Health and Social Secretariat

The Health and Social Secretariat (HSS) report is organized and aligned under themes within our new structure: Strategic Policy, Public Health, Mental Wellness, Children and Youth, Information Management, Primary Care, and Social Development. Health strategies and direction are developed in partnership with the National First Nations Health Technicians Network (NFNHTN) and the Chiefs Committee on Health (CCOH).

1. STRATEGIC POLICY

The Strategic Policy unit of HSS monitors the high-level work conducted across regions and levels of government with regard to health and social development. Broadly, it works on task groups that coordinate program and policy development seeking to secure healthier, stronger First Nation communities.

Key areas of work led by the Strategic Policy unit include: the Health Canada - Public Health Agency of Canada - Assembly of First Nations (HC-PHAC-AFN) Task Group, the Aboriginal Health Human Resources Initiative (AHHRI), the Health Accord, the First Nations Health Managers Association (FNHMA), and the Canadian Association of Schools of Nursing (CASN). Research and advocacy is conducted by the Strategic Policy unit on renewal of the Health Accord and the First Nations Health Plan.

A. National Health Forum

Key Issues and Activities

At the 2011 Annual General Assembly (AGA), Resolution 04/2011 was passed calling for the AFN to make health a priority. On November 7-9, 2011, the AFN hosted a National Health Forum in Ottawa. Over 780 representatives, including over 300 sponsored health directors and designates from every region in Canada came together to share new and innovative First Nation-driven approaches to health and wellness. The overall theme of the forum, Taking Action to Move Forward, provided the framework for discussions and presentations on five key issues within national health policy: sustainability, governance, jurisdiction, research, and knowledge translation. The First Nations Health Plan was presented within a dialogue session and contextually set the stage for the Forum and discussions during the week.

A variety of workshops, regional showcases, short courses, and an AFN Knowledge Circle were provided at the National Health Forum. Workshops took place on numerous topics, including Mental Wellness, Jordan’s Principle, eHealth, Non-Insured Health Benefits (NIHB), and Primary and Continuing Care. In addition, workshop slots were also provided to the regions to enable them to showcase model programs or best practices. Seven regions took the opportunity and showcased such programs/initiatives as Maternal Child Health, AHHRI, a First Nations Amalgamated Mental Health Service Delivery Model, First Nations Health and Well-being Memorandum of Understanding, the Model of Organization Based on a Multidisciplinary Approach, and Noojmowin Teg Health Centre. Eight short courses were also offered, providing a more in-depth look at such topics as Understanding How Government Works, Introduction to Basic Statistical Techniques and how to Interpret Statistical Results, Developing Community Health Plans, and Public Health 101. The AFN Knowledge Circle was a pavilion within the tradeshow that showcased the AFN’s work in the area of health and the social determinants of health. A special Health Bulletin was released at the Special Chiefs Assembly (SCA) in December 2011, which provided an overview of the National Health Forum.

Next Steps - Moving Forward

• A final report on the National Health Forum is being prepared and is set to be released at the end of summer 2012.
• Posting of the workshop presentations on the AFN website will be completed by the end of summer 2012.

B. Health Canada - Public Health Agency of Canada - Assembly of First Nations Task Group (HC-PHAC-AFN Task Group)

The Task Group coordinates the highest level of work on health and has the potential for immense influence and change for program and funding sustainability, program coherence and innovation. Phase One was completed and an agreement was signed on January 13, 2009, between the National Chief and the Minister of Health initiating work under Phase Two (2009-2011). In November 2011, a joint letter was signed by the National Chief and the Minister of Health renewing the HC-PHAC-AFN Task Group on First Nations Health from 2011-2012.

Key Issues and Activities

The AFN’s portion of the workplan involves the development of an analysis of the social determinants of health from a community development perspective which is on track for completion, having composed the most significant part of the Strategic Policy unit’s Task Group work since January 2012.

Next Steps - Moving Forward

• By fall 2012, a final report which reviews and analyses the key activities and conditions that led to the initiation of tripartite discussions in British Columbia to inform work in other jurisdictions is scheduled to be published and circulated to Provincial Territorial Organizations (PTOs). In addition, the AFN will develop a community level tool kit that highlights lessons learned and success stories on strengthening work with Federal/Provincial/Territorial health partners by the fall of 2012.
• Continue work with the HC-PHAC-AFN Task Group and advocate for a third phase of joint work.

C. Aboriginal Health Human Resources Initiative (AHHRI)

The AHHRI has been renewed for an additional three years from 2010-2015 at $80 million. The renewed AHHRI is focused on a number of issues including increasing the number of trained and certified First Nation health managers and community-based workers. In the first two years of the renewed AHHRI, the AFN advocated and secured continued funding for established cultural competency projects.

Key Issues and Activities

The AFN continues its advocacy efforts to obtain funding for new cultural competency projects as they remain unfunded under the AHHRI guidelines for years 2013-2015. The First Nations and Inuit Health Branch (FNIHB) has also mandated AHHRI to fund the startup of the First Nations Health Managers Association (FNHMA) from 2010-2012.

The AFN’s involvement with AHHRI also saw the Strategic Policy unit’s participation in, and presentation at, the AHHRI National Knowledge Translation Mawitaql Kijitaqnn Forum from January 31 to February 1, 2012, in Moncton, New Brunswick. The event focused on knowledge translation and lessons learned from past AHHRI projects.

Next Steps - Moving Forward

• Continue to advocate for funding of new cultural competency projects under the AHHRI mandate.
• Continue to work collaboratively with regional First Nation partners and participate in the creation and exchange of knowledge dissemination strategies.

D. Health Accord

In December 2011, Finance Minister Jim Flaherty announced a new model for the Canada Health Transfer (CHT) to replace the one negotiated in the 2004 Health Accord. While public support for Health Accord renewal is high, it is worth noting that there is no legal obligation for the federal government to renew the Accord. In the absence of a federal policy table, the provinces have formed an Innovation Working Group. The working group’s central task is to provide a forum to share best practices aimed at improving efficiencies in each province. Significantly, there has been no indication that there are plans to include First Nation content, representatives or experts in the working group discussions. The working group will meet a minimum of two times and deliver a progress report at the July 2012 Council of the Federation meeting in Halifax.

Key Issues and Activities

In March 2012, the Standing Senate Committee on Social Affairs, Science and Technology issued its review of the 2004 Health Accord, entitled Time for Transformative Change. Among its recommendations was a call for a federally-led table tasked with setting measurable indicators and benchmarks for success. The committee’s findings may serve as a useful tool to bolster the AFN’s advocacy efforts for Health Accord renewal.

The HSS has recently developed a review and analysis of the 2004 Health Accord and the recent CHT announcement, as well as developed suggested messaging moving forward, which is publicly available.

Next Steps - Moving Forward

• Advocate for 2014 Health Accord renewal and demand the inclusion of First Nations people and perspectives in meaningful ways, including the participation of the AFN in the Health Care Innovation Work Group, as its report is scheduled to be delivered at the Council of the Federation meeting in July 2012.

