Gender-based analysis (GBA) Plus

1.0 Clinical and Client Care

Target Population:

Clinical and Client Care (CCC) services are delivered in 74 nursing stations and five health centres with treatment located across five regions. ISC is responsible for the delivery of services in 50 remote/isolated communities located in Alberta (4), Manitoba (21), Ontario (24) and Quebec (1). Funding is provided to an additional 29 First Nations communities to deliver these services in Alberta (1), Saskatchewan (12), Manitoba (1), Ontario (5) and Quebec (10) and two federal hospitals located in Manitoba.

The target population is anyone living in the communities where CCC is delivered; this includes health care professionals and other professionals who live and work in the community (i.e. teachers, police, etc.). Accurate gender breakdown on the entirety of this group is unknown; however, historically health care and education has a higher representation of females.

Distribution of Benefits:^{Footnote 1}

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Remote/Isolated regions

Other Key Program impacts on gender and diversity:

The current reporting arrangement for essential services delivered in communities does not enable the gathering of GBA Plus disaggregated data. However, program decisions always take gender into consideration. The department is exploring options to overcome challenges related to lack of disaggregated data in many areas including nursing education and guidance, and the initiative to integrate various health care professionals to interdisciplinary models of care.

The First Nations and Inuit Health Branch Nursing Station Formulary is applying a GBA Plus analysis when considering drug specific indications for men, women, pregnant people, elderly, pediatrics, etc. Information from the manufacturer and other reference sources is used to identify precautions, warnings and contraindications for populations (e.g., pregnancy) for each drug.

In addition, Indigenous clients experience a disproportionate burden of disease (e.g., cardiovascular disease, diabetes) and those living in remote or isolated communities may have limited access to health services. These aspects are taken into consideration when reviewing a drug.

Clinical Care Pathways initiative: The review, update and dissemination of Clinical Care Pathways (CCPs; previously called Clinical Practice Guidelines) to nurses working in remote Indigenous communities is an ongoing ISC initiative. The CCPs are tailored to reflect the unique and diverse needs in remote Indigenous communities. In the development of clinical content for new guidelines, sex and gender are considered in relation to health conditions, outcomes, assessment and management needs. In addition to scientific/clinical guidance, the CCPs guide nurses to provide client-centered, trauma-informed, culturally safe and appropriate care. As such, the CCP templates, and the tailored guidance in each CCP, is based on an intersectional understanding of health inequalities and determinants of health.

Chapters of key significance from a GBA Plus perspective (e.g., gender violence / abuse topics; sexuality and sexual health topics; mental health and addiction topics; women's health/gynecology/obstetrics; and men's health and adolescent health) are already included in the suite of CCPs available to nurses, and will integrate GBA Plus analysis when updated.

There are currently no chapters or individual CCPs/CPGs specific to the health of 2SLGBTQQIA+ and/or gender diverse people. For example, existing CPG chapters with potentially significant implications for people of different genders and sexualities (e.g., sexual / domestic violence; sexual health topics; mental health and addiction topics; women's health/gynecology/obstetrics; pediatric assessment and child development, genitourinary topics, and adolescent health) do not currently integrate gender and sexual diversity considerations in a meaningful way. Recent investments allow for the expansion of the CPG team which increases the capacity to update all 35 chapters of CPGs over a cycle of the next 5-6 years. These and all other chapters being updated will integrate a GBA Plus lens including considerations for diverse sexualities, transgender and gender diverse clients into the clinical care pathways developed.

While integrating a gender and sexuality lens to every chapter and Clinical Care Pathway is a priority, the team also intends to develop a standalone Gender and Sexuality module (chapter), as this was recently identified as a gap in the CPG manual itself. This new chapter is planned to be developed over the next 5-6 year cycle and will provide guidance to nurses in remote and isolated Indigenous communities on culturally appropriate counselling, health promotion, assessment, referral and consultation, and management considerations for health concerns of 2SLGBTQQIA+ and/or gender diverse clients.

1.1 Community Oral Health Services

Target Population:

Community Oral Health Services includes the Children's Oral Health Initiative (target population: children, their caregivers and pregnant people) and dental therapy services targeting all populations living within First Nation and Inuit communities.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: Strongly benefits low income individuals

By age group: Primarily benefits youth, children and/or future generations

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals On Reserve or located in Rural, Remote/Isolated, Northern regions

GBA Plus Data Collection Plan:

A national oral health report was completed to analyze oral health outcomes and service utilization from 2007 to 2020. Based on the results, there were no significant differences in the oral health outcomes and service utilization patterns between male and female clients over time.

1.2 Individual Affairs

Target Population: First Nations

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

Other Key Program impacts on gender and diversity:

As of December 2020, individuals applying for Indian registration and/or for an Indian status card could select another gender identifier on the application form: M (male), F (female) or X (another gender). This change will support inclusion of gender-diverse, transgender and non-binary people and protect their personal safety.

Supplementary Information Sources:

An Assessment of the Population Impacts of Select Hypothetical Amendments to Section 6 of the Indian Act.

GBA Plus Data Collection Plan:

The Indian Registration System and Secure Certificate of Indian Status Web Application collect GBA Plus information from which the program can extract data such to measure and assess the impacts on gender and diversity.

Following engagement with First Nations, further changes were made to the Indian Act in 2017 and 2019 under Bill S-3, An Act to amend the Indian Act in response to the Superior Court of Quebec decision in Descheneaux c. Canada (Procureur général). These legislative changes addressed outstanding sex-based inequities in registration.

S-3 extends entitlement to descendants of women impacted by sex-based discrimination dating back to 1869. This entitles generations of First Nations people to Indian status. Based on independent demographic estimates of effects on population, ISC anticipates that there could be 270,000 to 450,000 newly entitled persons as a result of Bill S-3 amendments. Of persons who were already registered but were previously unable to pass entitlement on to their descendants, over 57,000 are now able to do so due to category amendments.

ISC is partnering with a variety of organizations in regions across the country to increase awareness on the legislative changes to registration and encourage persons who are newly entitled to apply for registration.

1.3 Supplementary Health Benefits

Target Population:

The Supplementary Health Benefits (Non-Insured Health Benefits - NIHB) Program provides coverage to registered First Nation and recognized Inuit clients regardless of their sex, gender, age, income or geographic location. The NIHB Program recognizes that a large number of clients live in rural, remote or isolated communities, and face unique challenges in gaining access to medically necessary health services. Similarly, while men and women access benefits at similar rates, across all age groups, their utilization patterns differ. Where demand is less than anticipated, reasons for the reduced uptake are explored, in collaboration with First Nation and Inuit partners, to identify and address any potential barriers that may be impacting access to benefits.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Not available – residency data not collected

Other Key Program impacts on gender and diversity:

While men and women access NIHB Program benefits at similar rates across all age groups, their utilization patterns differ. The Program considers assumptions and data around the health status, behaviours and needs of various segments of the client population, which differ in important ways, when developing policy designed to address differential impacts. The Program also considers differential access to benefits across the client population recognizing a disproportionately large number of clients live in rural, remote or isolated communities, which create unique challenges in gaining access to medically necessary health services on a systematic basis.

Supplementary Information Sources:

NIHB Status Verification System; Health Information and Claims Processing Services system data; Inuit Client Statistics Report

GBA Plus Data Collection Plan:

The data collected by the NIHB Program can be disaggregated based on a variety of identity factors for analysis and monitoring purposes at any time, and is used to inform policy development or interventions to address differential impacts. The NIHB program recognizes the importance of representative data and its gender diverse client population. The third generation of the Health Information and Claims Processing Services system, which came into effect in June 2020, includes "Gender X" as a data field, allowing gender data to be further disaggregated.

