21 April 2020, 9 a.m.
Indigenous people are disproportionately affected negatively by factors that influence health and well-being, known as the determinants of health, such as overcrowded and mouldy housing, poverty, unsafe drinking water and unequal access to health care.
While ethnicity is not a risk factor for COVID-19, compromised immunity, underlying health issues and the determinants of health put the Indigenous population at greater risk of poor outcomes from the virus.
This HillNote provides information about the federal role in providing health care to First Nations communities, including lessons learned from the H1N1 pandemic, recent federal funding announced for Indigenous health, and pandemic response and First Nations-led initiatives. Another publication is forthcoming related to COVID-19 and northern Indigenous peoples.
1. Access to Health Care
Access to health services is a critical determinant of health. While Canada’s public health care systems are widely lauded, quality health care is not available to everyone, and many Indigenous individuals face a number of barriers to access health care.
The federal government operates primary care services in remote First Nations and Inuit communities through Indigenous Services Canada’s First Nations and Inuit Health Branch (FNIHB). FNIHB operates health centres and nursing stations in remote and semi-remote sites, predominantly staffed by nurses. People living in remote communities rely on medical transportation to access certain primary, specialized and acute care services delivered by the provinces and territories. FNIHB also funds health promotion, disease prevention and public health protection.
Access to primary health care remains a daily challenge in remote communities. Challenges include inadequate health human resources, limited access to medical equipment and diagnostic tools, limited use of telehealth services, and poor integration of the FNIHB system with provincial health systems. While some progress has been made on these issues, COVID-19 may compromise already fragile delivery systems.
2. Lessons Learned from the H1N1 Pandemic
Following the SARS epidemic, in 2005 the federal government funded the development of pandemic plans in First Nations communities. In 2009 the H1N1 influenza virus (“H1N1”) pandemic affected Indigenous peoples with high incidence and deaths in certain regions. The federal government estimated that 80% of First Nations communities had pandemic plans in place at the initial outbreak.
First Nations people had a higher incidence of severe forms of the H1N1 illness. While First Nations people represented about 2% of the Canadian population, they represented 17% of mortalities reported from H1N1. The federal government was criticized for its delivery of health care and delays in coordinating sending basic equipment and protective supplies to remote First Nations communities.
After the H1N1 pandemic, the federal government reviewed its response, highlighting the measures that helped First Nations communities including:
- community-level pandemic planning and vaccinations;
- stocking antivirals and personal protective equipment in remote communities;
- creating a task force with First Nations leaders and federal and provincial officials to oversee health care coordination and communication; and
- establishing a senior medical advisor to oversee the on reserve response.
3. Current Federal Measures
First Nations may declare a state of emergency when an emergency is beyond their capacity to respond. Since 2005, the Emergency Management Assistance Program provides funds to First Nations communities and provinces during ongoing or imminent emergencies on reserve. Provinces deliver emergency management services on behalf of Indigenous Services Canada.
Budget 2019 announced health emergency preparedness with $80 million allocated over five years, and $17 million per year for First Nations communities for pandemic planning. On 26 March 2020, Indigenous Services Canada outlined measures for First Nations communities related to COVID-19, including :
- establishing regional health emergency management coordinators and a national emergency management secretariat;
- developing surge capacity response plans related to health human resources who could be deployed to communities in need;
- reviewing special community capacity supply and response needs in collaboration with the provinces, First Nations communities, and regional Indigenous Services Canada offices; and
- adapting the medical transportation policies for people with specific risk factors for COVID-19.
4. New Funding Related to COVID-19 and Indigenous Peoples
The government has announced new measures to mitigate the impacts of COVID-19 in Indigenous communities. On 11 March 2020 the Prime Minister announced $100 million to respond to immediate health needs in Indigenous communities, including updating and activating pandemic plans, supporting public health and primary care capacity, and ensuring that measures to respond to the outbreak are based on scientific evidence.
On 18 March 2020, the government presented a stimulus package, the COVID-19 Economic Response Plan, which included $50 million to help prevent outbreaks in women’s shelters, including those in First Nations communities, and $305 million for a new Indigenous Community Support Fund. The Fund will be allocated as follows:
- $215 million to First Nations;
- $45 million to Inuit;
- $30 million to the Métis; and
- $15 million to organizations supporting Indigenous peoples living outside their communities.
Indigenous Services Canada said the funds can be used for various measures, from supports to Elders, children and other vulnerable people to emergency preparedness initiatives. Some First Nations leaders have stated that this new funding is insufficient. Similarly, the Executive Committee of the Assembly of First Nations noted “that the funding allocated for medical, health, and the economic stimulus are not going to be enough.”
5. First Nations-Led Initiatives
First Nations communities responded to COVID-19 by taking steps similar to other Canadian communities, including closing schools, restricting travel inside and outside their communities, and closing non-essential businesses. For example,
- Constance Lake First Nation declared a state of emergency and identified insufficient medical supplies, personnel and testing materials;
- the Nisichawayasihk Cree Nation declared a state of emergency and used its declaration to lockdown the community;
- communities supported their members by collecting and donating traditional foods, and preparing emergency food packages and cleaning supplies for delivery to seniors among others;
- on-reserve COVID-19 testing was established for the Algonquins of Barriere Lake; and
- as the number of COVID-19 cases grew in First Nations communities, some requested military support and the Canadian Rangers were deployed in northern Ontario.
First Nations organizations are supporting their members by:
- declaring states of emergency to highlight the challenges faced by First Nations in responding to the pandemic (Assembly of First Nations);
- establishing a pandemic response team (Assembly of Manitoba Chiefs); and
- providing public health information in Oji-Cree and resources on First Nations pandemic planning (Nishnawbe Aski Nation).
Indigenous Services Canada, Indigenous Services Canada’s preparedness and response to COVID-19.
Indigenous Services Canada, COVID-19: First Nations Community Guide on Accessing Additional Supports.
No author, “COVID-19 in Community: How are First Nations Responding?,” Yellowhead Institute, 7 April 2020.
Pamela Palmater, “Priority pandemic response needed for First Nations,” Policy Options, 20 March 2020.
Dr. Alika Lafontaine, “Covid-19 and Indigenous Communities: Family Conversations,” Yellowhead Institute, 16 March 2020.
Public Health Agency of Canada, Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector, Annex B: Influenza Pandemic Planning Considerations in On Reserve First Nations Communities, updated June 2009.
Authors: Sara Fryer, Brittany Collier and Olivier Leblanc-Laurendeau, Library of Parliament