E. First Nations Health Managers Association (FNHMA)

AFN Resolutions 58/2008 and 46/2009 support collaboration to address First Nations health human resource shortages and support the development of the FNHMA and approve the First Nations Health Managers Competency Framework.

Key Issues and Activities

The draft Statement of Partnership between the AFN and FNHMA is currently on hold until the FNHMA addresses the parameters set out in Resolution 46/2009. While some issues have been addressed, many remain outstanding such as by-laws and governance. The AFN continues to advocate for the outstanding concerns in Resolution 46/2009.  The FNHMA has changed the name of our designation from Certified Aboriginal Health Manager to Certified First Nations Health Manager and their courses have changed from Aboriginal Health Management to First Nations Health Management.

Next Steps - Moving Forward

• The AFN continues to collaborate with the FNHMA to ensure the by-laws and governance issues raised in Resolution 46/2009 are addressed.

F. The Canadian Association of Schools of Nursing (CASN)

Key Issues and Activities

On March 19-20, 2012, the CASN held a symposium in Toronto with stakeholders that included First Nation, Inuit and Métis (FN/I/M) nursing educators and students to discuss concepts of cultural competence and cultural safety. The prime focus of the dialogue was to look at ways to incorporate these concepts into current nursing curricula. The cultural competence and cultural safety concepts discussed were based on previous work funded by AHHRI and developed in collaboration by the Aboriginal Nurses Association of Canada (A.N.A.C), CASN and the Canadian Nurses Association (CNA).

Next Steps - Moving Forward

• Continue to collaborate with the CASN Advisory Group on the outcomes report.
• Integrate the outcomes of the CASN symposium with other AFN health and education-related work, and strengthen cultural competency curricula in other areas of health education.

2. PUBLIC HEALTH

First Nations people suffer a disproportionately higher rate of morbidity across many diseases and mortality compared with the rest of Canadians. This disparity is a reflection of systemic, societal and individual factors that influence the health of our people. These influences are considered the broader determinants of health.

Public health focuses on the social, environmental and economic factors affecting health, as well as the communities and settings where people gather and live. Programs and services are designed to promote and protect health, and prevent injury and disease.

To improve the health of our people, we must begin to look past the mainstream interventions - recognizing that there may be validity to some approaches - and begin to look at First Nation specific approaches. Approaches must reflect and respect First Nation autonomy, values and practices.

Key Issues and Activities

Public Health Pilot Programs

The Community Public Health Pilot Programs in Four Arrows Regional Health Authority, File Hills Qu’Appelle and Kenora Treaty 3 have reached the end of their five years of funding. The year 4 evaluation has been completed and work is in progress to conduct and finalize the year 5 summative evaluation. These initiatives recognize the need for increased capacity at the regional level, a more inclusive governance structure in the management of public health services, enhanced disease surveillance, integrated public health programming with the provinces, and an agreed upon legislative basis on which to protect the health of individuals and their community.

AFN National Experts Committee on Public Health (NECPH)

The AFN NECPH held its first meeting November 30 - December 1, 2011. Membership on the panel consists of one representative per AFN region, one AFN staff and First Nations national experts in public health (currently 6), all of whom have been identified in a collaborative effort from the NFNHTN. The AFN NECPH will identify public health priorities, guide its actions and provide expertise and recommendations to address public health issues for First Nations.

Public Health Partnerships

The AFN continues to establish relationships and collaborate with federal government departments and national organizations such as the National Collaborating Centre for Aboriginal Health, Canadian Lung Association, and the Canadian Asthma Society among others, to ensure the ongoing inclusion of First Nations in the development of new strategies to improve the health of First Nations.

Next Steps - Moving Forward

• Completion of the Community Public Health Pilot Programs year 5 evaluation.
• Assist FNIHB and PHAC with the development of tools, policies and strategies relevant to First Nations.
• Continuation of the AFN NECPH.
• Completion of the review and update of the AFN Public Health Framework.

A. Cancer

The incidence of cancer is rising faster in First Nation communities than in the general Canadian population and is among the leading causes of death in some First Nation communities. While cancer was relatively rare in the past among First Nations, common cancers such as breast, prostate, lung, and colorectal have increased remarkably over the last several decades.

With the rapidly growing First Nations population, cancer will soon become a public health issue for First Nations and for Canada. There is a potential for cancer to surpass diabetes as the number one killer of First Nations peoples.

The AFN will continue to monitor the cancer care continuum (risk factors/prevention, screening, diagnosis, treatment, recovery, end of life/palliative care) to keep apprised of how First Nations might be affected. Efforts and limited resources this fiscal year will be focused on screening, liaison, raising awareness, working with partners to ensure access to the most current information, influencing decision makers, and advocating for the health of First Nations.

Key Issues and Activities

Canadian Partnership Against Cancer (CPAC)

The AFN has engaged with CPAC since 2007 and is currently negotiating expansion of funding from CPAC until the 2016/17 fiscal year. The main objective is to raise awareness of cancer as an emerging crisis for First Nations. Activities include policy development and analysis, as well as capacity building and development of communication components that will support the objective of raising awareness with leadership, all levels of government, professional organizations, and First Nation communities. The AFN also participates on CPAC’s Advisory Council for the FN/I/M website portal page, Cancerview.ca website. Cancerview.ca connects Canadians to online services, information and resources for cancer control. The FN/I/M portal will have a collection of FN/I/M specific resources for each of the groups.

First Nations/Inuit/Métis (FN/I/M) Advisory Council on Cancer Control

The AFN participates with CPAC and Inuit Tapiriit Kanatami (ITK) providing support to the FN/I/M Advisory Council on Cancer Control. The Council facilitated the development of the First Nations, Inuit and Métis Action Plan on Cancer Control. Implementation of the Action Plan has included a Request for Proposal (RFP) process that was promoted through FN/I/M and cancer control channels. Over the first year (2011/12), the focus has been on better understanding the realities of First Nations with respect to cancer control and identifying leading practices that can be further leveraged. This included a Knowledge Exchange Forum and work to develop an evaluation framework for the Action Plan.

Canadian Cancer Action Network (CCAN)

The AFN is represented on the CCAN board by a First Nations cancer survivor. CCAN’s priorities include playing a critical role in ensuring constructive and positive dialogue and development at both a provincial and national level. CCAN focuses on issues relevant to patient issues and ensuring patient voice by empowering and encouraging the cancer patient voice to be heard resulting in positive and quantifiable change. CCAN also works to establish strong, active and recognized presence in each province and territory, cultivate and pursue opportunities for effective dialogue and interaction with stakeholders through education and awareness, and establishing and implementing a strong and sustainable governance model.

