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Our approach

At Gathering Wisdom XII the FNHC will ask Chiefs and leaders to vote on a resolution approving the 10-Year Strategy on the Social Determinants of Health. We encourage Chiefs to review this new Consensus Paper, the 10-Year Strategy and to contact your FNHC regional representatives if you have any questions. We look forward to your participation at Gathering Wisdom XII in February 2023!

Leadership message about the 10-Year Strategy from the FNHC Chair and Deputy Chair.

Engagement and Approvals Pathway

Through Resolution 2011-01, First Nations asked the FNHC to design a process for making strategic decisions. In response, the FNHC released the Engagement and Approvals Pathway as the foundation for gathering wisdom, input and guidance to shape the future strategy for the First Nations Health Governance Structure. This Pathway guides decision-making on strategic issues that affect general direction, long-term goals, philosophies and values.


Nation-rebuilding refers to the process of remembering and reclaiming our traditions, culture, language and relationships. Colonialism has eroded many aspects of our worldview that kept our people well for thousands of years, dissolving our bonds and isolating us into individual “Indian Bands.” Nation-rebuilding is a complex process, driven by First Nations leaders, caregivers and citizens. It involves coming together to determine how we will work together as Nations in a modern context, and determining Community-driven, Nation-based models of programs and services to ensure all people receive a high standard of service.

Social Determinants of Health

The Social Determinants of Health are factors that influence the health of individuals, families and communities. They include:

  • Culture & Language
  • Self-Determination
  • Education
  • Access to Health Services
  • Income & Social Status
  • Employment & Working Conditions
  • Physical Environments
  • Genetics
  • Gender
  • Social Support Networks
  • Early Childhood Development
  • Personal Health Practices & Coping Skills
  • Social Inclusion

Why do they matter?

There is more to health and wellness than just the absence of sickness. More factors contribute to our overall health outcomes than just health services (although they are still very important). In truth, poor health later in life is usually determined by circumstances earlier in life, and the environment we grow up in. It is now acknowledged that a comprehensive and integrated approach to health care is needed to address risk and the root causes of poorer health. A full continuum of services and supports includes not only 'treatment' but also a much broader spectrum of services delivered collaboratively across social sectors. This means that multiple sectors — community health centres, schools, daycares, employment agencies, courts, policing, housing, and children and family agencies — all have a role and responsibility to provide services that promote health and well-being.

Guidebooks and Agreements

The journey to where we are today started with the following documents:

Transformative Change Accord (2005)

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Transformative Change Accord: First Nations Health Plan (2006)

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First Nations Health Plan Memorandum of Understanding (2006)

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Tripartite First Nations Health (2007)

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Basis for a Framework Agreement on First Nation Health Governance​ (2010)

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British Columbia Tripartite Framework Agreement on First Nation Health Governance (2011)

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The signing of the Framework Agreement on October 13, 2011, changed the course of First Nations health in BC with the creation of a new First Nations Health Governance Structure that will enable First Nations in BC to participate fully in the design and delivery of these services.

BC First Nations Chiefs overwhelmingly endorsed the Framework Agreement, voting for greater control by BC First Nations over their own health care. This was a key milestone in the 10-year Health Plan signed in 2007.

The British Columbia First Nations Health Governance Structure includes four components:

  1. The First Nations Health Authority (FNHA): responsible for planning, management, service delivery and funding of health programs, previously provided by Health Canada's First Nations Inuit Health Branch Pacific Region.
  2. The First Nations Health Council (FNHC): provides political leadership for implementation of Tripartite commitments and supports health priorities for BC First Nations.
  3. The First Nations Health Directors Association (FNHDA): composed of health directors and managers working in First Nations communities. Supports education, knowledge transfer, professional development and best practices for health directors and managers. Acts as a technical advisory body to the FNHC and the FNHA on research, policy, program planning and design, and the implementation of the Health Plans.
  4. The Tripartite Committee on First Nations Health (TCFNH): the forum for coordinating and aligning programming and planning efforts between the FNHA, BC Regional and Provincial Health Authorities, the BC Ministry of Health, and Health Canada partners.

The partnership between the FNHC, FNHA and FNHDA is directed and mandated by BC First Nations through the following governing documents:

The partnership between the FNHC, FNHA and FNHDA is directed and mandated by BC First Nations through the following governing documents:

Tripartite First Nations Health Plan

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Resolution 2011-01 and the Consensus Paper 2011: BC First Nations Perspectives on a New Health Governance Arrangement

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British Columbia Tripartite Framework Agreement on First Nation Health Governance

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Resolution 2012-01 and the Consensus Paper 2012: Navigating the Currents of Change Transitioning to a New First Nations Health Governance Structure

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Since transfer the FNHC has signed the following MOUs:

A Regional Engagement Process and Partnership to Develop a Shared 10-Year Social Determinants Strategy for First Nations People in BC (FNHC-BC 2016)

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Agreement Between Indigenous and Northern Affairs Canada and the First Nations Health Council in Relations to services for First Nations Children and Families in British Columbia (FNHC-Canada 2017)

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Tripartite Partnership to Improve Mental Health and Wellness Services and Achieve Progress on the Determinants of Health and Wellness (Tripartite 2018)

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FNHC-FNLC Protocol on Social Determinants (Signed October 1 2015)

The FNHC is currently engaged in a governance guidebook process entitled: Reclaiming Our Connections, The Next Ten Years.

The guidebook will help inform a decision by Chiefs and Leaders at Gathering Wisdom for a Shared Journey XII in 2022 on the direction of the work.