Engagement with First Nations, Inuit and Métis Communities
The Aboriginal Cancer Control Unit (ACCU) at Cancer Care Ontario has developed Relationship Protocols, a Letter of Relationship, and a Memorandum of Understanding in partnership with First Nations, Inuit and Métis leadership. These documents formalize sustainable relationships with First Nations, Inuit and Métis partners through mutual respect, recognition and understanding. They highlight Cancer Care Ontario’s commitment to establishing the strong foundation necessary for achieving common goals and objectives towards the delivery of cancer services with First Nations, Inuit and Métis peoples across the province.
Measure: Number of regions with Regional Aboriginal Cancer Plans developed and finalized
As of this Report:
In this spirit, the ACCU has also been working closely with Regional Cancer Programs (RCPs) to build regional capacity supporting engagement with local First Nations, Inuit and Métis communities and organizations. Together, the ACCU and RCPs are collaborating with local First Nations, Inuit and Métis communities and organizations to develop and implement initiatives that will address the unique cancer control issues and needs of First Nations, Inuit and Métis people living within each region. These initiatives are detailed within Regional Aboriginal Cancer Plans, which are currently being developed collaboratively within 12 of the province’s 13 RCPs.* These regional partnerships continue to be strengthened as most regions with Regional Aboriginal Cancer Plans have (with the support of the ACCU) initiated direct engagement with the core First Nations, Inuit and Métis Health Tables in their regions to develop and implement this work together.
*Note: The Toronto Central North and Toronto Central South RCPs are combined.
Who are the First Nations, Inuit and Métis Peoples of Ontario?
Three groups are recognized by Canada’s Constitution Act of 1982 as “the Aboriginal peoples of Canada,” who are explicitly defined as “the Indian [now referred to as “First Nations”], Inuit, and Métis peoples.” Together, the First Nations, Inuit and Métis people experience significantly poorer health outcomes than their non-Aboriginal peers, including lower life expectancy and a higher burden of chronic conditions [1, 2]. The lack of First Nations, Inuit and Métis-specific health data continues to hamper our collective ability to accurately determine and effectively address chronic disease prevention priorities in these at-risk populations.
Measure: Number of regions with newly developed but not yet finalized Regional Aboriginal Cancer Plans
As of this Report:
Prior to contact with Europeans, First Nations in what is now defined as Ontario represented diverse and stable communities whose economy and governance were sound and thriving. The arrival of Europeans and the resulting policies of assimilation, such as the residential school system, dramatically impacted the way of life of First Nations people and all aspects of their health.
Today there are 133 First Nations communities in Ontario, 126 of which have independently recognized land bases. As of 2016, there are approximately 236,680 people residing in Ontario who identify as First Nations, of whom approximately half live on-reserve or on Crown lands . According to the 2016 Census, there were 85,475 people who self-identified as First Nations but were not registered under the Indian Act .* Almost half of registered First Nations people in Ontario who are on-reserve live in communities that are urban . Over one-quarter live in special access communities (no year-round road access to a service centre) (28%) . First Nations people in Ontario are young, with an average age of 32 years (compared to 40.5 years for non-Aboriginal Ontarians) .
*Note: Canadian Census data may underestimate First Nations population numbers.
The genesis of Métis culture and nation dates back to the 1600s, when early European settlers first came into contact with local First Nations communities. Early unions between these predominantly male fur-trading European settlers and local First Nations women led to the emergence of a new and highly distinctive Aboriginal people with a unique identity and consciousness. Distinct Métis settlements began to appear throughout what was then called “the Northwest.” They subsequently spread throughout what is now defined as Ontario, as Métis settlements sprung up along the rivers and watersheds surrounding the Great Lakes and in the northwest of the province. Historical Métis communities were closely connected through the highly mobile fur trade network, seasonal rounds, extensive kinship connections, and a collective identity characterized by a common culture, language and unique way of life that was influenced by a complex blend of traditions from both sides of the Atlantic. The strong family connections and the unique Métis way of life that characterized these original Métis settlements form the foundation of the Métis nation we know today and remain strongly evident in contemporary Métis life.
