Ontario First Nations, Inuit, Métis Relatives ... with IPHCC and WLH in English

OurCare PrimaryCare Gathering

forFirstNations,Inuit, Métis,andRelatives livinginUrbanand RelatedHomelands: Newperspectivesand possibilitiesformeetingFNIM primarycareneedsinCanada

June2023

Acknowledgements

TheOurCareprojectteamgratefullyacknowledgestheco-leadershipof theIndigenousPrimaryHealthCareCouncilandtheWellLivingHousein thedevelopmentandhostingoftheOntarioPrioritiesPanelonPrimary CarefromaFirstNation,Inuit&Métis(FNIM)Perspective.Thispartnership waskeytoensuringanIndigenous“bycommunity,forcommunity” approachtothegathering.Theprojectteamthanksthosewho volunteeredtheirtimetoparticipateintheRoundtableandworktowards improvingcarefortheircommunities.TheRoundtablewasmade possiblebythecontributionsof:

Dr.JanetSmylie,DirectoroftheWellLivingHouse (www.welllivinghouse.com),Tier1CanadaResearchChairin AdvancingGenerativeHealthServicesforIndigenousPopulationsin Canada,andProfessorattheDallaLanaSchoolofPublicHealth, UniversityofToronto

TheWellLivingHouseisanactionresearchcentrethatisfocusedon Indigenousinfant,childandfamilyhealthandwellbeing.Atitsheartisan aspirationtobeaplacewhereIndigenouspeoplecangather, understand,linkandshareknowledgeabouthappyandhealthychild, family,andcommunityliving.

Dr.NicoleBlackman,DirectorofIntegratedCareandClinicalServices, IndigenousPrimaryHealthCareCouncil(iphcc.ca)

TheIndigenousPrimaryHealthCareCouncil(IPHCC)isanIndigenous governed,culture-based,andIndigenous-informedorganization.Itskey mandateistosupporttheadvancementandevolutionofIndigenous primaryhealthcareservicesthroughoutOntario.Itworkswith23 Indigenousprimaryhealthcareorganizations(IPHCOs)acrossOntario includingAboriginalHealthAccessCentres(AHACs),Indigenous InterprofessionalPrimaryCareTeams(IPCTs),IndigenousCommunity HealthCentres(ICHCs)andIndigenousFamilyHealthTeams(IFHTs)to addressthephysical,spiritual,emotional,andmentalwellbeingofFirst Nations,Inuit,andMétis(FNIM)peoplesandcommunitiesbeingserved.

RoundtableTeam

TheRoundtablewassupportedbyMASSLBP.EstablishedbyPeterMacLeodin 2007,MASSisCanada'srecognizedleaderinthedesignofdeliberativeprocesses thatbridgethedistancebetweencitizens,stakeholders,andgovernment.For morethanadecade,MASShasbeendesigningandexecutinginnovative deliberativeprocessesthathelpgovernmentsdevelopmoreeffectivepoliciesby workingtogetherwiththeirpartnersandcommunities.

OurCarePrincipalInvestigator

Dr.TaraKiran

Familyphysician,St.Michael'sHospitalAcademicFamilyHealthTeam; Scientist,MAPCentreforUrbanHealthSolutions,St.Michael'sHospital,Unity HealthToronto;FidaniChairofImprovementandInnovation,UniversityofToronto

NationalProjectDirector

JasminKay,Director,MASSLBP

FacilitationandProjectTeam

Facilitators

GenevieveBlais,Well-LivingHouse

MaggieYkorennioPoweless-Lynes,WellLivingHouse

DarrylSouliere-Lamb,IndigenousPrimaryHealthCareCouncil

Notetakers

AlexandraBarlow,IndigenousPrimaryHealthCareCouncil

RachelThelen,OurCare

SophieRoher,WellLivingHouse

ChimwemweAlao,MASSLBP

JasminKay,MASSLBP

OtherProjectTeamMembers

JuliaCreglia,IndigenousPrimaryHealthCareCouncil

ColinDickie,IndigenousPrimaryHealthCareCouncil

CarolineLidstone-Jones,IndigenousPrimaryHealthCarecouncil

MandyMack,IndigenousPrimaryHealthCareCouncil

PrabhjotSangha,IndigenousPrimaryHealthCareCouncil

ImageCredits

ArtworkbyEloyBida,providedbytheIPHCC-p.4,p.8,p.13

ArtworkbyHawliiPichette,providedbytheIPHCC-p.8,p.12,p.19

OurCarePresenters

Dr.JanetSmylieistheDirectorofWellLivingHouse (www.welllivinghouse.com)St.Michael’sHospital,UnityHealth Toronto;Tier1CanadaResearchChairinAdvancingGenerative HealthServicesforIndigenousPopulationsinCanada;and Professor,DallaLanaSchoolofPublicHealthandDepartmentof FamilyandCommunityMedicine,FacultyofMedicine,University ofToronto.HerresearchisfocusedonaddressingIndigenous healthinequitiesinpartnershipwithIndigenouscommunities. ShehaspracticedandtaughtfamilymedicineindiverseFirst Nations,Inuit,andMétiscommunitycontextsfor29years.A Métiswoman,Dr.Smylieacknowledgesherfamily,traditional teachers,andceremoniallodge.

