higher prescription rates than men have. This is also true in Canada and remains true for indigenous women when compared with their male indigenous counterparts and the Canadian population overall. Therefore, the NIHB remains critical for indigenous women to survive, and is a gendered issue.
However, the NIHB drug coverage plan, as continually highlighted by the Canadian Pharmacists Association and others, provides less drug coverage than the average Canadian receives. When we consider that indigenous women, girls, two-spirit, transgender and gender-diverse people encounter one of the highest disproportionate burdens of health disparities in Canada, which stems from various determinants of health, this can be catastrophic.
Access to birthing services close to home is something Canadians expect. This is not the case for indigenous pregnant people. A recent study published in the Canadian Medical Association Journal found that indigenous pregnant people in Canada experience striking inequities in access to birth close to home when compared with non-indigenous folks.
Although the NIHB covers many of the expenses associated with travel for pregnancy, it is limited to one pregnant person and the addition of another person, as of 2017. However, often this other person is a doula or a midwife, not a family member or friend. Children are left behind. This is problematic.
Birthing on or near traditional territories in the presence of family and community is a long-standing practice of foundational, cultural and social importance that contributes to overall maternal and infant well-being among indigenous people. It gives them a good start. Most Canadians have the luxury of giving birth near their home, with their partner in the room or perhaps with their family in the waiting room. NIHB simply does not allow for this, creating a standard for indigenous birthing people that is less than that for the Canadian population.
Layers of racism and sexism continue when you consider dental care for indigenous women, girls, two-spirit, transgender and gender-diverse people. Wearing dentures, receiving off-reserve dental care, asking to pay for dental services, perceiving the need for preventive care, flossing more than once a day, having fewer than 21 natural teeth, fear of going to the dentist, never having received orthodontic treatment and perceived impact of oral conditions on quality of life all have been correlated with experiencing a racist event at the dentist's office. Simple tasks that many Canadians take for granted, such as getting their teeth cleaned, become a potentially traumatic event for indigenous folks. This doesn't even begin to tackle the layers of issues that are rife within finding and accessing the dentist.
Before contact with European settlers, first nations and Inuit healers bore the responsibility of health for their people and relied upon a rich body of knowledge of traditional medicines and socio-cultural practices. The administration of the NIHB program must integrate this and be culturally and gender sensitive, as well as gender-informed, if we are ever to fully walk the path of reconciliation.
However, respecting the Ottawa Charter for Health Promotion, which was developed in 1986—so many years ago—and as outlined by PHAC, “reductions in health inequities require reductions in material and social inequities.”
When considering the NIHB, this means increasing coverage of easy access to and increasing the availability of preventive allopathic and traditional medicine.
In sum, we cannot risk any more indigenous women, girls, two-spirit, transgender and gender-diverse people falling through the cracks when looking to access the care they have a right to. NWAC wants to be part of the solution of how best to increase accessibility and better the administration of the NIHB program.
I look forward to presenting some more detailed recommendations throughout the hour.
Thank you. Meegwetch.
[Witness spoke in indigenous language]
I would like to begin by acknowledging that I'm joining you from Winnipeg on Treaty 1 territory, also the unceded lands of the Dakota.
I want to take a moment to acknowledge our elders, who are the keepers of our knowledge and culture and who faced significant barriers when attempting to access non-insured health benefits.
I want to thank the standing committee for the invitation to appear today.
Right now, there is a documented 11-year gap in life expectancy between first nations people and all others living in Manitoba, and that gap is growing.
I want to remind the standing committee that Canada has a responsibility to provide equitable health services to first nations citizens. According to article 24.2 of the United Nations Declaration on the Rights of Indigenous Peoples, indigenous peoples “have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view [of] achieving progressively the full realization of [that] right.”
First nations also have inherent aboriginal and treaty rights under section 35 of the Constitution Act of 1982, including the right to health and self-determination over health systems. Treaties have affirmed first nations jurisdiction over our health systems and established a Crown obligation to provide medicines and protection.
Due to the existing crisis in health care for first nations, the Southern Chiefs' Organization is actively leading a health care transformation process following the signing of an MOU with Canada in June 2020. Our community engagement process has included input on non-insured health benefit programs and services. The NIHB program has been identified as one of the most significant concerns in its aspects, as it impacts every first nations citizen, from our children and youth through to our elders, both on and off reserves.
The current NIHB services are some of the biggest barriers to positive health outcomes of first nations citizens. The administration of the program and the inconsistent application of the program policy result in citizens receiving substandard services or being denied care outright.
I cannot state strongly enough that our citizens told us that no component of the NIHB program meets their needs. For instance, 61% of southern first nations citizens have a drive time of between one and three hours to get from their nation to the nearest hospital pharmacy. The biggest barrier in getting to the hospital pharmacy is the denial of services by NIHB for medical transportation.
Let's stop and think for a moment about having to seek permission every time you need to get to the hospital or a pharmacy. Even when transportation is approved, NIHB medical transportation rates, including mileage and meals, sit well below the rates provided in other areas and by other programs like Veterans Affairs, for example. The current NIHB medical transportation private vehicle mileage reimbursement rate in Manitoba is 21.5 cents per kilometre. Veterans Affairs is almost double the rate, at 49.5 cents per kilometre.
