Public health and infrastructure: What do we need? 

On Nov. 19, 2012, Pete Sarsfield discussed the public health and infrastructure needs of Indigenous peoples in Canada. Now retired, Sarsfield practiced western-based illness prevention and care for 35 years, mostly in northern communities, and has worked with approximately 175 of the 700 Indigenous communities in Canada. Based on these experiences, Sarsfield finds that public health and infrastructure concerns in Indigenous communities often share a common barrier: politics.

“Much or most of Indigenous community life, in my experience, is politicized, as Indigenous community life has become a pawn in a cynical and destructive game… played by governments,” explained Sarsfield. “In Indigenous communities in Canada, public health services and community infrastructures are routinely vulnerable to open and nonchalant abuse due to the financial, ideological, and political whims of federal, provincial, and Indigenous governments.”

For example, the Canadian Constitution Act states that the federal government is responsible for “Indians and lands reserved for Indians,” and that provincial governments are responsible for providing public health services. When it comes to the question of who should cover Indigenous public health costs, it’s often a lose-lose scenario for First Nations people. There isn’t a federal public health act to determine which services the federal government must provide, and provincial governments say they aren’t responsible for the health of First Nations people.  As a result, First Nations people in Canada often receive minimal public health services from the federal government, especially in comparison to what provincial public health acts guarantee their non First Nations residents. Some First Nation chiefs reject offers of provincial public health services because they’re afraid that undermines treaty rights to federal services, Sarsfield said.

When Sarsfield was a boy, it was common and acceptable for rural communities to be without clean running water. Today, the standards of acceptability have shifted – but only in non-Indigenous communities. “Without being forced, [the conditions in Indigenous communities] aren’t going to shift,” Sarsfield warned. “Legal action needs to be taken against each and every province so that they include First Nations in their public health acts.”

Issues discussed this week:

You believe that the only solution is to take legal action against the provinces. Does anyone else talk about this?

Sarsfield said that First Nations citizens and lawyers have talked about this issue.  “It’s going to be expensive and time consuming.”

The Ontario Health Protection and Promotion Act has stronger wording than Manitoba’s Public Health Act. Would it be easier to take legal action in Ontario? 

Sarsfield agreed, noting that the Ontario wording was recently weakened, but is still far stronger than language used in the public health acts of Manitoba and especially Saskatchewan.  Ironically, “Saskatchewan and B.C. are the provinces that have taken the most action in shifting [standards of acceptability in Indigenous health]… So the [provinces] where the action needs to be taken are not the ones taking action on their own.”

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