Dr.NicoleBlackmanistheDirectorofIntegratedCareand ClinicalServices,IndigenousPrimaryHealthCareCouncil. NicoleisamemberofAlgonquinsofPikwakanaganFirstNation butwasbornandraisedinDurhamRegion.Academically, NicolehasbeenstudyingIndigenoushealthsince2006, completingherDoctorofNursingPracticewithhercapstone projectfocusingonIndigenousprogrammingfromapublic healthperspective.Professionally,Nicolehashadtheprivilege ofservingasDirectorofProfessionalPracticeforWeeneebayko AreaHealthAuthority,workingtogetherwithFirstNation communitiesintheJamesandHudsonBayregiontoaddress varioushealthneeds.Nicolehasstrivedtousehereducation, experiencesandknowledgetoworktowardsbuilding awarenessofthehistoryoftheIndigenouspopulationandhow thathistoryimpactsthepopulation’shealthtoday.

Dr.TaraKiranistheFidaniChairinImprovementand InnovationattheUniversityofTorontoandVice-ChairofQuality andInnovationattheDepartmentofFamilyandCommunity Medicine.ShepracticesfamilymedicineattheSt.Michael's HospitalAcademicFamilyHealthTeam(SMHAFHT).Dr.Kiran completedherfamilymedicineresidencyatMcMaster Universityin2004andspentherfirstcoupleofyearsinpractice asalocuminIndigenouscommunitiesinnorthernOntarioand incommunityhealthcentresinurbanToronto.Shepracticedat theRegentParkCommunityHealthCentrefrom2006to2010 beforejoiningSt.Michael'sin2011

OurCarePrimary CareGatheringfor FirstNations,

Inuit, Métis,andRelatives livinginUrbanand RelatedHomelands

Newperspectivesandpossibilities formeetingFNIMprimarycare needsinCanada

WhatPolicyMakers Should

Know

Ourcurrentrealityinhealthcare, particularlyprimarycare,isugly.The worldwidepandemichaswreaked havoconouralreadystrainedhealth caresystem-especiallyalong pre-existingfaultlinessuchas accesstotimely,relevant,and upstreamcare;healthhuman resources;andsocialdeterminantsof health.Theneedssimplyoutweigh whatisavailable,andwhenthis happensitisthepopulationsalready experiencingsocialexclusionwho suffermost.FromanIndigenous perspective,FirstNation,Inuit,and

Métis(FNIM)livinginurbanand relatedhomelandshaveconsistently foughttohavetheirvoicesheard abouthowthesystemisfailingthem, andwhatneedstobedoneto addressit.

Asmainstreamentitiesworkto implementstrategiestoimprove primarycareservicedeliveryfor Ontarians,it’snotunderstoodthat broadstrokeinitiativescommonlyfail tomeettheneedsofthoseimpacted themostbyCOVID-19orwhohave historicallyexperiencedhealth inequities.TheOurCareCommunity Roundtablesarebringingthose often-unheardvoicestotheforefront soabettersystemcanbedesigned basedonthevalues,needs,and prioritiesofallOntarians.Todoso,it isessentialforpolicymakersmoving thechangeforwardtoknowthe followingprimarycareconsiderations withregardstoFNIMlivinginurban andrelatedhomelands:

● Thereisconsiderable socio-cultural,linguistic, political,historical,and geographicdiversityamong FNIMinCanada.Assuch,a pan-Indigenousor one-size-fits-allapproachis notappropriatetoprimarycare designanddelivery;

● FNIMhealthneedsareunique andrequireadifferent approachthanmainstream modelsofcare;

● Indigenousmodelsofcare focusonwholistichealthand seeaneedforbalanceinall components(mental, emotional,spiritual),notjust physical;

● Cultureashealingisan importantpartofhealthfor manyFNIM;

● Mainstreamfocuson Indigenoushealthtendstobe deficit-based,missingthe opportunitytoincorporate positiveperspectivesand protectivefactorsintocare models;

● Today’shealthcaresystem continuestobeanunsafe placeforFNIMlivinginurban andrelatedhomelands,justas itwaswiththeinitial establishmentofIndian hospitalsin1946atCharles CamsellIndianHospitalin Edmonton;

● Approximately85percentof theIndigenouspopulationin Ontarionowliveinurban settingswheretheyare commonlydiscountedin enumeration,needs assessment,community engagement,andlinkagesto policies,programmingand serviceagreements;

● FNIMacrossgeographies (urban,rural,andremote) havethelargestgapsin accesstoaregularprimary careproviderofany populationgroupinCanada.

