pdf download - First Nations Health Council

Second Annual Forum
Vancouver, BC • May 20 - 21, 2008
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SUMMARY DOCUMENT

CONTENTS
Gathering Wisdom
for a Shared Journey
GATHERING WISDOM FOR A SHARED JOURNEY
Introduction ...........................................................................................................1
Background ............................................................................................................2
Report on the Forum .............................................................................................3
GATHERING THE COLLECTIVE WISDOM: DISCUSSION SUMMARY
Day One ..................................................................................................................4
First Nations Health Governance ...........................................................................8
Day Two ................................................................................................................11
Gathering the Collective Wisdom .......................................................................16
Appendix A: World Cafe Summaries ................................................................... 17
Professional Development Workshops ...........................................27
Appendix B: Feedback Charts ..............................................................................30
Appendix C: Participants .....................................................................................36

INTRODUCTION
On may 20 th - 21 st- , 2008 the second annual
“Gathering Wisdom” forum convened at the Coast
Plaza Hotel in Vancouver, BC. The annual forum has
become an important opportunity for First Nations
leadership and health professionals, as well as their
provincial and federal counterparts, to discuss the
significant progress made in the implementation of
the 29 action areas of the Tripartite First Nations
Health Plan. As well, participants were invited to
continue the conversation on First Nations health
that was initiated at the 1st Annual Forum, to
share ideas and experiences, to provide feedback
on the work that has taken place so far, and to
solicit suggestions for additional items to be taken
into consideration as work continues to refine and
implement the Tripartite First Nations Health Plan.
This second annual forum also offered participants
working for First Nations the opportunity
to participate in professional development
workshops focused on physical activity, personal
nutrition, traditional medicine, cultural inclusion
and youth engagement. Overall the forum sought
to celebrate and re-energize current efforts, to
provide new tools to be taken home to First
Nations communities, and to inspire new ideas for
improving the health of First Nations people in BC.
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VANCOUVER, bC • mAY 20 - 21 , 2008

BACKGROUND
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In march 2005, the Province of british Columbia
and the First Nations leaders agreed to enter into
a “New Relationship” guided by principles of trust,
recognition and respect for Aboriginal rights and
title. The “New Relationship” focused on closing
the gaps in the quality of life between First Nations
and other British Columbians.
In November 2005, the Province of british
Columbia, the First Nations Leadership Council
(a working partnership between the UBCIC, First
Nations and the BCAFN) and the Government of
Canada signed a historic agreement entitled the
Transformative Change Accord which recognized
the need to strengthen relationships on a
government-to-government basis, and affirms
the parties’ commitment to close social and
economic gaps in health, education, housing
and infrastructure, and economic opportunities
through a comprehensive ten-year implementation
strategy.
As per the Accord, the First Nations Leadership
Council and the Province developed a ten-year plan
for heath, the Transformative Change Accord: First
Nations Health Plan, in late 2006. The Government
of Canada, through Health Canada, entered into
a First Nations Health Plan Memorandum of
Understanding with the First Nations Leadership
Council and the Province of British Columbia on
November 27, 2006.
Two key documents, the Transformative
Change Accord: First Nations Health Plan and
the First Nations Health Plan Memorandum of
Understanding, identified priorities for action to
close the health gap between First Nations and
other British Columbians and were intended to
guide efforts to address the critical challenges that
must be overcome in order to deliver on the joint
commitments to improve the health and wellbeing
of First Nations peoples and communities.
A key deliverable of the tripartite mOU was the
completion of a tripartite health plan within six
months. A key deliverable for the signing of the tripartite
health plan was the completion of an initial
work plan within six months. The Health Plan itself
and the implementation workplan were informed
by the Transformative Change Accord: First Nations
Health Plan, and by key messages received from
participants at the 1st Annual First Nations Forum:
Gathering Wisdom for a Shared Journey held in
April 2007. A number of challenges, opportunities
and priorities for action were identified including
the establishment of the First Nations Health
Council.
The Tripartite First Nations Health Plan was
signed on June 11, 2007. Central to the Plan was a
commitment to create a new governance structure
that would enhance First Nations control of health
services, and promote better integration and
coordination of services to ensure improved access
to quality health care by First Nations living in
British Columbia.
