Conversation, collaboration and change: How a dream for Aboriginal children is bringing organizations together

“I want all of our children to have dreams – not bad dreams, but good dreams. Dreams about what they want to become, how they can strengthen each other.” –Ovide Mercredi It has been said in many different ways that societies can be judged by how they treat their most vulnerable members. The same might be said of an organization like the Canadian Paediatric Society (CPS), whose mission is to improve the health of children and youth in Canada. One way to measure progress is to look at how those most in need are doing. When it comes to health, Aboriginal children and youth are collectively one of the most disadvantaged groups of Canadian citizens (1–4). On virtually every measure of health and well-being, Aboriginal children and youth fare worse than their non-Aboriginal peers: infant mortality (two to three times higher), risk of unintentional injury (four times higher on First Nations reserves) and risk of death by suicide (two to six times higher) are just a few examples (1). Aboriginal children are a significant – and fast growing –group of Canadians. Children younger than 14 years of age represent one-third of the Aboriginal population and 5.6% of all children in Canada (5), and these numbers are growing: the fertility rate among Aboriginal women is nearly twice as high as that of other Canadian women (6). Yet, all too often, Aboriginal children and youth are invisible when it comes to health policy initiatives. The CPS has been concerned with the health needs of Aboriginal children and youth since its First Nations and Inuit Health Committee was formed in 1962. The committee develops position statements to help health professionals provide the best possible care. In spite of this good work, when we asked ourselves several years ago whether we could do more, the answer seemed painfully obvious. In 1999, during its annual conference in Winnipeg, Manitoba, the CPS was challenged by former National Chief Ovide Mercredi to play a leadership role in finding answers to the health needs of Aboriginal children. “What we need in this country is a summit for Aboriginal children,” he said. “You have to draw attention to an issue before government can do something about it” (7). The CPS struggled with how to do that. As a professional association, the strength of the CPS is in its members and its collective voice. The CPS First Nations and Inuit Health Committee helps support front-line paediatricians, and our advocacy efforts highlight the issues of Aboriginal children and youth (8). But, in isolation, these initiatives are not enough. After all, Mr Mercredi himself has written about how the well-being of First Nations children is so closely linked to poverty and political power (9). The causes of ill health are multifactorial, and there are no straightforward solutions. A few years later, I had the privilege of hearing Mr Mercredi speak again in a more informal setting. After his discussion, it was tempting to approach him and talk to him about how his challenge to the CPS was something that the organization still wanted to address. However, it would be difficult to admit that it was still not a reality. For many years, we wrestled with the question of how the CPS – an organization with many priorities and finite resources – could effectively take on such a complex issue. Then, it finally became obvious: the real question was how could we not? As an organization committed to the health needs of all children, we need to work the hardest on behalf of those who most need a strong advocate. With support from both staff and volunteer organizational leadership, we decided that we could no longer simply call on others to come up with solutions. That was the beginning of a journey that has involved listening, sharing and learning. That journey culminates in the national summit that Mr Mercredi challenged the CPS with six years ago: in December 2005, nearly 200 people with a shared commitment to First Nations, Inuit and Métis children and youth will gather in Victoria, British Columbia. They include Aboriginal and non-Aboriginal health professionals, social workers, educators, parents, administrators, policy makers, researchers and advocates. The aim of the summit is to build a new vision of health that has children, youth, families and communities at its core. It will encourage delegates to think differently about Aboriginal children's health issues. Most important, it is the first step in a long-term effort to create sustained, positive change. At its heart, this project is about collaboration. It started as a series of conversations with colleagues in national Aboriginal organizations – discussions about what is possible, about our dreams for children and youth, and about what can be achieved when we work together. One by one, individuals and organizations eagerly came on board. At the outset, we had no preconceived ideas about the outcomes. Instead, the vision for the summit and beyond emerged from the group's energy and experiences. Eleven national organizations are represented on the summit planning committee, and their representatives have collectively spent hundreds of hours planning this gathering (Table 1). Summit planning committee Aboriginal Nurses Association of Canada Assembly of First Nations Canadian Paediatric Society First Nations Child and Family Caring Society of Canada Health Canada, First Nations and Inuit Health Branch Inuit Tapiriit Kanatami Métis National Council National Aboriginal Health Organization National Indian and Inuit Community Health Representatives Organization National Association of Friendship Centres Pauktuutit Inuit Women of Canada Aboriginal Nurses Association of Canada Assembly of First Nations Canadian Paediatric Society First Nations Child and Family Caring Society of Canada Health Canada, First Nations and Inuit Health Branch Inuit Tapiriit Kanatami Métis National Council National Aboriginal Health Organization National Indian and Inuit Community Health Representatives Organization National Association of Friendship Centres Pauktuutit Inuit Women of Canada Summit planning committee Aboriginal Nurses Association of Canada Assembly of First Nations Canadian Paediatric Society First Nations Child and Family Caring Society of Canada Health Canada, First Nations and Inuit Health Branch Inuit Tapiriit Kanatami Métis National Council National Aboriginal Health Organization National Indian and Inuit Community Health Representatives