*OntarioMinistryofHealthandLong-termCare,PopulationandPublicHealthDivision.RelationshipIndigenous CommunitiesGuidelines,2018.Toronto,ON.Availablefrom: https://health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Relatio nship_with_Indigenous_Communities_Guideline_en.pdf

FNIMandRelativesinUrbanandRelated Homelands–ParticipationataGlance

Thisprocesswasledandco-facilitatedbyIndigenouspeopleand IndigenousorganizationsinpartnershipwithIndigenousallies.Itwasa partnershipbetweenIndigenousPrimaryHealthCareCouncil,WellLiving HouseandOurCare.Thedaywasco-chairedbyDr.JanetSmylie,Director, WellLivingHouse,andDr.NicoleBlackman,DirectorofIntegratedCare andClinicalServicesIndigenousPrimaryHealthCareCouncil.

Name Organization

Co-Chairs

Dr.JanetSmylie(Director) WellLivingHouse

Dr.NicoleBlackman(Director) IndigenousPrimaryHealthCareCouncil

WLH&IPHCCSupportingTeamMembers

CarolineLidstone-Jones IndigenousPrimaryHealthCareCouncil

DarrylSouliere-Lamb IndigenousPrimaryHealthCareCouncil

AlexandraBarlow IndigenousPrimaryHealthCareCouncil

JuliaCreglia IndigenousPrimaryHealthCareCouncil

SophieRoher Well-LivingHouse

GenevieveBlais Well-LivingHouse

MaggieYkorennioPowless-Lynes Well-LivingHouse

Participants

SaraGleeson

BevDyer

AnishnawbeMushkiki

DedwadadehsnyesAboriginalHealthCentre(DAHAC)

NataliePaavola DilicoAnishinabekFamilyCare

ChantalGaudreau MinoM'shki-kiIndigenousHealthTeam

TomMcLeod MushkegowukCouncilAreaPrimaryCareTeam

ErinPeltier NoojmowinTegHealthAccessCentre

KatieWantoro SiouxLookoutFirstNationsHealthAuthority

MaureenTomasini

AlgonquinsofPikwakanaganFirstNations

CurtisHildebrandt DilicoAnishinabekFamilyCare

ShannaWeir GizhewaadiziwinHealthAccessCentre

CarolEshkakogan MaamwesyingNorthShoreCommunityHealthServices

CrystalBell MatawaHealthCooperative

ConstanceMcKnight MisiwayMilopemahtesewinCommunityHealthCentre

NicoleSokoloski

NoojmowinTegHealthAccessCentre

SamanthaBottigoni NorthBayIndigenousHub

TeraOsborne

TsiKanonhkhwatsheriyoIndigenousInterprofessionalPrimary CareTeam

MaryWatson DurhamRegionRepresentative

AmyShawanda

PeterboroughRepresentative

JuliaCandlish IndigenousHealthLearningLodge,McMasterUniversity

PaulTylliros

Specialthankyoutotheparticipationof:

WaasegiizhigNanaandawe'iyewigamig

MarieGaudet Elder

JimmyGaudet Elder

ParticipantValues

● Community

● Relationships

● Culture

● WholisticCare

● IndigenousModelsofCare

● Trust

● Partnerships

● Access

PrimaryCare Gathering

ThePrimaryCareGathering, consistingof22participantsfrom acrosstheprovince,metin-person onFriday,June2,2023.Thedaywas chairedbyDrsNicoleBlackman (DirectorofIntegratedCareand ClinicalServicesIPHCC)andJanet Smylie(Director,WellLivingHouse), andsupportedbytheIPHCCandWLH staffalongwiththeOurCareteam. Thosewhowereunabletoattend in-personwerewelcometo participateonlineviaZoom. Participantswereinvitedinsucha waytoensureabroadrepresentation ofvoicesacrosstheprovince, particularlythosefromurbanand relatedhomelands.Duringtheirtime together,participantsshared informationaboutprimarycare(an aspectofthebroaderhealthsystem) andprimaryhealthcare(focuson preventionandsocialdeterminants ofhealth),aswellas Indigenous-designedmodelsofcare. Participantsalsospentasignificant amountoftimeinconversationwith eachother,astheyengagedina seriesoffacilitatedconversations sharingtheirexperiencesand identifyingtheneedsoftheir communities.

Weusedthefollowingpromptsto helpframeparticipantconversations:

● Whatisworkingwelland positivelycontributingtoour health?

● Whatbarriersaffectbetter health?Whatarebarriersto moreofthethingsthatare workingwell?

● WhatdoweneedinIndigenous models?Whatarethese modelsrootedin?Howdoyou doyourownprimarycare?

● Whataboutmainstream modelsofprimarycare:whatis workingandwhatarekey challengesandbarriers?

● Whatdoweneedsothatwe canbuildonexistingstrengths andcapacities?Howdowe achievemoreofwhat’sworking andlessofwhatisnotworking?

Participants’conversationshave beenorganizedbytheIndigenous co-chairs,withsupportofthe roundtableteam,intothemesthat highlighttheexperiencesand challengestheyshared,and recommendationsthatdetail potentialsolutionssharedby participantsduringtheroundtable discussions.

Government Representatives

WellLivingHouseandtheIPHCC invitedrepresentativesfromthe followinggovernmentalentities.