The NIHB Program indicators may be reported against some GBA Plus criteria. The Program's annual report, provides an additional comprehensive source of information for disaggregated administrative data. This public report, includes Program data reported along regional, ethnic, age and gender lines.

2.0 Assisted Living

Target Population:

The Assisted Living program is available to eligible individuals who are ordinarily resident on reserve or Status Indians in the Yukon territory who do not have the means to obtain such services themselves.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: Strongly benefits low income individuals

By age group: Primarily benefits seniors or the baby boom generation

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals On Reserve or located in Remote/Isolated regions

Additional characteristics: The primary characteristics or identity factors of Assisted Living program clients include Indigenous identity, seniors, and persons with disabilities/health issues, with additional considerations regarding sex/gender and geographic location. Pre-existing and intersecting factors such as chronic disease, disability, low-income, geographic isolation, and the impact of intergenerational trauma, when combined can uniquely impact individuals, and, for example, can increase the likelihood of First Nations facing adverse health outcomes.

Other Key Program impacts on gender and diversity:

As family members, especially women, are often responsible for the majority of informal and unpaid care that takes place in the home, they are also likely to benefit from the program being available in their communities.

Supplementary Information Sources:

This 2018 report by the House of Commons Standing Committee on Indigenous and Northern Affairs contains recommendations on long-term care services. There are some comments on women's representation in the long-term care workforce and the impacts of these services on seniors and persons with disabilities.

Committee Report Number 17 - INAN (42-1) - House of Commons of Canada

GBA Plus Data Collection Plan:

The Assisted Living program's existing data collection system collects little information that would be useful in determining gender and diversity impacts. That said, the Program is currently engaging with First Nations and Inuit on a continuum approach to delivering long-term care services in their communities. A new continuum approach to service delivery will likely entail significant changes to the Assisted Living program and to its data collection approach. Appropriate measures for determining the program's impact on women, disproportionally impacted populations and persons with disabilities will be defined during the redesign of the Program's approach to data collection.

2.1 Communicable Disease Control and Management

Target Population:

The target population for Communicable Disease Control and Management (CDCM) programming is for people living in First Nations and Inuit communities in the provinces as well as tuberculosis programming for people living in Inuit communities in the territories.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: Somewhat benefits low income individuals

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Rural, Remote/Isolated, Northern regions

Other Key Program impacts on gender and diversity:

Understanding what gender diverse people and age groups are more affected by communicable diseases allows more targeted and effective interventions.

Supplementary Information Sources:

COVID-19 case reporting follows Departmental protocols defining what information is collected, how it is shared, stored, used and eventually destroyed in pursuit of guiding Departmental response to COVID-19.

COVID-19 Epi Update has been produced daily during the first wave of COVID-19 pandemic and then 3 times a week. Frequency of reporting is adjusted based on current epidemiology with approval from senior management. The purpose of the Epi Update is to report on key trends in the burden back to the partners who provided their data and Departmental officials involved in assisting First Nation communities to target and manage prevention and response.

GBA Plus Data Collection Plan:

Gender-based analysis is a critical component of the CDCM programming as the health status and the need for health services may vary based on gender identity, ages, cultures, sexual orientations, and abilities.

When necessary and appropriate, CDCM data is disaggregated by relevant GBA Plus indicators (e.g. gender, age, Indigenous distinctions, remoteness) to provide a holistic analysis of factors related to health status.

2.2 Education

Target Population: Indigenous youth

Distribution of Benefits:

By gender: Although broadly balanced for elementary and secondary programs, post-secondary statistics reflect on average 70% female participation

By income level: No significant distributional impacts

By age group: Primarily benefits youth, children and/or future generations

By distinction: Benefits First Nations, Inuit, and Métis communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Inuit Nunangat, Northern regions

Other Key Program impacts on gender and diversity:

Through the Education Information System, the Department collects data for performance indicators related to GBA Plus to inform ongoing program design considerations. Examples of indicators for which the department now collects data for GBA Plus include:

• number of students being educated under First Nations school boards (or other transformative models);
• number of First Nations students who are provided full-day kindergarten services in First Nations administered schools;
• percentage of students who are provided with culturally-based curriculum or land-based learning services in First Nations administered schools;
• percentage of students attending First Nations administered schools who are taught at least one subject in a First Nations language; and
• percentage of First Nations on-reserve students who graduate from secondary school.

The collection of data on these indicators provides insight into the results of the Department's programming in relation to intersecting identity factors that are impacted in areas such as the provision of culturally and linguistically relevant programming and education attainment of diverse First Nations population groups, for example, as disaggregated by age, sex, and region (province/territory).

GBA Plus Data Collection Plan:

Future program enhancements may lead to analysis of First Nations over 21 pursuing a secondary diploma or equivalent disaggregated by age and sex and may support the identification of barriers to participation in education for the generation between youth and seniors and seniors or baby boom generation.

2.3 Environmental Public Health

Target Population:

Environmental Public Health Services (EPHS) Regional-based services: All First Nations individuals on-reserve south of 60°.

First Nations Environmental Contaminants Program (FNECP): All First Nations individuals on-reserve, with a specific focus on youth, Elders and other populations at higher risk of certain exposures.

Climate Change and Health Adaptation Program (CCHAP): All First Nations individuals on-reserve, with a specific focus on youth and Elders.

Environmental Public Health Officers: Certified health professionals, employed by ISC or First Nations organizations, delivering Environmental Public Health Services directly to First Nations communities.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Inuit Nunangat, Northern regions

* Climate Change and Health Adaptation Program (CCHAP) under EPH includes North of 60.

Other Key Program impacts on gender and diversity:

First Nations have access to all services delivered by regional Environmental Public Health Services.

Environmental Public Health services positively impact all members of the community to advance the Poverty Reduction, Health and Well-being goal of Canada's Gender Results Framework. The beneficiaries of the programs include men, women, elders, youth, 2SLGBTQQIA+ and others. These programs provide health benefits for all members of First Nations on reserve communities, and contribute to increasing access to the services within a community that are disproportionately impacted by socioeconomic factors, leading to improved health outcomes. For example, resolving long-term drinking water advisories positively impacts all members of the community but may be of a greater benefit to those responsible for cooking and other caregiver roles. The Environmental Public Health Officers (EPHOs) and Community Based Drinking Water Quality Monitors are working to improve access to safe water to positively impact the health of individuals. Absent, inadequate or inappropriately managed water and wastewater services expose individuals to preventable health risks. Services are delivered at a community level. That said, there is a special focus on facilities that house those that are the most vulnerable, such as the inspection of schools and long-term care facilities.

Youth and Elders are incorporated by design within proposal-based programs (FNECP and CCHAP) by requiring that funded projects reflect the impact of climate change on them, and include them in the development and/or implementation of adaptation plans.

First Nations children and youth focus of longitudinal study, Food, Health, Environment and Nutrition of Children and Youth.

Supplementary Information Sources:

Horizontal Management Framework for Clean Growth and Climate Change – 2020-21 Departmental Results Report.

GBA Plus Data Collection Plan:

Through the work undertaken in 2021, ISC worked to develop a recruitment and retention strategy for Environmental Public Health Officers who work in/with First Nations Communities. The goal of this strategy is the promotion and recruitment of both Indigenous and non-Indigenous people into the environmental public health profession to work with Indigenous partners and their communities, with an additional focus on women.