Measure: Number of regions where all core First Nation, Inuit and Métis Health Tables are engaged
As of this Report:
The Métis population is one of the fastest growing populations in Canada, having nearly doubled in size from 2006 to 2016 . This rapid growth is largely due to people changing their reported identity to Métis between Census years – a phenomenon known as “ethnic mobility.” In 2016, Ontario had the largest number of Métis living in Canada, with 120,585 people – 20.5% of all Métis. The Métis population of Ontario was relatively young, with an average age of 36.5 years . In 2006, nearly 70% of the Métis population in Canada lived in urban areas, less than the non-Aboriginal population (81%). However, Métis living in urban areas were twice as likely to live in smaller urban centres with populations of less than 100,000 residents (41%) than were urban non-Aboriginal people (20%) .
Inuit in Ontario constitute a small but fast-growing population. According to the 2016 Census, 65,025 people in Canada (3,860 in Ontario) identified as being Inuit .* Inuit are a young population, with an average age of 29 years . Rapid Inuit population growth and the corresponding young age structure are demographic trends that are expected well into the future. The Inuit population in Ontario continues to grow through high fertility rates and migration away from Inuit Nunangat (“the place where Inuit live”). Inuit Nunangat is made up of 4 regions: Inuvialuit Settlement Region (including parts of Northwest Territories and Yukon), Nunavut, Nunavik (Northern Quebec) and Nunatsiavut (Labrador). In 2016, over one-quarter (27%) of self-identifying Inuit in Canada lived in southern Canada, outside of Inuit Nunangat . A growing number of Inuit live in southern urban centres, such as Ottawa and Toronto.
*Note: The Canadian Census data may underestimate Inuit population numbers.
Measure: Number of regions with a sustainable engagement structure
As of this Report:
Inuit move to southern cities for many reasons. Some go for work, post-secondary education or housing, and many Inuit are living in Ontario due to long-term medical treatment – treatment that is not available in Inuit Nunangat. Most Inuit communities lack access to specialized medical care . The 2006 Aboriginal Peoples Survey found that Inuit were significantly less likely to have had contact with a medical doctor during the previous year than non-Aboriginal Canadians . Inuit living in the Qikiqtaaluk (Baffin) region of Nunavut primarily travel south to Ottawa for medical treatment via Iqaluit (Figure 1), while those living in the Kivalliq Region (Western region of Hudson Bay) are transferred to Winnipeg and those in the Kitikmeot Region go to Edmonton (via Yellowknife). Inuit in need of complex medical care living in Nunavik or Nunatsiavut travel to Montreal or St John’s, respectively. Due to limited options for post-secondary education in Inuit Nunangat, 50% of Inuit with post-secondary credentials (and 85% of those with a university degree) reported having to relocate for their education .
Aboriginal cancer control
The ACCU at Cancer Care Ontario works to improve the cancer system and journey for Ontario’s First Nations, Inuit and Métis people. It also strives to ensure that First Nations, Inuit and Métis people in Ontario have access to high-quality cancer prevention, screening and treatment services that are culturally appropriate and that incorporate the Aboriginal holistic approach to health and well-being. Following a culture-based belief in the interconnection between the physical, mental, emotional and spiritual aspects of life, the Aboriginal Cancer Strategy III (ACS III) promotes a holistic approach to cancer education, prevention, screening and research. The ACS III builds on the success of previous cancer strategies by continuing on the path towards health equity and well-being for First Nations, Inuit and Métis people. As we move forward on this path, Cancer Care Ontario remains committed to improving upon the achievements made through the Aboriginal Cancer Strategy II (ACS II) in the past 3 years, including the following:
- Establishing Relationship Protocols with First Nations, Inuit and Métis groups across Ontario.
- Developing Regional Aboriginal Cancer Plans in concert with hiring 5 Aboriginal Project Coordinators, 10 Regional Aboriginal Cancer Leads and 10 Aboriginal Navigators.
- Gaining new knowledge of cancer in First Nations, Inuit and Métis communities.
- Creating Aboriginal Relationship and Cultural Competency courses to increase understanding of history and knowledge in order to improve health outcomes and person-centred care.