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SECONd ANNUAl FORUm

THE REPORT ON THE 2008 FORUM
This narrative section of the report on the 2nd
Annual Forum will provide a synopsis of the event,
including:
• Summaries and excerpts from each of the
plenary speakers;
• Thematic results from the group discussions on
Governance, Relationships and Accountability,
the World Café rooms and the table topics, and
the Open Space tables;
• Highlights from the professional development
workshops;
• Summary of priorities for action as identified by
the participants;
• Future steps.
The appendices provide more detailed information
on the discussions in the various small group
sessions and on the participants, speakers and
volunteers who made the forum possible.
Appendix A contains summaries from the topic
tables selected from the Tripartite First Nations
Health Plan for discussion at the 2008 forum, the
Open Space tables where participants were able
to note any issue of concern to them, and the
summary reports from the Governance Session
and the professional development workshops. The
summary of opportunities and recommendations
contained within this narrative report are drawn
from these more detailed notes.
Appendix B contains participant feedback. Appendix
C contains a list of participants.
The First Nations Health Council, The ministry
of Health, and Health Canada would like to thank
all participants for making the 2nd Annual Forum a
success.
FUTURE STEPS
As described in the ‘Year in Review Report’
FNHC has separated the work of implementing
the health plan into two streams both having
opportunities for First Nations participation. In the
Health Actions stream the community engagement
hubs, working groups and committees being
developed are key access points, and in the Health
Governance stream the regional caucuses are the
key mechanism for community engagement.
The FNHC will continue to work with First
Nations communities, government partners and
other stakeholders to shape and implement the
TFNHP in ways that respond to community needs
and circumstances. The information contained in
this report will be provided to both the FNHC staff
and communities in order that it may be used to
identify appropriate modifications to workplans
and contribute to the design of the next Gathering
Wisdom forum.
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VANCOUVER, bC • mAY 20 - 21 , 2008

DAY ONE: WEDNESDAY, MAY 21, 2008
Opening Speakers: Our Journey So Far - What We’ve Accomplished Since the 2007 Forum
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Debbie Abbott
Co-Chair, First Nations Health Council
“The purpose of the Tripartite First Nations
Health Plan is to close the health gap between
First Nations and other British Columbians.”
“We are all here today because we know that we
can do better, we will measure progress and we will
achieve results. To us, these are not just numbers,
they are our relatives, our friends, and our
coworkers. Our well-being as a whole is intrinsically
connected.”
taking a leadership role, with anticipation that
there would be great feedback towards the
implementation of the Plan in year two, provided
during the World Café breakout sessions.
In appreciation of the front-line community
health service providers in attendance, the
Forum was offering a number of professional
development opportunities, including workshops
on engaging youth, self-care, nutrition, traditional
medicine and physical activity. Recognizing that
the work they did in their communities could
be demanding and stressful she noted that the
workshops and healthy activities were being
offered to participants at the Forum in the hopes
that they would be both energizing and inspiring.
ms. Abbott welcomed participants to the forum
and expressed appreciation to local First Nations
for allowing the event to be hosted in their traditional
territory. She then introduced fellow First
Nations Health Council members in attendance,
and members of the Self-Governance Working
Group. She reviewed the roles of the First Nations
Health Council to provide guidance, lobby support,
and to provide a political accountability framework
to the technicians working to implement the tenyear
Tripartite First Nations Health Plan.
ms. Abbott acknowledged the attendance
of many community health professionals at the
Forum, noting that at the 1 st Annual Forum,
government and health industry representatives
had filled nearly half the seats, and had taken a
lead role in guiding the discussion. This year there
were more First Nations health professionals
Dr. Evan Adams
Aboriginal Health Physicians Advisor
Office of the BC Provincial Health Officer
“I am reminded that our indigenous knowledge
from our homes is something we all need to
constantly renew.”
“The root of First Nations issues lies in historical
and personal trauma, and until those are
addressed, there will be a limited ability to affect
health outcomes.”
“It is only what is good and right to ensure that
First Nations have health opportunities that are
equal to those of other British Columbians.”
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SECONd ANNUAl FORUm

Dr. Adams spoke of the importance of
constantly renewing Indigenous knowledge,
through listening to and learning from the Elders.
He shared his recollections of having been taught
at an early age to help and respect others. He
discussed the composition of the Tripartite First
Nations Health Plan, the collaboration required,
and the commitment of parties to work in
partnership in the development, testing and
implementation of new ways of planning and
delivering health programs and services for First
Nations.
Dr. Adams offered suggestions for gathering
wisdom, moving plans forward, and getting better
outcomes for clients. He acknowledged that the
parties to the Plan were trying to find better,
clearer, faster and smarter ways to trickle down
resources in an appropriate fashion, and in a
fiscally responsible way.
