The Government of Canada's Response to: Supporting the Gifts of First Nations Adults Living with Exceptionalities

Table of contents

Message from the Senior Assistant Deputy Minister, First Nations and Inuit Health Branch

Thank you for your work on the Supporting the Gifts of First Nations Adults Living with Exceptionalities (PDF) report (the Report).

In the spirit of reconciliation and in keeping with the Principles respecting the Government of Canada's relationship with Indigenous Peoples, Indigenous Services Canada (ISC) remains committed to seeking resolution of issues through dialogue, co-operation, partnership, and negotiation based on the recognition of rights. As well, through the efforts of other departments, the government is also making significant progress to address the challenges faced by Canadians with disabilities more broadly.

In this context, ISC is pursuing program improvements specifically designed to support the delivery of services by and for First Nations and Indigenous communities. In doing so, we engaged Indigenous partners over the past 2 years in the co-development of a new and holistic framework for long-term and continuing care (LTCC), working with the Assembly of First Nations (AFN) and the Inuit Tapiriit Kanatami (ITK) on policy options to guide our efforts going forward.

The resulting overarching policy framework will help inform policy options and lead to the implementation of changes to our existing approaches to service delivery. We know that our partners recognize the opportunities that this work offers and understand the importance of supporting it, helping to build a renewed LTCC program both delivered and managed by Indigenous communities.

The Report has provided us with a valuable glimpse into the lived experiences and challenges faced by some individuals with exceptionalities in Manitoba that will assist us with this work. We appreciate the considerable effort that went into preparing the Report and look forward to continuing to work in partnership on these issues, in the spirit of reconciliation.

Candice St. Aubin
Senior Assistant Deputy Minister
First Nations and Inuit Health
Indigenous Services Canada

Introduction

The mainstream system

All orders of government in Canada face a changing context in the delivery and management of the full range of health services. Aging populations are placing new pressures on long-term and continuing care services, which are often struggling to meet a more complex set of needs for personal care and health supports. At the same time, similar pressures have created a need for faster patient turn-around in hospitals, making for much earlier discharge of patients who still have needs that must be met in and by the community. This in turn increases the range of challenges for LTCC service providers.

The demand for all health services has also increased significantly. Personal care needs are becoming more complex, due in part to the earlier release from hospitals, long-term care facilities focusing primarily on very high care need clients, comorbidity of chronic disease, but also increased desire to receive care in the home or community setting. These demand increases are more pronounced in geographically isolated locations.

It is important to note that these challenges are not exclusive to older adults or the elderly. Those with more complex health needsFootnote 1 at all ages depend on LTCC services to live their lives with the greatest possible degree of independence and autonomy. Services can range across the continuum of care, from support for activities of daily living and in-home health and social services, to the delivery of higher levels of care and support in institutional settings, through to palliative and end-of-life care. The services needed can be structured in a complex way and provided by various actors (such as provincial or regional coordinating agencies, or private, public, and not-for-profit sector service providers), with funding from a combination of public, private, and personal sources.

Services for all people with disabilities (adults and children) fall into this complex health needs category and all provinces and territories are faced with pressures to manage the growing caseload. For example, the waitlist for autism services for children in Manitoba is estimated to be 1.5 years, while in Ontario, the wait is a staggering 5-6 years, where children are ageing out of the program before ever receiving services (with over 50,000 children currently waiting for services). In addition to services, provincial and territorial governments all provide specialized income assistance for persons with disabilities as part of social assistance regimes, but applicants face specific eligibility criteria in order to access relatively low levels of income support.

In 2020, the Manitoba government began developing a process to track and publicly report wait time information for programs serving persons with disabilities and their families. The Department of Families provides these supports primarily through two programs, Children's disABILITY Services and Community Living disABILITY Services. For some programs, tracking wait time data is challenging. The Accessibility for Manitobans Act sets out a path to remove, reduce, and prevent barriers through the development of accessibility standards in fundamental areas of daily living. Enacted in 2013, it is currently undergoing a full review as part of its 5-year review cycle. The 2023/2024 annual plan (PDF) is now available.

For Indigenous peoples, these challenges are augmented by the legacies of colonialism and inequalities in the social determinants of health in communities, which lead to a greater burden of disease and illness, particularly for those living in remote and isolated communities. Individuals and families seeking services and supports face even greater barriers, with gaps in culturally safe and appropriate care within the mainstream system, and limited information and resources available to assist them.

ISC's engagement on LTCC

Indigenous Services Canada (ISC) is working to integrate 2 long-standing programs that are delivered in and managed by First Nations and Inuit communities, under new, distinctions-based frameworks for LTCC. The Assisted Living (AL) program funds communities to provide non-medical social services (i.e., in-home, group-home, and institutional care supports) for seniors and those living with chronic illnesses and/or disabilities (mental and physical) who are ordinarily resident on Reserve. The First Nations and Inuit Home and Community Care (FNIHCC) program is a coordinated approach to home and community-based health care services that funds in-home and community care services to First Nations and Inuit of all ages who have been assessed and determined to have a care need.

Budget 2019 provided $8.5 million for ISC to engage in work on these distinctions-based, co-developed and holistic LTCC frameworks with First Nations and Inuit partners, which covers the full spectrum of services and supports for people living with disabilities, including for those previously served under Jordan's Principle. The policy options that are being co-developed are expected to include these overarching frameworks along with implementable changes, as well as identifying areas where additional resources could be added to the existing approach to service delivery.

Although work was delayed due to the COVID-19 Pandemic, this work is nearing completion, with a framework for Métis to follow. This process has given us an opportunity to consider how best to merge the two historic programs into a more effective platform for assisting the work of communities in this area, including their services and supports for individuals and families with more complex health needs as described in the Report. For example, recommendations for improvements to existing programming were brought forward by First Nations partners during the National Engagement in First Nation Long-Term and Continuing Care activity that took place in Fall 2022. Options for the LTCC frameworks are in the process of being finalized with partners, and are expected to be shared in 2024-2025.

We are pursuing this work in the context of a renewed emphasis across all federal departments and agencies on reconciliation and respect for Indigenous sovereignty. For example, in 2016, Canada committed without reservation to the creation of a legal framework for the implementation of the United Nations Declaration on the Rights of Indigenous Peoples (UN Declaration), and in 2021, the United Nations Declaration on the Rights of Indigenous Peoples Act (UNDA) came into force. UNDA affirms that the UN Declaration has application in Canadian law and commits Canada to create and implement an action plan to achieve the objectives of the UN Declaration. The 2023-2028 Action Plan outlines the actions Canada must take in partnership with Indigenous peoples to implement the principles and rights in the UN Declaration and to further advance reconciliation in a tangible way.

