Co-developing distinctions-based Indigenous health legislation

Together with Indigenous partners and the provinces and territories, we are co-developing new distinctions-based Indigenous health legislation to improve access to high-quality, culturally relevant health services.

Current status: Open

The Minister of Indigenous Services publicly launched the engagement on January 28, 2021.

On this page

• Why
• Who
• What
  • Stage 1: Engagement
  • Stage 2: Co-development of legislative options
  • Stage 3: Review of the draft legislation

  Why

  In the September 2020 Speech from the Throne, the Government of Canada committed to walking a shared path of reconciliation with Indigenous peoples and remains focused on implementing the commitments made in 2019.

  The Government of Canada acknowledges the challenges faced by Indigenous peoples, including First Nations, Inuit and Métis in accessing culturally safe health care. Canada is committed to working in partnership to advance the priorities Indigenous peoples put forward when it comes to health care. The mandate letter for the Minister of Indigenous Services commits to "fully implement Joyce's Principle and ensure it guides work to co-develop distinctions-based Indigenous health legislation to foster health systems that will respect and ensure the safety and well-being of Indigenous Peoples." It is part of the Government of Canada's commitment to address the social determinants of health and advance self-determination in alignment with the United Nations Declaration on the Rights of Indigenous Peoples.

  The co-development of distinctions-based Indigenous health legislation is an opportunity to:

  • establish overarching principles as the foundation of federal health services for Indigenous peoples
  • support the transformation of health service delivery through collaboration with Indigenous organizations in the development, provision and improvement of services to increase Indigenous-led health service delivery
  • continue to advance the Government of Canada's commitment to reconciliation and a renewed nation-to-nation, Inuit-Crown and government-to-government relationship with Indigenous peoples based on the recognition of rights, respect, co-operation and partnership

  What co-development means

  Co-development is a collaborative approach that acknowledges the distinct nature and lived experience of First Nations, Inuit and Métis . This approach is guided by:

  • the Truth and Reconciliation Commission's Calls to Action
  • the United Nations Declaration on the Rights of Indigenous peoples and the United Nations Declaration on the Rights of Indigenous Peoples Act
  • the Calls for Justice in the final report of the National Inquiry into Missing and Murdered Indigenous Women and Girls
  • the Principles respecting the Government of Canada's relationship with Indigenous peoples

  Who

  The Government of Canada is working with the following partners:

  • national and regional Indigenous organizations
  • First Nations, Inuit and Métis leadership
  • self-governing Indigenous governments and Treaty nations
  • Indigenous women's organizations
  • provinces and territories
  • subject matter experts
  • health professionals
  • other groups

  What

  The co-development of Indigenous health legislation is being accomplished in 3 stages:

  1. Engagement: co-develop an approach to engagement that aims to capture Indigenous perspectives about the scope and substance of distinctions-based Indigenous health legislation.
  2. Co-development of legislative options: co-develop options, share work and ideas being developed across the country, identify common elements and areas of consensus, and discuss potential legislative and policy options.
  3. Review of the draft legislation: ensure that the distinct cultures, needs and aspirations of First Nations, Inuit and Métis are understood and reflected in any potential legislation.

  We also work with the provinces and territories to make sure potential federal legislation:

  • is informed by provincial and territorial perspectives
  • is complementary to existing provincial and territorial health systems, self-government or tripartite models
  • does not infringe on provincial jurisdiction or the territorial role in health

  Stage 1: Engagement

  Through 2021 and 2022, Indigenous Services Canada supported First Nations, Inuit, Métis and intersectional partners to lead national, regional and community engagement sessions that aim to capture Indigenous perspectives about the scope and substance of distinctions-based Indigenous health legislation. Intersectional individuals are those whose Indigenous identity, gender identity, physical ability, socio-economic status or other personal aspects of identity may cause overlapping impacts of discrimination. The goal of these engagements was to hear from as many voices as possible to inform the co-development of distinctions-based Indigenous health legislation.