Dr. Adams acknowledged difficulties expressed
regarding human resources, and assured that the
province would like to assist in this regard. He also
referenced the desire for a complete picture of
wellness that, while holding the First Nations vision
of wellness at the core - with specific aspects of
culture being present in planning and in healing
- still recognizes those areas where western
medicine is particularly effective (such as in pain
control and saving lives).
He recognized that those involved in the
Tripartite First Nations Health Plan had heard
the many painful stories that had been shared by
First Nations about how the health care system
had been insensitive and hurtful in dealing with
First Nations. He expressed his admiration and
appreciation that many had been able to keep their
hearts open and still wished to try to work with
people in partnership, in a culturally appropriate
way.
Dr. Adams discussed priority areas of action
that would be the focus of discussions at the
2nd Annual Forum relative to: governance,
relationships and accountability; health
promotion/injury and disease prevention;
health services; and performance tracking. He
commented on the need to understand the issues
around First Nations historical and personal
trauma, and for access to interventions with
support from health service professionals, Elders,
and loved ones who were aware of that history.
He reminded participants that during the
Forum they would engage in a dialogue about their
truths and things that they had discovered. Dr.
Adams commented that the framework for health
care had been supplied by academics and experts,
which needed shoring up through the sharing
of ideas and strengths. He also acknowledged
the rationale for a health authority, council, or
ministry, to gather ideas and to work centrally and
collectively. Help was needed in connecting with
health authorities, in delivering programs to First
Nation constituents.
Dr. Adams emphasized the importance of
passing knowledge amongst each other to plan
for the future, preserve the environment, provide
business opportunities, and set goals for youth.
OPENING REMARKS FROM TRIPARTITE LEADERS
Joe Gallagher
Senior Director
First Nations Health Council
“An area that we need to bring forward, to focus
on, is our First Nation teachings and the value
systems that we have so that the dialogue can be
encouraged to be positive in light of the needs of
the communities.”
mr. Gallagher stated that the 2 nd Annual Forum,
was part of an ongoing ten-year conversation
about the Tripartite First Nations Health Plan. He
commented that the 1 st Annual Forum had been
a great success, and that there was even greater
participation in the 2 nd Annual Forum, which
included federal and provincial partners.
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A historical overview of the Tripartite First Nations
Health Plan was provided which reflected the
five key messages and priority activities identified
at the 1 st Annual Forum relative to: a vision of wellness;
the need for a cultural, holistic approach to
health; support for a community driven process;
identification of common challenges; and an emphasis
regarding the need for communication.
mr. Gallagher discussed the composition of
the First Nations Health Council, which represents
a partnership of the British Columbia Assembly
of First Nations, the First Nations Summit, and
the Union of British Columbia Indian Chiefs. He
commented on the role of the Health Council in
overseeing the implementation of the Tripartite
First Nations Health Plan, and discussed the
formation of a technical team to assist in that
process. It was shared that the First Nations
Chiefs Health Committee (CHC) had recently
been restructured via resolution of the First
Nations Summit. As a result, CHC staff were now
embedded within the Health Council to streamline
the process.
The FNHC is working with the National
Collaborating Centre for Aboriginal Health to
develop the First Nations ActNow Initiative.
mr. Gallagher noted the importance of the
community driven process embedded in the Plan,
noting the Tripartite Health Plan’s focus and the
Health Council’s desire to support First Nations
communities in developing their own or collective
plans, as they chose.
It was shared that the First Nation Health
Council had participated in many local dialogues,
and in regional health forums regarding the
development of Aboriginal Service Plans in
the interest of ensuring a community driven
process. mr. Gallagher discussed the common
challenges identified, including a lack of resources
and funding. He noted that there had been
movement forward on a First Nations Health
Human Resources Strategy. Discussions were also
occurring with First Nations Inuit Health and the
provincial government on access to funding, and
the need for greater flexibility in funding received.
It was acknowledged that the need for
communication was extremely important and
was a great challenge. To this end, there was
ongoing work towards establishing community
engagement hubs to support collaborative efforts
in communication and planning, as a means of
finding effective ways of working with everyone.
As well, the Health Council had recently hired a
Communications Coordinator and would soon have
a revamped website and other communications
tools available.
mr. Gallagher commented that one of the
biggest challenges was to find the path for working
together in a new way. One of the functions of
the First Nations Health Council was therefore to
encourage a dialogue that was more respectful
for First Nations people. He looked forward to
participating in the 2 nd Annual Forum, and thanked
the Council for its work in organizing the event.
