Summary Of Discussions - Métis Breakout Group

Jurisdiction and Control

Launch Question:

How will we address the issues of jurisdiction and control that are impacting on the delivery of, and access to, health services?

Definition of Success

Working in four table groups, the participants identified approximately 55 points that could constitute successful outcomes if jurisdictional and control issues affecting Métis health were addressed. Jurisdictional issues were described in terms of how they limit access to existing health programs and services and fragment the Métis identity. Clarifying what the jurisdictional issues are, shifting relationships (e.g. fiduciary responsibility, bilateral relationships, devolution, Métis control, etc.) to address them, and evaluating progress were noted as key success outcomes. The suggested ideas provide a mix of broad, immediate and longer term ideas that support the development of definitions of success, as well as provide insight into the development of strategies and recommendations to increase:

• awareness of needs;
• access to Métis-specific and other health systems, services and programs;
• respect for Métis governance;
• equal participation in decision-making and political processes;
• partnerships with other governments and among Aboriginal groups; and
• securing a direct funding relationship with the federal government.

The definitions of success were grouped into the following four main categories and participants were asked to develop more detailed recommended actions pertaining to these categories:

• health services, status and improved data (Ownership, Control, Access and Possession) OCAP– “we know where we started”;
• clear roles and responsibilities;
• Métis-specific health strategies; and
• evaluation of progress.

Recommendations/Actions (We know where we started):

Improve health services, status and data by:

• addressing gaps in knowledge by providing for Métis identifiers in data collection, providing financial resources, capacity building and developing partnerships;
• increasing Métis capacity to translate data into Métis-specific policy; and
• creating a gender equality frameworks and applying it to both governance processes, and developing protocols and mechanisms.

Recommendations/Actions (Clear roles and responsibilities)

Establish a direct Métis/federal relationship and partnerships with other governments, Aboriginal organizations, etc., in order to pursue:

• an agreement to immediately establish a Métis-specific health table with equal federal/provincial/Métis partnerships;
• support for, and implementation of, a Métis-specific health strategy that includes a direct relationship with Métis leadership;
• clarification of federal/provincial responsibilities to Métis;
• mechanisms to demonstrate what federal/provincial governments do on Métis issues;
• community-driven consultations with both political and non-political dimensions; and
• application of the gender and geography lens as a natural component of community based approaches.

Short-term Recommendations/Actions

• primary care pilot projects;
• a federal commitment to, and recognition of, the Métis Nation;
• involvement of Métis in all F/P/T health discussions and decision-making processes;
• development of Métis registries;
• targeted funding for Métis-specific programming based on a negotiated allocation formula; and
• program guidelines to access funding to be developed by Métis with community input.

Medium-term Recommendations/Actions

• community based planning processes that feed into programming and services;
• increased number of Métis health care professionals;
• implementation and extension of basic primary health care services and programs; and
• implementation of a Métis Non-Insured Health Benefits Program.

Evaluation of Progress Recommendations/Actions

• design and implement processes to achieve success and recommended actions.

Access and Integration

Launch Question:

What are the key issues and adaptive approaches that would contribute to improved levels of access to, and integration of, health programming and services?

Definitions of Success

Working as a single group, the participants engaged in a brainstorming exercise that generated 22 ideas for what would constitute success in improving access and integration. The participants used a quick dot-voting technique to provide a sense of how this particular group of participants might rank the identified success indicators. While it is important that this be read in the context of the full list contained in the flip chart notes, key issues include:

• the narrowing and elimination of disparities between Métis and other Canadians;
• consideration of the impact of long-term systemic racism, including gendered racism, as a critical determinant of health;
• community-directed, Métis-focused promotional activities that build on knowledge and values of the community;
• ownership, control, access and possession of the health system;
• equitable and acceptable access to comprehensive high quality health care services (confidential, culturally appropriate, gender sensitive/specific);
• equitable and knowledgeable access to the current health system;
• Métis proportion of health care professionals that mirrors the Métis population; and
• a focus on improved access and recognition, not integration.

Recommendations/Actions

Given the time available, the group was unable to identify a working set of categories or themes upon which to develop recommended actions and as a result each table group was asked to review the entire list and develop recommended actions. The resulting recommended actions reflected and provided more detail to some of the ideas generated in the previous section (e.g. Métis Nation involvement in all F/P/T health discussions and decision making, Métis health drug benefits insurance, etc.), as well as additional recommended actions including:

Short-term/Intermediate Recommendations/Actions

• develop a federal access point for Métis;
• research and address knowledge gaps (e.g. access to government programs, gender equality analysis);
• develop and implement Métis-specific cultural accreditation of health care facilities and providers who serve Métis;
• implement Métis/community-controlled primary health care, health promotion and services and programs;
• develop a Métis Health Accord with Métis governance structures to build policy development capacity that represents the distinct needs of Métis people;
• allocate resources for capacity building through the development of a National Métis Health Action Plan inclusive of all Métis (provincial, women, people with disabilities, and remote Métis communities); and
• develop a comprehensive Métis health human resources capacity development strategy.

