For the first time in Canada, representatives of nearly 50 national Aboriginal organizations in diverse fields gathered together to view their work in a new light: from the prism of how they are contributing to the optimal health and well-being of First Nations, Inuit and Métis peoples across the country.

“We are all working together;  we are all working towards the same goal,” ethicist and researcher Willie Ermine, of the Indigenous People's Health Research Centre, First Nations University, told the gathering.  Participants came from the tourism, environmental and sports and recreation sectors, and from research, mental health, and housing; they included youth and Elders, and represented First Nations, Inuit and Métis peoples from across the country. 

The NCCAH initiated and hosted the inaugural multi-sectoral National Forum on Social Determinants of Aboriginal Health in February 2008 at the Museum of Civilization in Ottawa. The event helped to create a foundation for new alliances and cross-connections to help address the complex factors underlying health disparities experienced by Aboriginal peoples in Canada.

Central to that work, said Ermine, is a strengthened grounding in Indigenous ways of knowing. “We walk between two knowledge systems. We work with Indigenous realities and Western institutions…Our health comes from our way of being, not from the doctors; and the people in white coats.”

Ray Whanuch, executive director of the Council for the Advancement of Native Development Officers, said he was surprised to see so many varied interests gathered at a national level. “I had assumed we had all talked to each other; that there was somebody co-ordinating this and figuring it out.” He welcomed the potential for new alliances as critical for the sake of the next generation of children and the betterment of their health and well-being.

The national forum followed upon the NCCAH role on the international front in supporting Indigenous input into the World Health Organization's 2008 report on global health, Closing the Gap in a Generation: health equity through a social determinants of health. The report, by the WHO Commission on Social Determinants of Health, marshaled evidence on what can be done to address the “huge and remediable differences in health between and within countries” and broke ground by challenging a narrow view that looks to the health sector to deal with issues of health and disease.

Instead, the WHO Commission called for the involvement of the “whole of government,” civil society, local communities, business, international agencies and more to address the underlying causes of illness and disease, from unequal living conditions to unfair economic arrangements. “Policies and programmes must embrace all the key sectors of society not just the health sector,” the report said. 

The NCCAH launched Canadian discussions to address the inequities in health experienced by First Nations, Inuit and Métis peoples. Among the guest speakers were Dr. David Butler-Jones, Chief Public Health Officer of Canada, and the Honourable Monique Bégin, Canadian Commissioner to the World Health Organization's Commission on Social Determinants of Health.

“When we learn what the strange expression social determinants of health means, suddenly doctors and hospitals become only one part of the puzzle, just one determinant of health,” Mme. Bégin explained. She said “social determinants” encompass social, economic, environmental and other factors that “determine my health, your health and the collective health of all of us.”

Dr. Butler-Jones said it was important to understand that issues of self-determination, culture and equity, race, power, systemic inequalities and social justice all play a key and significant role in the landscape of the social determinants of health.

“As our understanding of these determinants grows, so does our understanding that virtually every aspect of our lives in communities contribute in some way to how healthy we are as a population.” 

Among First Nations, Inuit and Métis peoples, increased support for such issues as language revitalization, for land rights, or for community control over programs and research projects  can all be viewed as critical to supporting better health, he said.

Many speakers welcomed the discussion as embracing a more holistic view of health central to Indigenous philosophies, while youth delegates reminded participants that issues of belonging, addiction, suicide and alienation are pressing and immediate in the lived realities of young people.

“Youth continue to experience the negative aspects of social determinants of health. We carry the experience of racism, of language loss.  Addressing youth issues and youth engagement is essentially a social determinants strategy,” said Jocelyn Formsma, who co-ordinated a pre-conference youth forum.

NCCAH Academic Leader Dr. Margo Greenwood said many factors can be included in a “social determinants” list but that Indigenous peoples face unique challenges. “Many lists…. don't include self-determination. They don't include colonization. They don't include a number of our realities. This is beyond lists. It's a big challenge. We can do our parts, but the vision is the whole.”

Where health systems take into account culture, values and preferences, health outcomes can be improved, she said.

One of the significant outcomes of the forum was the production of a DVD - Circles of Health: Sharing our Gifts. This film has now been distributed widely in Canada, and to some 35 countries internationally. The NCCAH held a second national forum in 2009 to support moving to action on the social determinants of Aboriginal Peoples' health, and our work continues.