Restructuring First Nations Health Governance: A Multilevel Solution to a Multifaceted Problem
This paper investigates current health governance structures as a contributing factor to the disproportionate burden of ill-health and inequitable health service delivery experienced by First Nations communities. A review of the contemporary and historical context sets the stage for the analysis, ou...
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University of Victoria
2014
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ftunivictoriaojs:oai:journals.uvic.ca:article/13295 2023-07-16T03:58:26+02:00 Restructuring First Nations Health Governance: A Multilevel Solution to a Multifaceted Problem Kent, Alexandra J.M. 2014-10-31 application/pdf https://journals.uvic.ca/index.php/arbutus/article/view/13295 https://doi.org/10.18357/ar.kentajm.512014 eng eng University of Victoria https://journals.uvic.ca/index.php/arbutus/article/view/13295/4187 https://journals.uvic.ca/index.php/arbutus/article/view/13295 doi:10.18357/ar.kentajm.512014 Copyright (c) 2015 Alexandra J.M. Kent http://creativecommons.org/licenses/by-nc/4.0/ The Arbutus Review; Vol. 5 No. 1 (2014); 131 - 154 1923-1334 First Nations health governance health transfer policy jurisdictional gaps multilevel mosaic self-determination selfgovernance social determinants of health third order of government transfer arrangements Tripartite Framework Agreement info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion research-article 2014 ftunivictoriaojs https://doi.org/10.18357/ar.kentajm.512014 2023-06-27T18:15:37Z This paper investigates current health governance structures as a contributing factor to the disproportionate burden of ill-health and inequitable health service delivery experienced by First Nations communities. A review of the contemporary and historical context sets the stage for the analysis, outlining health status, social determinants of health and the policy framework within which health inequities are situated. The paper proceeds with a critical analysis of power imbalances perpetuated within Canada’s health care system in the form of barriers such as inadequate health services, fragmented governance, jurisdictional gaps and lack of government accountability. The discussion explores selfdetermination as a means of empowering First Nations communities to take control of the design, delivery and evaluation of health care services and ultimately, reclaim control of their health and wellbeing. Four models of self-government are evaluated to highlight several key features of a sustainable framework, including: recognition of autonomy, a voluntary process, an opt-in/opt-out provision, protection by legislation and the support of a fiduciary relationship with the State. Finally, a multilevel mosaic model of self-government is proposed as a pragmatic framework that is adaptable to the varying needs and capacities of First Nations communities. Article in Journal/Newspaper First Nations University of Victoria (Canada): Journal Publishing Service The Arbutus Review 5 1 131 154 |
institution |
Open Polar |
collection |
University of Victoria (Canada): Journal Publishing Service |
op_collection_id |
ftunivictoriaojs |
language |
English |
topic |
First Nations health governance health transfer policy jurisdictional gaps multilevel mosaic self-determination selfgovernance social determinants of health third order of government transfer arrangements Tripartite Framework Agreement |
spellingShingle |
First Nations health governance health transfer policy jurisdictional gaps multilevel mosaic self-determination selfgovernance social determinants of health third order of government transfer arrangements Tripartite Framework Agreement Kent, Alexandra J.M. Restructuring First Nations Health Governance: A Multilevel Solution to a Multifaceted Problem |
topic_facet |
First Nations health governance health transfer policy jurisdictional gaps multilevel mosaic self-determination selfgovernance social determinants of health third order of government transfer arrangements Tripartite Framework Agreement |
description |
This paper investigates current health governance structures as a contributing factor to the disproportionate burden of ill-health and inequitable health service delivery experienced by First Nations communities. A review of the contemporary and historical context sets the stage for the analysis, outlining health status, social determinants of health and the policy framework within which health inequities are situated. The paper proceeds with a critical analysis of power imbalances perpetuated within Canada’s health care system in the form of barriers such as inadequate health services, fragmented governance, jurisdictional gaps and lack of government accountability. The discussion explores selfdetermination as a means of empowering First Nations communities to take control of the design, delivery and evaluation of health care services and ultimately, reclaim control of their health and wellbeing. Four models of self-government are evaluated to highlight several key features of a sustainable framework, including: recognition of autonomy, a voluntary process, an opt-in/opt-out provision, protection by legislation and the support of a fiduciary relationship with the State. Finally, a multilevel mosaic model of self-government is proposed as a pragmatic framework that is adaptable to the varying needs and capacities of First Nations communities. |
format |
Article in Journal/Newspaper |
author |
Kent, Alexandra J.M. |
author_facet |
Kent, Alexandra J.M. |
author_sort |
Kent, Alexandra J.M. |
title |
Restructuring First Nations Health Governance: A Multilevel Solution to a Multifaceted Problem |
title_short |
Restructuring First Nations Health Governance: A Multilevel Solution to a Multifaceted Problem |
title_full |
Restructuring First Nations Health Governance: A Multilevel Solution to a Multifaceted Problem |
title_fullStr |
Restructuring First Nations Health Governance: A Multilevel Solution to a Multifaceted Problem |
title_full_unstemmed |
Restructuring First Nations Health Governance: A Multilevel Solution to a Multifaceted Problem |
title_sort |
restructuring first nations health governance: a multilevel solution to a multifaceted problem |
publisher |
University of Victoria |
publishDate |
2014 |
url |
https://journals.uvic.ca/index.php/arbutus/article/view/13295 https://doi.org/10.18357/ar.kentajm.512014 |
genre |
First Nations |
genre_facet |
First Nations |
op_source |
The Arbutus Review; Vol. 5 No. 1 (2014); 131 - 154 1923-1334 |
op_relation |
https://journals.uvic.ca/index.php/arbutus/article/view/13295/4187 https://journals.uvic.ca/index.php/arbutus/article/view/13295 doi:10.18357/ar.kentajm.512014 |
op_rights |
Copyright (c) 2015 Alexandra J.M. Kent http://creativecommons.org/licenses/by-nc/4.0/ |
op_doi |
https://doi.org/10.18357/ar.kentajm.512014 |
container_title |
The Arbutus Review |
container_volume |
5 |
container_issue |
1 |
container_start_page |
131 |
op_container_end_page |
154 |
_version_ |
1771545541970231296 |