ISC is specifically designated as the lead or co-lead of 34 of these 181 measures, alone and in partnership with other federal departments. Within the Action Plan, the Government of Canada also committed to working with provinces and territories to improve fair and equitable access to quality and culturally safe health services including meaningful engagement and work with Indigenous organizations and governments.

Working across departments and jurisdictions

In parallel with this work, Canada is also pursuing an important agenda within the Accessible Canada Act (ACA)concerning the interests, services, and supports available to persons with disabilities. The overarching goal of the ACA is to realize a barrier-free Canada by 2040, focusing on 7 priority areasFootnote 2, including the design and delivery of programs and services. All federal departments and agencies recently published ACA action p and are responsible for implementation by December 2024. A community of practice with departmental leads regularly meets to discuss their progress and best practices for the implementation of the ACA. Some examples of initiatives within these action plans are described below and include new regulations under the Canada Disability Benefit Act, and investments under the new health agreements with provinces and territories which include commitments to expand access to primary care and mental health care services.

ISC is also looking to work in collaboration with other federal departments as well as provincial and territorial governments, to effectively leverage resources to better serve and support Indigenous communities. Nevertheless, a coordinated approach to address the health needs of First Nations, Inuit, and Métis, and health care delivery among all levels of government, including Indigenous governments, remains an ongoing challenge. Many of the recommendations call for significant new funding in this shared-space signaling an overall cooperative approach that involves engaging governments, which was started with the LTCC framework. In the new bilateral health agreements, Canada has ensured that all provinces and territories commit to improving quality and culturally safe health services for First Nations, Inuit, and Métis. While the federal government cannot direct how provinces and territories work within their own jurisdictions to deliver on these commitments, ISC can play a role in helping to identify and address issues, in partnership with Indigenous communities and organizations.

In this context, the lived experiences of those who need supports and services to manage more complex health needs, as described in the Report, will help inform our work. However, given this focus on lived experience, the Report was not able to give a comprehensive overview of the wide range of programs and services that might be able to provide many of these services and supportsFootnote 3. Our view is that, taken together, the current activities at the federal level, along with efforts to enable and improve collaboration with provinces and territories, give us an opportunity to address many of the issues outlined in the Report. With that in mind, our approach in this response is to provide a comprehensive picture of the efforts across federal departments and agencies that could be leveraged, so that we can help support greater independence and autonomy in the day-to-day lives of these individuals and families. As such, the following sections highlight various programs and services, arranged based on the Report themes, that may already address some of the issues identified in the Report.

Culture as a foundation and self determination

The Government of Canada is committed to advancing reconciliation with Indigenous peoples through renewed nation-to-nation, Inuit-Crown and government-to-government relationships based on recognition of rights, respect, co-operation, and partnership as the foundation for transformative change. This includes continuing to change existing institutional structures and governance so that First Nations, Inuit and the Métis can build capacity to realize self-determination. The recommendations in the Report under the themes of culture as a foundation and self-determination are supported by these commitments and the following programs.

As noted above, ISC is currently engaged in co-development of new, distinctions-based frameworks for LTCC with First Nations and Inuit partners. Working with Indigenous partners in the development of this strategy demonstrates the importance that ISC places on self-determination as a principle for program development and renewal.

For the existing First Nations and Inuit Home and Community Care and Assisted Living programs described above, ISC provides funding, primarily through contribution agreements with First Nations or First Nation organizations, so that communities can set priorities and administer the services. For the Home and Community Care program, because the delivery of services is governed in this way, services may be offered in a culturally appropriate manner, with residual support provided by ISC. With Assisted Living, the in-home care for non-medical services stream includes services such as day programming, meal programs and housekeeping. Eligible expenses for this stream could be leveraged for cultural and land-based activities within the services area. In addition, a process exists to promote flexible funding agreements, and set funding is now only used in specific situations with solid justification. This new guidance has resulted in many contribution agreements with First Nations communities moving to a more flexible agreement type, such as the New Fiscal Relationship and New Fiscal Relationship Grant, which further emphasizes self-determination in the delivery of these programs.

Self-determination and culture are also aided by giving communities the tools to strengthen the quality and cultural safety of their health services, and ISC is committed to supporting processes that enable First Nations and Inuit individuals, families, and communities to access accredited health services that meet their needs and priorities. ISC works collaboratively with partners to improve access to high quality services with a vision to support Indigenous peoples to independently deliver services.

Pinaymootang Health Centre: We are exemplary

The ISC First Nations and Inuit Health Quality Improvement and Accreditation Program advances self-determination by supporting Indigenous-led systems and increasing health human resource capacity. Accreditation is a continuous, on-going process that measures evidence-based standards against a health organization's processes to make better use of resources, produce improved outcomes, increase efficiencies, enhance quality and safety, and reduce risk. The Pinaymootang First Nation Health Authority's Adults with Exceptionalities Program (AIDE) is an example of a successful quality improvement pilot project that aims to provide on reserve service to adults who have aged out of Jordan's Principle.

Canada is committed to ending anti-Indigenous racism in our health systems in a way that is informed by the lived experiences of Indigenous Peoples and based on the recognition of rights of Indigenous Peoples, respect, and co-operation. Four national dialogues (2020-2023) with governments, health systems partners, and Indigenous health organizations discussed measures to address anti-Indigenous racism in Canada's health systems. The discussions helped identify root causes and critical gaps to ensure systems are free of racism and systemic discrimination against Indigenous people.

The federal response to these dialogues consists of many initiatives including a new ISC Cultural Safety Partnership Fund to support Indigenous-led initiatives that aim to strengthen cultural safety and address anti-Indigenous racism and systemic barriers in health systems. In 2023, in collaboration with Indigenous partners, ISC also launched a new online hub dedicated to providing health professionals with information and resources to address anti-Indigenous racism toward First Nation, Inuit, and Métis in health systems. For example, the Incident Management Tracking System (IMTS) is a system for reporting patient safety incidents by health care providers. Psychological and cultural safety are key components of patient safety and First Nations' experiences of racism and prejudice within health services may overlap with IMTS-tracked incidents. By providing an opportunity to identify and correct issues with the quality of care, both of these initiatives help to support Indigenous self-determination and control over the services in their communities.