Medium-term/Intermediate Recommendations/Actions

• develop a Métis-specific health strategy and policy framework that respects communities and is protected by a federal/provincial/Métis accord;
• target funding and devolution for Métis-specific health care system and programming based on a negotiated allocation formula; and
• create a Métis health policy centre.

Capacity and Sustainability

Launch Question:

What capacity supports are needed to ensure progress on shared health priorities and improved health status?

Definitions of Success/Recommendations/Actions

There were approximately a dozen ideas suggested for what would constitute success in the area of capacity and sustainability. These ideas reflected and added to previous definitions of success statements and recommended actions (e.g. Métis governance structures, research, partnerships, etc.). Additional ideas include:

Capacity:

• comprehensive health and human resources capacity building and development strategies;
• Métis recruitment and retention initiatives; and
• development of post-secondary health professional programs.

Sustainability:

• targeted and multi-year resources (including core funding vs. proposal/competition based);
• development of health policy; and
• engaging all stakeholders in planning processes.

Broad Determinants of Health

Launch Question:

How could a “broad determinants of health approach” be applied within a Métis context?

Recommendations/Actions

• develop partnerships between government ministries and Métis government structures to support and resource joint holistic community-based health planning, promotion and prevention initiatives that empower communities to improve determinants of health;
• holistically address socio-economic marginalization, classism, violence and racism at all stages of planning, implementation and evaluation;
• recognize racism (including gendered racism) as a determinant of health and take this into account at all stages;
• consider health on all agendas, including other Sectoral Follow-up Sessions; and
• collaborate between Métis policy people across all sectors (i.e., health, housing, education).

Working with other stakeholders

Launch Question:

In what areas of our recommended actions and definitions of success will we work with other “stakeholders” and how will we do that?

The participants provided suggested areas to work together and details on how to work together (see flip charts), which are summarized as:

• Métis networking (starts by bringing Métis stakeholders together);
• instituting a single Métis access point within the federal system;
• pursuing Métis workforce development;
• engaging Métis-specific health prevention research;
• facilitating the inclusiveness of all Métis; and
• building partnerships with other groups in Canada (e.g. Indigenous/non-Indigenous).

Knowing we are making progress

Launch Question:

How will we know that progress is being made on our definitions of success and recommended actions?

Participants generated over a dozen responses relating to their internal environment and another dozen or so related to their external environment. These ideas reflect implementation of many of the recommended actions (e.g. agreements, processes, resources, plans) and the elements of success (e.g. Métis-specific health services, respect for community knowledge) raised throughout the breakout group discussions. The ideas also reflect the desire to see that the gap in key quality-of-life indicators (i.e. health status improvements, comparable life expectancy) is being closed. These ideas are summarized as:

• self-determined and self-governed design and delivery of health services and programs;
• sufficient resources, infrastructure and capacity in place to support Métis health initiatives;
• an inclusive Métis health accord signed with the federal government;
• measured improvement in Métis health status; and
• a representative Métis health workforce.

Application of the Crosscutting lens

At every stage of the discussions, the participants were asked to review their recommendations from the perspectives of providing Métis women an opportunity to participate and/or address issues of concern to their health status; and addressing the needs and concerns of Métis people in urban and northern/rural/remote situations.

A focused discussion on what applying Métis gender equality might entail was led by two participants. A lively discussion emphasized to all the participants that there are different health and social realities for men and women (e.g. access to pap tests/breast screening; rates of physical, emotional, sexual violence against Métis women, children and families; high rates of male youth suicide and low screening rates for adult males). The discussion indicated that a successful approach would include:

• a built-in Métis gender-equality analysis by all stakeholders and health officials when dealing with services, data, planning, development, implementation and evaluation;
• a specific focus on women's issues within research, cultural safety and community activities;
• increased participation by women in leadership/governance and program delivery; and
• include a gender-based analysis clause within Métis National Health Accord.

Table of Contents

The documentation contained on this website does not necessarily represent the views of any government or National Aboriginal Organization. The purpose of this website is to share information related to the Canada-Aboriginal Peoples Roundtable: background papers, Facilitator's sectoral and final reports, agendas and media announcements.

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