Aboriginal Relationship and Cultural Competency courses
Cancer Care Ontario has launched a series of 13 Aboriginal Relationship and Cultural Competency courses online to promote greater awareness of First Nations, Inuit and Métis history, culture and health context in order to help improve health outcomes and person-centred care.
The courses are geared to healthcare providers, professionals, administrators and others working with First Nations, Inuit and Métis people and communities. Each course takes about 60 minutes to complete and is accredited by the College of Family Physicians of Canada and the Ontario Chapter for up to 13 Mainpro+ credits (1 for each course).
Designed by the ACCU, the courses will help address the great need to understand the underlying history and challenges experienced by First Nation, Inuit and Métis populations. This, in turn, will inform the healthcare system on key issues related to addressing health equity for these populations. As Cancer Care Ontario is committed to developing a cancer system that ensures health equity for all Ontarians, the Aboriginal Relationship and Cultural Competency courses also will address a key recommendation from the Truth and Reconciliation Commission of Canada report: providing skills-based training in intercultural competency, conflict resolution, human rights and anti-racism .
Cancer Care Ontario’s ACCU has engaged in the development of Relationship Protocols, which also include a Memorandum of Understanding and Letter of Relationship with (a) Ontario’s First Nations leadership (both Political Territorial Organizations and Independent First Nations), (b) the Métis Nation of Ontario, (c) the Ontario Federation of Indigenous Friendship Centres and (d) Inuit health service providers in Ontario. These Relationship Protocols formalize the working relationships with First Nations, Inuit and Métis groups. The resulting relationships are based on trust and mutual respect, create accountability for the delivery of the Aboriginal Cancer Strategies, and enable a culturally appropriate approach towards addressing cancer control for First Nations, Inuit and Métis communities in the province
The use of a Protocol to formalize relations with First Nation, Inuit and Métis groups was adopted from the Ministry of Aboriginal Affairs, which recognizes protocol agreements to be:
- An agreement that recognizes the unique history and ways of life of Aboriginal communities in Ontario.
- An agreement that sets a new course for a collaborative relationship between the Ontario government and Aboriginal people.
- An agreement that is intended to improve the well-being of Aboriginal children, families and communities while protecting and promoting the distinct culture, identity and heritage of Aboriginal Peoples.
- An agreement that encourages partnership opportunities that recognize and respect Aboriginal traditions.
Table 1. Relationship Protocols signed with First Nations, Inuit and Métis Leadership as of March 2018
|Organization/First Nation||Date of signing|
|Grand Council Treaty #3||May 2013|
|Anishinabek Nation (Union of Ontario Indians)||June 2013|
|Ontario Federation of Indigenous Friendship Centres (OFIFC)||July 2014|
|Nishnawbe Aski Nation||August 2014|
|Kitchenuhmaykoosib Inninuwug (Big Trout Lake) First Nation||October 2014|
|Métis Nation of Ontario (the agreement signed is a known as a Memorandum of Understanding)||February 2015|
|Association of Iroquois and Allied Indians (agreement signed is known as a Letter of Relationship)||November 2016|
|Inuit Health Service Providers||May 7, 2017|
|Mississaugas of the New Credit First Nation||February 1, 2018|
Regional Aboriginal engagement
Regional Aboriginal Cancer Plans are regional blueprints for the implementation of Cancer Care Ontario’s ACS III. They have been developed through close partnerships with core First Nation, Inuit and Métis Health Tables and RCP leadership with the goal of ensuring that First Nations, Inuit and Métis people have a voice in the delivery of cancer services. As such, each plan reflects the unique needs of communities in its respective region. Regional Aboriginal Cancer Plans have been developed in the 13 regions* in Ontario, and 11 of these have been finalized.
*Note: The Toronto Central North and Toronto Central South RCPs are combined.
The ACCU has followed a 3 pillar approach to building regional capacity to address cancer control issues/needs.
- Meet with RCPs. An initial meeting was held to discuss Aboriginal Cancer Strategy priorities and targets, establish primary contacts and develop a working group within each RCP. The ACCU, in close partnership with the RCP working group, developed a draft Regional Aboriginal Cancer Plan to outline steps to make the cancer system more effective and accessible for First Nations, Inuit and Métis people in each region.
