Towards healthier Indigenous health policies? Navigating the labyrinth for answers

This research is based on two years of community-based participatory research that draws on Indigenous understandings of health policy in five First Nations in Ontario, Canada. While a number of policies have been put in place to increase Indigenous control over community health services, we argue that policies enacted to promote Indigenous self-determination in health care have been counterproductive and detrimental to Indigenous health and wellbeing. Instead, we suggest that Indigenous health policy exists on a continuum and aim to balance the need for including diverse Indigenous groups with comprehensive control from program funding and design to implementation. This poses some difficult questions: How do Indigenous peoples perceive the concept of self-determination, community-controlled health care and the efforts of the Canadian government to form collaborative arrangements between Indigenous communities, organisations and government? What does an inclusive and comprehensive Indigenous community-controlled health care system look like? The purpose of this article is to explore how Indigenous people and community stakeholders in Canada understand terms such as self-determination and health and draw conclusions about collaborative efforts between the government and Indigenous communities to support community-controlled health care. It further explores participant narratives and describes their experiences, particularly, the strengths and weaknesses of community-government health policy developments