The Lancet Series: Canada’s Global Leadership on Health

Jane Philpott

February 23, 2018

Thank you very much, Jocalyn, for that exceedingly generous welcome. It’s such a delight to be here with all of you this morning.  I want to thank our hosts, the Aga Khan Foundation, for your generosity to us today, as well and of course the University of Toronto for also supporting the gathering and the launch today.
Like others before me, I want to acknowledge that we are gathered here on unceded Algonquin territory. I want to thank the Algonquin people for letting us gather in this beautiful place on this land and for the way they have cared for this land over many, many years.

We’re really honoured that The Lancet chose to do this, to dedicate an entire issue to Canada’s health system and Canada’s role in global health.
In fact I did start reading The Lancet a very, very long time ago when I was a medical student in the 1980s and I think I can still remember some specific issues. I remember issues where we first started learning about acquired immune deficiency syndrome and the role that The Lancet played in some of the early research associated with that. Yes, Jocelyn, it still arrives in my inbox every Friday morning.

I can’t say that I always follow the links and get a chance to read the articles but I’m still receiving it. I had never dreamed back when I was a medical student that I would have this incredible privilege to be here today to celebrate this landmark series. I want to also acknowledge many of my colleagues in Cabinet who would have loved to be here today but weren’t able to join us.

I think of the Minister of Health, Ginette Petitpas Taylor, who would want to be here celebrating today. Also Marie-Claude Bibeau who is our Minister of International Development and la Francophonie, and also of course the incredible Carolyn Bennett who is our Minister of Crown-Indigenous Relations and Northern Affairs. All three women are champions of Canada’s healthcare system and Canada’s role in global health.
We’re also proud that our Prime Minister has contributed such an incredible commentary to The Lancet series where he elaborates on our vision for global health and focuses specifically on this important issue of gender equity.

If you haven’t already had the opportunity to read the article, you will note the Prime Minister’s decision around focusing our G7 Leaders’ Summit, that’s going to be hosted by Canada in just a few months, on gender equity.
Canada has a plan to devote 95% of our international assistance to initiatives that specifically target or integrate gender equity and the empowerment of women and girls.  As the Minister of International Development has said, focusing Canada’s international assistance on the full empowerment of women and girls is the most effective way for our international assistance to make a difference in the world.

As someone who has worked for many years in countries like la République du Niger en Afrique de l’Ouest, I can definitely attest to the incredible power that we will see in transforming nations when there is a focus on gender equity. In June of 2016, we launched Canada’s feminist international assistance policy. The Prime Minister has called this the first explicitly feminist international assistance policy in Canadian history.

To that end, our government is investing $650 million to address gaps in sexual and reproductive health and rights. I’m proud this morning – before I get away from the topic of gender and feminism – to look across the front bench here and see colleagues like Stephanie and Danielle and Jocelyn and Lynn, my U of T colleagues, and to see women leading the way and then to think about people like Margot and Nadine who are also major contributors.

I could point to many, many others of you in the room but we walk the walk around the role of women in leadership in health and equity in this country. Canada is also taking a leadership role to end epidemics that disproportionately affect women and girls including HIV/AIDS, tuberculosis and malaria. In September 2016, most of you will know that we hosted the fifth Replenishment Conference of the Global Fund to fight AIDS, TB and malaria.

World leaders responded to Canada’s call and we were able to raise nearly US$13 billion in pledges including Canada’s contribution of $804 million.  A future free of HIV/AIDS, tuberculosis and malaria is closer than ever, but we can’t celebrate our international progress without recognizing the tremendous amount of work we have to do here in Canada.

The Prime Minister notes that in his commentary, where he says we must address historic injustices and inequality on our own doorstep if we wish to champion these on the world stage. To illustrate some of these challenges that we face within our borders, I want to go to a story of a young girl named Ileen.