This principle is also reflected in An Act respecting First Nations, Inuit, and Métis children, youth, and families (the Act) which is another example of Canada's commitment to support Indigenous-led and self-determined approaches to the planning, decision-making, and delivery of child and family services (CFS). The Act offers Indigenous groups, communities, and peoples a framework to facilitate the exercise of their jurisdiction in relation to CFS and establishes national minimum standards for the delivery of CFS to Indigenous children and their families. The Act also affirms that the inherent right of self-government is recognized and affirmed by s. 35 of the Constitution Act, 1982 and includes jurisdiction in relation to CFS. The Act is part of Canada's broader commitments consistent with the UN Declaration and its implementation and is also in response to the calls to action made by the Truth and Reconciliation Commission.

Social determinants of health

Social determinants of health refer to a specific group of social and economic factors within the broader determinants of health. These relate to an individual's place in society, such as income, education or employment. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples. "First Nations view health as a holistic concept—balance between the mind, body, spirit, and emotion—that extends beyond Western notions that tend to focus on individual behaviours and genetics. Social determinants of health in a First Nations' context also include unique structural determinants, such as history, colonization, political climate, economics, and social contexts."

The Government of Canada acknowledges that Indigenous peoples, including First Nations, Inuit, and Métis may face challenges in accessing culturally safe health care. Canada is committed to working in partnership to advance the priorities Indigenous peoples put forward when it comes to health care. It is part of the Government of Canada's commitment to address the social determinants of health and advance self-determination in alignment with the UN Declaration.

The Public Health Agency of Canada (PHAC) is taking an Indigenous-led approach to engaging with Indigenous peoples through national Indigenous organizations in collaboration with ESDC on the National Autism Strategy and Canada's first ever Disability Inclusion Action Plan. The PHAC Centre for Health Promotion is leading meaningful engagement and consultation in the design of distinction-based autism strategies for Canada. The Canadian Academy of Health Sciences assessment on autism included targeted engagement with Indigenous peoples, informed by an Indigenous Advisory Committee. The committee included 2 First Nations and 1 Métis member, as well as a First Nations autism researcher.

In the context of the co-development work on distinctions-based long-term and continuing care (LTCC) frameworks with First Nations and Inuit as described earlier, ISC has also explored issues related to the social determinants of health with Indigenous partners. This has included discussions on the full spectrum of services from supports for people living with disabilities, aging in place approaches, improvements to facility-based care, and potentially services for those previously served under Jordan's Principle. This work, along with efforts across federal departments and agencies, has also addressed issues related to the social determinants of health, such as housing, income, and education.

Housing

Budget 2022 committed $4.3 billion over 7 years to support closing housing gaps in First Nations, Inuit, and Métis communities; and $300 million to co-develop and launch an Urban, Rural, and Northern Indigenous Housing Strategy (the Strategy). Budget 2023 adds another $4 billion over 7 years, starting in 2024-2025, to implement the Strategy, led by the Canada Mortgage and Housing Corporation (CMHC) and co-developed with Indigenous partners. The Strategy's focus will address the greatest housing needs of Indigenous people living in urban, rural and northern areas.

In December 2023, the Government of Canada announced that urban, rural, and northern funding would be delivered through both a National Indigenous Housing Centre, and directly by rights holders. It also announced the intention to launch an open a transparent Request for Proposal in January 2024, for Indigenous partners to be considered to lead the establishment of the new National Indigenous Housing Centre. One of the key roles of the National Indigenous Housing Centre will be to provide funding to address core Indigenous housing needs in urban, rural, and northern areas. Depending on the vision of the selected proponent, the National Indigenous Housing Centre could also play other roles including advocacy, conducting research, and partnerships, among others.

The Government of Canada will also work with First Nations, Inuit, and Métis partners and Modern Treaty Self Governing Indigenous Governments partners to co-develop funding agreements to support their citizens, members, and beneficiaries living in urban, rural, and northern areas and discuss interim approaches for those who may not be ready. This is a key step in advancing the Budget 2022 commitment.

CMHC also offers funding and financing options that support Indigenous and northern housing needs through the National Housing Strategy (NHS). The NHS Affordable Housing Fund supports the construction of new or the revitalization of existing mixed-income, mixed-tenure, and mixed-use affordable housing. CMHC budgeted $13.17 billion over 10 years to fund this strategy from 2018 to 2028. The target is to create 60,000 new housing units and repair or renew 240,000 housing units. As of September 30, 2023, 31,589 new units have either been built or are in progress, including 847 units for people with developmental disabilities. A total of 128,959 repair units are either repaired/renewed, or in progress.

Other CMHC funding programs include the following:

  • the On-Reserve Non-Profit Housing Program, ($8 million annual budget), supports First Nation communities by providing financial assistance to build affordable rental housing on-reserve. Communities can apply for subsidies and loans to help construct, purchase, and rehabilitate, as well as manage non-profit housing.
  • the Proposal Development Funding for First Nation communities is meant for the proposal stage of on-reserve housing projects. First Nation communities can apply for funding to help develop the proposal needed to enter CMHC's Non-Profit Housing Program.
  • the On-Reserve Direct Lending program offers First Nations the lowest possible interest rate for insured lending that can cover up to 100% of capital costs. First Nations and First Nations members' access to financing on-reserve may be limited due to the Indian Act. This program is the only federal lending authority for on-reserve housing development. The program subsidies help offset operating costs while the project is mortgaged, and securitization is provided in the form of a Ministerial Loan Guarantee issued by Indigenous Services Canada. This supports the construction of housing at a fraction of the up-front cost to the government. The annual budget for this program varies each year but averages $122 million.
  • the Insured Loans for On-Reserve First Nation Housing program provides financing for First Nation housing projects secured by a ministerial loan guarantee. Insured loans help First Nation members living-on reserve access financing for housing projects, including projects focused on buying, building, or renovating a single-family home or multi-unit rental property.
  • Homeowner Mortgage Loan Insurance on First Nation Lands is available for loans secured by a Ministerial Loan Guarantee, through the First Nations Market Housing Fund, by a leasehold interest in First Nation lands, or an A-To-A lease (where First Nation members who have an individual holding grant a lease to themselves).
  • Preservation Funding for community housing provides financial assistance to help eligible community housing providers (for example, non-profit housing organizations and rental co-operatives) complete preservation activities related to the sustainability of existing community housing projects. The maximum funding per project is $50,000 but may be increased to $75,000 on a case-by-case basis.
  • the Shelter Enhancement Program provides funding to build and repair shelters and housing for people who are fleeing domestic violence. CMHC works closely with First Nations across Canada to ensure these essential services are available in their communities and provide support to those looking to build new shelters or second-stage housing projects.
  • the Indigenous Shelter and Transitional Housing Initiative is a key federal response to the Final Report of the National Inquiry on Missing and Murdered Indigenous Women and Girls. The budget of $420 million over 5 years from 2020 will support the construction of 38 new shelters and 50 transitional homes for Indigenous women, children, and 2SLGBTQIA+ people fleeing gender-based violence. ISC delivers the on-going funding for operation and maintenance of the new shelters under this joint initiative.
  • the On-Reserve Residential Rehabilitation Assistance program provides funding for the repair of low-income housing including accessibility and other modifications to accommodate the needs of persons with disabilities. With an annual budget of $8.4 million, it provides up to $60,000 per home and an additional 25% for projects located in northern or remote areas.
  • the Affordable Housing Fund Renovation program provides low-interest loans and contributions to renovate and repair existing buildings for affordable housing. This option under the Affordable Housing Fund focuses on developing affordable, energy efficient, accessible, and socially inclusive housing that is mixed-income, mixed-tenure, and mixed-use that includes affordable housing.