● MinistryofIndigenousAffairs

● MinistryofHealth-Primary CareBranch

● MinistryofHealth-Mental Health&AddictionsBranch

● MinistryofSolicitorGeneral

● OntarioHealth-allregions

● IndigenousServicesCanada

Theintentwasforgovernmental representativestoengagewith gatheringparticipantsandhear directlyfromthemregardingthe challengesexperiencedwithprimary care,areaswherethingsweregoing well,andrecommendationsonhow toimproveprimarycaretobetter meetthehealthneedsofFNIMliving inurbanandrelatedhomelands. FNIMlivinginurbanandrelated homelandsarecommonlyexcluded fromtheprovincialandfederaltables despitethemcomprising85%ofFNIM populationinOntarioandmorethan 60%oftheFNIMpopulationnationally.

Invitedguestsjoinedtheroundtable forlunch,whichwasfollowedbya discussionwiththeroundtableleads fromWellLivingHouseandtheIPHCC. Discussionsfocusedonhow populationhealthisdefinedatthe

respectivegovernmentalareasand tables.Throughinvitedguests, emphasiswasplacedonthe importanceofcultureashealingand theneedtoexploreopportunitiesto harmonizecross-ministerial strategiesforsupportingIndigenous health.Theharmfulimpactsof discountingand/orexcludingFirst Nations,Inuit,andMetisrelatives livinginurbanandrelated homelandsfromplanningandpolicy tablesandtheimportanceofneeds andpopulationbasedresourcing andserviceswashighlighted.Itwas alsosharedthatpopulationhealth shouldencompasssocial determinantsofhealth,notpurely justaccesstohealthcareservices. Discussionsalsofocusedonhealth systemtransformationandwhatthat meansfromagovernmental perspectiveasitrelatesto Indigenoushealth.Itwas acknowledgedthatthegovernment needstorecognizeandrespondto thestrengthsandneedsof constitutionallyrecognizedFNIM acrossgeographies,includingin urbanandrelatedhomelands.

Invitedguestssharedthatit’shelpful tounderstandfromIndigenous PrimaryHealthCareOrganizations (IPHCOs)what’shappeningonthe ground-wherethegapsand challengesare.Itwasfeltthat hearingrealexamplesofwhatis happeningonthegroundiskeyto ensuringtruehealthsystem

transformation,asthisneedstobe basedongroundlevelimpacts. Anotherareaoffocusfordiscussions surroundedIndigenousmodelsof careandtheimportanceof collaborativeefforts.Variousareas throughoutgovernmentaredoing whattheycantoensuretheyare workingwithIndigenousprimarycare partnerstomakesurethatcareis safeandequitable.Ensuring implementationofprimarycare modelsthateffectivelyand sustainabilitymeetIndigenoushealth needsisapriorityareaforthe government.

Followingthelunchroundtable, representativesweretheninvitedto jointheSharingCircleattheendof theengagement,listeningtothe themesandrecommendations generatedbytheroundtable discussions.Representatives independentlyrespondedtothe recommendationssharedby participants.Thetakeawaysoftheir reflectionsinclude:

Collaboration,Partnership,and InformationSharing

Guestreflectionshighlightedthe significanceofworkingtogetherwith urbanFNIMpopulations,Indigenous communities,andIndigenousservice providerstosupportthepopulations theyserve.Theyrecognizedthe uniqueopportunityoftheroundtable toidentifyareasofsupportand

continuetofosterpartnerships.They indicatedanopennesstoreceiving moreinformationabouttheunmet healthneedsofFirstNations,Inuit, andMetisrelativeslivinginurban andrelatedhomelands.

StrengtheningHealthcareDelivery

Thereflectionsincluded commitmenttoconsiderIndigenous perspectivesandmodelsfor enhancinghealthcaredelivery. Guestsacknowledgedtheneedto improvetheirworkwithintheir ministriesandexpressedexcitement aboutthepotentialforfuture collaborativeeffortswithIndigenous serviceproviders.

CommunityIntegrationandSocial DeterminantsofHealth(SDOH)

Theimportanceofcommunity, accesstoservices,andsocial determinantsofhealthwasstressed throughouttheSharingCircle.The gueststhoughtthatearlyand ongoingengagementwith Indigenouscommunitieswas neededtobetterunderstandthe uniqueneedsofFirstNations,Inuit, andMetisrelativeslivinginurban andrelatedhomelands.

FundingFlexibilityand BureaucraticBarriers

Guestsacknowledgedand recognizedthechallengesposedby bureaucraticsystemsthathinder theabilityofIndigenous practitionerstoshiftmodelsand adaptthefundingtosuittheir context.Therewasacallfor

reflectiononwhatfundingflexibility trulymeansandwhatcanbedoneto mitigatethesebarriersuntilchange canbeenabledbypoliticalactors. Policyandfundingopportunities mustberesponsivetoandinclusive ofFNIMacrossurban,ruraland remotegeographies.

