| Summary: | The purpose of this dissertation is to discuss and evaluate processes and institutional structures that influence relationships between Aboriginal communities and government in the development, implementation, and evaluation of health policy. It explores the changing nature of Aboriginal health policy and politics in Canada and examines the shift to self-determination that has transpired in Canada’s Aboriginal health policies focusing on their application to Aboriginal peoples. This dissertation examines two Aboriginal health policies in Canada: the federal health transfer policy and Ontario’s Aboriginal Healing and Wellness Strategy. Both policies are intended to improve health at the community level by supporting the development of community-based and culturally appropriate health programs. Thus, using community-based research methods, this dissertation maps some of the key political stakeholders in Aboriginal health policy, from local level community members and health representatives to peak provincial and federal Aboriginal organizations, to the offices of ministers in Canadian parliament. I reflect upon the processes and institutional structures that shape relationships between the Aboriginal community-controlled health sector and government. I examine several First Nations communities in northern Ontario involving both federal and provincially supported initiatives to illustrate the strengths, weaknesses and paradoxes that surface from the implementation of locally controlled health programs. I contrast these efforts with a second First Nations community in Manitoba that operates solely under the federal health transfer policy. I juxtapose these two communities to assess whether additional layers of community-controlled initiatives make tangible differences to community wellness; particularly for Aboriginal peoples living off reserve. This dissertation is being written under the theoretical assumption that governance and community wellness are intrinsically linked. Arguably, there is a definitive correlation between self-determination and community well-being; self-determination may be a determining factor in improving conditions for Aboriginal peoples and understanding resiliency. This dissertation is about a long lasting colonial legacy of social inequalities in Aboriginal health but also about the incredible successes in Aboriginal health. It is also about the many challenges of Aboriginal representation and self-determination in the context of contemporary Canadian society. Doctor of Philosophy (PhD)
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