The Particularism Of First Nations Healthcare

The creation of an aboriginal-only health authority is more or less making part of the public healthcare system private while still being funded by the public.

Photo by Abby Anaday on Unsplash

This post is by regular Woke Watch Canada Contributor, Michael Melanson.

It's been a good Spring for the Southern Chiefs Organization of Manitoba, a regional lobby group for the chiefs of 34 Indian bands.  They were given the keys to the former Hudson's Bay store in downtown Winnipeg and promised loans and tax breaks in order to convert the old department store into a hub for affordable housing, offices, restaurants and retail spaces (the HBC was previously valued at $0 given its state of disrepair and the cost of demolition, plus it has asbestos).  The City Of Winnipeg signed a tax deal with several bands represented by the SCO that will allow them to collect municipal property taxes on a pending urban reserve but be obliged to remit only 65% of the taxes collected back to the City; the bands will get to keep the other 35% to invest in infrastructure on the new reserve (which means the City isn't recovering 100% of the cost of delivering municipal services to the urban reserve).  The most recent success for the SCO is an agreement with the provincial and federal governments to establish their own regional health authority.

"The tripartite table, led by the Southern Chiefs' Organization, will result in the formation of a 'holistic, trauma-informed Anishinaabe and Dakota health-care system,' the release said."

Because reserves are federal jurisdiction and healthcare is a provincial responsibility, there's always been some confusion about who provides healthcare on reserve and who pays.  Generally speaking, the policy has been for the province to provide medical services to reserves and then be reimbursed for it by the federal government.  Several years ago Manitoba established regional health authorities that included the reserves in their administrative jurisdiction.

Now 34 of those reserves will come under the new SCO health authority.  It's an ambitious move for a lobby group whose previous experience in managing healthcare was in the recent pandemic where  "the SCO responded to longstanding inequality in health care through advocacy, partnership and leading the delivery of services."

The mention of Anishinaabe and Dakota healthcare suggests a fairly specific notion of culturally appropriate services.  Presumably this is healthcare that differs appreciably from healthcare for any other Manitoba or from Dene or Cree healthcare, for that matter.  The distinction is probably more political than physiological.  Essentially this is a policy of kind-with-own-kind.  Our public healthcare system was conceived as an universal program: free and available to all citizens.  The creation of an aboriginal-only health authority is more or less making part of the public healthcare system private while still being funded by the public.

The political term I like to use for this is 'particularism'; special rules and allowances are made for a particular group within the state.

"First Nations leadership in health-care delivery leads to improved outcomes, federal Indigenous Services Minister Patty Hajdu said in the release."

Hopefully Minister Hajdu has seen data that supports her assertion, but if it is true, why would that be the case?  Is there a subtle insinuation that in instances where health-care delivery wasn't First Nations led, systemic racism resulted in poor outcomes for aboriginal people?

"Culturally competent primary care, 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."

'Cultural competence' can be read as synonymous with 'culturally appropriate' which is an euphemism for kind-with-own-kind but it might imply having care that is specifically competent in Anishinaabe and Dakota culture.  If so, wouldn't belonging to those cultures be the only way to possess such competence?  Does enhancing access to traditional healing methods mean hiring traditional healers as well as nurses and doctors?  Who gets to determine when a traditional healing method should be tried and who is responsible if it fails?

The SCO is a political body.  No other regional health authority is run by a political body.   Creating a new SCO health authority is redundant and will add another expensive level of bureaucracy to a health budget that is already strapped.  An aboriginal-only health authority runs counter to the universalist philosophy that informed the creation of our public healthcare system.  Worst of all, it fosters an illiberal and unrealistic expectation that people should be able to get medical services just from people that look like them.  Hospitals have some of the most culturally diverse staffs in Canada of necessity.  It is enough to expect and receive medical competence.  Making a prerequisite of cultural competence will most likely impede hiring licensed nurses and doctors for the new SCO health authority but given the certification process for becoming a traditional healer, the SCO should be able to easily fill those job vacancies.  Who's more culturally competent than a traditional healer anyway?

For patients on these 34 reserves, they were all just prescribed ideology.

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