Next Steps - Moving Forward

• Continue to raise the profile of cancer as an emerging crisis for First Nations with political leadership, CCOH, NFNHTN, and First Nation communities.
• Continue to identify key issues to explore options for policy change and other measures in cancer control and service delivery across jurisdictions.
• Continue to participate in the implementation of the FN/I/M Action Plan and development of an evaluation framework.
• Continue to strengthen partnerships that explore the development of a cancer strategy that promote a First Nations approach.
• Explore the linkages across the broad range of cancer and the environment, sexual and nutritional health.

B. Tuberculosis (TB)

TB is not just a public health issue; it is a social justice issue and a true marker of poverty. First Nations currently have rates of TB that are 31 times that of non-Aboriginal Canadians. Overcrowded housing, poor access to health care and food insecurity contribute greatly to this national disgrace.

Key Issues and Activities

FNIHB released its National TB Strategy in March 2012, which is expected to be implemented this year and aims to address the burdens of TB in many First Nation communities. The AFN continues to participate in the Prairie Wide Provincial Network Committee and the University of Alberta “The Determinants of Tuberculosis Transmission project”.

The International Union Against Tuberculosis and Lung Disease held its 42nd Union World Conference on Lung Health, in Lille, France, October 26-30, 2011. The forum provided the opportunity to showcase and create awareness on the health disparities that afflict First Nations. It also provided an opportunity to network with experts and organizations that can support our efforts in improving First Nations health.

Next Steps - Moving Forward

• Implementation of the FNIHB 2012 National TB Strategy in most regions.
• Ongoing participation in the STOP TB initiative, raising awareness of TB issues in First Nation communities.
• Distribution of the Teaching TB Resource Guide.

C. Lung Health

Respiratory ailments are more prevalent in First Nation communities. The AFN is working through partnerships to improve programs and policies into bettering promotion, education, access, and reduce incidence.

Key Issues and Activities

The First Nations Regional Longitudinal Health Survey (RHS) revealed that a significant number of First Nations people reported to have asthma. The AFN continues to collaborate with the Canadian Asthma Society, which has completed the development of a toolkit on education materials for First Nation children, youth and adults on asthma triggers. The AFN also continues working with the National Lung Health Framework (NLHF) and will be working closer with other internal AFN departments to explore the links between environment, housing and lung health.

Next Steps - Moving Forward

• Distribution of the results from phase II of the NLHF sponsored research studies.
• Development of a position paper on the linkages between environment, housing and lung health.

D. Pandemic Planning and Emergency Preparedness

Health Emergency Preparedness has been a top priority for all First Nation communities since the H1N1 pandemic. The AFN has been actively engaged with key stakeholders in an effort to ensure that all First Nations have access to appropriate prevention and treatment responses for any future health emergency.

Key Issues and Activities

The AFN has been participating on a Trilateral First Nations Pandemic Working Group (TFNP) with PHAC and FNIHB since 2006, with the goal to develop and monitor the implementation of a workplan on pandemic influenza preparedness and response for First Nation communities. The workplan includes such activities as developing materials on emergency response, distribution of previously developed tools, knowledge transfer, and publication of articles/results. It is expected that this might be the last year of the group, and efforts are underway to determine means for continuing pandemic planning activities.

The AFN has been involved in the update of the PHAC Module 5 Tabletop Exercise on Emergency Preparedness and the drafting of several articles on pandemic planning. The AFN also continues to participate in the federal government’s “Senior Officials Responsible for Emergency Management” group, advocating for First Nation interests at the federal and regional levels. Finally, the AFN continues to explore the development of a field guide that will allow for health assessment as part of the early response to emergencies, speeding up and increasing the efficiency of any health service response.

Next Steps - Moving Forward

• The Influenza-Like Illness (ILI) webinar tool and feedback results will be shared and future instruments will be planned accordingly.
• Distribution of the materials produced by the TFNP.

E. Environmental Health

The physical environment is an important determinant of health. At certain levels of exposure, contaminants in our air, water, food, and soil can cause a variety of adverse health effects. As well, in the built environment, factors related to housing, indoor air quality and the design of communities and transportation systems can significantly influence our physical and psychological well-being.

It is widely recognized that First Nations are at a higher risk of exposure than the general population because of their closer ties to the land. Therefore, the AFN is committed to working collaboratively with our regions and FNIHB’s Environmental Public Health Division to assist with the reduction of environmental public health related issues. The AFN recognizes the importance of preventing disease through environmental public health stewardship.

Key Issues and Activities

The AFN will continue to provide information to Chiefs regarding input and advice into emerging issues in First Nation communities related to Environmental Public Health, working collaboratively with our partners to address linkages between climate change, environmental health, traditional knowledge, and traditional foods.

Next Steps - Moving Forward

• Raise awareness of environmental health issues among First Nation leaders and citizens.
• Communication to First Nation communities and leadership on emerging environmental public health issues.
• Explore the linkages between environmental health and cancer.

F. Food Security and Nutrition

Many communities have expressed concerns regarding federal government policies that have disrupted and, in some cases, devastated the traditional practices of First Nations, including removing control over land and natural resources.

Food security exists when there is a comprehensive continuum of resources in a community’s food system. The continuum of resources ranges from those providing short-term relief of acute food insecurity, to those that build the capacity of the community to feed itself, to strategies that redesign the food system toward a more economically, socially and environmentally sustainable model. Therefore, actions must be taken to tackle the socio-economic and cultural barriers to opportunities for those living on reserves that result in their not enjoying fully their right to adequate food.

The AFN works on ensuring and increasing First Nation participation in the development of food security related policy and initiatives in collaboration with FNIHB, PHAC, Aboriginal Affairs and Northern Development Canada (AANDC), AFN regions, and other stakeholders.

Key Issues and Activities

The Nutrition North Canada (NNC) program began full implementation on April 1, 2011. The intention of the NNC program is to bring healthy nutritious foods to residents of the north. The new program has been designed around a market-driven/retail-based model. The AFN continues to monitor the progress of AANDC and Health Canada in the development and implementation of the new NNC and is undertaking a comprehensive impact analysis, as directed in Resolution 78/2010.

The AFN participates on the Food Security Reference Group (FSRG) to ensure collaboration towards improved food security for First Nations and Inuit. Key activities include building on a previously developed promising practices document, developing tools for community planning, exploring opportunities for influencing agendas to include food security, and continuing to build the evidence base.

The First Nations Food Security Working Group (FNFSWG) was established earlier in the year as a subcommittee of the NFNHTN. This working group met in November 2011 to set priorities and develop terms of reference. The priorities of the group are: advocating for more food security specific funding for communities, assessing the needs of communities through community-led food security assessments, developing a First Nations food security/sovereignty position statement, and examining linkages between food insecurity, income assistance and health outcomes such as diabetes. The AFN also participated and presented at the Turtle Lodge Roundtable on Community Food Justice in Sagkeeng First Nation, Manitoba, in August 2011. The intent of the Food Justice Roundtable was to ask community Elders and members, nutritionists, local, provincial and federal health staff, and other participants how to move toward food sovereignty.