ReportonShared StoriesfromFNIM PrimaryCare Gathering

Whoareweand whyweparticipated

Followingthedisseminationofthe OurCarenationalsurveythat reachedmorethan9,000Canadians togatherperspectives,aspirations andprioritiesforprimarycarein Canada,prioritypanelswereheldin Ontario,BritishColumbia,Nova Scotia,Quebec,andManitoba.The OntarioPrioritiesPanelconsistedof 35randomlyselectedvolunteerswho metfivetimesoverafour-month span,sharedtheirstoriesand experienceswithprimarycare,and identifiedprioritiesforchange.The outcomeoftheirworkincluded23 recommendationsonhowtoimprove primarycaretobettermeetthe healthcareneedsofallOntarians. Andwhilemanyofthe recommendationsresonatewith FNIM,specificpriorityareaswereleft unidentified.

FNIMcommunitymembersfrom acrosstheprovinceappreciatedthe opportunitytocometogetheratone ofthetenOurCarecommunity roundtablestohelpprovideacloser understandingoftheneedsand prioritiesspecifictoFNIMclientsand communities.Throughthis opportunity,FNIMserviceusersand providersweregiventhespaceto havetheirvoicesheard,andnow

theylookforwardtoseeingthe actionsthatwillcomefromit.The intentofthisincrediblyimportant gatheringwastofocusonFNIMliving inurbanandrelatedhomelands,as theyrepresent85percentofthe IndigenouspopulationinOntario, haveveryhighratesofprimarycare unattachment,andarecommonly discountedand/orexcludedfrom planningandpolicytablesandrarely involvedinprogramdesignatthe locallevel.Throughthisopportunity, FNIMserviceusersandproviders weregiventhespacetohavetheir voicesheard,andnowtheylook forwardtoseeingtheactionsthatwill comefromit.

Whatwasshared

Astrength-basedapproachwas appliedinlearningwhatwasworking wellinprimarycareforFNIM,while identifyingareaswherethingsarenot workingwell.Withthiscomprehensive pictureinmind,participants highlightedstrengths,raisedissues, andproposedsolutions.

Thestrengthswewantbuilt upon…

1. IndigenousModelsofCare deliveredthroughIndigenous primaryhealthcare organizations(IPHCOs),which arerootedinconnectionsto communityandculture throughceremonies,land,and language,havebeenshownto

● Supportdeliveryofwholistic healththatsupportall elementsofhealthincluding mental,emotional,spiritual, andphysicalcare;

● Provideeffectivecarethat cultivatestrust,activelistening, andrelationshipdevelopment withclientsandcommunities;

● Bridgeculturalgaps;

● Acknowledgetheuniqueneeds ofFNIMclientsand communities;

● Provideaspacefor participationofElders, KnowledgeKeepers, communityadvisoryboards, andprovisionofcarethatis relevanttodiverseIndigenous nationsandtheirunique cultures.

2. Client-led,community-based caretthatunderstandsand meetstheuniqueneedsof

FNIMlivinginurbanandrelated homelandsthrough relationshipsandculture.This buildsuponIndigenous principlesofautonomyof decision-makingand self-determinationby:

● Listeningtoclientsand community;

● Hearingandrespondingto self-expressedneedsand priorities;

● Supportingclientand communitychoice;

● Takingadequatetimeto engageandbuildrelationship andtrust;

● Assessingneedsfroma communitycontextbyasking communitieswhattheyneed fromtheirprimaryhealthcare provider.

3. Empoweringclientsand communitiestobetheexperts intheirownhealthneeds,while atthesametimerecognizing andrespondingtoexternally imposedlimitationswith respecttounmetbasic materialandhealthneeds.This includesteachingyouthabout healthandhealthserviceswho areabletosharethis informationwiththeirfamilies andcommunity,whothenalso learnandbenefit.

4. Employinginnovative outreachstrategiesthat mitigatechallengesof accessibility.Thisincludes supportingclientsinaccessing theircarethrough:

● Transportationresources;

● Mobilehealthteamsthatmeet clientswheretheyare;

● Flexibilityinappointment times/clinichourstorespondto localneedsdaily;

● Virtualcare,whenaccessible, forimprovingaccesstocare andrespectingclient’stime;

● Outreachteamscomprising interprofessionalcare providers,culturalteams,and TraditionalHealerswhotravel toclientsandcommunitiesto providecarewhileenabling themtostayintheirhomes.

5. Providingcarethatrespects Indigenousexpertiseand waysofknowing.TThis includesofferingtraditional healingpracticessuchas land-basedcare,accessto ceremoniesandteachings, one-on-onecounsellingwitha TraditionalHealer,andmore.

6. Providingwelcoming,warm, safe,andculturalhealthcare environments.Thisincludes creatingawelcomingrelational andphysicalspaceby ensuringthereisclear Indigenouspresenceinstaffing

andleadershipatalllevels,that non-Indigenousstaffare knowledgeable,skilled,and experiencedinserving Indigenouspopulations.Italso includesthedisplayofartworks andtheuseofculturally appropriateresourcesin Englishaswellascommunity appropriateIndigenous languages.

