Indigenous public health, Law and policy in Canada
This chapter presents an overview of the law, policy and governance practices that are most directly implicated in the population health of Indigenous people who reside in Canada. The first section provides a general description of the socio-legal categories that are drawn upon in health policy, programming and legislation regarding Indigenous peoples. It briefly describes roles in funding and delivering community health services and programming, as well as disputes about responsibilities and some shortcomings.
The second section provides an overview of the population health status of Indigenous peoples. Epidemiological data is presented, and select social determinants of health are also discussed, including education and income. Links are also drawn between poor health and intergenerational trauma. There is a fuller discussion of how community health programming is designed, funded and delivered. The section closes with an assessment of research gaps and research ethics.
The third section moves into two case studies of environmental determinants of health that are pressing for the Indigenous population: quality and availability of housing, and quality of drinking water. These case studies illustrate the operation of law and policy at various levels of jurisdiction and how these jurisdictions overlap. They also illustrate how constitutionally protected treaty rights, the legal implications of the special fiduciary relationship between the Crown and Indigenous peoples, and international law, are relevant for defining Canada’s responsibilities.
The fourth section considers how traditional Indigenous health practices are regulated. Two topics are considered: traditional midwifery and traditional healers. Interwoven within this chapter are assessments of how Aboriginal rights and constitutionalized doctrines may affect the lawfulness of existing legislation. Instruments under which Indigenous peoples have asserted jurisdiction are also identified.
The final section describes First Nation jurisdiction over public health, and instruments which supplement this jurisdiction such as Contribution Agreements and Comprehensive Claims. This section ends with a discussion of likely public health consequences of Indigenous communities having meaningful control over their health programming.
Constance MacIntosh, "The Intersection of Indigenous Public Health with Law and Policy in Canada" in Tracey M. Bailey, C. Tess Sheldon & Jacob J. Shelley, eds, Public Health Law and Policy in Canada, 4th ed, (Toronto: LexisNexis Canada, 2019).