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The Benefits Of Self-Determination In Improving Health Outcomes

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Indian philosopher Amartya Sen, who developed the ‘capability approach’ which states that the freedom of an individual to accomplish well-being is best interpreted by the abilities afforded them to achieve the life they want was quoted as saying that “…human beings live and interact in societies, and are, societal creatures. It is not surprising that they cannot fully flourish without participating in political and social affairs, and without being effectively involved in joint decision making.” (Public Health, Ethics and Equity, 2004).

This statement validates the importance of self-determination as it is an invaluable process for marginalized individuals to set their own goals and implement policies that benefit the target population and undoes the effects of colonial and destructive assimilative policies. Positive change occurs within self-determination and self-governance, as a result of giving the autonomy back to affected Indigenous population and encouraging them to be innovators of problem-solving strategies within their communities.

Speaking strictly in terms of health, the Marmot-Whitehall study is a prime illustration of the benefits of self-determination in improving health outcomes. Within this study, the researchers studied the hierarchy of British civil service and attempted to ascertain how certain social classes affected mortality and morbidity. The researchers found a correlation between higher status and better health outcomes. Michael Marmot attributed this relationship to autonomy and the level within which people feel in control of their lives, stating that “social injustice is disempowering. It deprives people of control over their lives. In low-income countries where people struggle to feed their children and have no access to clean water and sanitation, their disempowerment is material, as well as a sense of being at the mercy of forces beyond one’s control.” (The Health Gap, 2015). Therefore, when individuals don’t feel in control of their own destinies and livelihood, a positive correlation can be drawn with health outcomes being worse.

This relationship displays itself with the Indigenous population which shares a minimal amount of autonomy in Canada as a community, presenting the worst health outcomes across the board within the country. In the presence of self-determination and positive self-governance policies, communities feel they are in command of their future and fate. As a result, health outcomes improve from the degree of autonomy acquired, and areas that need to be specifically targeted and prioritized receive preeminence which serves to improve health and socioeconomic results more readily than an outsider attempting to rationalize the changes the community needs to make in order to benefit the target population.

One of the biggest handicaps towards Indigenous self-determination regarding health can be attributed to a general dishonesty from the federal government. This history dates back to the implementation of the Treaty 6 and the medicine chest clause, where the government exercised plausible deniability upon Indigenous peoples, insisting the spirit of the clause was not to provide free non-insured health benefits, ranging from dental care, pharmaceutical supplies and access to traditional healers to Indigenous people but claiming they only had to provide a literal medicine chest or first aid kit. This example of dishonesty is also displayed in today’s society with the federal government cutting back on transfer funding to First Nations health care facilities on reserves and Inuit health care in Northern Canada.

These policies have been justified by the federal government as being a result of deficits, and ensuring the budget stays balanced, however, this apathetic attitude comes at the expense of beneficial Indigenous self-governance within their own facilities and health results in general. This paradigm was eloquently explained in a book on Aboriginal social determinants as “… the existing shared federal/provincial responsibility for the responsibility for the provision of health and social services for First Nations peoples includes health services, education, social supports and child welfare. The shared responsibility has not been a collaborative effort based on meeting the needs of the client but, rather, has resulted in a jurisdictional ambiguity leading to inequitable access to required services – and, frequently, gaps in or barriers to service.” (Aboriginal Child Health and the Social Determinants, 2010).

These policies come at the expense of Indigenous self-government because it furthers the divide between obtaining healthcare at a city facility as opposed to an Indigenous individual receiving their treatment at a healthcare facility in rural reserves, as the disparity in funding leaves the healthcare facilities on reserves at a massive disadvantage in providing proper healthcare. The underfunding affects self-determination because it creates a scenario where only routine healthcare is met, the resources provided cannot meet up with demand, and compromises must be made by healthcare staff to save costs which runs antithetical to the attainment of optimal healthcare.