The 2023-2025 CMHC Accessibility Plan outlines a commitment for "The Procurement of Goods, Services and Facilities" which includes adding accessibility requirement considerations in procurement contracts. All procurement and contracting officers received training on how to support their clients to incorporate accessibility into procurement by December 2023. From January 2024 onwards, accessibility will be explicitly considered in all procurements.

CMHC also facilitates community-driven programs for continuous improvement of housing such as the HousingInternship for Indigenous Youth program, funded through Employment and Social Development Canada's (ESDC) Youth Employment and Skills Strategy. With an annual budget of $1 million, this program provides financial assistance via a wage subsidy to organizations and businesses to hire First Nation, Inuit, and Métis youth. These internships provide Indigenous youth with work experience and on-the-job training, supporting their efforts to pursue longer-term employment in the housing sector and build capacity within their communities. The Indigenous Skills Training Program, established in the 1970s and with an annual budget of $1.852 million, assists First Nation communities in acquiring the skills, training, and resources needed to achieve their housing objectives.

Relevant to the recommendations regarding housing, the ISC Assisted Living Program, provides funding for non-medical social support services for low-income individuals with exceptionalities ordinarily resident on-reserve under three streams (in-home care, institutional care, and adult foster care) to help maintain their independence for as long as possible in their home communities. The in-home care component for non-medical services includes funding for services such as meal programs, housekeeping, and expenses for minor home maintenance. Institutional care provides for 2 levels of care, such as care provided in provincially licensed residential facilities. Adult foster care provides funding support for supervision and care to individuals unable to live on their own and who do not need continuous medical attention.

Income and employment

"The outcomes of this study highlight a dire need to address poverty as a root cause of harm and suffering experienced by First Nations with exceptionalities and that existing financial supports are both insufficient and come with significant barriers to access" (the Report). There are no current plans to proceed with a Universal Basic Income (UBI) in First Nations; however, ISC is currently working with Indigenous partners to make the Income Assistance program more responsive to the needs of First Nations, and to address the increased socio-economic barriers and costs faced by people living with disabilities.

The goal of the new Canada Disability Benefit (CDB) is to reduce poverty and support the financial security of working-age persons with disabilities. The benefit is meant to supplement, not replace, existing supports. The details and design of the benefit, such as eligibility and amount, will be set in the regulations. The Canada Disability Benefit Act received Royal Assent on June 22, 2023, and requires that regulations be made within 12 months of the Act coming into force, no later than June 21, 2025. ESDC launched a distinctions-based process in January 2022 to provide funding to National Indigenous Organizations to seek their advice on developing and implementing initiatives under the Disability Inclusion Action Plan (DIAP), including the new CDB. ESDC also began engagement with holders of Modern Treaty and Self-Government Agreements on the design and delivery of the CDB in fall 2022. Engagement on the CDB with National Indigenous Organizations and holders of Modern Treaty and Self-Government agreements will continue through 2024. The 2023 federal budget committed $21.5 million in 2023-2024 to continue work on the design and delivery of the new CDB, including engagement on the regulatory process with the disability community, Indigenous organizations, governments, communities, provinces, and territories.

Income and tax assistance

The Disability Tax Credit (DTC) recognizes the impact of non-itemizable disability-related costs on an individual's ability to pay tax. The criteria for qualifying are set out in the Income Tax Act. An individual must have a severe and prolonged impairment in physical or mental functions, and the effects must be such that the individual is blind, or markedly restricted in the ability to perform a basic activity of daily living, or would be markedly restricted but for extensive therapy necessary to sustain a vital function. In the case of children and adults who do not have sufficient tax liability to fully use the DTC amount, it may be transferred to a supporting family member. Eligibility for the DTC is used as a criterion for other federal benefits such as:

  • The Canada Child Benefit is a tax‑free, monthly benefit provided to parents or primary caregivers of children under 18. Families with children who are eligible for the DTC and the CCB would also be eligible for the Child Disability Benefit.
  • The Canada Workers Benefit (CWB) is a refundable tax credit that supplements the earnings of low- and modest-income workers and improves their work incentives. The CWB has 2 parts: a basic amount and a disability supplement. The CWB Disability Supplement is available to those who qualify for the CWB and are eligible for DTC.
  • The Child Care Expense Deduction provides tax recognition of eligible child-care expenses incurred so a primary caregiver can work. If the child is eligible for the DTC, the caregiver has access to a higher maximum expense limit and care expenses. DTC-eligible children may be claimed regardless of their age.
  • The Registered Disability Savings Plan (RDSP), including Canada Disability Grants and Bonds is a savings plan intended to help an individual who is eligible for the DTC to save for their long-term financial security. To encourage saving in an RDSP, the Government supplements private contributions with grants and bonds.
  • The Home Accessibility Tax Credit is a non-refundable tax credit for eligible home renovation or alteration expenses for a qualifying individual who is either over 65 or any age and who is eligible for the DTC.
  • The Multigenerational Home Renovation Tax Credit is a refundable tax credit for expenses related to constructing a self-contained secondary unit so that a person over 65 or a person over the age of 18 who is eligible for the DTC may live with a qualifying relative.

Tax support is also available for individuals who incur above-average medical or disability-related expenses through the Medical Expense Tax Credit. Eligible expenses are listed in the Income Tax Act and the Income Tax Regulations and include those paid to a medical practitioner or a public or private hospital; as renumeration for attendant care or as payment for full-time care in a nursing home; for prescription drugs; and for laboratory, radiological or other diagnostic procedures. Taxpayers may pool and claim the medical expenses that they or their spouses or common-law partners and minor children incur. Caregivers who incur medical and disability-related expenses for an aging parent, adult child, or other relative who is financially dependent on them, are also generally able to claim these expenses. The Refundable Medical Expense Supplement is a refundable tax credit that provides low-income working Canadians with assistance for medical and disability-related expenses, including those claimed under the Medical Expense Tax Credit.

