Details scarce on new health funding

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The national chief of the Assembly of First Nations (AFN) and the federal Indian Affairs minister both came up a little short when they were asked for details about how the promised injection of money into Aboriginal health care-as much as $1 billion-will occur.

Prime Minister Paul Martin had announced the funding on Sept. 13, just before he and provincial and territorial leaders sat down with representatives from national Aboriginal organizations to discuss the state of Native health and health care programming.

Martin announced that a $200 million transitional fund will allow federal, provincial and Aboriginal governments to sort out jurisdictional battles that have hindered the effective delivery of health care in the past. A $100 million human resource fund will allow more Aboriginal doctors, nurses and other health care professionals to be educated and prepared for the workforce. And a $400 million fund was announced to deal with issues that seem to be prevalent in all regions of the country, such as diabetes, youth suicide and maternal and child care.

It was also promised that an "escalator clause" would allow Aboriginal groups to get their share of new monies transferred to the provinces as a result of any agreement between the federal and provincial and territorial governments. This escalator clause will allow for money beyond the $700 million to be targeted at improving Aboriginal health.

"If you put the two together we're talking about a financial commitment of over a billion dollars," said national chief Phil Fontaine.

Reporters wanted proof that the money wouldn't disappear into a bureaucratic sinkhole. Fontaine said the money would not stay in Ottawa, but would go out to the communities.

"What I'm confident about is that a large percentage of the funds will go directly to the First Nation governments to deliver directly to their citizens in our communities," he said. "But that won't necessarily be at the front end in some cases. For example, the $100 million for health human resources, that's directed to ensuring that we have more Aboriginal doctors and nurses and other health professionals. That won't necessarily at the front end go to First Nation communities, but the long-term benefits are going to be substantial. But the $400 million for diabetes, youth suicide and maternal and child care, that goes directly to First Nation citizens and hopefully a good effort will be made to ensure that we have a more effective public education program with respect to diabetes."

Minister Andy Scott said the government will judge the success or failure of its attempt to improve Aboriginal health by the results achieved.

"This is going to be measured against outcomes, not about how much money's spent. Everybody today was talking about this isn't about just spending money; it's about changing various health and wellness outcomes in the Aboriginal community where they fall well behind the rest of the country. My sense is that's going to require us to make sure this gets to the ground because otherwise the outcomes won't be affected," he said.

But when he was asked how that would work, he was not prepared to offer any detailed response.

"The one thing that everybody agreed on is it won't be one size fits all. The needs in some areas of the country are very different from others," the minister said.

He defended spending $200 million to sort out jurisdictional disputes among the three levels of government.

"My most personal experience around this had to do with a task force I did as a backbencher in the mid-1990s on disability and, quite frankly, it was awful to the extent to which people, human beings with needs, were being subjected to all kinds of jurisdictional wrangling that got in the way of any government's ability to offer what would be fundamental support. This has to be attended to. It's real. It's a real challenge, and the first thing you do with a real challenge is to ackowledge it. Then people with good will and creative intelligence can figure out how to deal with these things. And I think today was a step in the right direction in that regard," he said.

"Ultimately, it's to get to a place where the systems that exist in your part of Canada-some delivered by the provinces, some by us and some delivered by First Nations-so that those support systems that exist are done in a much more integrated way so that they're really based on the need of the client. It's going to cost money to get from here to there," he said.

He was asked if he saw the poor housing situation as a health issue.

"I would agree completely that to look at health or wellness exclusively from a perspective of illness is a mistake. There are a number of educational issues, housing is particularly important, even the kind of hope that comes from knowing that there are economic opportunities out there, all of these things bear on well-being," he said.

He was asked if bureaucrats would use the funding preparing plans and doing studies.

"We're not talking about studying anything. We're actually talking about having different players from the community, from the provinces and from the federal government sit down and actually get the job done," he responded.

"The prime minister announced today that the government of Canada put $700 million of new money on the table to dig holes and do things and get the outcomes that we're talking about. We can't do it by ourselves. We have to do it collaboratively, otherwise we'll get all kinds of attention but we won't get the outcomes that we want, and that wouldn't be good for anybody."

When he was asked who would check to see the money goes where it's supposed to go, Scott said that as vice-chair of the Cabinet committee on Aboriginal issues he would have a large role to play in that area.

Some regions of Health Canada have sizable deficits. Scott was asked if any of the "new money" would be used to pay down ld debts.

"Those are the details that the Prime Minister of Canada has asked officials from the provinces and officials from the government of Canada to solve now. . . We're working out those details now," he said.

Asked if non-insured health benefits (NIHB) funding would be restored, he repeated that the government is "working out the details."

The NIHB are health goods or services not covered by other federal, provincial, territorial or third-party health insurance plans, and include drugs, medical transportation, dental care, vision care, medical supplies and equipment, and crisis intervention mental health counselling.

Phil Fontaine said "NIHB has always experienced a shortfall. It has ranged from $31 million to $115 million. So we want that particular part of [First Nations and Inuit Health Branch's] mandate to replenish, to secure an appropriate resource level so that it will be able to deliver according to its mandate and responsibilities."

Restoration of previous cuts to non-insured health benefits is "part of our strategy and success will be very much dependent on how successful we are in putting the story together and that's something we're going to have to work out with Health Canada," explained Fontaine. "I get the sense though that we have the ear of government. I'm confident that we're going to be able to produce even better results in the next while."