Of all the issues affecting Indigenous lives in Canada, our dismal health status is the one that seems to be the most complicated and unsolvable. The various factors, or “determinants”, affecting Indigenous health extend into many areas beyond the healthcare field. Areas such as, history, socioeconomic status, and geography, all play a role in determining how healthy individuals and communities turn out to be. Add to this list Canada’s legal system, as Dr. Yvonne Boyer argues in Moving Aboriginal Health Forward: Discarding Canada’s Legal Barriers.
Based upon her doctoral research and prior experience with the health care system, Aboriginal Peoples, and the law, Boyer provides an authoritative (yet accessible) description of our current health situation and how Canada’s laws have played a role in getting us here. Moving Aboriginal Health Forward draws upon the fields of health and history, but is primarily situated in the field of law. At Part 1 of the book, the author covers how the current poor health status of Aboriginal people developed and then moves on, at Part 2, to analyze various law and policy approaches taken by the Federal and Provincial governments that have contributed to this status.
Boyer begins by explaining the impact of various health determinants including: poverty, lack of adequate housing, poor water quality, and colonialism. She then moves on to describe certain First Nations, Inuit, and Metis healing practices (which, on their own would make for an interesting book topic.) The purpose of their inclusion, however, is to show the effectiveness and existence of pre-contact healing sources – a critical aspect to meet the Supreme Court test for Aboriginal rights.
Moving into her main argument, at part two of her book, Boyer shows how Canada’s laws are a determinant of Aboriginal health through analysis on how the Constitution and other federal legislation, aimed at assimilating Indigenous people, contributed to the current poor health status of Aboriginal people. For example: the constitutional division of powers and the various heads (categories) of power assigned to the Federal and Provincial governments means that Aboriginal health doesn’t clearly fall within one area or level of responsibility. This can create confusion and, at worse, a complete failure to address urgent problems. Think of the case of the chronically ill 5-year-old Jordan Anderson, of the Norway House Cree First Nation, who died in hospital after two years of provincial and federal levels of government arguing about who was going to pay for his care.
Although the book explores some of the more painful historical factors affecting our current health situation, the author’s message is ultimately one of hope – that the current situation can be reversed. She notes that dramatic reductions in disease and death can be achieved through four areas: high-quality primary healthcare delivery, legislative changes, holistic health policies, and implementing Health Impact Assessments (in advance of Aboriginal and Treaty rights being affected.) She concludes that a “broad spectrum” of individuals and entities (including, politicians, legislative drafters, policy makers, Aboriginal communities, etc.) should play a role in improving the health of Aboriginal people. In Boyer’s own words:
If all governments are truly to contribute to positive change, they must commit to transcending political agendas and election cycles and recognize and halt the colonization that was implemented with the early health policies and legislation and that remain a barrier to progress in the health of Aboriginal people today.
Ultimately, Moving Aboriginal Health Forward will prove useful to anyone simply wanting to know more about how we, as a group, developed a poor health status. Likewise the book will benefit those seeking to affect positive change in the area of Aboriginal health. And, although the intention is never expressly stated, the author has also provided a broad foundation upon which future litigation could occur over an aboriginal or treaty right to health.
Yvonne Boyer, R.N., LL.B., LL.M, LL.D.; Moving Aboriginal Health Forward: Discarding Canada’s Legal Barriers; Saskatoon, SK: Purich Publishing Ltd., 2014; 224 pp., $35.00; ISBN 9781895830798