As we begin a new year, the First Nations Health Council (FNHC) wanted to provide an update to First Nations leadership in BC on our work to make progress on the social determinants of health. With the beginning of 2016, it is an opportune time to pause and reflect on where we have been, what we have achieved, and where we seek to move next.
This past year has been full of change. We appreciate the advice and guidance First Nations leadership has provided us in our discussions on the social determinants of health. We are optimistic with the opportunities in front us and mindful of the need to engage our leadership as we take the next steps in developing a ten-year strategy on the social determinants of health.
In this update, you will find a report on our advocacy activities, an update on our work with the First Nations Leadership Council (FNLC), and our reflections on the recently completed Regional Caucus sessions.
Report from the Chair
Chair, First Nations Health Council
BC First Nations are on a journey together. In May 2011, Chiefs freed ourselves from the insanity of federal and provincial health policies for BC First Nations citizens. While we appreciated the work of Health Canada, our Chiefs believed that anything that others do for us – we could do better for ourselves. Giving ourselves freedom required our Chiefs and Health Directors to overcome fears and doubts. We engaged in sub-caucuses, regional caucuses, and province-wide to air out fears, questions, and doubts. Together, we overcame our fears and created our own First Nations Health Authority.
Just over two years ago on October 1, 2013, the First Nations Health Authority began to manage and deliver all of those services once delivered by Health Canada. In a very short time, we built a new first-of-its-kind First Nations Health Authority. The first-of-its-kind in Canada, we are working together to achieve better health outcomes for all our citizens. We work for those at home and those living away from home. Together we will transform health policies, programs, and services. The First Nations Health Authority will do things differently and achieve improved health outcomes for our people.
Chiefs understood that we cannot achieve our Vision Statement of “Healthy, Self-Determining, and Vibrant BC First Nations Children, Families, and Communities” by transforming the sickness system. Chiefs understood that in addition to creating a new model of health governance that we had to make progress in the social determinants. As we transform the sickness system into a wellness system, we must also advocate for transformation of other federal and provincial programs.
When it comes to First Nations and Aboriginal policies, the federal government keeps doing the same thing over and over again and expecting different results. Yes, this is the definition of insanity. Yet, it is also a simple and shameful fact.
Chiefs mandated the First Nations Health Council to advocate and to make progress in the social determinants. The Government of Canada agreed to an annual meeting of Deputy Ministers with the First Nations Health Council and the First Nations Health Authority. The purpose of this meeting is to make progress on the social determinants. The Province of BC agreed to an annual meeting of Deputy Ministers with the First Nations Health Council and the First Nations Health Authority. The purpose of this meeting is to make progress on the social determinants.
Achieving transformative change requires leadership, organization, vision, and a clear purpose or mission. Past efforts at transformation often failed because of a failure to organize properly. When governments confront opportunities, they confront it like a banker afraid of losing money. If there is any unresolved conflict – the banker flees. So does the government.
On October 1, 2015, the First Nations Leadership Council and the First Nations Health Council signed a Social Determinants Protocol in a sacred ceremony. Our leadership and our organizations will work together. Working together, we will do things differently and we will make progress in the social determinants.
As we worked together to create agreement to build the First Nations Health Authority, we learned about the forces of status quo. Everywhere, in all organizations, at all levels – there are people very happy with the status quo. These folks and their families are doing well. These folks believe that any effort to improve health outcomes or make progress in social determinants poses a threat to their well-being.
During the fall and early winter of 2015, the First Nations Health Council carried out very successful regional engagements. We presented our strategy to make progress on social determinants. We aired out questions, comments, and concerns. Chiefs and leaders in each of the regions expressed support for moving the work forward. We will continue working with our regions to set priorities, develop ten-year plans, and to build on-the-ground capacity to do this.
Santa travelled through Canada two months early and gave Canadians an early present. Perhaps, Canadians gave themselves an early Christmas present on October 19, 2015. The new federal government, led by the Right Honourable Justin Trudeau, has set a new tone and made clear commitments to address the needs of First Nations. It is clear that the new Prime Minister listened to Chiefs as he travelled across the country as a Member of Parliament and then as the Leader of the Liberal Party of Canada.
There is a remarkable change in the energy in the early engagement between the Prime Minister and Cabinet members and Chiefs. This positive energy is making its way through central agencies and the ranks of Deputy Ministers and senior officials. The First Nations Health Council is prepared to do our share of the work to make progress on social determinants. We are meeting with Cabinet Ministers and other senior government officials to give them briefings on our mandate, our plans, and our approach to collaborating with Canada and the Province of BC.