  The timeline for engagement was extended in response to calls from partners for more time to build relationships and hear from community members, particularly given the pressures caused by the COVID-19 pandemic.

  Principles guiding engagement

  • Engagement is inclusive, with multiple opportunities and avenues to engage or re-engage.
  • Engagement is primarily Indigenous-led. Specific engagement plans are developed by Indigenous organizations and governments.
  • Engagement takes place multilaterally with federal, provincial, territorial and Indigenous organizations and governments.
  • Engagement is not endorsement. All feedback is being sought, whether it is in support of legislation or not.
  • Engagement informs the co-development process, which honours articles 18 & 19 of the United Nations Declaration on the Rights of Indigenous Peoples.

  Engagement approach

  In recognition of the right to self-determination, engagement was led primarily by First Nations, Inuit and Métis Nation partners at the national, regional and sub-regional levels.

  Indigenous Services Canada also hosted sessions to complement the First Nations, Inuit and Métis Nation-led sessions. Multiple streams of engagement were undertaken.

  Indigenous Services Canada developed an engagement guide designed for individuals, Indigenous governments, organizations or communities to help guide their engagement sessions and personal reflections about distinctions-based Indigenous health legislation.

  The engagement guide contains:

  • background information
  • a short list of existing literature
  • proposed engagement questions
  • a template for submitting feedback from your session to the Government of Canada
  • Treaty organizations
  • Nations
  • Self-governing Indigenous governments
  • Tribal Councils
  • Chiefs/community leaders
  • Inuit Land Claim Organizations
  • Inuit outside of Inuit Nunangat
  • Métis Nation governing members
  • Community members
  • Indigenous representative organizations
  • Women
  • Elders
  • Youth
  • Health directors/technicians/professionals
  • Survivors
  • Provincial/territorial representatives
  • Service providers
  • Indigenous women's organizations
  • Urban Indigenous organizations
  • Indigenous youth organizations
  • 2SLGBTQQIA+ organizations
  • Métis Settlements General Council
  • Métis outside of the Métis Nation
  • First Nations Health Managers Association
  • First Nations Information Governance Centre
  • Assembly of First Nations
  • Inuit Tapiriit Kanatami
  • Métis National Council
  • Self-governing Indigenous governments
  • Indigenous academics
  • Indigenous legal experts
  • Traditional Knowledge Keepers and Elders
  • Students
  • Youth
  • Health professionals
  • Ministries of health
  • Ministries of Indigenous affairs
  • Other provincial/territorial ministries
  • Multilateral engagement, where there is interest from Indigenous partners
  • General public
  • Interested groups

  Stage 2: Co-development of legislative options

  Canada established distinctions-based working level groups, or co-development tables, with Indigenous partners to meet regularly and translate what was heard through engagement into proposed legislative options.

  In total, 14 co-development tables were held with First Nations, Inuit, Métis and intersectional partners between October 2022 and June 2023. Participation in the co-development tables offered another opportunity for partners to help identify potential federal legislative measures necessary for supporting Indigenous-led approaches to improve health equity.

  Key Legislative Elements document

  Informed by the discussions and input from partners, ISC prepared a Key Legislative Elements document that presents a high-level compilation of the potential legislative and policy options being considered. The document was shared widely among partners for their review and feedback, between August 29 to September 22, 2023.

  If you wish to request a copy of the Key Legislative Elements document or provide feedback on the process, please visit the How to participate section of this page.

  Stage 3: Review of the draft legislation

  The Government of Canada, through its Department of Justice, will draft the bill in fall 2023 and winter 2024, following the conclusion of Stage 2: Co-development of legislative options.

  Consultation drafts of the legislation will be publicly released and shared with First Nations, Inuit, Métis and intersectional partners, as well as provincial and territorial governments, for feedback to ensure that proposed legislation is responsive to the views and needs of those affected before a bill is introduced in Parliament.