Ileen is from a small community called Qikiqtarjuaq. It is in Nunavut.  It’s over 2,500 km north of here in a community on Baffin Bay. Just over a year ago Ileen, who is the girl from this community, died here in Ottawa in a hospital. She was 15 years old.
Ileen had experienced symptoms for more than two years and she spent the last two weeks of her life in an intensive care unit in this city. Tragically, it was only a few hours before her death that she received a correct diagnosis. She had tuberculosis. In Ottawa, in 2017, a 15-year-old girl died of tuberculosis – a preventable, treatable bacterial infection.

But her story is of course not just the story of an infectious disease. It’s the story of nursing shortages, language barriers, weather delays in medical transportation from remote communities, and an epidemic that has persisted among Inuit in Canada for more than a century.

Ileen’s story illustrates a truth that is known to most of you. Improving health outcomes requires more than biomedicine. It requires an intentional focus on the social determinants of health. We will not achieve our goal of eliminating tuberculosis in the Inuit homelands unless we deal with issues like housing – recognizing that rates of overcrowding are as high as 52% among Inuit populations in Canada.
In Canada today there are 1.7 million First Nations, Inuit and Métis. When compared with non-Indigenous Canadians, life expectancy is as much as 11 years shorter for Inuit.  Infant mortality rates are two to three times higher than non-Indigenous Canadians for First Nations and Inuit. The prevalence of diabetes among First Nations on reserve is almost four times higher, and in some cases more than that.

The prevalence of tuberculosis among Inuit is a stunning 270 times higher than it is for the Canadian-born, non-indigenous population. Addressing that endless list of health inequities requires more than better healthcare. It requires better housing, education, roads and so much more.

In my role as Minister of Indigenous Services, I need to dig even deeper – yes, beyond biomedicine but even beyond the social determinants of health. How did we get to a place where Indigenous peoples do not generally enjoy the same health outcomes as non-Indigenous Canadians?
I believe that one of the most succinct descriptions of how these appalling gaps have developed can be found in one of the Calls to Action of the Truth and Reconciliation Commission.

Call to Action #18 reads as follows:  “We call upon the federal, provincial, territorial and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law and under the Treaties.”
That’s the real story. And I like to read that Call to Action, # 18, as a bit of a medical assessment because it has right there the cause, the ideology as well as the treatment plan. What’s the cause? What’s the ideology of how we got here? It says that health outcome gaps are a direct result of previous Canadian government policies.

What’s the treatment plan? It says that closing those gaps requires the recognition and implementation of rights. The deplorable health outcome statistics have their roots in laws, policies and operational practices of our country. For generations First Nations, Inuit and Métis were denied rights – denied the right of self-determination and subjected to laws, policies and practices based on domination and assimilation.

One of the most egregious policies was the residential school system, which began in 1876 and persisted for more than a century. With the explicit goal of assimilation under the dominant Canadian culture, roughly 150,000 Indigenous children – some as young as five – were separated from their parents, punished for speaking their own language and subjected to abuse, inadequate housing and insufficient nutrition. The effects on individuals, families and communities from this form of cultural genocide will be felt for generations.

Let me tell you another story that speaks to the trauma resulting from the residential school system. Jerry is a 25-year-old Métis youth. He was in foster care from the age of 8 to 14, during which time he lived in almost 40 different homes. His mother couldn’t take care of him because of her mental health issues related to residential schools.  Jerry’s grandparents wanted to take him in, but lacked the financial means to do so.

Jerry spoke about a month ago at an emergency meeting on First Nations, Métis and Inuit Child and Family Services that we hosted here in Ottawa. He said that foster homes “strip you of your identity when you walk in. They see us as numbers not people… you get lost and you slowly lose everything that made you.”  Jerry suffered from dyslexia and ADHD. He said that “foster parents have high expectations of behaviour and many couldn’t deal with my needs.” Jerry left the system at age 14 and got a job. He did manage to connect eventually with his Métis family, but he says he hasn’t made the same connection with his grandpa as he had when he was a child because that relationship is gone and the support he really needed was from “a mom.”