In 2016, the forces for transformative change must defeat the forces for status quo. Just as we overcame our fears of transformative change to create the BC First Nations Health Authority – we will overcome the forces of status quo and make progress in the social determinants. When Chiefs freed themselves from the insanity of federal and provincial policies on health – we created a pathway and a template to make progress on social determinants.
The First Nations Health Council is excited, motivated, and determined to overcome the forces of status quo. We will meet with the federal and provincial Deputy Ministers in 2016. As our work proceeds, we will keep you informed. The First Nations Health Council wishes you and your families a healthy, prosperous and successful 2016.
Chair, First Nations Health Council
FNHC and FNLC Sign Protocol on the Social Determinants in Sacred Ceremony
Protocol signing on October 1, 2015 in the Charlie Longhouse,
Grand Chief Stewart Phillip signing the Protocol at the Interior
Regional Caucus Session, November 2015.
The First Nations Leadership Council (FNLC) and the FNHC have committed to work together to make progress on the social determinants of health. With every significant agreement made on our health journey – we marked that accomplishment with ceremony.
In this spirit, the FNLC and the FNHC signed the Protocol on the Social Determinants of Health in a sacred ceremony at the Charlie Longhouse in Sts’ailes territory on October 1, 2015. This Protocol confirms a shared commitment to ongoing collaboration, information sharing, and coordinated action in addressing the social determinants of health. It grounds the work of the FNLC and the FNHC and reminds us of the importance of working together to fulfill our shared objective to improve health and wellness outcomes by improving the overall quality of life for First Nations children, families, and communities in BC.
With the signing of this protocol, the FNLC and the FNHC have established a new relationship for addressing the social determinants of health. We look forward to working with the FNLC to fulfil our joint commitment to make progress on the social determinants of health in order to improve the quality of life of BC First Nations.
“My heart is full of good feelings. I am very proud of the First Nations Leadership Council and the First Nations Health Council for coming together. The work of transformative change is heavy. The First Nations Health Council cannot do this work on our own. The First Nations Leadership Council cannot do this work alone,” said First Nations Health Council Chair, Grand Chief Doug Kelly. “We need to help one another. We need to carry this work together. We have promised our Chiefs and our communities that we will work together to build One Heart, One Mind, and One Spirit. The First Nations Health Council looks forward to working with the First Nations Leadership Council as we seek to make progress on the Social Determinants of Health.”
Top 10 Things to Know About a Ten-Year Wellness Determinants Strategy
In 2014, the FNHC started a dialogue with First Nations leaders and health leads on the concept of a ten-year plan to make progress on the social determinants of health. Since that time, the discussion has continued to evolve. To provide an update on our progress, we wanted to take the time to answer ten of the most frequently asked questions about our work.
1. What is the Ten-Year Wellness Determinants Strategy?
In 2005, the First Nations Leadership Council (FNLC) developed a First Nations Health Blueprint for British Columbia. Originally prepared for First Ministers Meetings in 2004 and 2005, the Blueprint formed the foundation of the Transformative Change Accord (2005) and the Tripartite First Nations Health Plan (2007). Similar to Blueprint, the ten-year strategy is a process of planning where First Nations work to build consensus on priorities relevant to the social determinants of health. This ten-year Strategy will inform advocacy with the Government of Canada and the Province of British Columbia.
2. What are the social determinants of health?
Our opportunities for better health begins where we live, learn, work and play. Our health is influenced by multiple factors, which include health, education, employment and skills development, economic opportunities, housing, infrastructure, environment, child and family development, and culture and language. From this perspective, health is an outcome. It is an outcome of factors that are interdependent and interconnected. To improve overall health outcomes, attention must be paid to the determinants of wellness.
3. What is the FNHC Proposing to do?
Similar to the tripartite partnership in health, the FNHC is advocating to establish a tripartite partnership that will make progress on the social determinants of health. Informed by the health and wellness priorities of First Nations in each region, the FNHC will advocate for concrete commitments and actions in the form of a Ten-Year Tripartite Wellness Strategy.
4. Where does the FNHC mandate come from?
The FNHC was established in 2007 to implement the Tripartite First Nations Health Plan (2007). In 2011 and 2012, BC First Nations endorsed Consensus Papers and Resolutions that mandated the FNHC to advocate on matters related to First Nations health and wellness, support health systems transformation, and build partnerships to make progress on the broader determinants of health.
5. What are Deputy Minister Tables?
The Framework Agreement on First Nation Health Governance (2011) is a legal agreement adopted by the Government of Canada, the Province of British Columbia and BC First Nations. This legal agreement primarily describes the process for transferring federal health programs and services to First Nations control. It also sets out commitments of the parties to annual meetings between the FNHC and Deputy Ministers for Canada and BC to discuss issues related to the social determinants of health. The FNHC is currently working with Deputy Ministers federally and provincially to bring clarity to these legal commitments and establish regular meetings.