2.4 Family Violence Prevention

Target Population:

First Nations, Inuit, Métis, Women, Children, 2SLGBTQQIA+, Families

Distribution of Benefits:

By gender: Benefits 60% - 79% women

By income level: Strongly benefits low income individuals

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations, Inuit, Métis communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Inuit Nunangat, Northern regions

Other Key Program impacts on gender and diversity:

As a result of colonial practices including residential schools, the Sixties Scoop, and the resulting intergenerational trauma, ongoing socioeconomic inequities, systemic barriers, and racism, Indigenous women, children, and 2SLGBTQQIA+ persons continue to be at increased risk of being victims of family violence. According to Statistics Canada, across Canada, the COVID-19 pandemic has exacerbated this issue by creating additional barriers for victims of domestic violence.

The Family Violence Prevention Program (FVPP) advances GBA Plus and diversity and inclusion objectives by aligning with efforts to eliminate violence against Indigenous women, children, and 2SLGBTQQIA+ people, and by responding to the specific needs of those affected by gender-based violence towards Indigenous peoples. The FVPP supports the reduction of family violence through the funding of emergency shelters for Indigenous women and their children as well as through culturally and community-based violence prevention projects. ISC-funded shelters serving Indigenous communities across Canada provide refuge for women and their children, help them escape situations of violence, provide education, and support families to prevent future violence. Examples of projects that have been funded through the FVPP have included training on safety of Indigenous women in urban settings, workshops on 2SLGBTQQIA+ inclusivity, and engagement with men and boys on violence prevention. Results of these projects are currently being collected through the FVPP's Data Collection Instrument.

Supplementary Information Sources:

Statistics Canada, Experiences of violent victimization and unwanted sexual behaviours among gay, lesbian, bisexual and other sexual minority people, and the transgender population, in Canada, 2018

Statistics Canada, Many shelters for victims of abuse see increases in crisis calls and demand for external supports in the first year of the COVID-19 pandemic, 2022

Statistics Canada, Violent victimization and perceptions of safety: Experiences of First Nations, Métis and Inuit women in Canada, 2022

GBA Plus Data Collection Plan:

The FVPP currently collects disaggregated data on the participants of program-funded violence prevention projects as well as on shelter clientele through the Data Collection Instrument (DCI). This data is based on sex, age, and whether clients are ordinarily living on reserve. The DCI is currently being revised to expand the data being collected from FVPP recipients. These changes will include ensuring that participation in and outcomes of family violence prevention activities are distinctions-based and reflect 2SLGBTQQIA+ needs. Collaboration with regional colleagues and Indigenous partners is necessary to effectively capture this data and allow for its disaggregation while respecting privacy of clients. A revised DCI will be used to collect program data beginning in 2023-24.

2.5 First Nations Child and Family Services

Target Population:

First Nations, Children

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: Strongly benefits low income individuals

By age group: Primarily benefits youth, children and/or future generations

By distinction: Benefits First Nations, Inuit, Métis communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Inuit Nunangat, Northern regions

GBA Plus Data Collection Plan:

This program does not collect sufficient data at this time to enable it to monitor and/or report program impacts by gender and other identity factors. The federal government's Six Points of Action for Child Welfare Reform includes the co-development of a data and reporting strategy, including gender-based indicators, with provinces, territories and Indigenous partners. ISC is also working with some partners and the Public Health Agency of Canada to determine if information related to Indigenous children, disaggregated by sex/gender can be included in the development of the Canadian Child Welfare Information System.

The need for new performance measures and data systems to address the unique requirements of child and family services and respect Indigenous data sovereignty is being communicated from communities, agencies and organizations across the country. These data improvements will allow for continued monitoring of outcomes, particularly those related to sex and gender, and ensure equity in the provision of prevention support and services to meet the needs of children, youth and families.

The department will work with the Public Health Agency of Canada to determine if new distinctions-based performance measures can be used to monitor outcomes. These measures will be used to ensure equity in the provision of prevention support and services to meet the needs of children, youth and families, as determined by Indigenous communities.

ISC will continue to rely on practices rooted in the co-developed principles of mutual accountability, including co-developed approaches to address gender considerations and data gaps. This includes reviewing the Institute of Fiscal Studies and Democracy's recommendations in Phase 1 report "Enabling First Nations Children to Thrive" and Phase 2 report "Funding First Nations child and family services (FNCFS): A performance budget approach to well-being". The IFSD Phase 2 report includes proposed "Measuring to Thrive Framework" indicators that capture the well-being of children, families, and communities and is premised on the understanding that a child's environment is integral to their well-being. ISC will continue to work with First Nations partners to improve Departmental and program-specific outcomes and performance indicators by looking at the Measuring to Thrive Framework as an important tool.

2.6 Health Human Resources

Target Population:

The work undertaken by the Health Human Resources table has been reflected under the Communicable Disease Control and Management program. (see 2.1 above)

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Remote/Isolated regions

Additional characteristics: This reflects all health human resources (HHR), inclusive of those performing services in remote, semi-isolated and not-isolated locations in over 500 First Nations communities across Canada.

2.7 Healthy Child Development

Target Population:

The Healthy Child Development (HCD) cluster's target populations are First Nations and Inuit individuals and families living on-reserve and in Inuit communities. The primary participants of the programs are those who are or who are aspiring to be pregnant, new /parents, and children from birth to age 6.

Distribution of Benefits:

By gender: Benefits predominately women (80% or more) - The gender breakdown for distribution of benefits of the Healthy Child Development (HCD) cluster varies by program. For Maternal Child Health (MCH) and the Canada Prenatal Nutrition Program (CPNP), the audience is predominantly pregnant people and new parents. The Fetal Alcohol Spectrum Disorder (FASD) program offers preventative programming for pregnant women, but can also provide screening and case management services for children, which are not gender specific.

Aboriginal Head Start on Reserve (AHSOR) is not gender specific and is aimed at children from birth to age 6 and their families.

By income level: Strongly benefits low income individuals

By age group: Primarily benefits youth, children and/or future generations

There is variation in the target audiences for the different programs in the HCD cluster. Youth is selected because all of the programs (especially AHSOR) serve children up to age 6. However, the MCH and CPNP programs target pregnant people and new parents, who may fall more within the middle choice in the age group section.

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Rural, Remote/Isolated, Inuit Nunangat, Northern regions

Urban is often used in the context of off-reserve, and is therefore not selected as the HCD cluster serves Indigenous individuals and families in First Nations living on-reserve and in Inuit communities.

Other Key Program impacts on gender and diversity:

Data collected for the Healthy Child Development cluster is captured through the Community Based Reporting Template (CBRT) and the Regional Health Survey (RHS). Healthy Child Development is a transferred program which means that communities are primarily in charge of handling the management and delivery of their programs. As part of the effort to transfer services to communities, flexible funding arrangements are promoted by the national and regional offices. These flexible funding arrangements have less stringent reporting requirements and offer a stable source of funds over a long period of time. While Indigenous communities capture gender/sex information as part of enrollment/client files supporting their service delivery, these are not captured through CBRT reporting.

2.8 Healthy Living

Target Population:

First Nations and Inuit communities

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations, Inuit, Métis communities and/or individuals

* a subprogram, Canada's Tobacco Strategy, includes funding for Metis Nation and Metis Governing Members.

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Rural, Remote/Isolated, Inuit Nunangat, Northern regions

GBA Plus Data Collection Plan: Healthy Living programs are supported by flexible, community-based funding, allowing communities to design and deliver activities based on their unique needs and priorities. To support self-determination, reporting requirements are kept to a minimum for many programs. As such, Healthy Living does not always receive GBA Plus-related data from funding recipients.