Catherine Lappe
Regional Director General
Health Canada, BC Region
“The Tripartite First Nations Health Plan marks the
beginning of significant change for First Nations
health care in British Columbia. It provides an
unprecedented opportunity for Canada, British
Columbia and First Nations to work in partnership
to improve the overall health and well-being of BC
First Nations people; to close the gaps between
health services provided to First Nations; and to
ensure First Nations are fully involved in decision
making regarding the health of their people.”
“The Tripartite First Nations Help Plan is a
fundamental rethinking and realignment of how
health services will be delivered for First Nations
in BC.”
“Health Canada will evolve its role of ‘health
program designer and deliverer’ to that of ‘funder
and governance partner’ as First Nations take on
their governance role as laid out in the Tripartite
First Nations Health Plan.”
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SECONd ANNUAl FORUm

At the 1 st Annual Forum, a number of
challenges and opportunities were identified as
well as priorities for action, which included the
establishment of the First Nations Health Council,
and informing the completion of the Tripartite First
Nations Health Plan, signed on June 11, 2007.
The Tripartite First Nations Health Plan marked
the beginning of significant change for First Nations
health care in British Columbia. Regional Director
lappe shared that minister Clement had often
said that signing the Plan was one of his proudest
accomplishments. BC was leading the way for
fundamental changes for First Nations health
service delivery, and was being closely observed
by other provinces who were hoping to learn from
BC’s successes.
Regional Director Lappe shared that since
the 1980s, Health Canada had been involved in
a process to transfer health services historically
delivered by Health Canada to First Nations.
She continued that the Tripartite First Nations
Health Plan was a fundamental rethinking and
realignment of how health services would be
delivered for First Nations in British Columbia in
a way that made sense for communities, with
evaluation and monitoring by the regional offices
and headquarters.
Central to the Tripartite First Nations Health
Plan was a commitment to create a new governance
structure that would enhance First Nations control
of services, and promote better integration and
coordination of services, to ensure improved access
to quality health care by all First Nations living
in British Columbia. The significant progress of the
First Nations Health Council, which had actively
sought partnership opportunities focused on the
needs of First Nations communities, was acknowledged.
Regional Director Lappe said that change would
not happen overnight and that the transition plan
would be a key component of the agreement to be
reached. meanwhile, within bC Region, opportunities
were being explored for interchanges between
the First Nations and Inuit Health Branch and the
Health Council to help pave the way for a smooth
transition to the new First Nation governing body.
As the first year anniversary of the signing of
the Tripartite First Nations Health Plan approaches,
there is opportunity to reflect on the successes
achieved thus far, and to confirm the way
forward. Over the past year, Health Canada has
worked closely with its partners, building strong
relationships, completing the initial work plan, and
aligning efforts on a number of fronts to ensure a
tripartite approach to program and service design
and delivery. Efforts had also been made to initiate
dialogue for the establishment of a new First
Nations health governing body.
Regional Director Lappe acknowledged that
while this was still the first year of implementation
of the Tripartite First Nations Health Plan, change
was already happening. Efforts would continue to
adjust how we are working together as well as on
aligning efforts and resources to make initiatives
much more effective in moving forward. She
concluded by recognizing the exciting linkages
occurring between First Nations and Health
Authorities within BC. She thanked all parties for
having the courage and energy to participate, and
looked forward to continued collaborative efforts.
Deborah Schwartz
Executive Director, Aboriginal Health Branch
BC Ministry of Health
“It takes tremendous leadership to get into a
canoe and paddle in the same direction as others
in the interest of all.”
ms. Schwartz referenced the photograph on the
cover of the Transformative Change Accord: First
Nations Health Plan which depicted three people
paddling a canoe. She acknowledged the visual as
a unifying metaphor about getting into the same
canoe while paddling in the same direction, which
took tremendous leadership in the interest of all.
The excellence of the provincial, federal and First
Nations leadership involved in this initiative was
recognized.
It was shared that First Nations had brought
together three political organizations in British
Columbia to develop a unified vision to inspire,
and that there was need to acknowledge the Chiefs
for that work. ms. Schwartz also recognized the
leadership of the First Nations Health Council, and
its staff who were responsible for translating the
Plan into actions on a day to day basis. She noted
that it was remarkable for the parties to have made
a commitment to overcome their differences,
and to work together to achieve results guided by
the vision and values set out in the Tripartite First
Nations Health Plan.