6. What is the Engagement and Approval Pathway?
The Engagement and Approval Pathway is a process last used by the FNHC in 2011 and 2012 when BC First Nations endorsed Consensus Papers at Gathering Wisdom for a Shared Journey IV and V. This is a proven process that is based on the principle of reciprocal accountability and designed to ensure engagement upholds Community-Driven, Nation-Based processes. The Engagement and Approval Pathway starts with dialogue, continues with consensus building, and ends with a decision made by BC First Nations leaders at the Gathering Wisdom forum.
7. How will priorities be determined?
In the early stages of the work, the FNHC will use the Engagement and Approval Pathway to determine high-level priorities and set strategic direction on the social determinants of health. Similar to the direction provided by BC First Nations in Consensus Papers 2011 and 2012, the FNHC envisions a process of regional planning where each Regional Caucus develops and endorses a Regional Social Determinants Strategy. These regional strategies will set out priority areas, specific actions and key partners to work with in each region.
8. Where is funding coming from?
Currently, no new funding for this work is required. By using our existing engagement network, we can support cost-effective engagement with First Nations in each of the five regions.
9. How will this work impact the First Nations Health Authority?
While the FNHC and FNHA share a vision and values as partners in the First Nation health governance structure, we operate independently of each other. The FNHA is mandated to plan, design, deliver and manage First Nation health programs and services. The FNHC is mandated to build partnerships to make progress on the broader determinants of health. As a health and wellness partner to BC First Nations, the FNHA continues to work with First Nations in the design, delivery, management and improvement of First Nation health services, including improvements to the First Nation Health Benefits (FNHB) program. This work will not distract from the work of the FNHA as a service provider and partner to BC First Nations.
10. How will this work impact the capacity of my community?
One of the most commonly cited concerns is capacity. The social determinants are complex and require the participation and input of multiple parties. We do not want to overburden our administrators with new or more work. In the short-term, the FNHC will focus much of its effort to engage First Nations leaders on governance matters. In the medium-term, the FNHC will advocate for additional resources to support communication, collaboration and planning at local levels. Similar to the Community Engagement Hubs established for our work in health, it will be important to consider how best to support comprehensive community planning and collaboration among First Nations.
Report on the Regional Caucuses and Next Steps for Engagement
The Northern Caucus showing off their new regional colours in October 2015.
The Regional Caucuses are a critical component of our First Nation health governance structure. The Regional Caucuses provide a forum for First Nations leaders and health leads to share information and perspectives, set strategic direction on regional matters, and provide direction to regional representatives of the FNHC. This last round of Regional Caucuses provided time for the FNHC to update on progress and to engage First Nations leaders and health leads on next steps in this process.
As part of this, we took the time to reflect on and define our shared vision statement of Healthy, Self-Determining and Vibrant First Nation Children, Families and Communities. We also took the time to discuss a Community-Driven, Nation-Based approach for developing a strategy for the social determinants that reflects regional and provincial priorities.
To maintain our high standard for engagement with First Nation leaders and health leads, the FNHC agreed to once again use the Engagement and Approval Pathway to support informed, consensus-based decision-making. The Engagement and Approval Pathway was last used in 2011 and 2012 when BC First Nations endorsed Consensus Papers to define the structures, standards and operations of the First Nation health governance structure. Similar to 2011 and 2012, the FNHC will engage First Nations through Regional Caucuses to build consensus on common perspectives and priorities related to the social determinants of health.
As presented at the Regional Caucuses, the FNHC proposed the following steps for 2015 and 2016:
- Fall 2015 – start a dialogue on the social determinants with leaders and health leads at the Regional Caucus
- Winter and Spring 2016 – FNHC to develop a guidebook on the social determinants to support an on-going dialogue with each Regional Caucus
- Spring and Summer 2016 – FNHC to develop a regional summary report to begin building consensus on regional priorities and interests
- Fall 2016 – BC First Nations to review results of engagement and deliberate a Consensus Paper at Gathering Wisdom VIII
- Winter and Spring 2017 – Regional Caucus to develop Regional Social Determinants Strategy
In the months ahead, the FNHC will review the outcomes of our regional dialogue. Informed by this dialogue, the FNHC will develop a set of engagement tools that can be used to support an ongoing discussion with First Nation leaders and health leads on core concepts and priorities. As part of this review, the FNHC will discuss the format and structure of Regional Caucuses to ensure First Nations are able to fully and effectively participate in the process as the dialogue evolves and extends beyond health services.
We invite you to visit the FNHC website to receive the latest news and updates – www.fnhc.ca.
2015 Regional Caucus Photo Gallery