The Nutrition North Canada Nutrition Education Initiatives annual report template has been revised, and beginning in 2022-2023 will seek to capture some demographic data for participants, i.e. by gender (woman/man/another gender) and age stratification.

2.9 Home and Community Care

Target Population:

The Home and Community Care Program is offered to all First Nations individuals on reserve and Inuit people living in Inuit communities of all ages, including disproportionately impacted seniors and those living with disabilities and acute or chronic illness, who have a need for in-home health care related services. There is no income testing requirement for Home and Community Care services, instead there is a needs assessment based on demonstrated medical need.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Inuit Nunangat, Northern regions

Other Key Program impacts on gender and diversity:

Home and Community Care (HCC) is a transferred program which means that communities are primarily in charge of handling the management and direction of their home care program. As part of the effort to transfer as much authority to communities, flexible funding arrangements are promoted by the national and regional offices. These flexible funding arrangements have less stringent reporting requirements and offer a stable source of funds over a long period of time.

While the majority of clients served by Home and Community Care are older individuals, HCC also serves a significant number of clients who are aged 25 or younger. In 2019-20, the program invested $140M for essential home and community care services to support clients of all ages with acute and chronic illnesses and disabilities. The program provided care to 1945 First Nations and Inuit children aged 25 and younger.

Supplementary Information Sources:

ISC's Assisted Living and Home, Community and Preventative Care Programs are collaboratively supporting regional and national distinctions-based long-term and continuing care engagement. This engagement process aims to solicit input from a wide range of stakeholders, including but not limited to, clients, families, communities, health and social services directors and/or other system representatives, Federal/Provincial governments where appropriate, members of Academia, and Indigenous leadership to gather valuable insight on the elements of a holistic continuum of long-term and continuing care. This new, more holistic continuum of care will better respond to the needs of Indigenous Peoples, and will cover the full spectrum of services from supports for people living with disabilities, to aging in place approaches, to improvements to facility-based care, and could include services for those previously served under Jordan's Principle. In the engagement guide originally shared with regions and partners, it makes the recommendation to consider specific GBA Plus inclusion criteria when completing regional and national engagement activities. We have seen evidence of this recommendation in several regional engagement plans, as well as, in the National Engagement Workshop(s) plans.

GBA Plus Data Collection Plan:

A co-developed data strategy that incorporates Indigenous-led strategies/indicators is in development and is expected to be finalized by September 2023. The strategy is designed to provide the best available data on the extent of need and demand for HCC services to support evidence-informed policy decisions and directions regarding HCC programming. Engagement with National Indigenous Organizations (NIOs), including the Assembly of First Nations and Inuit Tapiriit Kanatami and other federal departments regarding data collaboration efforts are underway. GBA Plus data collection is considered and included in the strategy. It is anticipated that the program will add more indicators upon completion of the strategy.

2.10 Income Assistance

Target Population:

Grants and contributions to eligible recipients under the Income Assistance program are intended to provide financial assistance to low-income on-reserve residents to support their basic and special needs and to help them become more self-reliant, in alignment with the rate schedule and eligibility criteria of the reference province or territory.

Distribution of Benefits:

By gender: Broadly gender-balanced - The program collects information disaggregated by sex, except in Ontario. As of 2018-2019, the distribution of supports to Income Assistance clients was balanced between males (53%) and females (47%).

By income level: Strongly benefits low income individuals

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations, Inuit, Métis communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve

Additional characteristics: In general, Income Assistance clients experience several intersecting factors that result in their need for support to meet their essential needs. In general, they are low-income, have low-educational attainment, are a greater risk of having a disability than the overall Canadian population, which may impact their ability to participate in the labour force, and are more likely to be single males or lone female parents and therefore have fewer familial supports than members of their communities who are not receiving Income Assistance. There is also a high number of youth in receipt of Income Assistance due to socioeconomic factors on reserve. In 2017-18, 29% of clients and dependents were between the ages of 18-34.

Other Key Program impacts on gender and diversity:

Case management and pre-employment supports are eligibility requirements for all provincial and Yukon income assistance programs and have proven to be an effective approach that can make a positive impact on an individual's long-term health and social well-being. Since the limited introduction of these supports in 2013, the national on-reserve dependency on Income Assistance has decreased from 34.0% in 2011-12 to 27.7% in 2018-19. In 2018-19, more than 5,400 clients received case management supports and approximately 1,900 exited Income Assistance (50% exited to employment, 12% exited to education, and 38% exited for other reasons) and the distribution of supports was generally balanced between males (53%) and females (46%).

GBA Plus Data Collection Plan:

The Income Assistance program's existing data collection system collects sex information and data that is useful in determining impacts for sex and other identity factors, but expansion of the data collection in this area could be beneficial. As the program undertakes co-development of reform options with First Nations partners to make the program more responsive to the needs of individuals and families and to identify the supports required to help individuals better transition from income assistance to employment and education, consideration of the program's data collection needs can be addressed. This could include both quantitative and qualitative data collection methods, determined in partnership with First Nations. GBA Plus has been flagged as an area for key consideration when the data collection instrument is reviewed with First Nations partners as part of program reform. The program reform process is expected to be completed by March 2023 with options for a new needs-based Income Assistance program that incorporates greater First Nations control over social development and reduces socio-economic gaps on reserve.

Additionally, the Income Assistance program is currently developing an IM/IT system that will be able to provide valid and timely reporting, allow for linkages to be made with other data, and better measure program effectiveness.

2.11 Jordan's Principle

Target Population:

The target population for Jordan's Principle is First Nations children who are in need of products, services and support. This applies to individuals between the ages of 0-18, and 19 in some provinces.

The target population for the Inuit Child First Initiative is Inuit Children who are in need of products, services and support. This applies to individuals between the ages of 0-18, and 19 in some provinces.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: Strongly benefits low income individuals

By age group: Primarily benefits youth, children and/or future generations

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Inuit Nunangat, Northern regions

Other Key Program impacts on gender and diversity:

2021-22 Approved products and services related to COVID-19

• Individual

  Between April 1, 2021 and March 31, 2022, approximately 1,203 products and services related to COVID-19 were approved for a total of $882,000

• Group

  Between April 1, 2021 and March 31, 2022, approximately 1,687 products and services related to COVID-19 were approved for a total of $489,000

• Total (Individual + Group)

  Between April 1, 2021 and March 31, 2022, approximately 2,890 requests for products and services related to COVID-19 were approved for a total of $1.4 million

GBA Plus Data Collection Plan:

In 2021-22, 56% of all approved products and services were for boys, while 44% of all approved products and services were for girls.

2.12 Mental Wellness

Target Population:

First Nations on-reserve and Inuit living in legally recognized Inuit communities.

Regardless of status or residence Survivors of Indian Residential Schools and their family members; Survivors of Indian Day Schools and their family members; Those affected by the issue of Murdered and Missing Indigenous Women and Girls.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: Strongly benefits low income individuals

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations, Inuit, Métis communities and/or individuals

While the Mental Wellness program primarily serves First Nations and Inuit, the trauma informed health and cultural support programs (Indian Residential Schools Resolution Health Support Program, Missing and Murdered Indigenous Women and Girls Health and Cultural Supports, Indian Day Schools Health and Cultural Supports) are available to all eligible people, regardless of status or place of residence, including Métis.

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Rural, Remote/Isolated, Inuit Nunangat, Northern regions

Urban populations are supported through the Trauma-Informed Health and Cultural Support Programs, but the majority of the Mental Wellness focuses on First Nations on-reserve and Inuit in recognized Inuit communities.