Jerry’s story is one of intergenerational trauma, poverty and disconnection from his culture. But it’s also a story of a people who have been denied control over their own lives. The denial of the rights of Indigenous peoples is directly linked to the glaring socio-economic gaps that we experience in Canada, as well as poor health outcomes.

In September of last year the Prime Minister stood before the United Nations General Assembly and acknowledged that the “failure of successive Canadian governments to respect the rights of Indigenous peoples in Canada is our great shame.”
Last week, in the House of Commons, Prime Minister Trudeau announced that our government will develop – in full partnership with First Nations, Inuit and Métis – a Recognition and Implementation of Rights Framework.

It was a historic moment with historic words.
However, as one First Nations elder reminded me at a meeting some months ago, “words do not feed a table.” His point was to demand action, including the resources to accomplish ambitious goals. So we need to respond to that matter first. Canada has designated, to date, in the last two federal budgets close to $12 billion to improve social determinants of health for Indigenous peoples, including funding for housing, clean water and equitable funding for education.

The progress achieved since 2015 by working together with Indigenous partners is significant. Direct investments for health include quadrupling the number of mental wellness teams across the country; approving more than 33,000 requests for care under a program called Jordan’s Principle; expanding our prenatal escort policy; creating an Inuit Crown Task Force on the Elimination of Tuberculosis; and more.

I am convinced that we will not definitively address health outcomes, nor the broad socio-economic gaps between Indigenous and non-Indigenous Canadians, without the recognition and implementation of inherent indigenous and Treaty rights.
Permit me to read from Articles 3 and 4 of the United Nations Declaration on the Rights of Indigenous Peoples: “Indigenous peoples have the right to self-determination. By virtue of that right they freely… pursue their economic, social and cultural development.  Indigenous peoples, in exercising their right to self-determination, have the right to autonomy… in matters relating to their internal and local affairs, as well as ways and means for financing their autonomous functions. “

Self-determination, autonomy, the free pursuit of economic, social and cultural development… These are the most fundamental determinants of health and wellness.  Yes, we need health workers. We need technology and medicine. We need housing and jobs and education.

Most of all, Indigenous peoples need what was prescribed for them in the Royal Commission on Aboriginal Peoples more than twenty years ago. It lists three things.  Number one: they need control over their lives. Number two: they need land, resources and self-chosen governments with which to reconstruct social, economic and political order. Number three: they need time, space and respect from Canada to heal their spirit and revitalize their cultures.

Behind us is a path marred by the denial of the inherent and Treaty rights of Indigenous peoples. The path ahead requires the recognition and implementation of those rights.

I’ll close with a final story from a recent visit with the Prime Minister to Pikangikum in northern Ontario. We met that morning with the Chief and Council, and as we sat there the Chief pointed down the table to a woman councillor and described the fact that she lives in a two-bedroom house with more than 20 other family members. He described how she and her family are required to sleep in shifts so everyone will get time in a bed. One young person recently had to drop out of high school because he was exhausted. The boy couldn’t study because he couldn’t get a decent night’s sleep.

This is happening in Canada – in this affluent province in this affluent country — today.  We must do better.

The United Nations Declaration on the Rights of Indigenous Peoples affirms that the recognition of rights is not only the foundation for better health outcomes – it is the prerequisite for the survival, dignity and wellbeing of Indigenous peoples.
This is the approach with which our government will go forward with Indigenous partners – so that Inuit girls from Nunavut will not die of tuberculosis – so that Métis boys are not sent to foster care because of intergenerational trauma and poverty – so that First Nations children do not have to drop out of school because they can’t get enough sleep in a crowded home.

Improving health outcomes for Indigenous peoples is a social and economic imperative for Canada. More importantly, it is a moral imperative. I assure you today of our government’s unwavering commitment grounded in the recognition and implementation of Indigenous rights – to the pursuit of justice and health for all.
Merci beaucoup. Meegwetch.

NT5