For generations, the First Nations have endured life threatening health situations from decades long boil water advisories to the delivery of a westernized health care system so inadequate that Settlers would never settle for it. Ending the crisis in First Nations health and overall well-being, requires the focus of brilliant minds and seasoned ‘red-tape’ warriors.

My name is James Cutfeet. I was born the third eldest of Daniel and Dorcus Cutfeet’s eight children. I spent my earliest years of life growing up in the tradition of the Oji-Cree. My family lived year-round along the 53rd parallel in our traditional territory. A little one room shack near the mouth of Bug River was all we needed. My father was a trapper and a fisherman. Life was as it should be, and our family was happy together.

When I was seven years old, that good way of life came to an end, with the federal government forcing my family into the village to claim me and my siblings to the Indian Day Schools. The village, formerly, Big Trout Lake, now Kitchenuhmaykoosib Inninuwug (KI), by today’s data, is a small community of just over 1,000 people, located some 600 kilometers north of Thunder Bay.

When I was fourteen years old, I completed my elementary education, and like most of my peers, I was faced with choosing between two vastly different paths.

I asked my father if I should go out to high school or remain in the community to learn the ways of livelihood like trapping and fishing. All he said to me was, “Whatever you decide, I’ll support you”. So, I had to weigh the two options: pursue traditional skills to survive in the community or go out to high school in an urban society. The conclusion I came to was that I did not know how to trap. And I did not really know how to fish other than to row the boat to set a net with my father. The only thing I knew was being in the classroom.

In my early twenties, I attended the Faculty of Education at Lakehead University. I launched my career with Indian Northern Affairs at Wunnumin Lake as an elementary school principal and teacher. Over a career which spanned decades, I held various high-level executive positions serving within the First Nations, and the provincial and federal governments. In these roles I provided oversight for capital projects valued upwards of 100 million, supported staff complements of over 100 people, and served as a senior federal negotiator on self-government files.

I was briefly in to my retirement from public service when I received a call on behalf of a KI Elder.

I was contacted in June of 2015. The person on the other end of the phone was asking if I would accept a nomination as Chief. The person that wanted to nominate me was an Elder. And one of the teachings passed on to me was to never refuse an Elder.

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Nishnawbe Aski Nation Corporation (NAN) “…is a political territorial organization representing 49 First Nation communities within northern Ontario with the total population of membership (on and off reserve) estimated around 45,000 people… NAN encompasses James Bay Treaty No. 9 and Ontario’s portion of Treaty No. 5, and has a total land-mass covering two-thirds of the province of Ontario spanning 210,000 square miles.”

I belong to the Treaty #9 Adhesion of July 1929, signed upon the KI homelands. Though Treaty #9 is comprised of several First Nations, including KI, and while NAN is composed of Treaty #9 and #5 First Nations, KI stands as an independent First Nation. Nevertheless, decisions made by NAN, especially political decisions, will have direct impact upon my homeland, and therefore myself and my family. First Nations Health is one of those critical issues that will be affected by NAN initiatives. Even though KI is independent, the NAN Grand Chief’s priority of Health Transformation will impact KI. This health priority is a blanket arrangement for Treaties #9 and #5. My family living on-reserve will be directly affected in the outcome. NAN, as a First Nations representative organization, has impacted me personally in many ways, as the story unraveled will reveal.

In August 2015, I was sworn in as KI Chief and completed my term in November 2017. I was not re-elected. However, while serving as Chief, I was grateful that I was able to draw upon my career experiences and professional connections to support my community towards transformation. In my brief two-year term, and navigating many community obstacles, I felt fortunate that I was able to:

  • Reduce the community’s pre-existing deficit of over 4-million-dollars by 50%
  • Generate 66 million dollars in capital projects which included: 33 million dollars for a new elementary school; 17 million to establish a hydro connection with Wapekeka; and 16 million to build a brand new, state of the art nursing station
  • Initiate and sign three agreements that will generate future dividends for KI’s next generations prosperity

During my time back home as Chief, I became aware of the dire health situation of my people. Not much had improved in health services since leaving my community over 40 years ago. I argued for, and supported, the February 2016 NAN Declaration of Health and Public Health Emergency. I assisted in the drafting of the declaration which was initiated by the Sioux Lookout First Nations Health Authority Chief’s Committee on Health.

Statistics gathered for a Sioux Lookout First Nations Health Authority (SLFNHA) October 2019 report entitled, Anishininiiw Nanadowi’Kikendamowin: Health Outcomes of Our People, indicates that between 1992 and 2014 there were 1,930 deaths among Sioux Lookout First Nations (33 northern communities). This is a rate of death of 120 deaths for every 1,000 people. 64% of all deaths occurred before the age of 65 compared to 22% for Ontario overall.

A SLFNHA May 2019 report entitled, Learning From Our Ancestors: Mortality of First Nations in Northern Ontario, illuminates the alarming disparity between the mortality rate of Indigenous people and non-Indigenous people which begins at infancy. The report presents a troubling breakdown of mortality rates by age bracket beginning with children between 0-17 yrs.

  • Of First Nation males between 0 to 17 years, a 10% mortality rate exists compared to just 2% of death occurring in the same age and sex group among non-Indigenous children in Ontario
  • Of First Nation females between 0 to 17 years, a 12 % mortality rate exists compared to just 2% of deaths occurring in the same age and sex group among non-Indigenous children in Ontario

The Anishininiiw Nanadowi’Kikendamowin: Health Outcomes of Our People also shows that injuries were the leading cause of death, and that the rate of death from injuries was 5.2 times higher than the provincial rate. Death by diseases of the circulatory system and cancer followed as the next highest risks to mortality.