Next Steps - Moving Forward

• Conduct an impact analysis on those First Nation communities using the NNC program, those who are remote but are not eligible and those communities removed from the eligibility list from the previous Food Mail Program.
• Explore the relationships between food security, environmental health and mental health.

G. Injury Prevention

Injuries are a major cause of morbidity and mortality in First Nation communities especially among youth and young adults. Injury prevention is concerned with modifying behavioral or contextual factors that place First Nations at greater risk for unintentional injury, morbidity and mortality from injuries when they occur.

Key Issues and Activities

The AFN continues to work at the national level on raising awareness of injuries and their impact, building capacity for communities to carry out injury prevention work and relationship development with the goal of addressing programming gaps and the adaptation of existing injury prevention programming/guidelines. Much of this work is guided by the First Nations Regional Injury Prevention (FNRIP) Advisory Group.

In order to raise awareness, the AFN has developed a First Nation Injury Prevention communications plan that is designed to coordinate and promote injury prevention efforts from a national perspective with the overall goal of safe and healthy First Nation communities that are injury free. Some of the activities include the promotion of and participation at the Canadian Injury Prevention and Safety Promotion Conference in November 2011, where the AFN was a co-lead on the Aboriginal Stream component of the conference which included FN/I/M speakers, workshops, presentations, and research.

The AFN continues preliminary work on a high level overarching Injury Prevention Framework, participation in the First Nations and Inuit Injury Indicators Working Group and talks on the renewal of the partnership with the Canadian Red Cross (CRC).

Next Steps - Moving Forward

• Explore the development of the First Nations Injury Prevention Framework. 
• Continue exploring the renewal of the AFN-CRC statement of partnership.
• Continue to develop a collective evidence base on injury prevention, including the collection of community-based stories on successes with injury prevention activities.

H. HIV/AIDS and Sexual Health

First Nations continue to be overrepresented in Sexually Transmitted Infections (STIs) and Blood Born Infections (BBIs) and are acquiring HIV at a disproportionately higher rate than the general Canadian population. In particular, the rate among First Nation women and young adults (under 30 years of age) are much higher than those observed in Canada. As well, two-thirds of new infections are acquired through injection drug use; a proportion that is two times higher than that seen in Canada overall.

Key Issues and Activities

The AFN continues to implement the HIV/AIDS and Sexual Health communication plans with a focus on youth-oriented mediums. In partnership with the Canadian Aboriginal AIDS Network (CAAN) for Aboriginal AIDS Awareness Week (AAAW), the National Chief recorded a public service announcement that was disseminated through YouTube and the AAAW website and was again featured in CAAN’s poster campaign.

The AFN is a partner on the Native Youth Sexual Health Network’s project, entitled Taking Action II: Using Arts-Based Approaches to Foster Aboriginal Youth Leadership in HIV Prevention for 2011-2012. In addition, the AFN is participating on the CAAN National Toolkit Committee to identify, collect and evaluate resources, materials and research on HIV/AIDS and Aboriginal people.

Next Steps - Moving Forward

• Continue to collaborate with the AFN National Youth Council (NYC) and the Society of Obstetricians and Gynecologists Canada on the development of community-based pilot projects on sexual health for First Nation youth.
• Development of CAAN’s National Toolkit of HIV/AIDS materials.
• Continue implementation of the Taking Action II project to build the capacity of Aboriginal youth leaders to address the issue of HIV/AIDS in their own community.

I. Immunization

Vaccines are proven to reduce the burden of disease, many of them potentially fatal, during childhood and adulthood, thus improving life and health quality and representing one of the most cost-effective public health interventions.

Key Issues and Activities

The AFN continues to work with FNIHB’s Communicable Disease Working Group and the Health Information, Analysis and Research Division in order to provide guidance and influence program-related decisions.

The AFN continues working with FNIHB in the development and implementation of a social marketing campaign aimed at young parents and decision-makers promoting the importance of immunization. This initiative is strongly based on the use of social media and electronic distribution channels such as Facebook, YouTube and Twitter, as well as printed materials and DVDs.

Also, the AFN explored the possibility of conducting a National Immunization Status Survey in Collaboration with the First Nations Information Governance Centre (FNIGC).

Next Steps - Moving Forward

• Steps will be undertaken to conduct a National Immunization Status Scan, including seeking funding and putting in place protocols.

J. Diabetes

Type 2 diabetes is a growing health concern among First Nations. First Nations on reserve have a rate of diabetes three to five times higher than that of other Canadians. Rates of diabetes among First Nations are expected to rise significantly in the future given that risk factors such as obesity, physical inactivity and unhealthy eating patterns are high.

The AFN First Nations Diabetes Working Group (FNDWG) was established to promote optimum holistic health, increase awareness, educate, and to reduce the risk and protect the health of First Nation individuals, families, communities, and nations through actions aimed at reducing prevalence and incidence of diabetes and its risk factors. They also provide ongoing support and guidance to the Aboriginal Diabetes Initiative (ADI), as well as other related diabetes initiatives and AFN activities.

Key Issues and Activities

The ADI initiative continues to support the training for 300 community diabetes workers.  The ADI Capacity Building and Training National Advisory Committee met in Montreal on October 20-21, 2011, to advise on the development of the Community Diabetes Prevention Worker Competency Framework. The framework will serve as a tool to assist regions and First Nation communities in selecting training programs, drafting job descriptions, raising the profile of Community Diabetes Prevention Workers training, and working towards stronger relationships and teamwork with other health providers.

First Nations Web-based Diabetes Surveillance System pilot

The First Nations Web-based Diabetes Surveillance System provides secure, centralized and easy access to diabetes information in First Nation communities. Developed in 2011, the system has been successfully piloted in five communities with diverse health care models, levels of isolation and population size.

Just Move It - Canada

Together with FNIHB, ITK and Indian Health Services - Healthy Native Community Partners in the United States (US), “Just Move It – Canada” (JMI) launched in March 2012. It is based on the Just Move It campaign in the promotion of US American Indians and Alaska Natives to be more physically active. It is a web-based tool to unite communities in the sharing of ideas, resources and activities and how to get people moving. For more information visit www.justmoveit.org/jmicanada.

What is the Story of Diabetes and Men?

While it has been common in the past to look at First Nation women’s health and gender roles, the story of First Nation men’s health and diabetes is underdeveloped. To facilitate dialogue and direction on this area, the 2011 AGA included a presentation by Dr. Evan Adams called What is the Story of Diabetes and Men? Evaluation following this session revealed the need to build on this further, and include the story of chronic disease and men. A second session on men, cancer and chronic disease was held at the SCA in Ottawa, in December 2011. Again, the interest expressed was to continue with these types of information sessions.

Traditional Knowledge Approaches

The AFN continues to explore Traditional Knowledge approaches. The FNDWG members continue to restore knowledge in harvesting traditional medicines and foods in addressing diabetes in First Nation communities.