Additional characteristics: The population accessing Mental Wellness Programs are similar to that accessing other services through ISC; however, given the target audiences for some specific programs, there may be a greater representation of Survivors of Indian Residential Schools and Indian Day Schools and their families as well as people impacted by the issue of Missing and Murdered Indigenous Women and Girls. Mental Wellness programs are available in northern and remote communities which may lead to an increased representation of people living in those areas accessing the services.

Other Key Program impacts on gender and diversity:

GBA Plus assessments indicate Indian Residential School Survivors and intergenerational Survivors constitute a large and diverse cross-section of the Indigenous population, including women and men in relatively equal numbers, as well as a representation of gender diverse people. The Survivor population includes individuals from all distinctions groups, all regions, and urban and rural/remote residents. Indian Residential School Survivors are also an aging population, with the majority being over the age of 65.

Health and Cultural supports are provided by community-based Indigenous organizations that are able to provide trauma-informed, culturally relevant services designed and delivered with an essential understanding of the Indian Residential Schools system and its ongoing gendered impacts on Survivors, their families, their descendants, and all First Nations, Inuit and Métis community members.

2.13 Urban Programming for Indigenous Peoples

Target Population:

Indigenous Peoples in urban communities

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: Strongly benefits low income individuals

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations, Inuit, Métis communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located in Urban regions

Other Key Program impacts on gender and diversity:

While there is limited data regarding the experiences of Indigenous 2SLGBTQQIA+ people, it is likely that Indigenous youth and adults who identify as 2SLGBTQQIA+ face additional barriers and risks when transitioning to urban areas due to intersecting identity factors. The Canadian Survey on Victimization showed that 2SLGBTQQIA+ individuals are more likely than cis-gender and heterosexual individuals to experience violent victimization. Indigenous Peoples are also at a higher risk of experiencing violence, therefore it is likely that Indigenous 2SLGBTQQIA+ individuals are at an even higher risk.

GBA Plus Data Collection Plan

Due to the pandemic the reporting obligations had been put aside to release the burden on the recipients, and this information is not necessarily disclosed when the recipients complete the reports.

3.0 Economic Development Capacity and Readiness

Target Population:

Target population is First Nations and Inuit community owned businesses

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Inuit Nunangat, Northern regions

GBA Plus Data Collection Plan:

ISC is aware of existing data gaps with regards to GBA Plus considerations which are being addressed through a number of ongoing initiatives to improve the representativeness of reporting and better reflect the realities and needs of the communities served. For example, ISC is working to collaborate with Indigenous Organizations such as the National Aboriginal Lands Managers Association, who already disaggregates their data collection and information via gender in management positions with self-identifying women. Training and education will also be led by self-identified and gender diverse Indigenous Organizations to capacity build via appropriate and culturally relevant inquiries and reporting tools.

In support of the government commitment to innovate as well as the departmental mandate to transfer services, which will be done by applying Indigenous and decolonial methods and methodologies to ISC's current reporting and data gathering mechanisms. In recent years, lenses, such as race, gender, class, ability, sexual orientation, among other factors, are embodied in how ISC works alongside of key partners, and how ISC sets up mutual and shared goals and expectations. Going forward this will support more holistic outcomes with respect to data and information collection that is built alongside of Indigenous partners, which reflects Indigenous Peoples own ideas about measurement, that better responds to emerging needs.

3.1 Education Facilities

Target Population:

First Nations children and youth in education facilities (K-12) on reserve.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: Primarily benefits youth, children and/or future generations

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated regions

Additional characteristics: Improved educational facilities will benefit school-aged First Nation children on reserve by supporting the creation of quality learning environments that are safe and healthy, promoting better educational outcomes for students living on reserve. This can translate into future socio-economic benefits for these individuals as they enter the workforce.

Other Key Program impacts on gender and diversity:

The department considers GBA Plus principles as a core component of processes which will lead to investments that support closing the infrastructure gap between non-Indigenous and First Nations communities by improving the overall social well-being and economic prosperity of First Nations children of various identities including, culture, language, sexual orientation, education, ability, geographic location, faith, gender, ethnicity, and socio-economic status. Additionally, education facilities enable quality programming for all children, regardless of gender and/or ability. Gender inclusive washrooms, ramps and larger washroom stalls for wheelchair accessibility and additional spaces for students with developmental, learning, and other disabilities are all design elements that can be integrated into schools as circumstances dictate.

The impacts of this program support the pillars and goals of the Gender Results Framework, through the education and skills development goals:

• equal opportunities and diversified paths in education and skills development;
• economic participation and prosperity – Equal and full participation in the economy; and
• poverty reduction, health and well-being – Reduced poverty and improved health outcomes.

Overall, investments in education facilities will help bridge the infrastructure gap between First Nations and the rest of Canada and positively impact all members of the community. It will improve the overall social well-being and economic prosperity of First Nations communities on reserves.

GBA Plus Data Collection Plan:

First Nations develop their infrastructure plan according to their needs and priorities through the First Nations Infrastructure Investment Plan process and proposed projects are assessed based on the following four priorities:

• protection of health and safety and assets;
• health and safety improvements;
• recapitalization/major maintenance; and
• population growth.

In accordance with the applicable program terms and conditions, the provision and management of adequate and safe community infrastructure on reserve is the responsibility of First Nations. As a result, it is difficult to predict the differential impacts this initiative could have on Indigenous women, men, Elders, youth, single parents, people with disabilities and 2SLGBTQQIA+ people.

Though there are limitations to the collection of gender-disaggregated data, steps have been and are being taken by ISC to strengthen its departmental capacity to further develop GBA Plus tools within the next year, including within the infrastructure programs.

3.2 e-Health Infostructure

This includes electronic medical records, virtual health and clinical and client care reporting under eHealth initiatives. Work on this file is at exploratory stage and the current reporting arrangement does not allow the gathering of gender disaggregated data. However, program decisions always take gender into consideration. The team is exploring options to overcome challenges related to lack of disaggregated data.

Target Population:

First Nations

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Rural, Remote/Isolated regions

GBA Plus Data Collection Plan:

As stated by the Health Facilities Program, ISC does not collect gender-specific data for the eHealth Program. The provision and management of health facilities on reserve, where eHealth support services are delivered, is the responsibility of the First Nation recipients. Furthermore, the multi-jurisdictional complexity of health service delivery to Indigenous peoples creates challenges in gathering comprehensive Indigenous health data. Many key indicators of health come from systems held by provinces and territories. There is no simple mechanism to identify Indigenous-specific data within these systems compounded by First Nations guidelines around ownership, control, access and possession (OCAP) of all information about their peoples, and the absence of ethnic identifiers. Consequently, health status information routinely available for Canadians is not available for Indigenous Peoples.

3.3 Emergency Management Assistance

Target Population:

First Nations communities

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

GBA Plus Data Collection Plan:

The Emergency Management Assistance Program does not collect data that monitors or reports impacts related to gender and diversity. At this time, no specific steps are being undertaken to collect this data. Although there is some interest within the program to collect GBA Plus and diversity-related data, we could only do so with the expressed consent from and engagement with First Nation communities. Nothing to report in 2021-22.

3.4 Health Facilities

Target Population:

First Nations and non-First Nations people living on reserve

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

Additional characteristics:

Whole Community:
Investments in health facility infrastructure through expansion, renovation and/or new construction on-reserve will increase access to health care programs and services. Across all demographics, upgraded health facilities will enable First Nations communities to provide enhanced health programs and services to its members, thus reducing the necessity for individuals to leave their community in search of care. Many First Nations communities suffer from disproportionately high rates of chronic disease, and other factors, such as overcrowding, can exacerbate the spread of diseases such as COVID-19. Investments in health facility infrastructure are crucial to mitigating against the effect of chronic disease and the pandemic.