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8
In her concluding remarks, ms. Schwartz discussed
the importance of each of the partners, their
motivation to try, and their willingness to take risks,
noting that none of the efforts would be successful
if the communications did not continue. In the
spirit of committing to listen and learn together, she
thanked participants for their participation at the
2 nd Annual Forum.
FIRST NATIONS HEALTH PLAN
- GOVERNANCE
Grand Chief Ed John
First Nations Health Council Governance
Subcommittee
“The Tripartite First Nations Health Plan is
an integrated, interrelated, and coordinated
approach to dealing with a range of First Nations
health issues.”
Grand Chief John acknowledged the Coast
Salish for allowing the 2nd Annual Forum to occur
on their territory, and noted the importance of
always acknowledging the people whose ancestral
lands meetings were held on.
Grand Chief John shared that the work in the
communities was vital, and recalled the signing
of the Tripartite First Nations Health Plan the
year prior, which brought First Nations, federal
and provincial governments together on a willing
basis, to address serious health issues in the 203
First Nations communities within British Columbia.
What made this possible in British Columbia was
the cooperation of the Union of British Columbia
Indian Chiefs, the First Nations Summit and the
BC Assembly of First Nations who were all driven
and mandated to begin to do something about the
many significant health issues that continued to
exist for First Nations in British Columbia.
Grand Chief John discussed a First Nation community
in British Columbia where approximately
60% of the housing was affected by serious mould
infestation (Category #1) noting that with that
many houses and people impacted there would be
serious health considerations. He noted that Canada,
British Columbia and First Nations had signed
a memorandum of Understanding on housing and
are committing to work together to address health
issues, including ensuring that good, affordable,
and safe housing was available.
It was shared that on June 11, 2008 another
milestone would be reached relative to the legacy
of the Indian Residential Schools: a First Nations
Summit meeting would be one of many venues
where Chiefs could come together and listen
to the Prime minister of Canada make a nation
wide apology. Grand Chief John acknowledged
Chief Charlene Belleau for her work on the
Indian Residential Schools file, and recognized
the leadership of the Alkali Lake community in
addressing the impacts of residential schools.
It was further shared that the Chiefs in British
Columbia had led the charge in the area of
residential schools, having gathered in the early
1980s to ask for an independent inquiry into
what happened in the Indian Residential Schools.
It was not until much later that the Government
of Canada and the churches came to the table
as a result of litigation on behalf of residential
school survivors in Port Alberni, to establish that
Canada and the churches had legal liability for the
damages and abuses that took place. Grand Chief
John continued with a note that the First Nations
Leadership Council had met the prior week to
discuss creating a dialogue on residential schools
as had been done in Australia. He cautioned that
communities needed to be prepared in the event
that the Prime minister’s June 11, 2008 address
“triggered” survivors.
In health, housing, residential schools, fisheries,
forestry and justice, Grand Chief John advised
that there were extensive plans discussed for a
coordinated approach and strategy. He shared
that on September 13, 2007, the United Nations
voted to adopt the Declaration on the Rights
of Indigenous Peoples; the articles of which
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SECONd ANNUAl FORUm

spoke to the minimum standards for the dignity,
survival and wellbeing of indigenous peoples,
and encouraged First Nations to insist on those
standards within all plans.
Grand Chief John noted that in signing the
Tripartite First Nations Health Plan the parties had
agreed that the First Nations Inuit Health Branch
would not exist as it presently did, and that the
business of delivering health services would be
transitioned to First Nations. A three year horizon
was agreed to, with First Nations being charged to
set up a body to deliver health services throughout
First Nation communities.
It was noted that 75% of First Nations
communities in British Columbia had health
plans. The driver for health services had to be the
community – working from its health plan in its
relationship with provincial health authorities.
Grand Chief John clarified that an institution would
not be formed that would divert funds from the
communities, and added that the Leadership
Council had communicated to government that
there was a period of funding ‘catch up’ that was
required.
Chief Wayne Christian
First Nations Health Council Governance
Subcommittee
“The most extraordinary leaders that First
Nations have are ordinary people. Many people
are suffering for the work that they have done for
First Nations people in the past, and they need to
be acknowledged.”
“There is no one solution or ‘one size fits all’
approach to health or health governance. The
province of British Columbia is dynamic with 203
First Nation communities. How people organize
themselves is critical, and will be respected.”