Next Steps - Moving Forward

• Continue to raise the profile of diabetes in the areas of self-care management, surveillance, screening, and primary health care services with partners, government, political leadership, and First Nations.
• Continue to provide policy direction and advice on ADI with FNIHB, the NFNHTN and the CCOH.
• Continue to work in collaboration with FNIGC to develop a report on the story of diabetes and men and chronic disease.
• Continue to promote and seek sustainable funding for the JMI initiative.
• Continue to explore promising evidence-based policy and research initiatives and monitor trends in diabetes across jurisdictions.
• Continue to promote and find resources to translate the Diabetes Medicine Wheel Walk video into French for distribution nationally.

K. Tobacco

Misuse of commercial tobacco has been shown to be a major risk factor of chronic diseases. Smoking increases the risk for diabetes by 50 per cent and we know that First Nations experience rates of diabetes that are three to four times as high as the general Canadian population. The high prevalence of smoking among First Nations and the fact that smoking rates have not changed indicates that this pressing problem must be addressed in a comprehensive and sustained way.

Through the Federal Tobacco Control Strategy (FTCS), the AFN received funding to continue the development of an Action Plan for the National First Nations Tobacco Control Strategy (NFNTCS).

Key Issues and Activities

The AFN Tobacco Advisory Circle (TAC) has guided the development of an Action Plan to develop a NFNTCS. The objectives of the project were to host a meeting on the tobacco strategy in collaboration with AFN Councils (Elders, Women’s and Youth) and continue promotion efforts to support traditional tobacco use as a smoking cessation and tobacco control tool.

The second objective was to disseminate information resources on tobacco cessation and prevention. These informed and augmented the work being done on tobacco control and enabled feedback on the AFN Tobacco Action Plan and provided valuable information to leadership and communities on tobacco work.

Traditional Tobacco Use presentations have been delivered during major AFN events, including the AGA and the National Health Forum, and have served to promote traditional tobacco use and to raise awareness among the youth.

Health Canada is awaiting Treasury Board approval for a renewed anti-smoking strategy that will include $25 million over the next five years of targeted funding for First Nations living on reserve and Inuit living in Inuit communities. Funding will support a limited number of communities who are ready to implement a comprehensive tobacco control strategy.

Next Steps - Moving Forward

• Continue to raise the profile of the tobacco misuse and the NFNTCS and Action Plan.
• Provide policy direction and advice on tobacco issues as they relate to the pending Health Canada announcement of new anti-smoking efforts that are expected to include funding for First Nations living on reserves and Inuit living in Inuit communities.

3. MENTAL WELLNESS

Mental Wellness areas of work within the AFN include: the National Aboriginal Youth Suicide Prevention Strategy (NAYSPS), National Native Alcohol and Drug Abuse Program (NNADAP), Indian Residential Schools Resolution Health Supports Program (IRS RHSP), Brighter Futures and Building Healthy Communities Program, and the First Nations & Inuit Mental Wellness Advisory Committee (MWAC). Work consists of the development of a First Nations-driven agenda, advocacy within federally funded programs and initiatives, and advocacy for First Nation engagement in national initiatives, including the Mental Health Commission of Canada (MHCC) and the MHCC First Nations, Inuit and Métis Advisory Committee (FNIMAC) and the Prescription Drug Abuse Coordinating Committee (PDACC).

A.   Mental Wellness

The AFN Mental Wellness Committee (MWC) was established as mandated by the NFNHTN in April 2010. The AFN MWC provides technical expertise and knowledge to the Mental Wellness portfolio and mental health and addiction information to the regions.

Key Issues and Activities

The AFN continues to be a key partner on the MWAC. The MWAC has most recently been working towards the final approval of the Strategic Action Plan and creating next steps for the committee. A face-to-face meeting of all key partners took place in December 2011 in Ottawa. The meeting showcased some of the work that has taken place within FNIHB- HC, the Community Programs Directorate (CPD) and also opened the floor to discussions on addressing gaps within the CPD with regards to policy and service delivery.

Starting in January 2012, the AFN, in collaboration with FNIHB, began work with key partners to design a process to describe a coordinated continuum of mental wellness, specifically with respect to Health Canada’s mental health and addictions programming for First Nations. This process will be guided by an external advisory committee, and prioritize engagement processes that draw upon the expertise and knowledge of relevant partners and stakeholders.

The MHCC released the Mental Health Strategy for Canada on May 8, 2012. The strategy is made up of six strategic directions. Although each of the six can be adapted to suit First Nations, Strategic Direction #5 - Recognizing the Distinct Cultures and Mental Health Needs of First Nations, Inuit and Métis, outlines the key importance of distinction-based programming within mental health. The AFN worked closely with the MHCC in the development of Strategic Direction #5.

Next Steps - Moving Forward

• A second gathering of the AFN MWC will be held.
• The Mental Wellness Comprehensive Continuum Framework will be close to completion.
• The AFN will work closely with the MHCC to disseminate the Mental Health Strategy for Canada to national and regional organizations and First Nation communities.

B. Suicide Prevention

As a part of upstream renewals, the National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) was renewed at par for an additional five years. The AFN’s efforts have now focused on advocating for an evaluation summation that reports findings, supports increases and enhancement past 2015 and promotes mental wellness, community empowerment and youth leadership at the community level.

Key Issues and Activities

The AFN continues to participate on the Canada - US Memorandum of Understanding (MOU) on Indigenous Health, between Health Canada and the US Department of Health and Human Services. The overarching goal of the MOU is sharing knowledge and discussing opportunities for collaboration among those working on behalf of, and with, American Indians and Alaska Natives in the US and with First Nation and Inuit peoples in Canada to prevent youth suicide.

In October 2011, 15 First Nations youth from across Canada gathered in Winnipeg to attend the AFN Youth Mental Wellness Forum (YMWF). The AFN YMWF provided youth with information on mental wellness, current Applied Suicide Intervention Skills Training (ASIST) and provided an opportunity for youth to share their experiences and views on mental wellness in their community. As a whole, the forum encouraged the promotion of the roles and responsibilities of youth as peer counsellors, leaders and role models for one another.

Next Steps - Moving Forward

• Facilitate a meeting between the AFN NYC and the youth councils in the US to discuss best and promising practices in the area of Indigenous suicide prevention and mental wellness.
• Continue advocacy on the need for clear First Nation consideration and engagement in a potential National Suicide Prevention Strategy, as is being discussed in the House of Commons through various private member’s bills and a key opposition motion that received all-party support.

C. Addictions

In partnership with the National Native Addictions Partnership Foundation (NNAPF) and Health Canada, the AFN continues to be a key partner in the NNADAP Renewal Process. The NNADAP Renewal Process has been exceptional in taking an approach to developing a renewed program framework that is informed by culture, evidence and needs. The renewed program framework is unique in taking a systematic approach to supporting First Nations in addressing addictions prevention and treatment needs.