The Learning From Our Ancestors: Mortality of First Nations in Northern Ontario report indicates that 2.3 out of every 10 deaths in community “could potentially have been avoided with effective and timely health care or public intervention.” The report further explains, “Amenable [avoidable] mortality includes all deaths before the age of 75 that were due to causes that are avoidable with timely and appropriate medical care or public health intervention. Amenable causes of death include things like diabetes, motor vehicle accidents, chronic obstructive pulmonary diseases, among others.”

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When I left politics, it did not deter me from continuing my efforts to advocate for improved First Nations health care. I applied for the position of Manager of Health Policy and Advocacy at NAN. At the time, I felt NAN was in the position to achieve broader changes in health care. The Manager’s role evolved into the Director’s position of Health Policy and Advocacy.

As Director, my long-term vision for elder care was to promote elders to be in their communities with appropriate supports, or in long-term care hubs nearby. Mental health was previously established as a priority under Health Policy and Advocacy. Advancing these priorities were short-lived when I received a demotion, essentially a constructive dismissal, from Director to Manager during my 2019/20 contract renewal. Prior to this first-ever career demotion, I was never reprimanded verbally or written up for any performance infraction by NAN’s Chief Administrative Officer (CAO).

Upon learning of my demotion, I also learned that the Health Policy and Advocacy department was going to be absorbed under the Health Transformation department. NAN’s CAO made a unilateral decision to promote the Health Transformation Manager, who was significantly less qualified in experience, to Director of Health Transformation without competition. There was no opportunity given for NAN senior management to compete. I felt that advancing individuals who were not yet experienced enough to meet the high-level demands of such a critical file was a detriment to the Grand Chief’s health transformation priority initiative. I raised these concerns at a Health Transformation meeting and was fired shortly thereafter. I was also on medical leave in March 2019 when I was terminated. Ultimately, I was fired for expressing my firm conviction on the matter in defence for the pressing health care needs of the First Nations people in the NAN territory.

NAN Corporate receives provincial and federal government program funds in the tens of millions of dollars annually. These funds flow through NAN to the communities up north. A portion of these funds are channeled into NAN’s administration budget. It is this budget line which NAN has drawn from to hire an internationally renowned lawyer to fight its Charter of Human Rights case (CHR), a human resources matter, against me.

Prior to my filing of a Charter of Human Rights Complaint to the CHR, I expressed a desire to reconcile my dismissal directly with NAN. NAN did not meet me at that table. In the early stages of the CHR process, there was a second opportunity to mediate. NAN did not meet me at that table either. Currently, my CHR complaint against NAN is in the investigative phase.

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On July 24, 2017, the NAN Grand Chief on behalf of the people, Ontario, and Canada signed the Charter of Relationship Principles of Nishnawbe Aski Nation Territory. This Charter is commonly known as Health Transformation. The Health Transformation agreement is to develop an improved health care system to operation to meet the needs of the 49 communities. If the political leadership in NAN territory, and its program leaders effectively collaborate, the people of NAN stand to gain an equitable health care system.

The government has drawn Treaty and Indian Act artificial boundaries to divide and conquer the First Nations. Owing to colonialism, First Nations communities are forced to adopt the colonist’s Indian Act legislative framework of governance, hence Chief and Council. There are approximately 45,000 people living within the NAN territory yet there are 49 distinct communities, all with their own Chief. That is 49 Chiefs for 45,000 people. How does anything get done?

For decades, at the leadership level, quick fixes are always in discussion regarding potential for improvements to First Nations health care. In the meantime, as a quick fix, the First Nations have taken on the federal government’s short-sighted devolution of policy program transfers. Devolved programs have insufficient, if any, dollars for training of workers. Most often, staff are hired and learning on the job with minimal direction, if any. Thus, communities have an unskilled workforce, and are unable to hire qualified individuals.

As more young people take on leadership roles, they will require training. Currently, and like many young people in the workplace, Chiefs and Council are thrust into leadership positions, often without appropriate work experience or equitable education necessary to effectively serve. Unlike government which has dedicated education and training budgets to train their senior executives and workforce, such funds are not provided to Chief and Council. Yet, the government assumes proficiency from First Nations to administer government programs which require various degrees of expertise.

As an organization, NAN ought to recruit through a fair process and prioritize hiring the most qualified individuals in the organization’s high-level positions. Yes, the staff recruited must understand First Nations culture and traditions as well as, understand the various bureaucracies and their internal processes. Where there are deficiencies in skill sets, training or internal mentoring should be a provision.

The Grand Chief signed an agreement to prioritize a high-level of health transformation, and as such, he contracted a well-known consultant to lead health structure negotiations. The NAN Health Transformation Director is to provide high-level support to the lead negotiator.

As the gatekeeper of all agreements, a CAO is obligated to maintain the Charter of Relationship signed by his superior. At NAN, the CAO’s superior is the Grand Chief. If First Nations health transformation is to be successful, it is imperative that the priorities of the senior administration and Grand Chief are in sync. This shared priority would, therefore, be reflected in the hiring of individuals to senior level positions who possess qualifications and career milestones demonstrating competency to carry high profile, politically charged files such as the Director of Health Transformation.

The grim snapshot of the First Nations health crisis underpins it is vital the most qualified and competent individuals be recruited to address life and death issues plaguing the First Nations.