Manitoba’s natives suffer from health problems that would be considered intolerable in any community less marginalized from the Canadian mainstream. Like First Nations elsewhere, they have rates of suicide, diabetes, obesity, and addictions far higher than any other group in the country. Cultural and social factors play an undeniable role in this public health nightmare, but the vulnerabilities of aboriginals are exacerbated by the fact that they’re at the intersection of two Canadian policy problems: our inaccessible medical system and our failure to give natives the same rights and protections enjoyed by other Canadians.
With the admirable exception of clinics and doctors who devote themselves to helping the most excluded among us, the inequalities in our current health care system are felt most keenly by the underprivileged. Access to specialists and diagnostics, as well as preventive care, is most easily gained by those with a family doctor. Poverty, lack of education, and social isolation all decrease the chances of having a GP. This divide is, for aboriginals, exacerbated by their exclusion from the mainstream health system, as many fall under the jurisdiction of their local aboriginal administrations, funded directly by the federal government.
When the Virginia Fontaine Addictions Foundation was linked in 2000 with the fraudulent use of millions of dollars, and the Globe and Mail broke the story that records were destroyed to prevent an investigation, many hoped that the lack of transparency and accountability that characterizes much of aboriginal governance might finally change. It’s clear today that the situation has deteriorated since then. In 2005, Ottawa suspended funding of an Anishanaabe group charged with distributing medical services to natives in the Interlake region north of Winnipeg, after discovering that band chiefs and senior staff had abused over 10% of the agency’s budget since 1997.
Even when aboriginals are allowed under the umbrella of mainstream health care, the inequality continues. The Burntwood Regional Health Authority, responsible for providing health care to most of northern Manitoba, including a large native population, was rocked in late 2006 by the firing of top level administrators, including the VP for aboriginal health, for yet more financial wrongdoing. Examples of unauthorized spending ranged from the purchase of thousands of dollars in cigarettes, to unpaid loans for the purchase of personal cars and furniture, and reimbursement for the costs incurred when RHA staff chose to bring their families with them on business trips.
The initial intent behind this segregation, in which aboriginals are shunted out of the medical system provided for all other Canadians, was to ensure excellent health care for Canada’s First Nations, as well as targeted programming to address the health problems that disproportionately affect natives. Maintaining this broken bureaucracy in the face of pervasive fraud and ever-worsening health in native communities is now itself an injustice that must be corrected.
While education, health care and welfare are provided for most Canadians through provincial and municipal bodies that are, however imperfectly, audited and subject to democratic processes, aboriginals are often dependent on autocratic band councils and chiefs for such services. Tribal politics, unsurprisingly, too often result in unequal access and corruption. The VFAF, Burntwood RHA and Anishanaabe health agency all demonstrate that even when larger, more impersonal structures are established to address medical needs, the health of aboriginals remains hostage to administrative incompetence and financial impropriety.
The provision of health care along geographic lines is sensible and often necessary, especially in the northern and remote areas in which so many reserves are located. Medical programs designed to reach Canadians for whom health care is especially inadequate can be helpful, but only when they improve access and outcomes, rather than worsening them as has lately been the case for aboriginals. But establishing parallel and decidedly unequal medical systems that deepen the growing socioeconomic gulf between native and their fellow citizens is actively harmful.
There is a strong case to be made that aboriginals have specific medical needs beyond those of the rest of the population. If such problems persist once health care delivery to native communities is brought up to the same standard provided to all other Canadians, then specialized services tailored to First Nations, and other ethnic groups with similar needs, may be appropriate. Today, though, despite the conviction of most Canadians that wealth must not determine access to medical care, we have created a situation in which delivery of care is dependent on ethnicity. Canadian health care is flawed, but its benefits should be enjoyed by all Canadians equally. Health care segregation is destructive, expensive, and actively harms the very people it was meant to protect.