The Canada Revenue Agency (CRA) provides support to First Nations tax payers with disabilities to access benefits they are entitled to via the following programs:

  • The Northern Residents Phone Line is a dedicated phone line available to Individuals in the Yukon, Northwest Territories, and Nunavut for questions about northern residents' and medical-related tax credits and benefits, such as the DTC.
  • The Community Volunteer Income Tax Program (CVITP) and other outreach programs provide tax awareness to help vulnerable populations access the benefits and credits to which they are entitled. They work with partners in Indigenous communities to offer education and support, including sharing promotional materials, delivering customized information sessions, and recruiting and training volunteers.
  • Super Clinics are multi-stakeholder events where CVITP volunteers, benefits outreach officers, and other stakeholder/partners provide support to individuals. The Super Clinic model eliminates barriers by providing essential tax filing support in one place, at one time, and free of charge.

Food security

ISC supports food security-related activities indirectly through a range of programs, services, and initiatives that address priority areas such as diabetes prevention, nutrition education, income assistance, lands and economic development, and health adaptation to climate change. Included in these are a suite of community-based, culturally relevant health promotion programs that focus on healthy child development, healthy living, and social and mental wellness. ISC also collaborates with other federal departments on food-related policy efforts and mechanisms such as the Food Policy for Canada, the development of a National School Food Policy and programming, and the Nutrition North Canada Horizontal Initiative. ISC is currently working with Indigenous partners to make the Income Assistance program more responsive to the needs of First Nations, and to address the increased socio-economic barriers and costs faced by people living with disabilities. This includes flexible funding for community driven projects such as food security.

The ISC First Nations and Inuit Home and Community Care (FNIHCC) supports culturally appropriate services through a community-based care model that provides comprehensive, culturally sensitive, and responsive services unique to the health and social needs of First Nations and Inuit. The HCC supports nutrition, meal planning, and meal preparation as part of the home care available on reserve, including incorporating traditional foods where available. Furthermore, the in-home care portion of the ISC Assisted Living program (ALP) includes expenses for meal programs, meal preparation, and menu planning. In some communities, ALP funding is used to pay for culturally appropriate traditional or "feast" food. For example, a health centre in Sioux Lookout received a special exemption to serve uninspected wild meats and game to patients as part of their Miichim traditional food program.

Education and employment

The ISC Elementary and Secondary Education Program (ESE) provides flexible core funding for eligible on-reserve First Nations students from kindergarten to grade twelve. The formulas allocate funding based on provincial comparability with adaptations and enhancements for unique First Nations contexts. Funding through the ESE program is provided for special education services for First Nations students identified as having mild to profound learning disabilities. Services commonly funded include: programming, remedial instruction, clinical services, and resource teacher staffing. First Nations have the flexibility to spend these core funds based on the education-related priorities of their communities and students.

The ISC High-Cost Special Education Program (HCSE) provides additional funding for supports and services for on-reserve students assessed with moderate to profound learning disabilities and whose special education needs cannot be met within the resources available through ESE program. The ESE and HCSE programs are available to eligible on-reserve students aged 4 to 21 and who wish to continue to attend school past age 18, which exceeds some P/T jurisdictions. ISC continues to work with partners on their priorities in this area.

Budget 2021 invested $350 million over 5 years in adult education to expand access to secondary completion and upgrading for First Nations students living on reserve, as well as in Yukon and Northwest Territories. Implementation and expanded activities are currently supported through targeted funding, and adult secondary education will soon also be supported through ISC's ESE program funding formulas. Adult education funding is flexible, and First Nations may use it to develop their own programs to support students, inclusive of those with special needs to complete or upgrade their secondary education. This arrangement supports First Nations control over First Nations education. ISC provides funding and supports for First Nations Post Secondary Education (PSE) students through the First Nations PSE Strategy and is committed to closing the post-secondary educational attainment gap. The PSE Strategy includes:

  • The Post-Secondary Student Support Program provides non-repayable financial support for First Nations students to advance towards a recognized PSE credential, prioritized and directed by First Nations.
  • The University and College Entrance Preparation Program provides non-repayable financial support for students enrolled in accepted PSE entrance preparation programs, prioritized and directed by First Nations.
  • The Post-Secondary Partnerships Program provides funding to support First Nations to define their own partnerships with institutions to increase the availability of PSE programs tailored to First Nations needs.

ISC is committed to advancing forthcoming First Nations' regional PSE models that are intended to enable First Nations to transition from the current suite of PSE programs to holistic approaches more responsive to First Nations' local priorities and needs. ISC also provides funding to First Nations for employment and life-skills development through the pre-employment supports and case management components of the Income Assistance Program. ISC is working with First Nations partners to increase access to these supports, both which were raised in the Income Assistance program engagement and co-development processes.

There are other skills programs that support the recommendations such as the ESDC Indigenous Skills and Employment Training Program (ISET) and the Skills and Partnership Fund (SPF). The ISET is a distinctions-based labour market program designed to reduce the gap in skills and employment between Indigenous and non-Indigenous people. ISET funds Indigenous organizations to design and deliver skills training and employment supports, including for Indigenous persons with exceptionalities. The ISET annual budget is $408.2 million plus as additional $131 million for 2021. The SPF is a project-based program of $50 million per year to fund Indigenous organization and industry employer partnerships to provide skills training for Indigenous people, including those with exceptionalities.

Support across the lifecourse, person-centred care, and caring for caregivers

Caregiving can be demanding, complex, and stressful and we hear this loud and clear. "Despite little to no training, caregivers are expected to provide medical and nursing care in the home, navigate complicated health and long-term care systems, and serve as substitute decision makers". The Report refers to informal caregiving "where care is provided to someone in their immediate circle who is not a typical paid health or social services professional".

In February 2023, Canada announced an investment of $196.1 billion over 10 years, including $46.2 billion in new funding, for provinces and territories to improve health care services for Canadians. This funding will be distributed partly through the Canada Health Transfer and partly through tailor-made bilateral agreements with provinces and territories that allow for flexibility for jurisdictional health care system needs. In addition, it will invest $2.5 billion over 10 years to support the unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. The Indigenous-specific funding stream will be distributed on a distinctions basis through a health equity fund.

