Romanow report receives mixed reviews

Page 28

After 18 months of cross Canada consultations, the Commission on the Future of Health in Canada released its final report on Nov. 28, and the document was met with a lukewarm reaction from the Aboriginal community.

The commission, which was headed up by former Saskatchewan premier Roy Romanow, was given the task of talking to Canadians about the future of health care in Canada, and recommending ways the system could be changed to "preserve the long-term sustainablity of Canada's universally accessible, publicly funded health care system."

The final report, Building on Values: The Future of Health Care in Canada, contained 47 recommendations, including developing a Canadian Health Covenant that reflects the collective vision of Canadians regarding health care, updating the Health Act, and creating a Health Council of Canada to promote collaboration between governments, health providers and Canadian citizens.

One entire chapter of the report was given over to dealing with ways to improve health care for Aboriginal people, who continue to have poorer health than the general Canadian population.

Two recommendations come out of the chapter on Aboriginal health. The first, that current funding for Aboriginal health services provided by federal, provincial and territorial governments and Aboriginal organizations be pooled into one budget in each province and territory, and that budget be used to integrate Aboriginal health care services, improve access to health care, and provide funding that is adequate, stable and predictable.

The second recommendation suggests the pooled budgets coming out of the first recommendation should be used to create Aboriginal health partnerships, which would work to develop policies, provide health care services, and work towards improving the health of Aboriginal people.

These partnerships, the report states, should take a holistic approach to health and reflect the specific needs of the communities they serve, and the services must be adapted to the realities of those communities.

The report also contained three recommendations designed to improve access to health care in rural and remote communities, including creating a rural and remote access fund to support new approaches to delivering health care in rural and remote areas, developing strategies to attract and retain health care providers in these areas, and expanding telehealth services.

"I was happy to see that he devoted a whole chapter to Aboriginal health," said Assembly of First Nations (AFN) Vice-Chief Charles Fox. "That in itself was a positive statement in terms of priorizing Aboriginal health."

Fox chairs the Chiefs' Committee on Health and holds the health portfolio for the AFN executive.

"The report is intriguing, quite challenging actually in terms of the recommendations, the pan-Aboriginal approach," Fox said.

"Historically, First Nations and the Inuit have received funding for medical services, and we're being asked to share that pot of money with the Metis and non-status, who have received little or no funding. There are two difficulties in that. One is just the politics of creating a pan-Aboriginal table. And to the second element is sharing limited resources. So I suppose in that respect it's quite a challenge. I guess the disappointment that I have is that there's no new resources being talked about," he said.

"The second thing is the creation of a partnership with federal, provincial, and territorial governments. And again, historically, the politics there is one that's always posed a problem for us, in that there's no real equality in terms of authority and decision-making at those tables, at those forums. So I look at that with mixed feelings, I suppose. But again, I view it as a challenge. If there's political will to move on a united front to deal with the question of health for all Canadians, that's fine, let's do that."

Another part of the report that Fox has concerns about is the proposed pooling offunds for Aboriginal health.

"If the Romanow report is serious about identifying Aboriginal dollars, then the provinces and territories are going to have to be prepared to identify the dollars that they get for Aboriginal people in their respective provinces and territories. And I would guess it would probably be over a billion dollars for that. So are they prepared to funnel that to the Aboriginal envelope? That's what I mean by intriguing elements of the report, the challenges. I don't see them necessarily as barriers, I see them as challenges," he said.

One thing that disappointed Fox about the report is that it makes no reference to treaty rights or Aboriginal rights to health, but the omission didn't surprise him.

"I empathize with (Romanow) because I know the position he's put in as a commissioner. We're always fighting with the federal government over that particular issue. I didn't particularly think that he would weigh into that battle for either side, and that's fine," Fox said.

Disappointing also is that there were no new dollars committed for Aboriginal programs, although Fox added that Aboriginal organizations would just have to compete for their part of the $15 billion injection the report would give to health care in general.

When asked if he thought there was any political will from the federal government to act on any of the recommendations coming out of the Romanow report, Fox said he was taking a wait-and-see attitude on that question, but felt the first indicator of whether that will exists will come when the first ministers meet in the new year.

Just prior to the release of the final report AFN National Chief Matthew Coon Come joined with Metis National Council (MNC) president Gerald Morin and Jose Kusagak, president of the Inuit Tapiriit Kanatami in writing a letter to the Prime Minister to request representation at that meeting. No response to the request has been received.

"I think the first indication will be the First Ministers Conerence. If we're invited to the table, then I see true political will. If we're not invited to the table then, yes, it's going to be the same disappointing turn of events in relation to the other reports, implementation of those recommendations. We'll be on the outside, fighting again to be recognized," said Fox.

Harley Desjarlais is president of the Metis Provincial Council of British Columbia, and Minister of Health for the MNC. Desjarlais has a less favorable view of the Romanow report than Fox.

"We weren't exactly clicking our heels when we read it," he said of the report.

Desjarlais sees inclusion of a chapter dedicated to Aboriginal health as really the only positive thing to come out of the document, but while such an inclusion may be viewed as encouraging for Aboriginal people as a whole, he doesn't see it doing much for Metis people specifically.

The MNC took part in the forum organized by the National Aboriginal Health Organization (NAHO) and the Commission for the Future of Health Care held in June, Desjarilais explained, and both he and MNC president have met with Commissioner Romanow to provide input on health care for Metis people, but none of what was presented made it into the report.

"We've had several audiences (with Romanow). Some very direct, and we expected, you know, more clarity with respect to the relationship between the government and the Metis Nation," Desjarlais said.

"One of the things that we presented to Romanow was the fact that we wanted some specific relationship with the federal government when it came to service delivery on behalf of Metis people. We feel that as Aboriginal people with the same inherent rights under section 35 that we have been basically ignored in the health area, even though our people are being affected by a lot of the problems that First Nations and urban Aboriginal people encounter. And we were led to believe that this report would address some of those shortcomings, and it obviously did not," Desjarlai said.

"The second problem I may have is one of the recommendations was for a consolidated revenue relationship between all of the organizations and I don't know if that's very realistic for one thing, keeping in mind the diversity of the Aboriginal community, including the Metis community. I find that a lot of these pan-Aboriginal service delivery mechanisms have really failed the Metis people in the past, and this only perpetuates a lot of the things we've had problems with," he said.

"I think the government is constantly trying to put square pegs in round holes, and trying to look for one kind of universal, one size fits all service delivery mechanism. And I don't know if that is the way to go. I think you need to sit down, talk with the communities and find out what's best for them and I'd like to see something more driven at the community level as opposed to some kind of a massive service delivery structure," Desjarlais explained.

There's always, I guess, kind of a propensity to try and slot us into being some homogenous group of people who all think the same and everything. I think any type of service delivery needs to be respective of the user group. And not just with the Metis, but other Aboriginal groups and other Aboriginal nations should be given more flexibility to incorporate programming that might be more accommodating to the needs of their community."

Given the history of Royal Commission recommendations, Desjarlais isn't particularly optimistic that any of the recommendations in the Romanow report will be implemented anyway.

"I'm very sceptical of anything that goes into a Royal Commision. You know, Gathering Strength, for example, basically promised to address the needs of the Metis people. . . . I'm very pessimistic that a lot of the findings will be incorporated in their entirety, particularly with the consolidated revenues that Mr. Romanow is proposing. I don't know if I agree with it anyway."