Canada is well-known throughout the world for its ground-breaking work in FASD knowledge, research and practice. Health Canada implemented FASD initiatives beginning in the early 2000s, including some that were specifically directed at improving access to services in Indigenous communities. The First Nation Inuit Health Branch’s FASD Program and the Public Health Agency of Canada’s FASD National Strategic Projects Fund are the basic components of Health Canada’s FASD Initiative introduced at that time.
The FASD National Strategic Projects Fund has been responsible for advancing a number of important FASD projects. They have funded a wide range of projects including the development of:
- Clinical Practice Guidelines for Diagnosis of FASD
- Alcohol Use and Pregnancy Clinical Practice Guidelines for physicians
- a National Screening Toolkit for FASD
- Prevention statements
- Adult diagnosis statements
- development of a national prevalence plan
- economic analysis and research funding through Canada’s FASD Research Network
- Child Brain Health (originally called “NeuroDevnet”)
However, despite the successes of the Public Health Agency of Canada’s National FASD initiative, actual service delivery at the community level in Canada has not improved significantly. In 2011, it was reported that the clinical capacity in Canada to diagnose the disorder was 2288 diagnoses per year while the number of people projected to be affected by FASD was 1,279,454. Canada’s specific legislation dealing with healthcare, the Canada Health Act shares the responsibility of coordinating the Canadian medical system between levels of government. The provinces and territories have been given the primary responsibility for health service delivery, while the federal government through Health Canada provides direction, research and support.
So, despite the Public Health Agency of Canada’s direction, there was no real change in provincial health policy and practice, particularly as it pertains to providing services to Indigenous communities. Health services for Indigenous people are provided through complex arrangements between the provinces or territories, the federal government and Indigenous communities. Often there is confusion as to the responsibility of each of these in relation to the funding and the delivery of particular health services. The federal department that has the specific mandate for Indigenous health is First Nation and Inuit Health Branch. The First Nation and Inuit Health Branch’s mandate is to:
- Ensure the availability of, or access to, health services for First Nations and Inuit communities;
- Assist First Nations and Inuit communities address health barriers, disease threats, and attain health levels comparable to other Canadians living in similar locations; and
- Build strong partnerships with First Nations and Inuit to improve the health system.
Most health services for Indigenous people, however, are delivered by the provinces or territories under basic medicare. Indigenous Services’ Canada’s “un-insured benefits program” is supposed to fill in the gaps for First Nations and Inuit citizens by covering health services that are not provincially insured, for example, dental services, eyeglasses or prescriptions. This program could also provide the framework to fund FASD diagnostic services that are lacking in provincial/territorial health plans.
However, presently there is no core funding for the First Nation and Inuit Health’s FASD program, only project support. The actual focus of the program has been on prevention through mentoring services and support for women, although the stated objectives of their program are broader:
- Reduce the number of babies born with FASD;
- support children (age 0-6) who are diagnosed with FASD and their families to improve their quality of life.