Canada’s system for delivering health care to Aboriginal Canadians is out-of-date and deeply flawed, according to experts in the health care field, who say it effectively creates drastic inequalities in access to services and treatment.
In a recent statement to the parliamentary committee looking into the high suicide rates in indigenous communities, Dr. Cornelia Wieman, psychiatrist at the Centre for Addictions and Mental Health in Toronto, Ontario, said the current system requires on-reserve patients to deal with added layers of bureaucracy and approvals in order to access prescription drugs to treat mental illness.
“I would often have to try the older versions of medications that according to the clinical practice guidelines were out of date, and I would have to have a patient fail on those older medications before they received funding for newer medications that were available on the market,” says Dr. Wieman, who spent eight years as a community-based psychiatrist at Six Nations of the Grand River Territory reserve near Brantford, Ontario.
The problem, according to Wieman and others, stems from Health Canada’s Non-Insured Heath Benefits program, which oversees the delivery of coverage for prescription drugs, dental care, vision care and mental health counseling, among others. It requires program approval for medications and procedures more easily accessed by non-aboriginal Canadians.
Recently, an Alberta mother filed an application for judicial review against the Attorney General of Canada over the NIHB’s refusal to pay for her daughter’s dental care. Stacey Shiner’s daughter Kennedy needed braces to fix an overbite and reposition her molars, a procedure deemed medically necessary by two separate orthodontists.
“This has been about a two year battle with the NIHB and the federal government,” Shiner told the CBC. “Because she is aboriginal, she is considered a federal issue, so it skips Alberta Health Care completely and goes to the federal level [under NIHB].”
According to Charlie Angus, New Democrat MP for Timmins – James Bay, who has brought the issue to parliament, there have been at least 534 cases where indigenous children’s claims for orthodontic care have been rejected, amounting to 80 per cent of all cases.
A 2015 report from the Wellesley Institute on racism in the health care of Canada’s Indigenous peoples argued that the cumbersome and antiquated NIHB program is a key source of systemic racism in Canada’s health care system. Researchers found that pervasive racism within the system is causing many people to either strategize on how to deal with anticipated racism before seeking out medical attention or sometimes to avoid care altogether.
“The delivery of NIHB poses challenges to equitable access to health services in comparison to non-Indigenous people, particularly in northern and remote communities,” says the report.
For the federal government’s part, Health Canada’s strategic plan for First Nations and Inuit Health acknowledges the inequalities built into the system, stating that the approach “has not changed substantively since its inception” almost 40 years ago, and that “it is becoming increasingly clear that we need to provide further guidance on how to manage the new opportunities and challenges emerging in this dynamic environment.”