- Work with established Aboriginal Health Tables. The ACCU identified core Aboriginal Health Tables (First Nations, Inuit and Métis communities, boards, committees, advisory groups, Friendship Centres, Aboriginal Health Access Centres and other Aboriginal groups) to provide guidance and feedback on the Regional Aboriginal Cancer Plans before finalization. This ensures that Aboriginal people in each region have a voice in the delivery of cancer services, and it allows the RCPs to engage directly, respectfully and sustainably with First Nations, Inuit and Métis groups.
- Build RCP capacity. To address First Nations, Inuit and Métis cancer control issues effectively, dedicated resources were established in the RCPs. Aboriginal Navigators provide support for First Nations, Inuit and Métis people with cancer and their families along every step of the cancer journey. Regional Aboriginal Cancer Leads champion the ACS III strategic vision by engaging and collaborating with healthcare providers across the matrix of primary care. Aboriginal Project Coordinator positions have been created within 5 RCPs to support the work of the Regional Aboriginal Cancer Leads. The ACCU also employs 3 Partnership Liaison Officers to support the work of the RCPs and to ensure sustained engagement between the RCPs, ACCU and the First Nations, Inuit and Métis leadership, core Health Tables and communities across Ontario.
The ACCU has established regular reporting procedures to ensure that First Nations, Inuit and Métis leadership, provincial-level Health Tables and local First Nations, Inuit and Métis partners are engaged and informed regarding the Aboriginal Cancer Strategy progress. This also provides an opportunity to ensure that the partners are able to guide and provide feedback on the implementation of deliverables that impact their communities. As such, the ACCU meets with Political Territorial Organization leadership (Grand Chiefs and Chiefs), First Nations Tribal Councils, local-level core Health Tables and communities, the Métis Nation of Ontario Healing and Wellness Branch, Ontario Federation of Indigenous Friendship Centres, Inuit service providers and Aboriginal Health Access Centres.
As outlined within the Relationship Protocols signed between Cancer Care Ontario and First Nations, Inuit and Métis leadership, the ACCU has committed to providing regular written reports. As such, a written reporting process has been developed to ensure that the First Nations, Inuit and Métis political leadership with whom Cancer Care Ontario has a formal relationship receives an annual report detailing work carried out with, and for, the associated communities. These reports were distributed for the 2015/2016 and 2016/2017 fiscal years, and they will be developed based upon activity in the 2017/2018 fiscal year. An annual report was developed for the Ontario Federation of Indigenous Friendship Centres for activities in fiscal year 2016/2017.
A key component of developing and implementing Regional Aboriginal Cancer Plans is to ensure that engagement between the RCPs and the core Aboriginal Health Tables is sustained. Structures to sustain the engagement may take the form of developing a regional Aboriginal cancer advisory committee, meeting with local groups that are already established (such as LHIN Aboriginal Health Circles), or holding regular touchpoints with individual community health committees. Regular meetings ensure that progress reports on the implementation of each Regional Aboriginal Cancer Plan are provided to First Nations, Inuit, Métis partners, and that these partners have the opportunity to provide feedback and guidance on all work undertaken to address cancer control within their communities. Work undertaken in ACS III will involve working closely with RCPs and core First Nations, Inuit, Métis Health Tables to develop sustainable engagement structures in every region of the province, while continuing to engage closely with those already established.
What do the results show?
- Table 1 provides an overview of Relationship Protocols between Cancer Care Ontario and First Nations, Inuit and Métis leadership. These documents formalize relationships with Aboriginal partners through mutual respect, recognition and understanding, and they highlight Cancer Care Ontario’s accountability and commitment to establishing strong foundational engagement structures necessary to achieve common goals and objectives.
- The strength of the partnerships developed through the Relationship Protocols has ensured a sustained and ongoing dialogue that has been instrumental to the implementation of Regional Aboriginal Cancer Plans that are resulting in improved access to services and person-centred care. These Protocols set a new course for the way that Cancer Care Ontario will engage and collaborate with First Nations, Inuit and Métis groups to address increasing cancer incidence and mortality rates among Ontario’s Aboriginal populations.