Supports for individuals with disabilities and supports for family caregivers were both identified by First Nations partners as key themes in the LTCC engagement noted above. Co-development discussions have been exploring ways to remove barriers for individuals with disabilities as part of the distinctions-based LTCC frameworks. The framework will cover a full spectrum of services including supports for people living with disabilities, aging in place approaches and improvements to facility-based care.

The First Nation Child and Family Services program exists to provide resources and funding to support the holistic and culturally appropriate delivery of child and family services (prevention and protection) that meet the needs of children, youth, and families ordinarily resident on reserve or in the Yukon. The assessment of an individual's needs as they relate to disability supports would occur at the individual / family, service provider, and First Nation level. Post-majority support services include supports that assist First Nation youth transition into adulthood and independence, such as housing, food security, health and wellness activities, life skills development, education or assistance, community and cultural (re)connection and assistance to establish family and social relationships and self-care. ISC developed a new Post-Majority Care Services Toolkit in 2022 to inform youth and providers of tools and supports available. The toolkit is updated regularly, most recent version in March 2023. ISC also partnered with the Kids Help Phone in Jan 2023 to provide First Nations youth and young adults with access to information on post-majority support services and connection to relevant resources.

An Act respecting First Nations, Inuit and Métis children, youth, and families (the Act): If an Indigenous group, community or people intends to exercise its legislative authority in relation to CFS, funding, through a coordination agreement, is available to Indigenous governing bodies acting on behalf of that Indigenous group for post-majority support services. Post-majority care is an array of services for First Nations youth and young adults formerly in care that are intended to support the successful transition to adulthood. The supports proposed here for Indigenous governing bodies will aim to provide services to support the safety and well-being of Indigenous youth in a culturally appropriate approach that is also grounded in the principles of substantive equality and the best interest of the youth. Support services and programs can include, life skills training and assistance, housing, community and cultural (re)connection supports, wellness, financial supports, and education supports.

The ISC Healthy Children, Youth, and Families Division provides support for healthy pregnancies, healthy births, and healthy child development in First Nations and Inuit communities through services such as Maternal Child Health, Canada Prenatal Nutrition (First Nations and Inuit Component), Indigenous Midwifery, Aboriginal Head Start on Reserve, and Fetal Alcohol Spectrum Disorder. These services aim to improve health outcomes for First Nations and Inuit infants, children, youth, families and communities through access to a basket of supports with areas of focus that include pre and postnatal care and supports, pre-conception and reproductive health, nutrition, early literacy and learning, physical, emotional and mental health.

The First Nations and Inuit Home and Community Care Program (HCC) is a coordinated approach to home and community-based health care services that enable First Nations and Inuit of all ages with disabilities or chronic or acute illnesses, and the elderly, to receive care in their homes and communities. Service delivery provides a managed care process that incorporates case management, referrals, and linkages to existing services provided both on and off reserve. ISC supports HCC operators in ensuring that community members can access essential service elements of the program such as the provision of in-home respite care and establishing linkages with other professional and social services.

The PHAC Dementia Community Investment program provides funding for people living with dementia and their caregivers. The DCI supports community-based projects that seek to improve the wellbeing of people living with dementia and family/friend caregivers, and/or increase knowledge about dementia and its risk and protective factors among project participants.

The Medical Expense Tax Credit (METC) recognizes the effect of above-average medical or disability-related expenses on an individual's ability to pay tax. Taxpayers may pool and claim the medical expenses that they or their spouses or common-law partners and minor children incur. The METC provides tax recognition for specific expenses, which are listed in the Income Tax Act and the Income Tax Regulations. Caregivers who incur medical and disability-related expenses for an aging parent, adult child, or other relative who is financially dependent on them, are also generally able to claim these expenses.

The Canada Caregiver Credit is a non-refundable tax credit for those supporting a spouse, common-law partner, or a dependent relative with a physical or mental impairment. An individual is considered dependent if they rely on the taxpayer to regularly and consistently provide some or all of the basic necessities of life, such as food, shelter and clothing.

The Disability Tax Credit (DTC) is a non-refundable tax credit that helps persons with disabilities or their supporting family members reduce the amount of income tax they may have to pay. If the person with the disability does not need the entire disability amount to reduce their income tax, the unused amounts may be transferred to the supporting family member.

Health care and social service systems

"We recognize that disabilities are diverse in nature and there is no one-size-fits-all solution. But whatever a person's needs may be, the Government of Canada is committed to making our country more accessible and more inclusive for everyone."

Justin Trudeau, December 2022

In ISC's engagement on LTCC, receiving services closer to home, service provision and service delivery issues were identified by First Nations partners as key themes. Separate from the engagement process, in 2022, ISC received $183 million over 3 years for improving LTCC in Indigenous Communities (which included $2.8 million to expand the engagement to include Métis). In addition, ISC is currently working with Indigenous partners to make the existing Income Assistance program more responsive to the needs of First Nations, and to address the increased socio-economic barriers and costs faced by people living with disabilities.

Palliative care is a key element of the continuum of services for First Nations living within their own homes and communities. Budget 2017 announced investments in home and palliative care services for First Nations and Inuit – $184.6 million over 5 years and $69.1 million ongoing – representing a 76% increase in annual funding in this area. The funding will support enhancements to the First Nations and Inuit Home and Community Care program (FNIHCC), including the provision of palliative care services. Offering palliative care services, including culturally appropriate palliative care assessments, and training, will allow clients to remain in their home community for care rather than having to seek treatment in larger, and often unfamiliar, urban centres.

ISC is also working on the recruitment of public health professionals and the goal of providing funding to support community-led approaches. The community approach is important to address key public health priorities and support public health training needs for existing professionals and Indigenous youth interested in community public health. ISC recognizes the need to increase representation of Indigenous workers in the health care system and to address health human resources needs, particularly for rural and remote communities. The challenges related to training and retention of health professionals on reserve may be related to numerous factors including staff wages and geographic isolation. ISC's Aboriginal Health Human Resources Initiative (AHHRI) provides training to community-based workers and health managers delivering services in First Nations communities to improve the quality and consistency of services. The AHHRI program is managed by regional leads who prepare training plans ahead of community requests to disseminate funding. As such, service delivery channels will vary in relation to community needs and capacity, and they would not necessarily receive specific applications for the program. Between 2015 to 2020 (most recent data available), 1680 community-based workers and health managers completed training in health promotion and disease prevention funded by AHHRI.

ISC's Non-Insured Health Benefits (NIHB) Program provides registered First Nations and recognized Inuit with coverage for a range of health benefits, when not otherwise covered by other plans or programs. Per the mandate of the NIHB Program, benefits coverage is evidence-based; nationally consistent, and managed in a sustainable and cost-effective manner.