Health Centre Workforce:
Improved health care infrastructure would help to increase rates of recruitment and retention for nurses in First Nations healthcare facilities. While currently, this would be a greater benefit to female nurses, because they make up the majority of the nurses in First Nations communities, better infrastructure, and therefore better working conditions can attract a vast untapped labour market. This is important to address the challenge of staffing healthcare professionals in remote and isolated communities.

First Nations Children/Youth:
First Nations, Métis and Inuit populations have a higher proportion of young people compared to the non-Indigenous population. Social determinants of health note that infrastructure, or that lack thereof in a community, significantly affects the health of children during the formative years of their development. This is especially important of healthcare infrastructure. Improving healthcare infrastructure will enable this large demographic to better access medical services, counselling and other support services. Increasing technical support services in health care can also improve access to specialists as well as to health training and education.

First Nations Women:
Indigenous women are 3.5 times more likely to experience violence than other Canadian women. Building, retrofitting and renovating spaces in communities permit a broader range of health services to be accessed within that community, including counselling. For women who need additional prenatal and postnatal care, this can mean a reduced amount of time away from their community.

First Nations Men:
Increasing the quality of social infrastructure and as a result, access to health care, will also positively impact First Nation/Inuit men. Having infrastructure in place that offers the opportunity for men to access parenting and prenatal programming is important for men as well as women. Men have specific needs when it comes to health care. Men under report or delay reporting abuse from residential schools, however, they are increasingly seeking out mental health support. Having infrastructure in place will allow for culturally-relevant programming and health care to develop within communities who lack access because of their remote and isolated locations.

First Nations Two-Spirited and LGBTQQIA+ People:
Two-spirit and LGBTQQIA+ people are more likely to experience violence than heterosexual First Nations and they are twice as likely to experience assault (including physical assault, sexual assault, and assault with a weapon) than 2SLGBTQQIA+ people in the general population. For transgender and gender non-confirming people, this violence is compounded by the lack of gender affirming care as well as other health services. Two-Spirit people are also more likely to experience mental health issues such as depression and anxiety, and are more like to use substances (e.g. drugs and alcohol) as coping mechanisms. Having infrastructure in place can increase anti-homophobia and anti-transphobia education in rural and reserve communities and also increase the amount of culturally-relevant counselling available to First Nations Two-Spirited people.

First Nations Elders:
While the First Nation population is younger than the rest of the population in Canada, it is also aging. Improving health infrastructure will allow for increasing the overall level of care to First Nations elders and allow necessary renovations to accommodate elderly people with mobility issues.

Employment and Training:
Research shows that poverty and ill-health are inextricably linked. The economic impact of employment during the construction, renovation and repair in health facilities will positively impact First Nations people by creating opportunities for employment and training opportunities within communities.

A higher proportion of First Nation men identify employment as a main reason for leaving their community. Therefore, creating jobs in the construction industry will benefit men living on-reserve.

For women, poverty can also mean higher rates of family violence, inequality, and sexual exploitation/harm. Therefore, giving First Nations women the opportunity to gain employment and also training in the construction industry as a part of this initiative will have a positive impact on women and their health. For example, if women can gain employment and training opportunities within their community, their support system for childcare is more readily available than if they had to leave their community to gain the same income and experience which could mean an increase in their social connectedness and financial independence. This in turn will have a positive impact on First Nations children and youth, including possibilities of internships/summer job opportunities.

GBA Plus Data Collection Plan:

ISC does not collect gender-specific or social data for the Health Facilities Program (HFP). In accordance with the HFP's Terms and Conditions, the provision and management of health facilities on reserve is the responsibility of the First Nation recipient. Furthermore, the multi-jurisdictional complexity of health service delivery to Indigenous peoples creates challenges in gathering comprehensive Indigenous health data. Many key indicators of health come from systems held by provinces and territories. There is no simple mechanism to identify Indigenous-specific data within these systems compounded by First Nations guidelines around ownership, control, access and possession (OCAP) of all information about their peoples, and the absence of ethnic identifiers. Consequently, health status information routinely available for Canadians is not available for Indigenous peoples.

Recently, the HFP has been enhancing its pre-capital planning process. The program has begun to engage with First Nation recipients more directly on the expected outcomes associated with new health infrastructure projects, including how infrastructure improvements are expected to address current health service needs. This will allow HFP and First Nation recipients to better identify potential GBA Plus considerations related to health infrastructure projects, and which relevant data could be collected by First Nations to track performance.

3.5 Health Planning, Quality Management and Systems Integration

Target Population:

First Nations communities and institutions

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Rural, Remote/Isolated, Northern regions

Other Key Program impacts on gender and diversity:

In the Accreditation and Quality Improvement program, GBA Plus has been considered in a funding formula that includes rural and remote communities servicing vulnerable populations. The health status of Indigenous populations is well below the Canadian average, and Indigenous access to health services is limited, especially for those living in remote and/or isolated communities. The program includes a strong focus on rural and remote communities, as these communities are particularly underserved and experience unique challenges and inequities.

GBA Plus Data Collection Plan:

Data collection for the Health Planning, Quality Management and Systems Integration Program focuses on community and organization levels across First Nations communities. Gender and diversity data cannot be collected as part of this program.

To overcome these data collection challenges, the department works collaboratively with Indigenous organizations such as the First Nations Information Governance Centre (FNIGC). The FNIGC oversees the First Nations Regional Health Survey (RHS) that collects self-reported information on Western and Traditional understandings of health and well-being, on reserve. Although the RHS provides sex-disaggregated data that is broken down by age, the data collected via a self-reported survey and linked to perceived health outcomes. The RHS does not report on perceived health outcomes related to health infrastructure. Nonetheless, RHS data can help to provide important context and considerations surrounding the regional health status of First Nations, which can be used by the Program throughout program implementation.

3.6 Housing

Target Population:

The First Nation On-Reserve Housing Program helps provide more and better quality housing in First Nation communities in Canada. The Housing Program supports First Nations Communities and First Nations organizations to undertake new construction, repairs, lot servicing, capacity and innovation. Data on benefits cannot be disaggregated by gender, income or age group.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

Additional characteristics: The lack of adequate housing on-reserve is linked with numerous socio-economic outcomes that are lower for First Nations on-reserve, than for other Canadians. Intersectional impacts of poverty, intergenerational trauma, racism, sexism, homophobia are attributable to the effects of colonialism. Increased economic self-sufficiency, self-determination and a self-reliant economic base, supported by programming which improves housing conditions while and ultimately transfers the control and management of housing services to First Nation, is expected to have positive impacts on the type of housing, housing conditions and availability, and on all community members, regardless of age, gender and ability, and so on.

Other Key Program impacts on gender and diversity:

Positive impacts on all members of communities are expected. Access to safe and adequate housing can provide benefits for all members of a First Nation on-reserve community, particularly those considered most vulnerable (e.g. women, children, persons with disabilities, etc.).

The Government does not collect sex or gender-disaggregated data on Housing, under the Capital Facilities and Maintenance Program, for the performance framework. Each community develops their infrastructure plan according to their needs and priorities.

