Working within the territorial health context: a framework to understanding and applying the northern lens
Find out how this framework will improve the understanding of First Nations and Inuit health in the territories.
Improving the overall health and wellbeing of First Nations and Inuit is an important mandate of Indigenous Services Canada (ISC). Despite progress, the health status of First Nations and Inuit, as measured by most major indicators of health, remains below that of the Canadian population. These discrepancies are rooted in a range of historical, political, cultural, geographical and jurisdictional factors.
Indigenous peoples make up the largest shares of the population of Nunavut and the Northwest Territories. This provides the foundation for great strengths as Indigenous cultures and traditional practices remain strong in communities. The territories rank better in some measures of wellbeing than the rest of Canada, with 71% to 83% of territorial residents feeling a "strong" or "somewhat strong" sense of belonging to their local community compared to only 64% for Canada. However, the legacies of colonization and residential schools and other important factors such as lack of access to adequate housing, high rates of food insecurity and limited resources in small communities, have contributed to high rates of suicide and widespread physical, sexual, verbal and emotional abuse affecting the health of First Nations and Inuit in the North (in this context, "North" refers specifically to the territories). This, as well as the geography and vastness of the territories, has contributed to poor health outcomes and makes health service delivery challenging. For more information on the risk and protective factors related to suicide among Inuit in the North, refer to the National Inuit Suicide Prevention Strategy (PDF).
The territories encompass almost 40% of the land mass of Canada, however, only 0.3% of the Canadian population lives there. Communities are generally small, varying in size from a population of 140 to just over 8,000, with the majority having approximately 500 to 1,000 residents. They tend to also be spread out over hundreds of kilometers, often in remote and isolated areas and only linked to other communities or parts of the country by air transportation and sometimes seasonally by winter road or barge. There is snow and ice cover for 7 to 10 months and permafrost in the soil.
These exceptional conditions create challenges in establishing and maintaining basic infrastructure, such as, transportation, communications, water and sewage. With limited highway access, the transportation of goods, as well as travelling to and from communities, can be costly and time consuming. It also impacts service delivery due to a heavy reliance on travel in and out of the territories.
The health service delivery context in the territories differs from other provinces. Territorial governments are responsible for delivering insured health services to all of their citizens, including First Nations and Inuit. Unlike other provinces, there are no First Nations reserves in the territories. Therefore, the federal government does not have a direct primary health care service delivery function for Indigenous communities. That being said, ISC provides funding for a variety of programs, such as home and community care, health promotion and disease prevention programs, Indian Residential Schools Resolution Health Support Program and the Health Services Integration Fund for First Nations, including those that are self-governing, and Inuit in the territories. There is variation in the delivery of Non-Insured Health Benefits (NIHB). In the Yukon, ISC delivers the full NIHB program to eligible First Nations, whereas in Northwest Territories and Nunavut, a portion of the program is delivered in partnership with territorial governments. In Northwest Territories, the territorial government provides equity of service delivery to Métis.
Purpose of the framework
To support the responsiveness of the federal program and policy development to the unique Northern context, ISC's Northern region developed this document with input from partners. This framework aims to build greater awareness across ISC and other federal departments of the health context across the territories. This is meant to ensure the unique needs and service delivery context of the North are considered in the development of policies and programs and that Indigenous governments, territorial governments and organizations are consulted and included in the development, implementation, enhancement, and evaluation of programs and services. The ultimate purpose of this framework is to reduce barriers to improved health outcomes for First Nations and Inuit in the North.
The framework is an evergreen document, which will be updated every 2 years to ensure its continued relevance.
Developing the framework
This inaugural version of the framework was developed by ISC's Northern region, in consultation with key partners delivering health services in the territories, to describe the unique territorial contexts, roles and responsibilities, program strengths and gaps and opportunities in each territory.
The framework is divided into 5 sections:
- Northern context: examines the legislative, policy, socio-historical and geographical context and considerations for ISC health services and programs.
- Health overview: provides an overview of the health system in the territories, the context for delivering health services and the common challenges for health service delivery amongst the territories that need to be addressed through coordinated action.
- Challenges delivering health services in the North: describes challenges shared by all 3 territories.
- Territorial profiles: provides a profile for each territory, including demographics, health status, role of key health partners, priorities, unique challenges, gaps and barriers.
- Implementation: describes how ISC can work with territorial partners to improve the health status of First Nations and Inuit in the territories. It includes an analytical tool, called the "Northern Lens", which supports consideration of the unique territorial context in policy and program development by policy makers.
To obtain a copy of the entire framework or to provide feedback on how it can be improved, please contact ISC's Northern region: