There has never been anything quite like it in Canada – the wholesale relinquishment of Ottawa's long-held control over native health services in British Columbia to first nations themselves.
Although the final transfer of authority is still months away, leading B.C. chiefs are already taking their historic responsibility seriously, in a way few desk-bound bureaucrats or cabinet ministers would consider part of the job. They're getting fit.
In recent weeks, Sto:lo Grand Chief Doug Kelly has lost 22 pounds, while Chief Willie Charlie of the nearby Chehalis band in the Fraser Valley is down nearly 20 pounds. The beefy chiefs have cut junk and fast food from their diet, and they are exercising.
"I'm at 218 pounds. In my dreams, I'd like to get down to 200," Mr. Charlie said. He is also encouraging dozens of band employees to join him in a walk and run program.
The two are among 14 chiefs overseeing the new native health authority who were challenged by its chief executive, Joe Gallagher, to set an example for their people.
"Every chief is a champion in their community, so we asked them to look at themselves and their own health," Mr. Gallagher said. "We want them to have health in the forefront of their mind, instead of in the back, and we want them to model what they're doing."
Mr. Kelly, 52, an enthusiastic architect of the looming takeover, was all for it. "Willie is doing his physical activity, his diet," he said. "He's looking after himself. He's showing his people how to recover good health. I'm doing the same. I'm telling my story everywhere."
The chiefs' personal embrace of good health practices is just one example of how native leaders hope that by running their own show the abysmal health gap between aboriginal and non-aboriginal British Columbians will begin to narrow. After Oct. 1, native health programs will be designed, delivered and managed by the First Nations Health Authority (FNHA), which will also pay for prescription drugs, dental care and travel costs for acute care, as Health Canada does now.
Federal Health Minister Leona Aglukkaq says the switch to first nations control in B.C. is a game-changer. "This has been a very fun file for me," she said Friday. "Why? Because it empowers first nations to take charge of their health, to focus on areas that are important to them, and to make their own decisions. As an aboriginal person, this is very rewarding."
Once in control, the FNHA intends to stress hands-on health prevention, promotion and wellness programs, while restoring traditional native healing methods to the health-care system. That could mean the use of community medicine men and women, elders and native healing centres.
"Right now, we have a sickness system," said Mr. Kelly, chair of the council providing direction for the FNHA. "We're talking about encouraging lifestyle changes, taking responsibility for ourselves, and heading off disease. We can take the best of modern medicine and blend it with our traditions, our medicines, our sacred ceremonies."
Programs inevitably will be more culturally appropriate, and without the rules and reporting burdens that often frustrated public health nurses employed by Health Canada.
"Ottawa is big and far away, and that's life," said Health Canada's Lynn Bernard, director general of the B.C. Tripartite Agreement between Ottawa, B.C. and first nations that established the FNHA. "We have good programs, but now they will be tailored closer to the local level, to the person on the reserve."
The federal government is not abandoning the field, however. The landmark transfer of its responsibilities to the country's first provincewide native health authority will be mostly funded by Health Canada, as services currently are, to the tune of $2.5-billion over the next five years.
At the same time, the switch is more than paperwork. It will directly affect Health Canada's 200 B.C. employees, who will lose their government jobs. They will have the choice of working for their new boss, or heading out the door.
Mr. Kelly insisted there has been a sea change in employees' attitudes, as the parties get to know each other better. "In our first meeting, the tension was as thick as some of that fog we've been having," he said. "Last month, I couldn't believe the difference, the energy in that room. We understand there's some anxiety and resentment, but we need these people, and we've told them that."
Meanwhile, the way to the new frontier will be eased by the many native communities in B.C. that already run much of their own health programs. The Seabird Island band in the Fraser Valley has a particularly ambitious native health centre, which includes a mobile diabetes clinic, dental services, full-time nutritionist, home support and mental illness treatment, all administered with a "holistic view" of health, according to director Carolyne Neufeld. They are now graduating their own licensed practical nurses, and just started a Weight Watchers' program. They have also eliminated doughnuts from band meetings.
"Please come and visit us," Ms. Neufeld implored. "I want everyone to see what first nations can achieve, and now we're taking over. [The FNHA] won't be perfect. No health care system is. But this is about first nations taking on responsibility. This gives us the chance."
Few are more pumped at the prospect than Evan Adams, the Coast Salish actor and doctor who is deputy provincial health officer for B.C., which is contributing $83.5-million to the venture over the next six years. "First nations people are firm: We can look after ourselves," Mr. Adams said. "Who wants to let someone else decide whether they live or die? We won't let others decide these things."