7. Implementingaprimary healthcaremodelvs.primary caremodel.Thisinvolves extendingfarbeyondjust managingillnessbuttoalso includediseaseprevention(e.g. immunization)andhealth promotion(e.g.education)as well.

8. EmbeddingIndigenous modelswithinmainstream frameworks.Thisprovides culturallyrelevantcarechoices, respectsclientpreferences, andimprovescollaboration Indigenousandmainstream models.Forexample, mainstreamorganizationsthat havecreatedservice navigationroleswiththe expectationthattheyworkwith localIndigenousorganizations haveseenbettercoordination andhealthoutcomesforFNIM clientsandcommunities.

9. Establishingpartnerships betweenIndigenousand non-Indigenousspecific providerstobringservicessuch asdentistryandalliedhealthto communities

10. Recognizingandrespondingto theuniquestrengthsand needsofFNIMacrossrural, remote,andurban geographies.

Theissueswewant addressed…

1. Existingfundingmodelsfor Indigenoushealthcare continuetobeaformidable barrier,encompassing restrictionsthatcurtail Indigenoussovereigntyand self-determinationinhealth caredecisions.Forexample, IPHCOsmayfindhiringtwo NursePractitionersmoreuseful fortheirservicedeliverythan onemedicaldoctorbutthe fundingmodelrestrictshowthe fundscanbeallocated.

2. Fundingof‘appropriate’ healthservicesisbasedonthe Westerndefinitionofhealth careandsuitability.Thislimits thepotentialbreadthand depthof‘appropriate’health care,asTraditionalHealersand CulturalPractitionersarenot properlyorequitably compensated,salaried,or recognizedincomparisonto Westernpractitioners.

3. Continueddevaluationof Indigenousmodelsofcareby mainstreampractitionersis evidentthroughthecontinual disregardoftraditionalhealing practicessuchasmedicines, ceremonies,land-basecare, andtheCulturalPractitioners providingthecare.Thereare continuedtensionsand resistancefromWestern practitionerswhenFNIMclients requestculturalcaretobe embeddedwithintheircare plan.Forexample,mainstream providersarehesitantto supportuseoftraditional medicinesduetouncertainties ofinteractionswithother treatmentsormedications.This couldbemitigatedbyworking collaborativelywithTraditional MedicinePractitioners.

4. Recognizeandrespondto strengthsand population-basedunmet healthneedsofFNIMrelatives livinginurbanareas.FNIM relativeslivinginurbanand relatedhomelandsare commonlyexcludedor under-representedin populationcounts,health needsassessments, decision-makingtables,and fundingstreams.Forexample, duringCOVID-19vaccine roll-out,despitepublicpolicy statementsregarding prioritizedaccessforFNIM populationsinOntario,elderly andhomelessFNIMlivingin urbancentreswithhighdensity ofCOVID-19infectionhad delayedaccesscomparedto FNon-reservecommunities. Policyandfundingsupportfor Indigenoushealthcare organizationsforFNIMlivingin citiesispoorlymatchedtothe actualpopulationdistribution andhealthserviceneeds.The resultislowratesofprimary careattachmentandhigh ratesofemergencyroomuse forFNIMlivingincities,despite evidenceofhighratesof diseaseburdenandsocial challenge.Strengthswhich couldbebuiltonincludestrong andresilientsocialnetworks

andpre-existingurban Indigenoushealthandsocial servicesorganizations.

5. Geographicalbarriersimpact accessttocomprehensive, safe,andculturallyappropriate careforthoselivinginremote areasaswellasthoselivingin urbansettings.Thisisseen throughchallengeswith recruitmentandretentionin remotecommunities,lackof internetconnectivitytoaccess virtualcareorotherresources, lackoftransportationtoaccess services,lackofeldercareand childcare,aswellascontinued discriminationfromhealth practitionersinthemainstream system.

6. FNIMexperiencesinprimary carearemarredbysystemic racismandcoloniallegacies. Participantssharednumerous examplesofclinical encounters,punitiveactions, anddismissiveattitudesof healthcareprovidersthey believestemmedfrom anti-Indigenousracismand discrimination.WithinWestern caresettings,participants reportedexperiencing discrimination,detachment, andrushedcare,which negativelyimpactedtheir

clinicalexperiencesand underminedpositivehealth outcomes.Participants highlightedhowtherigidityin appointmenttimesorlackof flexibilityinservicedelivery posesabarrierduetopossible penalization.Actsof discriminationand anti-Indigenousracism perpetuateFNIMmistrustofthe healthcaresystemandthose workingwithin,which discouragesIndigenousuptake ofWesternmodelsofcare.

