The Role of Provinces,States, and Territories in Shaping Federal Policy for Indigenous Peoples’ Health

ABSTRACT

Under both Canadian and United States law, the availability and quality of healthcare and health services to Indigenous peoples are primarily a federal responsibility. Nevertheless, sub-national authorities—most importantly provinces, states, and territories—play a crucial role by virtue of covering (often through federal mandate) services, and regulating health facilities and health personnel off-reserv(ation). While both federal governments have undertaken efforts to transfer, within their fiduciary obligations, their responsibilities for Indigenous peoples’ health to the management of Indigenous peoples themselves, that transfer has considered or included provincial, state, and territorial authorities and resources unevenly, and, in some cases, in tension with the objectives of respecting standards for quality and access. This article applies the methodology used by Canadian researchers of the sub-national health authority issue to the health transfer experience in the United States. The article summarizes findings that demonstrate similar deficiencies as those present in the Canadian transfer process. The article further outlines the experiences of Hawai`i and Ontario as offering models through which to address some of these deficiencies. The article finally suggests that there is a positive relationship between greater participatory models adopted by provinces, states, and territories and better health outcomes among Indigenous groups so included.     

ÉVOLUTION DE L'AGRICULTURE MARAÎCHÈRE AU QUÉBEC DE 1940 À 1990: SUPERFICIES,PRODUCTIONS ET DIVERSITÉ

Depuis plus d'un siècle, l'agriculture québécoise en général, et la production maraîchère en particulier, ont subi d'importantes transformations. Cette étude historique vise à comprendre comment la production maraîchère a évolué par rapport aux changements dans l'environnement décisionnel général de l'agriculture entre 1940 et 1990. L'analyse des données statiques de superficie, de production et de rendement pour 12 légumes ont permis d'identifier trois périodes, intercalées d'années transitoires, dans l'évolution de la production maraîchère référant chacune à une stratégie agricole particulière. La première (1940–1957) correspond à une stratégie agricole de type familial traditionnel; la seconde (1963–1975), à une agriculture marchande spécialisée fondée sur la maximisation des revenus à court terme par intensification; la troisième (1980–1990), à une agriculture marchande diversifiée fondée également sur une maximisation à court terme. Les facteurs externes de l'environnement décisionnel qui ont entraîné ces changements sont identifiés et discutès. For more than a century, Quebec agriculture in general, and market-gardening production in particular, have experienced important changes. This study, using a historical perspective, seeks to understand how market gardening evolved in relation to changes in the broad decision environment for agriculture between 1940 and 1990. Statistical analysis of data on the areas cultivated, production levels, and yields for 12 vegetable crops revealed three distinct periods, separated by periods of transition, in the evolution of market gardening. Each period is characterized by a particular type of agricultural development strategy. The first period (1940–1957) is characterized by a focus on the traditional family form; the second (1963–1975), by a specialized market agriculture driven by short-term income-maximization intensification; the third (1980–1990), by a diversified marketoriented agriculture, also based on short-term income maximization. External environmental factors that stimulated these changes are identified and discussed.     

Health geography in Canada: where are we headed?

This paper overviews the emergence of medical/health geography in Canada. The paper discusses the key questions that Canadian health geographers have explored in the past two decades, how these enquiries have featured in the field and how they contribute to the wider discourse of human geography. It also addresses questions on emerging themes and where Canadian health geography will go in the years ahead. With shifting health landscapes in terms of changes in social, political and physical environments, and changes in health care restructuring, Canadian health geographers are entering a new phase of research, teaching and policy. The complexity of the questions that health geographers seek to address means it is necessary to continue to highlight the policy implications of their findings. Health geographers need to emphasize the public agenda through interdisciplinary research and by continuing to work with geographers in other subfields.