Another way the federal government has put themselves within the driver’s seat of determining who obtains certain benefits is with the management of the First Nations and Inuit Health Branch, the problem with this program is “…the FNIHB limits their services to First Nations and Inuit peoples who are registered with the Department of Indian and Northern Affairs Canada and many of their programs are restricted to people living on reserve. As mentioned earlier, Metis and First Nations peoples without status are excluded from FNIHB health services, benefits and programs.” (Social Determinants of Health: Canadian Perspectives, pg. 454). The irony with the eligibility for benefits from the First Nations and Inuit Health Branch, is this procedure which is founded upon specifically accommodating the needs of Indigenous peoples, ultimately takes the option of candidacy for these benefits out of the hands of Indigenous peoples and is decided by an arbitrary third party of the government and certain groups of Indigenous peoples are excluded from reaping the benefits.

Michael Murphy in the University of Toronto Law Journal attributed ancient colonial Indigenous policies which had served to define who qualified as an Indigenous individual from a white perspective to a divide and conquer mentality from the government and attributed it to a legacy of isolation that had always been established by stating that in those times, “alienation was more important, from the government’s point of view, because their ultimate objective was to legally define Indians out of existence, thereby relieving themselves of any further political or financial responsibilities for these populations” (Representing Indigenous Self-Determination, 2008).

The types of policies that we see with the selective policing of the First Nations and Inuit Health Branch run contrary to self-determination and are strangely not too far off from policies of isolation instituted in 1850 with the Lower Canada Lands Act, which defined what allowed an individual to be considered an ‘Indian’ and eligible for legal benefits accorded by that status without consulting the people.

During the National Assembly of First Nations gathering on July 2018, the National Chief of the Assembly, Perry Bellegarde urged the Canadian Federal government to reorient in a new direction and enable Indigenous leaders to proceed with governance that align with Indigenous traditions and customs. In his speech, Perry Bellegarde appealed to the Canadian government by stating that “We’ve heard clearly from delegates from many territories that any proposed decision, policy or legislation impacting First Nations’ rights, title and jurisdiction must respect the right to self-determination. First Nations must work together in accordance with our protocols and responsibilities to get it right, and getting it right, means our work cannot be rushed.

Many First Nations are telling Canada to stop and work together in ways that truly affirms and implements rights, title and jurisdiction, and to commit to a First Nations driven process guided by First Nations’ laws and customs” (Newswire, 2018). This statement from the national figurehead is another example of Indigenous individuals in Canada attempting to fight to obtain autonomy over their lives and decide its own affairs in a way that is congruent with Indigenous values and customs. The Metis Nation has also addressed the issue of self-governance and is another organization which is clamoring for these same goals of autonomy and heralding Indigenous ideals within Indigenous communities. Within the Metis Rights and Land Title, the Metis National Council outlined these views saying that, “…the Métis seek rights under two categories, land and resource rights and self- governing rights. The Métis do not advocate sovereignty or separation from Canada. Instead, they desire greater control over their lives within Canada, the same objectives which motivated the 1869 and 1885 resistance struggles.” (Metis Nation, 2014).

These examples make it clear that the ability of Indigenous people to pursue their political pedigree and the uninterrupted pursuit of their socioeconomic and cultural development within sovereign states is a key priority within the community and must be adhered to by the government to inspire self-reliance of Indigenous people, prevent further injustices by the Crown and establish proper well-being. With these points in mind, the barriers to achieving self-determination for Indigenous peoples in Canada are plentiful, and like referenced earlier in this essay, the dishonesty from the government is one area that needs to be addressed.

Another one of the barriers towards self-determination, especially in terms of self-governance, is the principle of territorial integrity which runs contrary to self-determination where nation-states such as Canada are discouraged from promoting the secession of other states from the nation. Therefore, if the government felt Indigenous peoples in Canada were attempting to cede their citizenship from Canada, it could encourage the government to prevent such movements and stall progress within that regard.

Another hurdle to Indigenous self-determination is a lack of self-ownership of business and programs within the community and I believe a solution to this problem is Indigenous peoples taking steps to increase self-ownership in terms of property and capital, which could come in the form of basic steps such as purchasing land and returning to an agricultural way of life with individuals cultivating food and supplying the least in the community with these whole food method of eating, rather than relying on the government who provide substandard methods of nutrition to citizens in reserves where food insecurity is rampant with malnutritious food options and overpriced nourishing food.

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