Key Issues and Activities

The final framework was launched at the AFN National Health Forum in November 2011. The AFN National Chief and Chief Austin Bear, President of the NNAPF, circulated a joint press release announcing the publication of the National Framework and their continued efforts to work together throughout its release and dissemination.

The AFN continues to work in partnership with NNAPF and Health Canada on the NNADAP Renewal Leadership Team. The Leadership Team is responsible for advising on the transition and change management from renewal through to implementation and dissemination.

The PDACC has recently been expanded from an internal FNIHB committee to include the AFN (as a co-chair), the NNAPF and the Canadian Centre on Substance Abuse (CCSA) after the Deputy Minister of Health Canada directed FNIHB to work in partnership with First Nations, provinces and territories and relevant organizations.

Next Steps - Moving Forward

• Continue to work with the NNAPF and Health Canada in the dissemination of the NNADAP Renewal Framework and provide ongoing presentation of the NNADAP Renewed Program Framework to First Nation communities, professionals and associations working with First Nations in the area of addictions.
• Continue to participate on the PDACC, as a co-chair.
• Continue to advocate for short-term and immediate culturally competent, holistic and safe supports for communities struggling with prescription drug abuse.

D. Mental Health Supports for Indian Residential School Survivors

The AFN has advocated for thorough provision of mental health supports for survivors, their families and communities throughout implementation of all components of the Indian Residential Schools Settlement Agreement.

Key Issues and Activities

In 2009, Health Canada was instructed to provide mental health supports at Truth and Reconciliation Commission (TRC) national and community events. As a result, the AFN has focused on advising Health Canada on the provision of mental health supports and planning for safe spaces through participation on the Resolution Health Supports Advisory Committee (RHSAC), participation at the regional level through Regional Implementation Working Groups and a direct working relationship with the Mental Health and Addictions health support planning team. Through participation on these working groups and strong relationships with FNIHB, the AFN has also been directly advising FNIHB on various components of the IRS RHSP and TRC event planning.

In June 2011, the second National Truth and Reconciliation event took place in Inuvik, Northwest Territories. The AFN helped to advise on the two-day training leading up to the event, as well as the four-day event.

In October 2011, the third National Truth and Reconciliation event took place in Halifax, Nova Scotia. The AFN was present for the two-day training leading up to the event, the four-day event and an additional day afterwards for debriefing and assessment of the overall event. The AFN provided support to Health Canada and TRC workers throughout the event and has been working with each group closely on planning for the Saskatchewan National TRC event on June 21 - 24, 2012.

In addition, the AFN has been exploring ways to work with the NNAPF to hold regional dialogue sessions with stakeholders and key partners to help identify gaps in health support services with regards to the Indian Residential School (IRS) process and TRC community and national events. It will also help to identify needs/gaps emerging with the sunset of the IRS RHSP in 2015.

Next Steps - Moving Forward

• Continued participation on the RHSAC, tasked with advising Health Canada on mental health support planning for TRC events and activities.
• Partnership with NNAPF to hold regional dialogue sessions with stakeholders and key partners to identify gaps in health support services with regards to the IRS process and TRC community and national events.

4. CHILDREN AND YOUTH

The Children and Youth team continues to advocate for increased culturally-appropriate prevention and intervention strategies and programming that will lead to improved health outcomes for First Nation children and youth.

Key Issues and Activities

Childhood Obesity

With RHS data demonstrating an alarming increase in childhood obesity rates since the 2002/03 report, the AFN has made addressing the childhood obesity epidemic a priority. This past year, the AFN worked with a consultant to update the 2006 report entitled, Protecting Our Gifts and Securing Our Future: First Nations Children and Obesity: A Growing Epidemic. Interviews were conducted at the community and regional levels in order to get a better understanding of the key issues, best practices and challenges surrounding children and healthy eating, physical activity and food security in First Nation communities.

Children’s Nutrition

The AFN continues to raise awareness of the need for a universal school nutrition program and promote organizations such as ONEXONE and the National First Nations Breakfast Program.

Early Childhood Development

Pursuant to Resolutions 21/2010 and 10/2011, both of which are associated with increases to and accessibility of Aboriginal Headstart on Reserve (AHSOR) and Daycare funding, the AFN continues to advocate for additional funding so that more communities can access early childhood development programs. Recently, the AFN successfully advocated to have food reinstated as an eligible childcare expense for First Nation daycares.

Fetal Alcohol Spectrum Disorder (FASD)

The AFN National Youth Council has continued discussed on FASD prevention towards achieving their goals of the Five-Year Action Plan to address FASD.

Partnerships

Working in partnership with other non-governmental organizations such as the Canadian Paediatric Society (CPS) and the Canadian Association of Speech-Language Pathologists and Audiologists ensures that the issues that affect First Nations children remain a priority with the federal government.

Next Steps - Moving Forward

• The AFN will continue to advocate on behalf of First Nations children and ensure child health issues remain a focus for policy and decision-makers. 
• Finalizing the Childhood Obesity report, and make it available for First Nation communities. 
• Increasing partnerships with high profile organizations such as UNICEF and ONEXONE and other non-governmental organizations to ensure ongoing and focused advocacy for the improved health of First Nations children and youth.
• The AFN NYC will work to ensure recognition of National FASD Awareness Day on September 9, 2012.

5. INFORMATION MANAGEMENT / E-HEALTH

Recent years have seen investments in eHealth on the part of Canada Health Infoway (Infoway) and provincial/territorial ministries of health. In part because of jurisdictional uncertainties, these initiatives have tended to leave First Nation health services out. While Health Canada has made modest investments into First Nation initiatives, sustainable infrastructure and support investments for First Nation communities have lagged behind. First Nations are keenly aware of the importance of leading the eHealth revolution.

Key Issues and Activities

National eHealth Convergence Forum

On June 20, 2012, the AFN cohosted a National eHealth Convergence Forum with Canada’s Health Informatics Association (COACH), with support from Health Canada and Infoway. The Forum provided provincial/territorial Chief Information Officers (CIOs) a First Nations eHealth perspective, as well as provided a platform to share principles and best practices in eHealth integration, data-sharing, Ownership, Control, Access and Possession (OCAP) conformity, and interoperability efforts.

AFN First Nations eHealth Strategy Framework

This year, the AFN, with direction and input from the National eHealth Advisory Committee (NeHAC), developed the AFN First Nations eHealth Strategy Framework. The Framework aims to accelerate the development, implementation and adoption of eHealth initiatives by Canada’s First Nations. It articulates how First Nations eHealth strategies can align with F/P/T eHealth strategies and demonstrates the need for appropriate levels of investment by F/P/T jurisdictions.

Data Sharing Agreement Template and Guidelines

Following a recommendation from the AFN National eHealth Policy Forum Outcomes Report, the AFN has developed a Data Sharing Agreement (DSA) Template and Guideline. First Nations generated DSAs ensure that First Nation concerns are addressed in ways that also allow interoperability with F/P/T applications.

