Self-determination in health: a road to community wellness? A critical look at Island Lake's evolving model of health service delivery

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Grimes, Deborah L.
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The disproportionate burden of disease in the Aboriginal population in Canada has become so great that it is now being referred to as a health ‘crisis’. Evidence suggests that the answer to these ills lies not in the western biomedical model of heath care, but within the Aboriginal traditions of self-determination and holism (RCAP, 1996; O’Neil, Lemckuk-Favel, Allard & Postl, 1999; Romanow, 2002; CIHI, 2004; Maar, 2004; First Nations & Inuit Regional Health Survey, 2004). To this end, First Nations communities have been negotiating with the federal government and transferring responsibility for their community-based health services since 1986, despite the limitations of the federal Health Transfer Policy (Gregory, Russell, Hurd, Tyance & Sloan, 1992; Lavoie, et al, 2005; RCAP, Vol 3, Chp 3, 1996; Speck, 1989). These self-determination initiatives in health attempt to improve the health status of community members. Thus, determining an approach to health service delivery that contributes to positive health outcomes is of particular significance. Examining Island Lake’s evolving model of health service delivery indicates the success of the intergovernmental, interdepartmental, and intersectoral partnership approach they have taken; as evidenced by the Regional Renal Health Program, with dialysis treatment services, that has been established, perhaps for the first time in the country, in a remote First Nations community without existing hospital services. There remains work to be done in creating a holistic system of health service delivery that reflects their unique worldview within a context of health promotion and self-determination; however, their accomplishments to date, established processes, willingness to put their dreams into action and build what has not been built before demonstrate a potential to improve community health and well-being.
First Nations, health, service delivery models, self-determination