Bad Medicine

Kind-with-own-kind Policy is a Repudiation of what has been Self-Evident for Centuries

Photo by Marcelo Leal on Unsplash

By Michael Melanson

Earlier this month nine different reserves in Southern Manitoba undertook walks coordinated by the Southern Chiefs Organization (SCO), a regional lobby group for the chiefs of 34 bands, to raise political support for establishing a separate health authority for the approximately 81,500 members of those 34 bands.

“For years, the Southern Chiefs' Organization has pushed to take more control over the delivery of health services to their people, and in June it announced it was working with the federal and Manitoba governments on the first steps toward developing its own health authority.”

Proceeding from earlier discussions the SCO had with the federal government, Manitoba's provincial government recently joined the SCO and federal counterparts in another round of talks about establishing this new health authority.

"Manitoba Health Minister Audrey Gordon called the initiative a 'monumental task,' but said in the release the province is pleased to work with the SCO and the federal government on establishing a health-care model focused on Indigenous-led and community-based health care." 

Healthcare is provincial jurisdiction and creating a new health authority dealing with just status Indians under the auspices of SCO represents a remarkable devolution of provincial authority without any public consultation. The delineation of provincial jurisdiction is laid out in the Constitution and theoretically revisions of jurisdiction could only be undertaken with constitutional amendment.

Why is a separate regional, aboriginal-specific health authority believed necessary?

"Life spans for First Nations people are currently 11 years shorter than the average Manitoban, and the goal of creating a First Nations-driven health system is to close that gap,” Sagkeeng FN Chief Derrick Henderson said, "And I think one of the ways is basing it on our values, our traditional values … our sacred teachings.”

Almost mechanically the reasons for this gap in life spans are attributed to "Colonization — and residential schools in particular — severed First Nations people from their traditional practices, including medicine,” according to SCO Grand Chief Jerry Daniels.

Being that this was a CBC story, supine deference to aboriginal claims is to be expected. Colonization has of course greatly extended the life expectancy of Canada's indigenous peoples and if only about a third of all native children attended residential schools over the many years of their operation, it isn't reasonable to attribute general ill health now to what was experienced then by a minor fraction of the entire aboriginal population. What is never considered in the public domain is what effects has the reserve system had upon health outcomes for status Indians. Living apart from mainstream society means living apart from mainstream social norms and aboriginal communities consistently feature higher rates of smoking, obesity, diabetes, alcoholism and heart disease compared to the general population. The politically charged and intellectually lazy attribution of medical (and social) pathologies to external historic factors deprives status Indians of sober sociological analysis. As ever, ideology sickens more than it heals.

Back in the time when traditional practices and folk medicine were quotidian, tobacco wasn't readily available. Sugar wasn't anywhere near as prevalent in people's diets, nor were saturated fats. Vaccines didn't exist and surgery was unknown. People had to be physically active in order to hunt and gather. It's not at all clear what exactly Daniels intends to extrapolate from the past for the sake of new directives in this pending health authority but being somewhat adept at dealing with the media and given the uncritical disposition of many Canadian journalists these days, all Daniels has to do is blather about how good things were and people will accept that they could be that way again if aboriginal people were allowed to lead themselves back to those good times. These are halcyon days for aboriginal particularists; their chauvinisms are tendered without discount by scores of people weaned on aboriginal romanticism and rote pity. 

There have been instances in the past where status Indians living on reserve received inadequate and tardy healthcare owing to the discrepancy of reserves being federal jurisdiction and healthcare being delivered by the province but that has since been rectified by Jordan's Law which compels provincial governments to treat reserve residents first and worry about billing later. Adding a new health authority risks introducing a new bureaucracy without clear determination of who is actually paying for it. Manitoba's existing regional health authorities are funded by the provincial treasury helped considerably by federal transfers. Manitoba's portion is derived from provincial taxation but there are no applicable provincial taxes on an Indian Reserve. Will Manitobans be expected to pay for something they have no control of and which isn't accountable to anyone but the SCO? 

The SCO executive is elected by just the 34 chiefs it represents. There has been no vote by the 81,500 registered band members on whether or not they want their healthcare handed over to a lobby group which has no experience or expertise in managing something as complex as healthcare. It isn't clear if the new SCO health authority would be given per capita jurisdiction but the 81,500 number of affected band members includes those living off reserve. The lack of consultation between the SCO and band members is all the more egregious because it hasn't given band members an opportunity to consider if an ideologically driven health authority is in their best interests.

“I think sometimes a lot of our people don't understand when they're given a western medication. They just take it because that's what the doctor prescribes, but there might be alternative methods of treating an ailment through our traditional medicines," claims Sagkeeng FN Chief Derrick Henderson. 

So if there are people who trust their doctors to prescribe the correct medicine and they are in the future confronted by an aboriginal homeopath who suggests they try some herb instead, won't those people be trusting the homeopath to do the right thing? What happens if that homeopath thinks there's a natural remedy for meningitis? How will the use of modern diagnostic technology be viewed by a new health authority that is looking back to the time before there was electricity? Will belief or disbelief in aboriginal medicine affect how a band member is dealt with by the new health authority?  Will belief or disbelief in aboriginal spiritualism affect diagnosis and treatment?

“Culturally competent primary care (read: 'aboriginal-only'), improved access to mental health services, enhanced services for grandmothers and grandfathers, access to traditional healing methods and local community access to health care have all been identified as priorities.”

"Health care that is led and delivered by First Nations results in better access and outcomes," Patty Hajdu, Minister of Indigenous Services Canada, said in a June press release announcing the partnership. 

Presumably there is data somewhere to support Hajdu's assertion but in this mute climate of reconciliation, there's no guarantee that any statement any government representative makes about any aboriginal issue is based on actual research. How, for instance, will better access to healthcare come about through the new SCO health authority without a commensurate and costly investment in new hospitals and clinics all adequately staffed with culturally competent nurses and doctors? The new SCO health authority will have to, for a period at least, negotiate with Manitoba's existing health authorities to have their resources made available to SCO patients.

But consider Hajdu's central premise that First Nations led and delivered healthcare will be better for First Nations people. Essentially she is saying that kind-with-own-kind is best for aboriginal people which also implies that our current provincial healthcare, ostensibly staffed by one of the most multicultural work forces anywhere, is somehow doing a poor job of treating aboriginal people. If her assertion is true, then why wouldn't it also be true for Filipino-Canadians or Ukrainian-Canadians, for example? If a race-specific health authority is justifiable in one instance, then why not in all other instances? A SCO health authority presages a northern counterpart so can we expect there to soon be a Manitoba Keewatinowi Okimakanak health authority (MKO is the lobby group for northern Manitoba chiefs)?

A racial health authority is redundant and repugnant. Since when did segregation become healthy? If the historic civil separateness of being Indian in Canada is a causal factor in accounting for the 11-year gap in life expectancy, then aboriginal patients are about to have the poison prescribed as the cure.

Healthcare has been one of the sterling examples of universalism in Canada and universalism in public services has been the actualization of our fundamental belief in human equality. For anyone, including shameless aboriginal particularists, rolling back our universalism to create a race-specific health authority represents a moral inversion of the central creed that has brought us a Just Society. Kind-with-own-kind policy is a repudiation of what has been self-evident for centuries – that we are created equal.