NIHB is committed to continual improvement of program benefits and services and regularly reviews administrative processes for prior approval of benefit coverage, and implements changes to streamline these processes or, where possible, remove the requirement for prior approval. For a drug to be listed on the NIHB Drug Benefit List for coverage, it must be approved by Health Canada under the Food and Drug Regulations and have a Notice of Compliance signifying compliance with the regulations and a Drug Identification Number.

Items covered through the NIHB medical supplies and equipment benefit are intended to address NIHB clients' medical needs in relation to basic activities of daily living. Benefit coverage policies (including frequency and quantities) are informed by evidence, best practices, device life expectancy, and the advice of health professional expert advisory committees. The program reviews all requests for exceptional coverage on a case-by-case basis.

The Government of Canada is engaged in a multi-year joint review of the NIHB program, in partnership with the Assembly of First Nations (AFN). The objectives of the review are to identify and implement actions that enhance client access to benefits, identify gaps in benefits, and streamline service delivery. This review includes a review of the medical transportation. Budget 2017 provided $86 million over 5 years to expand the NIHB mental health counselling benefit, which now includes the services of traditional healers to address mental health needs. ISC facilitates access to traditional healers by providing clients (or the healer) coverage for travel, accommodations and meals to see a traditional healer when medically necessary.

The NIHB medical transportation benefit provides transportation to assist clients access medically required health services that cannot be obtained on the reserve or in the community of residence. Coverage is provided for the most economical and efficient means of transportation. In some communities, the NIHB Program may fund medical vans/vehicles (including accessible vehicles) for community use in transporting NIHB clients in the community to and from medical appointments, when this represents the most cost-effective mode of transportation. Note that the NIHB Program mandate is specific to transportation for medical purposes and does not purchase vehicles for individuals/families. NIHB clients travelling to an urban centre as part of a medical trip receive coverage including transportation to and within the urban centre to access appointments, as well as coverage for meals and accommodations. For those residing in urban centres who require assistance with the cost of public transportation, subsidies are available through provincial social assistance and/or disability programs. The NIHB medical transportation benefit provides coverage of multiple modes of transportation. For clients who drive their personal vehicle to a medical appointment outside the community where they live, NIHB coverage rates per kilometre continue to follow increases in the National Joint Council kilometric rates. Medical transportation coverage rates are currently under review.

The Report specifically asks for a commitment to transition from the current sole reliance on nursing model of care to a multidisciplinary team-based, community-driven, holistic health care model. ISC has and will continue to expand its model of care in remote and isolated nursing stations. This expansion toward an interprofessional model of care includes registered nurses, paramedics, nurse practitioners and licensed practical nurses. The move towards an interprofessional model is critical in terms of meeting the needs of communities within the context of global shortages in health human resources which have only increased since the COVID-19 pandemic.

Another area where ISC is working to expand the model of care towards an interprofessional is oral health. ISC's Community Oral Health Service is provided on-reserve to increase access to oral health promotion, prevention and basic treatment. Oral health teams include children's oral health aids, dental hygienists and, in some cases, dental therapists. The focus of these providers is largely children, their parents/caregivers and pregnant women, with or without disabilities.

In terms of social supports, Canada Revenue Agency (CRA) also has programs that indirectly support a multi-disciplinary team approach such as the Community Volunteer Income Tax Program that has existed since 1971. The program is a longstanding partnership between CRA and communities that facilitates free tax clinics where volunteers complete income tax and benefit returns for eligible individuals. CRA also offers in-person visits across Canada through an outreach program and can help organizations educate clients about benefits and credits they may be entitled to receive.

Overall, the Report identified 3 overarching and intertwining key components that factor into the perspectives around disability services:

  1. Design, structure, and administration of federal government programs
  2. Inadequate resources, services, and supports
  3. Failure to deliver culturally and stigma-safe services/supports to First Nation persons with exceptionalities on-reserve.

ISC's mandate serves to advance partnerships, the closing of socio-economic gaps, and the transfer of responsibilities and services to Indigenous partners and institutions. This means making sure Indigenous peoples are at the table for any decisions affecting their interests, that funding is available for these processes, and that we work together to build foundational pieces to support community-led control of programs and services and through the ongoing co-design and transfer of programs and services.

Community infrastructure, resources, capacities and research and data

The report shared that "poor community infrastructure and a lack of accessibility at the community-level drastically limited participants' ability to participate in community life, cultural activities, and recreation." Further, "we envision a world where First Nations have enhanced control over services, supports, and infrastructure as they see fit in their communities." Canada supports the key role that First Nations Band Councils play in community accessibility.

The Accessible Canada Act (ACA) requires regulated entities, including First Nations band councils, to prepare and publish accessibility plans. First Nations organizations raised concern about the ability of band councils to comply with this requirement due to competing priorities, lack of administrative capacity, and dedicated accessibility funding. A 5-year exemption for band councils from the planning and reporting requirements of the ACA was included in the Accessible Canada Regulations that will expire December 2026. The ESDC Accessible Canada Directorate is progressing work related to its UN Declaration Action Plan 2023 commitment to advance the implementation of the ACA in a way that is culturally appropriate. As part of this work, ESDC will work with First Nations to establish programming that would support communities in identifying their unique accessibility needs.

The Canada Mortgage and Housing Corporation (CMHC) 2023-2025 Accessibility Plan outlines a commitment to accessibility in "The Design and Delivery of Programs and Services" which includes helping housing developers to fund new projects. While working to make programs more accessible, CMHC will inform people with disabilities about the accessibility accommodations. For example, CMHC will provide a dedicated phone number for program questions and will include an accessibility statement on requesting documents in alternative formats from the Housing Knowledge Centre.

Other CMHC programs that support community driven accessibility planning include:

The ESDC Enabling Accessibility Fund (EAF) also supports community driven accessibility planning. It is a grants and contributions program that provides funding for infrastructure projects to make Canadian communities and workplaces more accessible. In the 2022 Small Call for ProposalsFootnote 4 under the EAF, $3 million was allocated to Indigenous-led organizations for construction, renovations, retrofits, and assistive technologies to increase access to programs, services, and community activities. Through this Call For Proposals, approximately $4.8 million supported Indigenous-led organizations. The EAF is a competitive program and eligible organizations can apply for funding through calls for proposals.