  The tabling of the bill is scheduled to occur in late winter 2024.

  To learn more on how legislation is developed, please visit How new laws and regulations are created.

  About Indigenous health care in Canada

  The organization of Canada's health care system is largely determined by the Canadian Constitution. Roles and responsibilities are divided between the federal, provincial and territorial governments. Generally, provinces and territories have primary jurisdiction over the administration and delivery of health care services. Indigenous communities also play an important role in the delivery of health services and programming.

  The federal government exercises a role in health care primarily through the use of the federal spending power. For example, the Canada Health Act is Canada's legislation that imposes national standards on provincial health care insurance plans as a condition of accepting a federal contribution to the cost of those plans.

  With respect to health care for Indigenous peoples, which include First Nations, Inuit and Métis, the federal, provincial and territorial levels of government share some degree of jurisdiction. Indigenous peoples are included in the per capita allocations of funding from the federal fiscal transfer and are entitled to access insured provincial and territorial health services as residents of a province or territory. Indigenous Services Canada funds or directly provides services for First Nations and Inuit that supplement those provided by provinces and territories, including primary health care, health promotion and supplementary health benefits. The federal role is guided by the 1979 Indian Health Policy's 3 pillars:

  1. Special relationship with "Indians."
  2. Inter-relationships with provincial and territorial health systems.
  3. Community development.

  The term "Indian" is only used when referring to or citing the 1979 Indian Health Policy.

  Any federal legislation in the area of health care must be developed in consultation with provincial and territorial governments and with careful attention to the constitutional division of powers.

  • Indigenous health care in Canada
  • Role of the provinces and territories
  • Constitution Act, 1867
  • Canada Health Act

  What we heard

  Stage 1 engagement reports

  • 2 Spirit Health Legislation Project: Final Report (PDF)
  • A New Trail to Blaze: Moving toward an Equitable Access to Healthcare in Urban Areas for Indigenous People
  • An Open Dialogue on Indigenous Health Legislation: Summary report
  • Assembly of First Nations, Resolution no. 16/2023: Distinctions-Based Indigenous Health Legislation (PDF, pages 40 to 41)
  • First Nations Health Council's Engagement Report to Inform the Development of Federal Indigenous Distinctions-based Health Legislation (PDF)
  • Indigenous Youth Reforming Healthcare
  • Inuit Sexual and Reproductive Health: Supporting Inuit Families and Communities
  • Our Health, Our Voice: Advocating for Urban Indigenous People in Distinctions-based Healthcare Legislation (PDF)

  The national report summarizing feedback received from stage 1 engagement sessions, What we heard: Visions for Distinctions-based Indigenous Health Legislation , is now available:

  • online, as an executive summary
  • in full, by request to lsa-ihl@sac-isc.gc.ca

  How to participate

  Co-development work has advanced to Stage 2: Co-development of legislative options. Starting in the fall 2022, distinctions-based co-development tables were launched to discuss potential legislative options. Informed by these discussions and input from partners, ISC prepared a Key Legislative Elements document that presents a high-level compilation of the potential legislative and policy options being considered.

  While the feedback period for the Key Legislative Elements document is now closed (August to September 2023), ISC continues to receive and analyze feedback from partners and is now exploring the best course of action to move forward in a meaningful way.

  There are 2 ways to participate:

  1. Attend an engagement session. Please contact us to learn more.
  2. Request a copy of the Key Legislative Elements document at lsa-ihl@sac-isc.gc.ca, and send comments directly by email or mail to the address listed in contact us.

  Contact us

  Indigenous Services Canada
  Distinctions-based Indigenous Health Legislation
  10 Rue Wellington Suite 1455
  Mail Stop 1921C
  Gatineau QC K1A 0H4
  Email: lsa-ihl@sac-isc.gc.ca

  Thank you for your feedback