Supporting Indigenous self-determination in health : Lessons learned from a review of best practices in health governance in Canada and Internationally
December 2020
Control over health programs and services is considered by many as key to closing existing gaps in health outcomes between Indigenous and non-Indigenous populations across Canada and globally. Self-determination empowers and enables communities to build capacity and gain control over the wide-ranging forces that affect Indigenous Peoples’ health and well-being at individual and collective levels. In the past, health equity and self-determination may have been acknowledged in policy rhetoric but not necessarily a priority in implementing policy. In recognition of this, governments in Canada and internationally have committed to health systems reform to address health inequities and determinants of Indigenous Peoples’ health, support Indigenous Peoples’ self-determination, and influence better health outcomes for Indigenous Peoples.
This paper provides a targeted review of literature on various models of Indigenous health governance implemented across Canada and globally that have led to improved access to primary health services, greater ownership, control and management by Indigenous Nations, and improved health outcomes. Its purpose is to inform the creation of new health governance structures and funding models in Canada that support the devolution of health services and self-determination. The paper begins by providing an overview of the factors that affect Indigenous Peoples’ health and the context of Indigenous health governance in Canada. It then describes examples of health governance structures and funding models currently in place across Canada and in the United States, Australia and New Zealand. The paper concludes by synthesizing key findings and lessons learned from these examples of health governance.
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