It takes more than health care to make people healthy


“We don’t just deal with health care. We deal with the social determinants of health within the same portfolio. That includes housing, drinking water, education and child welfare because it takes more than health care to make people healthy.” – Dr. Jane Philpott, Minister, Indigenous Services Canada

BY NORM TOLLINSKY
Putting the burden on any one individual to close the significant health-related gaps that exist between Indigenous and non-Indigenous Canadians is unfair, but there is probably no one more suited for the job than Dr. Jane Philpott, the new Minister of Indigenous Services.
A family physician who practiced in a Toronto suburb for 17 years, Philpott was elected to represent the federal riding of Markham-Stouffville in 2015, and served as Minister of Health until her recent appointment as Minister of Indigenous Services in August.
A graduate of the University of Western Ontario School of Medicine, Philpott earned a Masters of Public Health from the Dalla Lana School of Public Health at the University of Toronto, and gained a reputation for promoting medical education in Africa, HIV/AIDS fundraising, refugee advocacy and for her work on the social determinants of health.
“Having a federal government department of Indigenous services is a new concept that allows us to focus on making sure that we address quality of life issues,” said Philpott in an interview with the Northern Ontario Medical Journal. “We don’t just deal with health care. We deal with the social determinants of health within the same portfolio. That includes housing, drinking water, education and child welfare because it takes more than health care to make people healthy.
“Even more important, the entire underpinning of the department is on self-determination and recognizing the rights of Indigenous people. The ultimate goal is as much as possible on services that are designed, led and managed by Indigenous people for Indigenous people. Having that mindset and that ultimate, long-term goal is what will be really transformative.”
There is no shortage of health-care challenges, said Philpott.
“You can look at almost any indicator of health outcomes and see that there are significant gaps that exist between Indigenous and non-Indigenous people. The broad categories we look at are infectious diseases – including the rates of tuberculosis, HIV and Hepatitis C – chronic diseases like diabetes which is three to four times more prevalent in First Nation communities, and mental wellness and substance use disorders which are largely the result of problematic policies in the past, including residential schools.”
In July 2017, Philpott joined Nishnawbe Aski Nation (NAN) Grand Chief Alvin Fiddler and Ontario Minister of Health and Long-Term Care Dr. Eric Hoskins in signing a Charter of Relationship Principles for Health System Transformation.
It’s a little early to say with any conviction what health system transformation will look like, said Philpott, “but probably the closest example of the model they’re looking towards would be what’s taking place in British Columbia with the B.C. First Nation Health Authority.
“It’s entirely First Nation led and the data to date suggests it has been very effective. It may take on a slightly different format in Ontario, but that’s the direction in which we’re heading.”
But it won’t happen overnight, cautions Philpott.
“Everyone’s enthusiastic about health-care transformation to occur as quickly as possible, but we know that it took 10 years of negotiations to establish the First Nations Health Authority in B.C. We have good strong partners from NAN and the provincial government, and we’ve learned a lot over the years from looking at other models, so we hope to move forward as quickly as possible.”
Among the social determinants of health that the Department of Indigenous Services will be working on, perhaps none are more important than clean drinking water.
“This is something that Prime Minister Trudeau has identified as a top priority issue,” said Philpott. “In 2016, we set aside $1.8 billion and committed to lifting all long-term drinking water advisories on reserves by March 2021. Many people would like to see it done faster, but we’re talking about some of the most remote parts of the country. A lot of work has to go into the design, planning and construction of entirely new water systems for some of these communities and training people to operate them.”
Housing is another huge challenge, acknowledged Philpott.
“We’ve already made some good progress with investments in housing across the country. The numbers we’re looking at are close to 10,000 homes that are either newly built, under construction or undergoing major renovations, but the gap in housing is extraordinary, so there’s a lot more to be done.”
On the issue of accessing fresh, nutritious and affordable food in remote Indigenous communities, Philpott points to the 24-kilometre Freedom Road connecting Shoal Lake 40 to the Trans-Canada Highway as an example of government efforts to improve access to lower-cost, higher-quality food via ground transportation. The Nutrition North program, she said, is also being reviewed to support communities that want to rely more on traditional food sources.
Mental wellness and substance use disorders are among the most challenging issues facing Indigenous Canadians, said Philpott.
“We have put huge investments in mental health supports. Across the country, we have quadrupled the number of mental wellness teams that can go to communities when they are in crisis. We’re funding a program called Choose Life, which is a culturally appropriate program designed by NAN communities, but all the mental health workers in the world will not entirely solve the challenges because so much of what contributes to mental wellness goes beyond health care. It’s issues like education, access to good jobs and being able to live in a decent home. Even deeper than that is people having their rights respected, including the right to control their own lives.”

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