Jennifer Butler, B.Sc.(Pharm)

The Honorable Justice Murray Sinclair said that everyone throughout their lifetime needs to answer four questions: Where do I come from? Where am I going? Why am I here? and, Who am I? (Deerchild, 2021). During a recent conversation, University of Manitoba professor Dr. Amanda Fowler-Woods taught me that introducing oneself through these fundamental life questions is particularly meaningful when engaging with Indigenous people (Personal communication, Nov 2024). As such, I consider it important to briefly provide some answers to these questions before continuing my post.

My name is Jennifer, and my parents are Kathy and John. I am of Irish and Scottish heritage and have lived my entire life in Winnipeg, Manitoba. I was raised Catholic, but as an adult, I no longer identify with any particular faith. I grew up in a middle-class family and attended French immersion schools in St. Boniface.

Growing up, I had little awareness of the pervasive nature of systemic inequalities and how they shape society. However, in my late teens, my introduction to feminist principles sparked a broader, ongoing journey of learning about human rights and social justice. This evolving awareness has deeply influenced my professional path, leading to a strong commitment to health equity. As a pharmacist, I work in a distance-care pharmacy providing for people living in remote communities, the vast majority of whom are First Nation and Inuit.

With all this being said, it should be noted that this post does not speak on behalf of Indigenous Peoples, nor does it claim to provide any type of framework for reconciliation. Rather, it is a reflection of my ongoing learning and engagement with these important issues.

In 2015, the Truth and Reconciliation Commission of Canada (TRC) published 94 Calls to Action to advance the process of reconciliation, with calls 18-24 specifically addressing health and healthcare. Call to Action #22 specifically states “We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.” (Truth and Reconciliation Commission of Canada, 2015). Modernization of the Canada Health Act (CHA) is an opportunity to address this Call.

As stated in the CHA, the primary objective of Canadian healthcare policy “is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”. Unfortunately, under the CHA, coverage is limited to hospital services, physician services and surgical-dental services (Canada Health Act, 1984). Although the recent announcement by the Minister of Health clarifying that this definition includes medically necessary physician-equivalent services provided by regulated healthcare professionals is expected to make an overall positive impact on the health of Canadians (Health Canada, 2025), it does not go far enough to meet the stated objective of healthcare policy, particularly as it concerns Indigenous Peoples of Canada.

Indigenous models of health typically adopt a more holistic approach, encompassing various aspects of an individual beyond the mere presence of ailments. Instead considerations are made for the physical, mental, emotional, and spiritual wellness, and generally try to take a preventative approach, rather than focusing on secondary prevention (Eni et al., 2021; Marchildon et al., 2021).

An example of a system that incorporates many of these models can be found in Alaska, where the Nuka System of Care has gained international recognition for its success in efficiently improving the overall health and wellbeing of Indigenous residents (Slaten, 2014). The Nuka System provides a wide range of services, including primary care, dentistry, behavioural care, traditional healing, complementary medicine and more. They employ a variety of service delivery models, including in-person appointments, virtual care, health information and education classes, inpatient hospital services and a comprehensive distance-care model that sees clinical teams travelling to remote communities to provide services (Gottlieb, 2013). When customer-owners (the term used by Nuka in place of patients or clients) access primary care services, they receive care from a team that generally includes a provider, a nurse, a case manager, a behaviourist, a nutritionist and a pharmacist (Slaten, 2014). According to their former President & CEO, this system has led to significant improvements, including a rise in Indigenous residents with primary care (35% in 1996 to 95% in 2013), same-day access to routine appointments, near-elimination of the behavioral health waitlist, and sustained reductions in hospital days (36%), ER visits (42%), and specialty clinic visits (58%) over 10+ years (Gottlieb, 2013).

Modernization of the CHA provides the opportunity to partially respond to the TRC Call to Action #22 by broadening the definition of what is considered “medically necessary”—or replacing this standard altogether—to include a holistic approach to care informed by Indigenous models of health and including traditional healing practices as an insured health service.

References

Canada Health Act, Pub. L. No. 1984, c. 6, R.S.C. 1985, c. C-6 (1984). https://laws-lois.justice.gc.ca/PDF/C-6.pdf

Deerchild, R. (Host), Kaschor, K. (Producer), & Knowles, E. (Producer). (Sept 23, 2021). Reconciliation reality check with Murray Sinclair [Audio podcast episode]. In Unreserved. The Canadian Broadcast Corporation. Retrieved February 8, 2025, from https://www.cbc.ca/listen/live-radio/1-105-unreserved/clip/15868493-reconciliation-reality-check-murray-sinclair

Eni, R., Phillips-Beck, W., Achan, G. K., Lavoie, J. G., Kinew, K. A., & Katz, A. (2021). Decolonizing health in Canada: A Manitoba first nation perspective. International Journal for Equity in Health, 20(1), 1–12. https://doi.org/10.1186/s12939-021-01539-7

Gottlieb, K. (2013). The Nuka System of Care: Improving health through ownership and relationships. Circumpolar Health Supplements, 72, 93–98. https://doi.org/10.3402/ijch.v72i0.21118

Health Canada. (2025, January 10). Statement from the Minister of Health on the Canada Health Act [Statements]. https://www.canada.ca/en/health-canada/news/2025/01/statement-from-the-minister-of-health-on-the-canada-health-act.html

Marchildon, G. P., Lavoie, J. G., & Harrold, H. J. (2021). Typology of Indigenous health system governance in Canada. Canadian Public Administration, 64(4), 561–586. https://doi.org/10.1111/capa.12441

Slaten, R. (2014, September 1). Southcentral Foundation’s Nuka System of Care: Exporting Alaska’s success in healthcare delivery. Alaska Business Monthly, 30(9), 86.