Organization National Association of Friendship Centres Pauktuutit Inuit Women of Canada Aboriginal Nurses Association of Canada Assembly of First Nations Canadian Paediatric Society First Nations Child and Family Caring Society of Canada Health Canada, First Nations and Inuit Health Branch Inuit Tapiriit Kanatami Métis National Council National Aboriginal Health Organization National Indian and Inuit Community Health Representatives Organization National Association of Friendship Centres Pauktuutit Inuit Women of Canada Early on, no one fully appreciated just how rare this type of collaboration was, despite the many mission-driven organizations involved in health promotion. The Canadian voluntary health sector is a large, diverse group that includes charities, not-for-profit associations (like the CPS) and coalitions working to improve the health of Canadians. Approximately 5500 of the 80,000 registered charities in Canada “place a strong emphasis on health” (10). However, although children's health and Aboriginal health are central to the mission of many organizations, no single group or collective was focusing exclusively on the health needs of Aboriginal children and youth, a very vulnerable group of Canadians. Research on collaboration between the voluntary sector and Aboriginal peoples in Canada is virtually nonexistent. Much of what is known comes from a 2003 study by the First Nations Child and Family Caring Society of Canada on the nature and extent of voluntary sector resources available to First Nations children, youth and families living on reserve (11). It found little evidence of collaboration between the voluntary sector and First Nations child welfare agencies. Among the main reasons was a lack of understanding between Aboriginal peoples and voluntary sector organizations, which have difficulty seeing how their missions are relevant to First Nations children and families. In general, the voluntary sector is not knowledgeable about Aboriginal issues, partly because of a sense of national guilt over the historic abuses committed against Aboriginal peoples in Canada and a desire “not to upset entrenched national values of equality, multiculturalism, inclusion and freedom” (11). Other barriers to collaboration include a reluctance to reach out to one another, and a lack of opportunity to meet and network. Essentially, we don't know each other very well, and we're not sure where to start. That was certainly the experience of the CPS when we began to approach national Aboriginal organizations about collaborating to improve the health of children and youth. We knew the process had to be embraced and led by Aboriginal organizations, so we started by calling people who had been involved with the CPS through committee work. They suggested others in their networks. Together, we identified gaps and kept encouraging people to join us. Some of the initial conversations were awkward. We wanted to work together, but we didn't know exactly how. We described the CPS's role as a catalyst, not a leader. Let's get the right people in the same room and see what happens, we said. Understandably, we were met with a healthy degree of skepticism and even some mistrust. People shared how for many years, Aboriginal-led organizations had been excluded from critical processes, invited to participate too late to make a meaningful contribution. Being involved in the process from the outset – indeed, driving that process – was, for many, a new experience (12). Luckily, enough people with vision and commitment agreed to take a chance. They kept coming to meetings, and we kept talking. We started to understand more about one another, and the commitment to work together deepened. It has been more than three years since those initial phone calls and introductions, and we have come a long way. Indeed, it is tempting to celebrate the end of this part of the project. The summit is becoming a reality, and we have built many new relationships that should ultimately benefit Aboriginal children and youth. The real challenge, of course, is not the summit itself but the work that follows. Our goal is to create fundamental change in the way we approach the health issues of First Nations, Inuit and Métis children – to recognize that communities have the strength to promote health and healing, and that organizations like the CPS need to do whatever they can to support that empowerment. If we are successful, we should see much more collaboration among voluntary sector organizations –Aboriginal and non-Aboriginal – in ways that recognize the unique contribution that each has to make. Part of the role of the CPS and similar organizations is to encourage our colleagues in the voluntary sector to get involved. An engaged sector, aware of the health needs of Aboriginal children and committed to collaborating to improve health outcomes, could make a significant difference. The voluntary sector could also contribute to more effective health care advocacy, recognizing the need to develop broad-based, strategic and coordinated efforts for public policy changes, such as a national injury prevention strategy. National voluntary sector organizations could also support the development of community-based organizations. All of these efforts must be led by Aboriginal people, working together with non-Aboriginal health care providers and organizations in new relationships characterized by reciprocity, respect and a balance of power. Perhaps the biggest lesson to date is that to make meaningful change, sometimes you need to take another point of view. With this project, the CPS left comfortable, tried-and-true processes behind. We typically approach organizations to collaborate when we have a concrete idea. With this initiative, we started with conversation and let the idea emerge. The project became a product of the relationships, not the reason for them. The same is true for gatherings –the CPS is accustomed to hosting didactic, faculty-led conferences. The summit is a participatory event, where outcomes will emerge from the group. The summit is called “Many Hands, One Dream: New perspectives on the health of First Nations, Inuit and Métis children and youth”. Many of us at the CPS already have a new perspective on these issues. It has come from assuming a new role – from asking questions instead of providing the answers, from listening instead of speaking, and from following instead of leading. By Lynsey, Fort Providence, Northwest Territories

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