First Nations communities do not have legally enforceable safe drinking water protections comparable to those in place in provinces and territories. In 2013, the Safe Drinking Water for First Nations Act came into effect to support the development of federal regulations to support First Nations' access to clean, reliable drinking water and effective treatment of wastewater. However, First Nations voiced concerns about this legislation during ongoing engagement since 2018, saying the law was not effective. In response to these concerns, the Government of Canada repealed the 2013 Safe Drinking Water for First Nations Act in June 2022. Canada is committed to developing and introducing new First Nations drinking water and wastewater legislation, in consultation with First Nations.

Research and data

The Report shared "there is no systematic or national data available to understand the number or type of disabilities for First Nations on- and off-reserve". UN Declaration priority action 85 states, "Ensure that the equality rights of Indigenous persons with disabilities are respected in the design and delivery of Government of Canada programs, policies, and services. This includes seeking concrete data solutions to better understand the socio-economic situation of Indigenous persons with disabilities." Budget 2022 provided $37 million in funding over 5 years to support the core capacity of Indigenous governments, organizations, and groups to continue to contribute meaningfully to the implementation of the UN Declaration Act and the associated Action Plan.

ISC is committed to developing a data strategy with First Nations and Inuit partners to be implemented as early as FY2025-2026 for the Assisted Living and the First Nations Home and Community Care Programs. During the pre-implementation phase, ISC will hold discussions with the First Nation and Inuit partners to determine the approach to an overall data strategy. These discussions will be respectful of an Indigenous-led approach for data that, in addition to conforming with federal legislation, aligns with the principles of service transfer including Indigenous ownership, control, access and possession (OCAP®) for how data and information should be collected, protected, used and shared, to support the requirements for results reporting and decision making for both ISC and Indigenous service operators.

The Public Health Agency of Canada (PHAC) is working to support data sovereignty and help ensure that First Nations, Inuit, and Métis have sustainable data capacity through a combination of internal activities and engagement with partners to ensure that First Nations' data, surveillance and science priorities are appropriately reflected and resourced. Post-covid, PHAC is launching renewal processes including the development of our 2025-30 public health data, surveillance, and science priorities. The goal is to transform public health through improvements in data and surveillance systems, aligned with science priorities. Endorsed by federal, provincial and territorial ministers of health in October 2023, the Pan Canadian Health Data Charter articulates a common set of principles intended to guide collective action towards a shared vision for health data in Canada, including a commitment to support First Nations, Inuit, and Métis data sovereignty and Indigenous-led governance frameworks.

PHAC provided financial support to the First Nations Information Governance Centre to develop a mental wellness report focused on First Nations living on reserve and in northern communities that will use data from the First Nations Regional Health Survey (RHS). The data are collected using an approach built on an inherent respect for data sovereignty in accordance to First Nations principles of OCAP®.

The PHAC Enhanced Dementia Surveillance Initiative supports the surveillance of dementia, including data collection and community engagement, in Indigenous populations. The National Indigenous dementia surveillance initiative aims to work with First Nations, Inuit, and Métis partner organizations to conduct a feasibility study to explore acceptable and appropriate methods for improving dementia surveillance among Indigenous populations. The second part of this project (2022- 2024) aims to enhance the monitoring of dementia by First Nations communities. A robust training platform will be developed and piloted to facilitate uptake of the Canadian Indigenous Cognitive Assessment.

The PHAC Enhanced Surveillance for Chronic Disease Program includes projects to support the co-development of a culturally-safe and relevant surveillance tool on Vancouver Island. The project aims to work with the Gwa'sala-‘Nakwaxda'xw people to design and implement a culturally-sensitive, community-led and sustainable chronic disease surveillance system.

The PHAC Métis Nation Health Data program supports the Métis Nation in building capacity for sustainable health data monitoring and reporting systems within their governments by ensuring the necessary partnerships and resources are in place to gather and analyze health data related to their citizens. Métis Nation-specific health data will provide evidence to further support policies and programs for health service delivery that is culturally responsive with the ultimate goal of improving health outcomes for the Métis Nation.

The CMHC Indigenous Research and Data HUB (HUB6) supports Indigenous-led and co-led housing research on priorities identified by Indigenous organizations and communities. External projects supported through HUB6 funding are Indigenous-led using methodologies preferred by Indigenous proponents. CMHC staff are involved in liaising and supporting funded partners but do not direct these projects or have involvement in data collection, analysis, interpretation, and reporting. All staff working in HUB6 undergo OCAP® training offered by the First Nations Indigenous Governance Centre. The fundamental eligibility criteria for funding is the ability to advance housing related research priorities of Indigenous organizations. As such the populations included (or "studied") in a project depend purely on the discretion of the First Nations, Inuit, or Métis organization.

Conclusion

We know that implementing the UN Declaration requires internal changes to government. Within ISC, we are committed to raising awareness of our obligations and supporting change. As of September 2020, ISC implemented a mandatory cultural competency learning policy and is now developing a cultural competency survey to assess its effectiveness. This year ISC delivered training sessions to over 900 employees to raise awareness of how our work intersects with the UN Declaration. We are ensuring policy consistency through the creation of tools for Cabinet documents, and a monthly community of practice to build capacity around implementation and working in consultation and cooperation with Indigenous peoples. All of the above programs and services are critical to advancing self-determination and increasing equity — key objectives of the UN Declarationcurrently being implemented by ISC and the rest of the Government of Canada, in collaboration and consultation with Indigenous Peoples.

Canada is committed to co-developing distinctions-based Indigenous health legislation. Together with Indigenous partners and the provinces and territories, we are co-developing new distinctions-based Indigenous health legislation to improve access to high-quality, culturally relevant health services. The co-development of distinctions-based+ Indigenous health legislation is an opportunity to establish overarching principles as the foundation of health services for Indigenous peoples; support the transformation of health service delivery through collaboration with Indigenous organizations in the development, provision and improvement of services to increase Indigenous-led health service delivery; and continue to advance the Government of Canada's commitment to reconciliation and a renewed nation-to-nation, Inuit-Crown and government-to-government relationship with Indigenous peoples based on the recognition and implementation of rights, respect, co-operation and partnership.

Canada is also committed to taking additional steps to combat racism, racial discrimination and all other forms of social injustice in Canada, including through a National Action Plan on Combatting Hate. Canada will take further action to combat and eradicate systemic racism against Indigenous peoples, especially in the health-care system, through the co-development of distinctions-based Indigenous health legislation and a mental health and wellness strategy.

The Government of Canada is engaged in a number of initiatives to make progress on the health and social needs and interests of Indigenous people. We will build on these initiatives as we continue to work on improving the services and supports that are there to help Indigenous individuals with more complex health needs and their families, through the work of ISC and other government departments.

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