The federal government has distinct responsibilities for Indigenous health that don't apply to healthcare generally. These responsibilities flow from treaties, constitutional relationships, and specific legislation—not simply from federal spending power but from the Crown's obligations to First Nations, Inuit, and Métis peoples. Indigenous Services Canada administers federal Indigenous health programs, but the scope, adequacy, and appropriateness of federal Indigenous health involvement remain contested. Reconciliation requires transforming federal Indigenous health roles in partnership with Indigenous peoples themselves.
Constitutional and Legal Basis
Federal Indigenous health responsibilities derive from multiple sources. Section 91(24) of the Constitution assigns "Indians, and Lands reserved for the Indians" to federal jurisdiction. Treaty provisions include health-related commitments. The Indian Act, despite its colonial origins, establishes federal relationships with First Nations. These various sources create federal obligations that don't exist for healthcare generally.
The scope of federal responsibility is contested. Federal government positions have historically been narrower than Indigenous interpretations. Disputes about what treaty promises entailed, what "medicine chest" provisions meant, and what ongoing obligations exist have generated litigation, negotiation, and policy conflict. The federal role isn't definitively settled.
Jordan's Principle, named after a child who died while governments disputed jurisdictional responsibility for his care, requires child-first resolution of such disputes. If a service is available to other Canadian children, jurisdictional disputes between federal and provincial governments shouldn't delay Indigenous children's access. This principle addresses gaps created by jurisdictional finger-pointing but doesn't resolve underlying responsibility questions.
Current Federal Programs
Indigenous Services Canada delivers or funds various health services for First Nations and Inuit peoples. Non-Insured Health Benefits (NIHB) covers prescription drugs, dental care, vision care, medical transportation, and other benefits not covered by provincial health plans. On-reserve primary care, public health, and community health programs receive federal support. Mental wellness programs address particular community needs.
Federal health services for Indigenous peoples exist alongside provincial health systems. Indigenous individuals can access provincial healthcare like other residents; federal programs provide additional coverage for items provincial plans don't cover. This arrangement creates complexity—two parallel systems with coordination challenges.
Métis health receives different federal treatment than First Nations and Inuit health. Without the same constitutional and treaty foundation, federal Métis health programming has been more limited. Recent developments, including recognition of Métis rights and negotiation of self-government agreements, may expand federal Métis health roles.
Gaps and Shortcomings
Indigenous health outcomes remain substantially worse than non-Indigenous Canadian outcomes across most measures. Life expectancy is lower; chronic disease rates are higher; mental health challenges are more prevalent; access to care is more difficult, particularly in remote communities. Federal programs have not achieved health equity for Indigenous peoples.
On-reserve infrastructure deficits affect health. Housing conditions contributing to respiratory illness. Water quality issues creating health risks. Lack of adequate healthcare facilities limiting access. These infrastructure gaps—themselves reflecting underfunding—create health problems that health programs alone cannot solve.
Cultural safety concerns affect how Indigenous peoples experience healthcare, whether federal or provincial. Historical trauma from residential schools and other colonial policies affects healthcare relationships. Racism within healthcare systems affects Indigenous peoples seeking care. Federal health roles include addressing these systemic factors, not just funding services.
Indigenous Self-Determination
Indigenous governments increasingly seek to design and deliver health services for their communities. Transfer agreements move program control from federal government to Indigenous governance. Self-government agreements may include health authorities. The direction is toward Indigenous peoples determining their own health approaches rather than receiving federally defined programs.
Federal roles shift in self-determination contexts. Rather than delivering programs, the federal government may fund Indigenous-governed health systems. Accountability relationships change—Indigenous governments accountable to their communities rather than Indigenous services accountable to federal bureaucracy. Federal responsibility becomes funding and support rather than direct administration.
Traditional Indigenous health approaches gain recognition. Indigenous healing practices, traditional medicine, and land-based wellness are not alternatives to Western medicine but complements that Indigenous communities value. Federal support for Indigenous health includes supporting these approaches alongside Western healthcare.
Questions for Consideration
What should the federal government's Indigenous health role be? How should federal responsibilities differ from provincial healthcare responsibilities? How can Indigenous self-determination in health be supported while ensuring adequate resources? What would health equity for Indigenous peoples require? How do treaty obligations shape federal Indigenous health responsibilities?