Regional Aboriginal Cancer Plans have been developed in partnership with First Nations, Inuit and Métis peoples within all of the province’s 13 Regional Cancer Programs.
- Figures 1 and 2 provide an overview of the development of Regional Aboriginal Cancer Plans across Ontario.
- The RCPs responsible for serving the 10 regions in Ontario with the highest First Nations, Inuit and Métis populations each developed Regional Aboriginal Cancer Plans during the period of 2013 to 2015. For the period of 2015 to 2019, the ACCU has worked closely with each of the 13 RCPs in Ontario to develop updated Regional Aboriginal Cancer Plans based on ACS III that reflect provincial and regional First Nations, Inuit and Métis cancer control priorities.*
- Regional Aboriginal Cancer Plans are regional blueprints for making the cancer system work better for First Nations, Inuit and Métis groups in each region. Each plan is the result of close partnership and dialogue between the ACCU, RCPs and core First Nations, Inuit and Métis Health Tables. The collaborative and respectful engagement process employed to develop the Regional Aboriginal Cancer Plans ensures that each plan represents the unique needs of (and belongs to) First Nations, Inuit and Métis groups in each region.
*Note: The Toronto Central North and Toronto Central South RCPs are combined.
Regional partnerships continue to be strengthened as most of the regions with Regional Aboriginal Cancer Plans have engaged with all of the core First Nations, Inuit and Métis Health Tables in their respective regions to develop and implement this work together (Figures 3 and 4).
- Figures 3 and 4 provide the percentage of core First Nations, Inuit and Métis Health Tables engaged by RCPs since the launch of ACS III in September 2015. This engagement process between the RCPs and core First Nations, Inuit and Métis Health Tables will continue throughout the lifetime of ACS III, and it will be supported by the ACCU’s Partnership Liaison Officers.
- Throughout the lifetime of ACS II (2012 to 2015), the ACCU worked closely with the 10 regions in Ontario with highest First Nations, Inuit and Métis populations, and with the Central region. With expanded capacity as a result of hiring an additional Partnership Liaison Officer in early 2017, the ACCU has been working closely with all RCPs to provide direct support for relationship building and enhanced First Nations, Inuit and Métis cancer control in every region in the province. Regional Aboriginal Cancer Plans have been developed with the remaining regions, focusing on the strategic priorities identified within ACS III.
- A sustainable engagement structure (Figure 5) was developed when all core First Nations, Inuit and Métis Health Tables were engaged in the development of a Regional Aboriginal Cancer Plan. Together, they agreed to an established process that ensures the opportunity to provide ongoing guidance to the cancer system at the local level. Since the launch of ACS III in September 2015, sustainable engagement structures have been established in 10 regions in Ontario (Erie St. Clair, South West, Hamilton Niagara Haldimand Brant, Central, Central East, South East, Champlain, North Simcoe Muskoka, North East and North West).
Why is this important to Ontarians?
A foundation of trust and mutual respect between Cancer Care Ontario and Ontario’s First Nations, Inuit and Métis leadership, Health Tables and communities is essential if we are to work together to improve cancer control for Aboriginal peoples in the province. For this reason, “Building productive relationships” is the First Strategic Priority of both ACS II and ACS III, and it is the foundational component of all work undertaken. In order to build, develop and maintain relationships with its First Nations, Inuit and Métis partners, Cancer Care Ontario recognizes First Nations, Inuit and Métis traditions and practices, and it honours the unique histories, cultures and diversity of Aboriginal peoples in Ontario.
The mechanisms outlined above that have been put in place by Cancer Care Ontario and RCPs set a course for a new relationship with First Nations, Inuit and Métis Peoples, and they emphasize Cancer Care Ontario’s ongoing commitment to working appropriately, effectively and sustainably with First Nations, Inuit and Métis in Ontario. This approach is vital to ensuring that Ontario’s cancer system recognizes the First Peoples of this country, understands their unique needs and works with them in true partnership to address cancer control.