OurRecommendations

A. ModelsofCare

Tobuilduponthestrengthssharedofprimarycaredeliverythrough Indigenousmodelsofcare,andtoaddressthebarriersidentifiedof devaluingsaidmodels,werecommendthatpolicymakersand mainstreamorganizations,includingproviders,workwithFNIMleadersand serviceuserstoactivelysupporttheadvancementofIndigenousmodels ofcareacrossurban,ruralandremotegeographiesby:

I. Recognizingthevalue,diversity,anduniquenessofFNIMhealth,wellbeing, andhealingpractices,andsupportingaccesstotheminthecareofFNIM clientsandcommunities;

II. Implementingamodelofclient-led,community-basedcarethat understandsandmeetstheuniqueneedsofFNIMclientsthrough relationshipsandculturewhileempoweringclientstotakeleadershipin theirownhealthandwellbeing;

III. WorkingincollaborationwithTraditionalHealersandCulturalPractitioners whererequestedbyFNIMclientsandcommunities;

IV. AdvocatingforandadvancingIndigenoushealthpolicythatrecognizes theneedtoincreasethenumberandsizeofIPHCOs,sotheymatchthe size,distribution,andhealthneedsofFNIMinOntarioacrossgeographies; and

V. Developing,sharing,andimplementingwisepracticeexamplesof Indigenousmodelsofcare.

B. Funding

Toaddresstheidentifiedbarriersassociatedwithfundingthatinclude restrictions,Westernapproachtodefiningappropriatehealthservices, andthecontinualdevaluingofTraditionalHealersandCultural Practitioners,werecommendthatthefederalandprovincialgovernments workwithFNIMleaderstoensurethatfundingbarrierscurrently underminingtheadvancementofFNIMhealth,wellbeing,and reconciliationarecorrectedby:

I. EnsuringthatFNIMspecificfundingstreams,attheprovincialandlocal level,arematchedtolocalandregionalFNIMpopulationsize,distribution, andneedsacrossurban,rural,andremotegeographies;

II. Advancingsustainable(versusshort-term/last-minute)fundingfor IPHCOsthatwillsupportmental,emotional,andspiritualhealth,inaddition tophysicalhealth;

III. EnsuringthereareFNIMfundingstreamsspecificforFNIMyouth,asthey representasignificantproportionoftheFNIMpopulation,havelifestage specificservicerequirements,needtobeabletoself-determinetheirown healthandhealthservices,andarethefutureleadersofcommunities;and

IV. Ensuringfundingmechanismsandstructuressupportratherthan underminefull-scopeIndigenousmodelsofcareandtheTraditional HealersandCulturalPractitionersworkingwithinthem.

C. CulturallySafeCare

TobuilduponthestrengthssharedofIndigenous-ledorganizations providingwelcoming,warm,safe,andculturalhealthcareenvironments, andtoaddressthesystemicanti-Indigenousracismandcolonial processesembeddedintheCanadianhealthcaresystem,we recommendthatpolicymakersandmainstreamorganizations,including providers,workwithFNIMleadersandserviceusersinurban,rural,and remotehomelandstoacknowledge,recognize,andrespondto anti-Indigenousracismattheindividual,organizational,andsystemslevel by:

I. Acknowledgingpersonallyandinstatementsofreconciliationthatthe currentstateofIndigenoushealthinCanadaisadirectresultofprevious Canadiangovernmentpolicies,includingresidentialschoolsandIndian hospitals;

II. RecognizingthatadvancementofIndigenousmodelsofcare,Traditional Healers,andCulturalPractitionersisinsufficientandthatatwo-pronged approachisrequiredinwhichnon-Indigenousspecificmodels,services, andprovidersarealsoprovidinghighquality,culturallysafercaretoFNIM;

III. WorkinginpartnershipwithFNIMleadersandserviceuserstodevelopand implementorganizationalandsystemlevelstrategicplanswithclearand measurableindicatorsofsuccessthattangiblyadvancethehealthcare rightsofFNIMpeopleasidentifiedininternationallaw,constitutionallaw, andundertheTreaties;

IV. Ensuringallhealthcareprovidersandhealthcaretraineeshave completedbaseline,evidence-basedIndigenousculturalsafetytraining andareparticipatinginongoingevidence-basedpracticeevaluationand continuingmedicaleducationCMEthatistailoredtotheirlearningneeds andisadvancingtheknowledge,self-awareness,andskillsrequiredto providehighqualityandculturallysafercaretodiverseFNIMclientsand communities;

V. WorkinginpartnershipwithFNIMexpertsandhealthleaderstodevelop andimplementqualityassurancesystemsthatdocumentandrespondto incidentsofanti-Indigenousracismanddifferentialadherencetoclinical practiceguidelines;and

VI. AdvancingIndigenousstaffingandleadershippresenceatalllevelsby workinginpartnershipwithrelevantFNIMorganizationstoco-developand co-implementIndigenousspecifichealthandhumanresourceplans.

D. Partnership

Tobuilduponthestrengthsofsharedcollaborativepartnerships,andto addresssystemicracismandcolonialactivitiessuchasmainstream organizationsplanningIndigenousserviceswithoutIndigenousinput,we recommendthatpolicymakersandmainstreamorganizations,including practitioners,workwithFNIMcommunitiesandorganizationsinurban, ruralandremotehomelandstoadvanceIndigenousHealthinIndigenous Handsby:

I. EnsuringadequateandinclusiveFNIMrepresentation(including representativesofFNIMlivinginurbanandrelatedhomelands)atall decision-makingtableswherediscussionstakeplaceanddecisionsare madethatwillimpactFNIMhealthandwellbeing.