Canada’s Health Informatics Association (COACH)

Over the past year the AFN has been developing a relationship with COACH. Recently, the National Chief sent a letter to the COACH CEO, Don Newsham, articulating the need for greater inclusion of First Nations within COACH’s work and supporting future partnerships.

National eHealth Advisory Committee (NeHAC)

NeHAC continues to play an integral role in setting the AFN’s eHealth agenda. For example, NeHAC provided key input into the development of both the First Nations eHealth Strategy Framework and the DSA Guide.

Next Steps- Moving Forward

• Promote the AFN First Nations eHealth Strategy Framework.
• Promote the DSA Template and Guidelines.
• Continue to support the regions to work with the provinces and territories to develop sustainable, inter-operable eHealth applications.
• Continue NeHAC meetings to facilitate implementation of eHealth Strategic Planning Forum recommendations.
• Continue discussion with Convergence Forum partners related to hosting regular discussions with provincial/territorial CIOs.
• Strengthen the AFN’s relationship with eHealth stakeholders including COACH, Infoway and F/P/T partners.

6. PRIMARY CARE / HEALTH BENEFITS

A. Non-Insured Health Benefits (NIHB)

The national NIHB Program provides coverage to registered First Nations and recognized Inuit to support them in reaching an overall health status that comparable with other Canadians. Benefits under NIHB include eye and vision care, dental, medical transportation, drugs, medical supplies and equipment, crisis mental health counseling, and approved health services outside of Canada. While this program has a strong foundation in Health Canada, the services it provides are chronically underfunded. There is a demonstrated need for expanded services, holistic approaches to healing and greater access, all of which can only be met through the consistent and adequate provision of funding to the program.

Key Issues and Activities

Population Growth and Program Funding Shortfall

The continued struggle to meet the demand for services, particularly those of NIHB, have become increasingly strained as a result of pre-existing funding shortfalls, as well as First Nation population stemming from new registrants eligible under changes to the Indian Act as a result of the McIvor case and the newly recognized Qalipu Mi’kmaq First Nation. In the AFN’s 2011 pre-budget submission, it was estimated that an additional $376 million in 2012-2013, and $805 million over the next five years, would be required to meet the existing shortfall, and respond to anticipated demands from new registrants.

With the stressors on dental, pharmacy, transportation, medical supplies, equipment, mental health services, and no additional funding to respond to the population increase, First Nations children, adults, and elders will face an uphill battle and possible crisis for accessing basic health care needs and benefits.

House of Commons Standing Committee on Health (HESA)

A letter was submitted to HESA in January 2012, requesting a study be conducted on NIHB on five key areas: a comparative analysis to other federal health benefits programs, new client population requirements, using Nation-to-Nation consultation processes for health management issues, contractual obligation for Express Scripts, and a review of administrative procedures (e.g. predetermination, prior approvals, etc.). To date, a response from HESA has not yet been received.

Medical Transportation

Resolution 5/2011, passed at the 2011 AGA, mandates the AFN to conduct a cost analysis of current fuel and airfare rates compared to NIHB Medical Transportation (MT) allocations. A consultant was hired to do this analysis and is currently working with the AFN to complete this work.

Vision Care

The NIHB Program undertook a review of the Vision Care Policy Framework in Fall/Winter of 2010/11. In an effort to respond and ensure adequate vision care benefits, the AFN reviewed NIHB changes to vision care and sought the expertise of the Vision Institute of Canada and the Canadian National Institute for the Blind (CNIB). As a result, recommendations were drafted and provided to NIHB for consideration prior to the roll-out of the new vision care framework. NIHB streamlined processes to improve efficiency and client access, and encouraged the CNIB to register with the NIHB claims processor to facilitate claims payments.

Medical Supplies and Equipment

The AFN, with the expertise of an orthopedic and prosthetic specialist, reviewed the NIHB policy specific to orthotic and prosthetic medical supplies and equipment. Recommendations for improving this area of benefit coverage were provided to the NIHB program, as well as the recommendation to streamline prior approval requirements for prosthetics and orthotics to reduce wait times and lengthy delays for amputees. As a result, NIHB agreed to streamline the prior approval process for medical supplies and equipment (MS&E) and prosthetic medical supplies.

NIHB Client handbook

The AFN and Health Canada reprinted the NIHB Handbook in August 2011, and 50 copies of the booklet were distributed to all First Nations across the country.

NIHB Navigators

The AFN continues to encourage NIHB headquarters and the regions to provide funding for at least one navigator in each region. There are three regions that currently do not have a navigator in place.

The National NIHB Access Data Base

The AFN is currently working on developing a national database and template for navigators to store data on NIHB access issues. This is being done in collaboration with the FNIGC to house the data as per OCAP principles. The database will enable the AFN and the regions (navigators) to compile reports, track access issues and build a case for sustainable funding and needed improvements to the NIHB program, while reducing hardship on First Nations trying to access the NIHB program.

Next Steps - Moving Forward

• Continue to advocate for increased and sustainable NIHB Program funding.
• Continue work to reduce policy restrictions to the NIHB Dental Program and improve access to benefits.
• Continue to advocate for NIHB Navigators in each region.
• Continue to advocate with HESA for needed political attention to key NIHB issues, including underfunding and program sustainability.
• Complete analysis of fuel and airfare rates compared to NIHB Medical Transportation allocations.
• Continue to work with FNIGC in the development of the NIHB database.

B. Home and Community Care (HCC)

The First Nations and Inuit Home and Community Care Program (FNIHCC) was established to assist individuals who suffer from chronic and acute illnesses to receive treatment in their homes. HCC can include nursing care services such as personal care like bathing and foot care, home support meal preparation and in-home respite care. This in-home care enables the person to receive the required care in familiar surroundings and for the person requiring the care to be close to family, friends and community as long as possible to maintain some of their independence.

Key Issues and Activities

The AFN and First Nations HCC Partners (FN HCC Partners) work very closely and continue to seek support from FNIHB to address the many in-home care issues and follow up on the recommendations made by First Nation nurses, who play a very vital role in the delivery of the program at the community level.

Funding & Capacity Issues

Wage parity remains a longstanding cause for concern within HCC. First Nation communities have a very difficult time competing with the salary of provincial nurses and the lack of resources very often hampers the recruitment and retention of health care service providers in First Nation communities. While wage levels have remained lower than in other jurisdictions, First Nation nurses have faced increasing demands due to rising HIV/AIDS rates, as well as the increased rates of chronic diseases such as cancer and diabetes. At times, First Nations HCC resource-challenged nurses are not able to provide the same quality and level of care to patients, nor are they provided the same training opportunities as provincial nurses.

Resources and funding levels are nowhere near meeting the required demand at the community level and AFN continues to advocate for increases in these funding levels.

Integration

Discussions regarding the integration of AANDC’s In-Home Care (IHC) component of the Assisted Living (AL) program and Health Canada’s HCC services are ongoing. Despite the AFN’s continuous efforts insisting upon meaningful engagement of First Nations, the federal government continues to unilaterally pursue discussions of a potential merger between the two departments. 