GBA Plus Data Collection Plan:

The Program does not collect gender-data related to the renovation, construction, sub-divisions, and other eligible activities under the on-reserve housing program. Program officials work with First Nations organizations to plan for, collect, and control First Nations Data according to their priorities and identified need following principles of OCAP i.e., Ownership, Control, Access and Possession. Qualitative and quantitative information pertaining to housing outcomes for diverse sub-populations are collected by First Nations and First Nations organizations including First Nations Information Governance Centre, Assembly of First Nations and Native Women's Association of Canada and others, shared with federal partners, and are used to inform GBA Plus analysis, as are other data sources (Census, Indian Register etc). Dialogue and information exchange about GBA Plus analysis, and Two-eyed seeing, and culturally-appropriate, distinctions-based versions of this type of analysis is ongoing with federal partners who support improved housing outcomes on-reserve.

3.7 Indigenous Entrepreneurship and Business Development

Target Population:

The access to capital stream of the Aboriginal Entrepreneurship Program (AEP) supports Indigenous entrepreneurs' access to business financing. The AEP also has a Business Opportunities stream that is dedicated to supporting the growth of Canada's Indigenous business sector.

Distribution of Benefits:

By gender: Predominately benefits men 80% or more

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations, Inuit, Métis communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located in Urban, Rural, Northern regions

GBA Plus Data Collection Plan:

The access to capital stream of the Aboriginal Entrepreneurship Program has been devolved to Indigenous partner organizations the National Aboriginal Capital Corporations Association and five Métis Capital Corporations. These partner organizations collect and manage data.

3.8 Indigenous Governance and Capacity

Target Population:

First Nations and Inuit

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: Somewhat benefits low income individuals

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations and Inuit communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Inuit Nunangat, Northern regions

Other Key Program impacts on gender and diversity:

The IGC Program is general in application and does not include, at this time, any targeted investments that advance gender-based or intersectional identity specific priorities. However, its sub-programs support Indigenous recruitment, professional development activities of Indigenous governments and institutions, and overall strengthened governance capacity. These supports have an impact on community leaders, band employees, and the community as a whole, inclusive of men, women, members of 2SLGBTQQIA+ communities, youth, and elders. In addition, the IGC Program has identified projects that advance diversity and inclusion in Leadership as a key area of focus for funding under the P&ID Program, meaning that such projects will receive positive consideration by regional officials that assess P&ID proposals.

GBA Plus Data Collection Plan:

In 2021-22, the IGC Program did not collect sufficient data to enable it to monitor and report on gender, diversity, and other GBA Plus-related impacts. The Program did identify Diversity in Leadership as an area of focus for the P&ID Program in 21-22 and beyond. In 2021-22, the IGC Program did not collect sufficient data to enable it to monitor and report on gender, diversity, and other GBA Plus-related impacts. The Program did identify Diversity in Leadership as an area of focus for the P&ID Program in 21-22 and beyond. While there has not been dedicated funds for such an area, nor a specific means of tracking progress, it will remain an area of program development for 2022-23. Further efforts in 22-23 will be concentrated on the modernization of the IGC Program, which will involve ISC examining how the Program can better support gender diversity among elected and administrative leaders in Indigenous governments and institutions.

3.9 Land, Natural Resources and Environmental Management

Target Population:

First Nations and individuals residing on reserves (First Nations Land Management (FNLM), Land Use Planning and the Reserve Land and Environment Management Program (RLEMP)).

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

Other Key Program impacts on gender and diversity:

FNLM operational First Nations were able to develop and pass emergency laws to implement community safety measures in response to the pandemic. However, many First Nations faced challenges with enforcement of these laws.

3.10 Other Community Infrastructure and Activities

Target Population:

First Nations Peoples and communities where funding is provided through the Capital Facilities Maintenance Program (CFMP) and the First Nation Infrastructure Fund for Other Community Infrastructure and Activities (Cultural and Recreation Facilities, Planning and Skills, Structural Mitigation, Administrative buildings, Energy Systems, Fire Protection, Connectivity and Roads and bridges). Benefits are not distributed by gender, income, age group, or geography.

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated regions

Additional characteristics: In some areas of Other Community Infrastructure, Indigenous Elders, women, people with disabilities, youth and children are likely to benefit more from these investments, such as investments in cultural and recreational facilities. Culture and recreation facilities help to ensure Indigenous women, girls and 2SLGBTQQIA+ people have safe, no-barrier, permanent, and meaningful access to their cultures and languages and help contribute to building identities and vibrant cultures. Research shows that cultural and recreational centers and similar facilities are used mainly by women for child care, skills training, counseling, peer learning, literacy and rights education, etc. Improved cultural and recreational infrastructure could have a larger positive impact on the lives of women than men in Indigenous communities.

The fall 2018 Report from the Auditor General of Canada concluded that accessibility to broadband high-speed Internet continues to lag behind for certain population groups in Canada, notably communities in rural and remote areas, which includes First Nation communities. The World Bank report titled Making Infrastructure Work for Women and Men (1995 - 2009) states that this could limit education and economic development opportunities for Indigenous women and girls. An increase in connectivity allows women to access support network and can provide a platform for health-related education. It can also give women access to a supportive network of other women with similar experiences. Improved connectivity could lead to improved primary and secondary education and new opportunities for post-secondary education, training, and lifelong learning. It provides youth with access to online resources and connects them with others, allowing them to share information and collaborate. Improved connectivity also allows remote communities to access a wide range of entertainment products and services, provides opportunities to develop new forms of cultural expression, and provides the tools to explore traditional languages and cultures. This is critical for children and youth, as they are developing their individuality and their sense of self.

The World Bank report titled Making Infrastructure Work for Women and Men (1995-2009) also states that better electricity allows more time for education and income-generating activities and that improved roads lead to increase in school enrollment and attendance, particularly for girls. Additionally, safe transportation or improvement of roads and bridges can improve women's and girls' safety.

Other Key Program impacts on gender and diversity:

The impacts of this program support the pillars and goals of the Gender Results Framework, through the Economic Participation and Prosperity goal as well as the Poverty Reduction, Health and Well-Being goal. The department considers GBA Plus principles as a core component of renewed, respectful, and inclusive nation-to-nation processes which will lead to reliable and sustainable infrastructure that supports the well-being of Indigenous communities through closing socio-economic gaps between Indigenous and non-Indigenous communities. Local and community-driven infrastructure projects improve the overall social well-being and economic prosperity of First Nations communities on reserve and supports First Nations in their efforts to develop healthier, more sustainable communities.

Supplementary Information Sources:

2018 Fall Reports of the Auditor General of Canada – Connectivity in Rural and Remote Areas

Making Infrastructure Work for Women and Men – A review of World Bank Infrastructure Projects (1995-2009) (PDF)

GBA Plus Data Collection Plan:

First Nations develop their infrastructure plan according to their needs and priorities through the First Nations Infrastructure Investment Plan process and proposed projects are assessed based on the following four priorities:

• protection of health and safety and assets;
• health and safety improvements;
• recapitalization/major maintenance; and
• population growth.

In accordance with the applicable program terms and conditions, the provision and management of adequate and safe community infrastructure on reserve is the responsibility of First Nations. As a result, it is difficult to predict the differential impacts this initiative could have on Indigenous women, men, Elders, youth, single parents, people with disabilities and 2SLGBTQQIA+ people.

Though there are limitations to the collection of disaggregated data, steps have been and are being taken by ISC to strengthen its departmental capacity to further develop GBA Plus tools, including within the infrastructure programs.

3.11 Statutory, Legislative and Policy Support to First Nations Governance

Target Population:

Matrimonial Real Property (MRP): First Nations and individuals residing on reserve

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

Other Key Program impacts on gender and diversity:

Unless a First Nation has its own MRP law in force, the provisional federal rules provide rights and protections for individuals living on reserve in the area of MRP – with some exceptions (ex. Self-governing First Nations).

