THUNDER BAY—In 2019, the days should be long gone when “white men in ties” decide what is the best way to deliver health care to Indigenous people.

After 150 years of colonialism — of Indian residential schools, of the Indian Act and the presence of Indian hospitals where First Nations and Métis people received second-class health care — the power of health-care decision making should not be left in patriarchal hands so clearly linked to the past.

Yet in Ontario, the Ford government is turning back the clock as it proceeds with the formation of the new super health care agency, Ontario Health. The new agency’s creation means blowing apart much of the current health-care delivery system — Cancer Care Ontario, eHealth Ontario and Local Health Integration Networks and others — and centralizing decision-making power to save money.

Or, as Health Minister Christine Elliott calls it, “modernizing” the system.

But by centralizing health care decisions, the Ontario government is doing exactly the opposite, returning to a top-down approach where health-care needs are decided by the few for the many.

The new agency threatens to derail nearly three years of negotiations between Ontario, the federal government and Nishnawbe Aski Nation (NAN) concerning turning over decision-making power about health care to 49 northern nations so they can bring health-care services closer to home.

To be fair, Elliott did send a letter to NAN Grand Chief Alvin Fiddler on Feb. 26, to say Ontario recognizes First Nations’ role in health-care delivery and programs, and Elliott’s letter appeared to offer a sliver of hope for Indigenous communities.

“In particular,” Elliott wrote, “I am writing to you today to confirm that my ministry and I will continue to work with First Nations communities through dedicated trilateral processes and relationship agreements, including existing agreements, to explore options to transform First Nations’ health. I have asked my officials to resume full participation in these discussions and I look forward to further conversations with First Nations leadership.”

But since then it has been radio silence. NAN has not heard a word.

NAN is still waiting for a meeting with the minister. And the Ford government has not made any funding available to support NAN’s work for this year — funding that helps cover administrative costs, staffing, communications and travel over a vast northern territory.

There is much to discuss.

The current health care system was never created with Indigenous people or views in mind, and the 1984 Canada Health Act makes no commitment to restoring the wrongs of the past and bringing equity to Indigenous people — this after 150,000 children were sent to Indian Residential Schools where they received little to no health care, where they were medically experimented on and no health clinics were put in place to support the needs of survivors.

It used to be that hospitals did not want to treat Indigenous patients. In the 1920s, Canada began to establish segregated — yes, I said segregated — Indian hospitals. By the 1960s, there were 22 in existence.

In northern Ontario, the difference in the quality of health care for Indigenous and non-Indigenous people is astounding. In the NAN communities, there are next to no doctors, no well-staffed health centres, no specialists or properly supplied pharmacies. And medical care is hard to deliver when there is no drinkable water or properly running sewage systems.

But the Ford government might have met its match in Ovide Mercredi, the former national chief of the Assembly of First Nations, who since 2017 has led the NAN health transformation team.

Mercredi, a lawyer and a poet, has, from a young age, dedicated his life to fighting for the right of our people to be treated humanely and equitably.

Ford’s super agency threatens to undermine everything NAN is doing in order to obtain the right to make decisions over health care, he said.

“We cannot co-operate with this legislation with respect to the bill of the law that is there now,” Mercredi said.

The approach NAN is taking is a two-track process. The first is addressing gaps in services, and the second is looking at making fundamental changes in the system to better deliver health care. NAN would form a commission overseeing health care by the people, for the people.

“We were way ahead of the province on our thinking,” Mercredi said. “The challenge to them is how to support our process.”

Under the Ford super agency model, the health-care gap will never be closed — it will widen.

“Our people have to get control of their health issues, and as long as governments control what happens we’ll never get control of it. It is more than gaining more doctors, more nurses, more dialysis units. It is our way of existing, our identity and culture,” he said.

It is quite simple. Suicide, diabetes, addiction and food insecurity must be tackled by Indigenous people for Indigenous people.

“A white man with a tie will not solve it,” Mercredi said. “But in order to get there, we need the power and resources to do it.”

Tanya Talaga is a Toronto-based columnist covering Indigenous issues.