The current NIHB meal allowance rate for our citizens is set at $48 per day, where Veterans Affairs is $93.50. When travelling to larger urban areas for medical appointments that are not available on reserves, the commercial accommodation rates are not high enough to ensure the safety and comfort of our citizens. Accommodations in Manitoba are at a maximum of $120 per night, whereas with Veterans Affairs it's $157 to $169.
For essential life-saving treatment like dialysis, many are forced to relocate to large urban centres like Winnipeg, because there is no treatment available closer to home, yet no medical transportation is available to our citizens who live in urban centres, even if those citizens are elders.
We could talk about other program inadequacies and fundamental inequities with dental, vision, mental health, prescriptions and other medical supplies, and here are a few examples.
Our citizens face long wait times in backlogged services from the NIHB vision department. Providers, even those on the approved list, are charging additional fees, but these monies cannot be reimbursed as they are above the approved rates. Providers should be required to make clients aware of this, as clients assume that if they are on the approved list, they shouldn't be directly billed, so they're taking on those additional costs.
In order for us to secure long-term, positive outcomes for our citizens and nations, these inadequate NIHB programs and services must be dismantled. I understand that the federal government acknowledges the gaps and the devastating results, but despite identifying this as a problem since at least 2016, there have been almost no improvements in seven years.
In conclusion, these are just some of the reasons that the Southern Chiefs' Organization is building a new first nations health system that will provide better service and close the health gap between Anishinabe and Dakota peoples and the rest of Canada.
I thank you for your time and interest today and look forward to any questions.
Unfortunately, it is rife with layers of issues. Being someone who would be two-spirit, transgender, gender-diverse, or part of the 2SLGBTQQIA+ community is already difficult. If you then layer on being indigenous, that's only going to become more difficult. The indigenous experience in health care has traditionally been extremely difficult. Combining that with something that's already difficult, as well, would make it, unimaginably, almost impossible.
The idea of being two-spirit is something that is very foreign to most health care providers. They often associate that with being gay, bisexual, or something, and it's just a totally different thing. It's sacred; it's spiritual, and an understanding of that would probably increase the ability to seek gender-affirming care. However, especially if you're in a rural or remote community, it's going to be almost impossible to do that.
In regard to your first comment about having access to birthing services, yeah, it's a decision between bringing your midwife, your doula, or your child, and which child do you choose if you have several? Do you bring your partner, or does your partner look after them? Hopefully, there are elders in the community. There are just layers of having to decide who to have with you.
Mr. Shields was speaking about having a navigator with you. Having a navigator is great, but so is having family, and having just one person is not enough when.... I'm sure many folks here have been around people who have given birth. You're allowed to go to the hospital. It's easy. You drive over, you go, and you get to see the baby. It's incredible.
That doesn't happen for the majority of indigenous people who give birth and have family members. They have to wait until they fly home. Flying is already traumatic for some folks, but never mind with a newborn, so the layers and layers of barriers just continually keep coming up.
I want to thank all the witnesses here today, as well, for their testimony and for sharing—with honest concern—some of the things they face.
Grand Chief Daniels, I want to talk with you about your navigator position for a couple of minutes.
I was looking at your organization's website and the work the navigator does. Back on May 3, we had Dr. James Makokis here. He's a Plains Cree family physician, and he shared how, to get many services covered through the NIHB, there has to be a fair amount of advocacy on his part, on behalf of patients. My expectation is that your community members have faced similar situations. You talked about the inconsistent application of policies. If I'm making the right connections, that's where your navigator position comes in.
My questions for you are as follows. Would you share some of the challenges that are faced? Is it the bureaucracy or the process? How has your navigator position been used to address some of that?
Absolutely. What's going on is huge in terms of what the additional costs are. Food security is a huge problem that's going on and a concern.
Even our nurses have been restricted from the north, except in emergencies only, as a result of the high need for nurses in the urban areas. It reflects how first nations communities are not the priority here. It's really focused on the urban areas in terms of how health is managed in the region. It's for those reasons that we need independence from these provincial systems in some ways. We have to take care of ourselves.
We travelled internationally to create a value-added model in partnership with Cuba at one time. We're looking to provide health care service experts for our communities. We also had the ability to train our citizens within the health system over there.
That could have created some solutions to the problems that we experienced with COVID, although we weren't given that ability. We weren't given that opportunity. We were shipping people out of Manitoba, because the system wasn't able to take on the crisis.
Now we're seeing another example of this here in Manitoba, where our nurses are being taken away. In a case like that, where we're not being prioritized, it's quite simple that the system is not putting first nations in the place where we need to be. There's already an 11-year life expectancy gap. It's terrible for our elders, who need to be passing on that knowledge.
We need to create our own system. It needs to be independent. We need to have our health experts looking out for us. Until there's trust built.... I don't know. It's decades and decades of a culture that has not been built to serve the needs and interests of indigenous people.
I'm always glad to hear from you, Grand Chief Daniels.
As we go through this study, one of the things that keeps popping into my mind is that a lot of the challenges that are being faced are the result of someone besides first nations deciding for first nations how they should manage their health system, what to approve and what not to approve. It's not based on that community's needs or cultural values, but rather what a bureaucrat has decided should be appropriate for our communities.
With the successes I've seen around nations taking on their own jurisdiction, whether it be in education or health, is that part of the solution, Grand Chief, that we need to look at? It's giving nations the ability to take over jurisdiction of their own health with bilateral agreements between the federal government and those nations.
We've seen really good examples of how that's happened, including MK out in Nova Scotia. I wonder if you could speak to that a bit.