GBA Plus Data Collection Plan:

Nothing to report for 2021-22. Funding for the program sunset as of March 31, 2021.

3.12 Water and Wastewater

Target Population:

All Peoples living on-reserve in a First Nations community

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

Other Key Program impacts on gender and diversity:

Overall, water and wastewater systems are essential community infrastructure that can provide positive benefits for all members of the community on reserve. It is anticipated that improved access to clean water can benefit men, women, elders, youth, 2SLGBTQQIA+ people, and others. Reliable water and wastewater infrastructure can particularly benefit people with disproportionately greater needs for clean water due to health impacts, such as pregnant people, elderly, people with disabilities, children, and caregivers.

Supplementary Information Sources:

• Assembly of First Nations (2009), Gender Balancing: Restoring Our Sacred Circle Gender Balanced Analysis
• Assembly of First Nations (2019, 2021), National Water Symposiums, Key Notes
• Government of Canada, Budget 2019 GBA Plus Chapter 3.
• Haworth-Brockman, M. (2009) "Women, Gender and Potable Water (commentary)". In: Rising to the Challenge: Sex- and gender-based analysis for health planning, policy and research in Canada. p.112.
• Human Rights Watch, 2016. Make it Safe: Canada's Obligation to End the First Nations Water Crisis.
• Native Women's Association of Canada (2021), Indigenous Water Operators: Community Engagement and Career Guide
• WHO, 2019. Drinking water factsheet.

GBA Plus Data Collection Plan:

Overall, water and wastewater systems are essential community infrastructure that can provide positive benefits for all members of the community on reserve. It is anticipated that improved access to clean water can benefit men, women, elders, youth, 2SLGBTQQIA+ people, and others. Reliable water and wastewater infrastructure can particularly benefit people with disproportionately greater needs for clean water due to health impacts, such as pregnant people, elderly, people with disabilities, children, and caregivers.

ISC does not directly collect sex or gender-disaggregated data to analyze and assess the immediate gender and socio-economic impacts of Indigenous infrastructure investments – as communities develop and implement their infrastructure plans according to their needs and priorities. As a result, it is difficult to quantify the differential impacts this proposal could have on Indigenous women, men, elders, youth, single parents, people with disabilities and 2SLGBTQQIA+ people.

The Department acknowledges that much work must be done to address the existing data gap relating to the direct impacts of water and wastewater on specific demographics of First Nations communities on reserve. As such, the Department is undertaking a number of initiatives to better quantify and qualify the impacts, positive and/or negative, of clean water on underrepresented members in First Nations communities.

The Department will undertake internal analyses and scoping work to identify the targeted research and data collection required to improve disaggregated data gaps relating to water and wastewater infrastructure users starting in 2022.

4.0 British Columbia Tripartite Health Governance

Target Population:

First Nation Communities (Health Transformation is applied to all First Nations living in British Columbia and is not aimed at a specific gender, income level or age group)

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

Additional characteristics: The First Nations Health Authority (FNHA) has raised key issues relating to cultural safety and humility in the health system which has shaped the experiences and health outcomes of First Nation women which could contribute to health issues, including chronic health conditions, mental issues and substance abuse issues. The FNHA states that they are "committed to making room for everyone, and are inclusive in their communications, information-sharing, and discussions." Furthermore, the FNHA's Draft Multi-Year Health Plan 2022-23 to 2026-27 indicates that its vision and 7 Directives support the traditions of their matriarchs, as well as lift up their 2SLGBTQQIA+ leaders working to decolonize gender and reclaim the important roles they hold in many First Nations cultures.

Other Key Program impacts on gender and diversity:

All operational responsibilities for the management and delivery of health programs and services for First Nations in British Columbia were transferred to the First Nations Health Authority (FNHA) as of October 2013. Since that time, all decisions relating to program activities and funding allocations are determined by the FNHA in accordance with their Multi-Year Health Plan, which is a forward looking document and covers a five year period. Canada has the role of funder and governance partner and is responsible for administering a contribution agreement with FNHA. As a result, Canada does not have any service delivery responsibilities and has no control on how the funding is allocated in British Columbia. Consequently, it is challenging for Canada to directly qualitatively assess the potential sex and gender impact of this initiative on First Nations in British Columbia. However, the FNHA encourages advancement of general equality goals through the administration of their health systems. Their decision-making is intended to reflect the interests of all First Nations in British Columbia, leading to just and equitable treatment. The FNHA states that they are "committed to making room for everyone, and are inclusive in their communications, information-sharing, and discussions." Furthermore, the FNHA's Draft Multi-Year Health Plan 2022-23 to 2026-27 indicates that its vision and 7 Directives support the traditions of their matriarchs, as well as lift up their 2SLGBTQQIA+ leaders working to decolonize gender and reclaim the important roles they hold in many First Nations cultures.

Supplementary Information Sources:

Sacred and Strong: Upholding Our Matriarchal Roles (PDF)

First Nations Population Health and Wellness Agenda (PDF)

GBA Plus Data Collection Plan:

In June 2021, the Province of British Columbia and the FNHA released a baseline report called the First Nations Population Health and Wellness Agenda that expands the original suite of seven indicators to monitor progress and health improvements into a broader set of 22 indicators and targets that will be monitored over the next 10 years. These expanded indicators are grounded in First Nations teachings and guided by reconciliation and relationship building. This data will be disaggregated by sex (male and female). The indicators will be updated to reflect this report and data sets and will inform performance indicators as it relates to short, medium and long- term results on accessing culturally appropriate and improved health services for BC First Nations communities and will be disaggregated by sex. In all evaluation and monitoring processes, ISC will work collaboratively to monitor progress and will incorporate lessons learned from tracking and reporting by monitoring the progress and working closely with Indigenous and provincial partners as progress advances. Reporting will also be built into the Governance of the FNHA and an annual report will be made available. Additional evaluations that are embedded into the existing agreements including the Memorandum of Understanding on Mental Health and Wellness evaluation and the 10-year Canada Funding Agreement evaluation will also be used (where GBA Plus data is available) to assess progress.

4.1 New Fiscal Relationship

Target Population:

First Nations

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

Other Key Program impacts on gender and diversity:

The New Fiscal Relationship Grant impacts participating First Nations communities. All individuals living in those communities will be impacted.

GBA Plus Data Collection Plan:

The National Outcome-Based Framework, which is a key component of mutual accountability in the New Fiscal Relationship, will provide disaggregated information, including by gender and other factors, such as age, geography and income, on the socio-economic gaps between First Nations and non-Indigenous Canadians. The type and level of disaggregation will vary with each indicator included in the framework, depending on the availability of data. Reporting on the framework is anticipated to begin in 2023-24.

4.2 Self-Determined Services

Target Population:

Indigenous youth covered by Regional Education Agreements and First Nations communities covered by the British Columbia Tri-partite Health Agreement

Distribution of Benefits:

By gender: Broadly gender-balanced

By income level: No significant distributional impacts

By age group: No significant inter-generational impacts or impacts generation between youth and seniors

By distinction: Benefits First Nations communities and/or individuals

By geography: Benefits Indigenous communities and/or individuals located On Reserve or in Urban, Rural, Remote/Isolated, Northern regions

GBA Plus Data Collection Plan: As of 2022-23, the Self-Determined Services Program has been removed from the program inventory and will be reported under the Education program as the program activities relate primarily to the Education Program Regional Education Agreements.