The History of First Nations Health in BC
"Most fundamentally, good health was believed to lie in the strength of a person which, in turn, relied on the strength of the community." (Goldthorp Inquiry Vol 1. pp. 27-114)
The impact of colonization in the Kwakwaka'wakw and Salish territories, and the associated waves of communicable disease, social and cultural upheaval and oppression, considerably undermined both the strength of the individual and the community.
By 1945, federal health services had become organized under the umbrella of Medical Services Branch (MSB). Up until the late 1970s, health services were conceived, designed, and implemented by the Government, with little or no input from First Nations. Public health services were typically provided by nurses employed by the government directly or through arrangements with church-run operations.
In 1979, Health Canada’s "Indian Health Policy," provided the opportunity for First Nations to begin influencing the development of their own health system through increased involvement and control over setting the direction of health services in their communities. The Community Health Representative (CHR) and National Native Alcohol and Drug Abuse Program (NNADAP) were among the first Government programs that recognized the need for First Nations control over the design and delivery of services.
Between the late 1980s and mid 1990s, many First Nations in BC took advantage of the progressive Health Transfer Policy, and entered into multi-year funding arrangements with Health Canada. This better enabled community control and ownership over the services provided.
An increasingly greater range of federal health service functions were transferred to First Nations, and Health Canada began to close some "zone offices" and its senior managers spoke of "getting out of business", in favour of First Nations-controlled operations at the community level.
The Roots of ITHA
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It is from this policy environment that ITHA emerged. With the closure of Health Canada's Vancouver Island Zone Office in 1996, Coast-Salish and Kwakwaka'wakw Chiefs on the Island mobilized under the leadership of Ray Harris of Chemainus First Nation, and the operational guidance of Jackie Major and Rick Dowdell, to form a unique First Nations-owned health service organization that would fill the gap left by the Zone closure. For the first time, the two cultures came together to work collaboratively under an "inter-tribal" collectivity: The Inter Tribal Health Authority.
A funding agreement with Health Canada enabled ITHA to assume the regionally focused functions that were performed by the Zone Office. Mostly, this included nursing consultation support for community nurses serving its member Nations. The administrative resources that are required by a multi-Nation service agency were provided through this agreement. Once established through this funding, ITHA was able to proactively pursue other avenues of completing the devolution from Health Canada’s MSB, or as it became known in 2000--the First Nations and Inuit Health Branch (FNIHB).
The first step was to register a Constitution and Bylaws under the Societies Act of B.C. on July 10, 1998. The Constitution defined the purposes of ITHA and the Bylaws established the means through which a Board of Directors would be selected and the agency would be governed.
A first priority of the member Nations and ITHA's first Board of Directors was to assume control over the non insured health benefits (NIHB) program of FNIHB. ITHA was one of eleven First Nations health organizations to be designated as pilot site for First Nations control of NIHB. Another key priority was to establish the means through which its small independent member Nations could participate in FNIHB’s transfer policy. Through the direction of ten member Nations, a unique agreement was negotiated with FNIHB which provides flow-through funding, otherwise unavailable to them because of population eligibility restrictions.
In the intervening years, ITHA has continued to innovate and lead the way in moving First Nations-owned and operated health services forward for the benefit of its Member Nations. This has included: a First Nations House of Healing to support the survivors of residential schools and their families; a demonstration program through which new approaches to team management of chronic illnesses; a centre of excellence for connecting First Nations to essential services through eHealth; a program to connect new and expecting mothers with health mentors; a community suicide prevention program; and research initiatives in FASD and injury prevention.
ITHA continues to evolve. Its roots can be found in the determination of the Chiefs of 29 First Nations to create an organization that will support them to control their own health services and in their efforts to improve the health status of their people.