II. SupportingoutreachtoFNIMclientsandcommunitieswhoare experiencingbarrierstoaccessingprimarycareandotherhealthcare sectors(e.g.,acutecare,homecare,long-termcare).

III. Advancinginformationflow,definedcarepathways,andservice navigationwithinandbetweenprimaryandtertiarycare.

IV. SupportingIndigenousspecificcareteamsand/orvisitsbyprimarycare providersforFNIMpatientsinotherhealthsectorssuchasacutecare, homecare,andlong-termcare.

AboutOurCare

OurCareisapan-Canadianconversationwitheverydaypeopleaboutthefuture ofprimarycare.TheprojectisledbyDr.TaraKiran,afamilydoctorand renownedprimarycareresearcherbasedinToronto.OurCarehasthreestages:

1. NationalResearchSurvey

ThesurveywasonlinefromSeptember20toOctober25,2022.Morethan 9,200Canadianscompletedthesurvey,sharingtheirperspectivesand experiences.VoxPopLabsco-designedandexecutedthesurvey.

2. PrioritiesPanels

PrioritiesPanelswereheldinfiveprovinces:NovaScotia,Quebec,Ontario, BritishColumbia,andManitoba.MASSLBPco-designedandexecutedthe panelswithOurCareadvisorsandlocaldeliverypartners.

3. CommunityRoundtables

Communityroundtableswerehostedineachofthefiveprovinces, focusingonhistoricallyexcludedgroupsthatwedidnothearenoughfrom duringstages1and2.MASSLBPco-designedandexecutedthe communityroundtableswithOurCareadvisorsandlocalcommunity organizations.

OurCareProjectPartners

OurCareisfundedby:

HealthCanada

HealthCanadaistheFederaldepartmentresponsibleforhelpingCanadians maintainandimprovetheirhealth,whilerespectingindividualchoicesand circumstances.Productionofthisdocumenthasbeenmadepossiblethrougha financialcontributionfromHealthCanada.Theviewsexpressedhereindonot necessarilyrepresenttheviewsofHealthCanada.

MaxBellFoundation

MaxBellFoundationbeganmakinggrantstoCanadiancharitiesin1972.Today, theFoundationsupportsinnovativeprojectsthataredesignedtoinformpublic policychangeinfourprogramareas:Education;Environment;Health&Wellness; andCivicEngagement&DemocraticInstitutions.TheFoundationalsodelivers thePublicPolicyTrainingInstitute,aprofessionaldevelopmentprogram designedtohelpparticipantsmoreeffectivelyengageinthepublicpolicy process,andPolicyForward,afuture-orientedspeakerseriesthatbringsthought leaderstogethertodiscusstheintersectionsofpolicy,technology,and innovation.

StaplesCanada—EventheOddsCampaign

StaplesandMAPhavecometogethertocreateEventheOdds:aninitiativeto raiseawarenessofinequityinCanadaandtohelpbuildvibrant,healthy communities.Thepartnershipisbasedonthesharedbeliefthateveryone shouldhavetheopportunitytothrive.EventheOddsfundsresearchand solutionstohelpmakethefuturefairforeveryone.Learnmoreat staples.ca/eventheodds.

OurCareProjectPartners

OurCareisbasedat:

MAPCentreforUrbanHealthSolutions

TheMAPCentreforUrbanSolutionsisaresearchcentrededicatedtocreatinga healthierfutureforall.Thecentrehasafocusonscientificexcellence,rapid scale-upandlongtermcommunitypartnershipstoimprovehealthandlivesin Canada.MAPisbasedatSt.Michael’sHospital.

St.Michael’sHospital,UnityHealthToronto

St.Michael’sHospitalisaCatholicresearchandteachinghospitalindowntown Toronto.ThehospitalispartoftheUnityHealthTorontonetworkofhospitalsthat

OurCareisalsosupported by:

DepartmentofFamily&CommunityMedicine,UniversityofToronto

TheUniversityofToronto’sDepartmentofFamily&CommunityMedicineisthe largestacademicdepartmentintheworldandhometotheWorldHealth OrganizationCollaboratingCentreonFamilyMedicineandPrimaryCare.

St.Michael’sFoundation

Establishedin1992,St.Michael'sFoundationmobilizespeople,businessesand foundationstosupportSt.Michael’sHospital’sworld-leadinghealthteamsin designingthebestcare–when,whereandhowpatientsneedit.Fundssupport state-of-the-artfacilities,equipmentneeds,andresearchandeducation initiatives.BecauseSt.Michael'sFoundationstopsatnothingtodeliverthecare experiencepatientsdeserve.

TolearnmoreaboutOurCareandthemembersoftheadvisorygroup,please visitourwebsiteatourcare.ca.

OurCareisfundedby

OurCareisbasedat OurCareissupportedby