First Nations have many concerns about such a merger. Both programs need to be economically viable from the outset in order to be sustained effectively at the community level. Integration may place additional burdens on workloads, reporting, training, and/or certification requirements to upgrade the skills of front-line workers at the community level.

Creating a Healthy Work Place Environment

The Creating a Healthy Work Place manual highlights the importance of creating a healthy work environment for nurses in First Nation communities. Four documents were developed which examined the challenges faced by First Nation nurses working in First Nation communities and recommendations were provided towards improving these conditions. This work was guided by the regional FN HCC Partners who were involved in the process from the outset.

10-Year Strategic Action Plan

The AFN continues to facilitate discussion between the FN HCC Partners and FNIHB so that the FN HCC Partners have the opportunity to provide input into the development of a FNIHCC 10-Year Strategic Action Plan. FN HCC Partners reviewed the first draft of a Strategic Action Plan in March of 2012.

Next Steps - Moving Forward

• Continued push for full First Nations involvement into the discussions of a potential merger of the IHC component of the AANDC AL program and the Health Canada HCC program
• Translation, dissemination and delivery of the “Creating a Healthy Work Environment for nurses” will be completed. Training/orientation and use of the manual will need to be completed.
• Continue to develop an effective 10-Year Strategic Action Plan.
• Continue to bring forward FN HCC Partners concerns to FNIHB senior management and advocate for increased funding levels.
• Continue to participate in the National Evaluation, Quality Improvement Working Group, the Abuse of Older First Nation Seniors Committee, Alzheimer’s Committee, and the Palliative Care Committee in order to better respond to questions and concerns raised by communities.

7. SOCIAL DEVELOPMENT

The AFN Social Development Secretariat follows the mandate provided by the Social Development Policy Framework, which proposes the long-term vision of “an inclusive, holistic and culturally-based social development system under First Nation control that builds healthy, safe and sustainable communities”. As such, the AFN Social Development Secretariat has the responsibility to work in the areas of First Nations Child Welfare, Income Assistance (IA), Assisted Living (AL), and Family Violence Prevention (FVPP).

Key Issues and Activities

Canadian Human Rights Tribunal

The AFN and the First Nations Child and Family Caring Society (FNCFCS) filed a complaint with the Canadian Human Rights Commission (CHRC) on February 23, 2007, regarding inequitable funding and services for First Nation children who are in the care of First Nation child and family service agencies. The CHRC referred the complaint to the Canadian Human Rights Tribunal (CHRT) on September 30, 2008.

On March 14, 2011, the CHRT Chair, Shirish Chotalia, dismissed the complaint stating that the CHRT was not the appropriate forum to hear the case and that because First Nation children on-reserve are served by the federal government, the services they receive cannot be compared to the services provided by the provinces that are received by other children off-reserve.

A judicial review of the decision was filed in April, 2011, and the appeal was heard February 2012, in Federal Court. Justice Mactavish ruled in favor of the AFN and FNCFCS on April 18, 2012. In her decision, Judge Mactavish stated that a differently constituted panel of the CHRT should hear the case. Her decision also included that the CHRT failed to provide reasons as to why they could not hear the complaint under the Canadian Human Rights Act, and also made an error in requiring a comparator group for First Nation children living on-reserve. The Federal Government filed an appeal on May 18, 2012.

Income Assistance (IA)

The AFN worked closely with the First Nations Income Assistance Working Group (FNIWAG) and the AFN NYC to provide input and direction into a youth IA toolkit, an Active Measures Community Resource booklet, an environmental scan of existing IA data management systems and the initial planning stages of a National Social Learning Event. All of the resources developed are available on the AFN website under the Social Development tab.

Assisted Living (AL)

The AFN attempted to work with strategic partners to move forward the matters pertaining to AL on-reserve. It is the AFN’s hope and expectation that moving forward, the AFN will have increased participation, especially pertaining to the potential consolidation of the AL IHC component and the Health Canada HCC Program, which would include the transfer of this program from AANDC to FNIHB-Health Canada.

Family Violence Prevention (FVPP)

The FVPP operated by AANDC provides funds to First Nations to operate women’s shelters and family violence prevention programming.

The FVPP was evaluated and a final public report is pending. This program received funding for the current fiscal year in the 2012 Federal Budget and AFN will continue advocacy for sustainable and increased funding.

Child Welfare - First Nations Canadian Incidence Study on Reported Child Abuse and Neglect–2008 (FN CIS-2008)

Kiskisik Awasisak was publicly released on November 14, 2011. The FN CIS-2008 is the largest study of child welfare investigations involving First Nation children (living both on and off reserve) ever conducted in Canada. The study examines data collected from 89 provincial/territorial agencies and 22 First Nations and urban Aboriginal agencies during a three-month data collection period.

The AFN has participated in the FN CIS-2008 Advisory Committee since 2007 and, in keeping with OCAP principles, holds the copyright for Kiskisik Awasisak. The AFN was approached about the copyright once the analyses presented in the report had already been completed.

The information sheet which provides an overview of the study background, advisory committee members, methods, findings and details of dissemination/briefing activities can be found at the following website: www.cwrp.ca/general-info-FNCIS-2008.

The AFN and the other members of the FN CIS-2008 advisory committee are in the process of planning dissemination events including co-hosting webinar briefings on the methodology and key findings. So far, there have been two webinars, the first on November 14, 2011, and the second on December 1, 2011. Additional dates and times for webinars will be announced via the AFN website to give First Nations and other interested partners the opportunity to participate.

Details of additional dissemination events, as well as the full report, will be posted on the report website (www.cwrp.ca/general-info-FNCIS-2008) and the AFN website (www.afn.ca) as they become available.

Canadian Centre for Child Protection (Missingkids.ca)

The Chiefs-in-Assembly passed Resolution 38/2011, Support for Missingkids.ca: Canada’s National Missing Children Resource Centre. Since then, the AFN has worked with Missingkids.ca to develop a Public Service Announcement featuring the National Chief, which aired on the Aboriginal Peoples Television Network and was launched at the AFN’s National Justice Forum in February 2012.  Additionally, the AFN supported the mail-out of information resources from the Canadian Centre for Child Protection to every First Nation community. Moving forward, the AFN will participate on the Missingkids.ca advisory committee.

Next Steps - Moving Forward

• Work on awareness and promotion of strategies to prevent family violence, including dialogue at the 2012 Annual General Assembly on an Action Plan to Ensure Safety and Security of Indigenous Women and Girls.
• Disseminate the youth IA toolkit and Active Measures Community Resource booklet.
• Complete a review of existing IA models, conduct at least three regional discussion sessions and write a report based on the results of the discussions.
• Ensure First Nations involvement in the potential program integration of the IHC component for the HCC and AL initiatives.
• Continue working towards the delivery of a National Social Learning Event which would explore themes such as employment, health and education.