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Grand Chief Doug Kelly
First Nations Health Council Governance
Subcommittee
“First Nation health directors are the change
agents responsible for leading the way to make
things better in First Nations communities.”
Grand Chief Kelly in his address referenced
a report by Chandler and Lalonde which related
to the strength of First Nations culture and
communities governing their own affairs. He also
spoke to the issue of First Nations youth suicide.
Grand Chief Kelly shared that it was necessary
for First Nations to have control over the resources
that come into their communities, and that First
Nations have the ability to design programs and
services that are consistent with their culture,
spirituality and traditional teachings, in order to
achieve improved health outcomes. He added that
the role of the First Nations Health Council was to
create that opportunity, not to create a foreign
institution, but to hear what the communities had
to say, and to use that advice to design something
to address the needs of First Nations.
Chief Christian acknowledged the ancestors
of the territory, and those who had come before,
and spoke of the need to acknowledge the work of
ordinary people.
Chief Christian provided an overview of the First
Nations Interim Health Governance Committee.
The Committee was seeking additional at-large
representatives willing to work together, and with
Health Canada and ministry of Health, to carry
out the Transformative Change Accord mandates,
including the development of a framework for the
203 First Nations in British Columbia. He discussed
the goal of engaging communities to focus on
strengths while making people feel safe and
comfortable about working together.
To date, it was noted that there had been
several meetings which were the beginning of
dialogue to find ways for First Nations, and the
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10
federal and provincial governments, to work
together to develop a comprehensive and inclusive
First Nations health governance structure.
Chief Christian recognized that First Nations
culture, belief and identity were linked to the land
and resources, and were all interconnected. As
such, issues could not be considered in isolation.
There was a need to start, with an understanding
that the initiative would be to enhance, empower
and seek resources for communities based on their
requests for help.
It was offered that a critical part of
transformation was creating space for British
Columbia First Nations to design and develop their
own standards of governance that supported local
self-government processes. There was a need
to begin to engage communities on a regional
basis, and to complete the First Nations Interim
Health Governance Committee membership. The
Committee was seeking additional members, to be
identified by the regions. A political and technical
process needed to be considered for determining
those individuals. A role of the regional caucuses
during the 2nd Annual Forum was to give
voice to that process, and to agree to common
communications language and presentation
materials. This was evidence of an evolving and
respectful relationship.
Chief Christian concluded with reference to
an address by Chief Dan George in 1967, which
recognized the opportunity to focus on changing
the health of First Nations people. He also
acknowledged leadership for putting aside any
differences in the interests of First Nations.
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SECONd ANNUAl FORUm

DAY TWO: THURSDAY, MAY 22, 2008
OPENING SPEAKER: TINA KEEPER
Tina Keeper
member of Parliament for Churchill, manitoba
“This is not a time of emergence of a new
generation of Indian leaders. We are the
culmination and product of our ancestors.
Canada is now ready to deal with us because
our leaders of the past have been saying for so
long that there is a need for change. We are
seeing the fallout of all the years of policy and
legislation in which Indian people had no selfdetermination.”
“There is opportunity in this partnership model
for First Nations to share their incredible gifts
with the world, and with Canadians, because
they need it too. It is an important piece to
remember in your work.”
“It is despicable that this great country should
be having these failings for any sector of the
population, and in particular for First Nations for
which there are no guiding principles or policies.”
the urgency in Aboriginal health, noting that
Indigenous peoples around the world suffer similar
health and social issues as here. She spoke of the
opportunities she had enjoyed throughout her
career to work with renowned researchers on
the issue of Indigenous peoples and suicide. The
opportunity to seek solutions in a different way, as
with the Tripartite First Nations Health Plan, is very
important. What was in place was not working.
ms. Keeper referenced the difficulty of making
systemic changes, noting that this was about the
very life of First Nations people, and the lives of
their cultures, heritage and communities.
ms. Keeper discussed the opportunities she has
as a parliamentarian, and as an actor, to travel the
country meeting people and hearing them speak.
She had found that there is a common myth among
Canadian people, that because of new emerging
leadership First Nations were beginning to work
in partnership with government. It is important to
deconstruct that myth because First Nations are
aware that they have been struggling for decades.
The leaders of today exist because of the strength
of their ancestors. The partnerships of today are
possible because of the work done in the past.
In speaking about health, self-determination is
a critical factor. ms. Keeper shared that she was
raised in the north at a time when there was little
intrusion of Canadian policy and legislation and
when the magnitude of the trauma of residential
schools was unknown. There was no CmHC
housing then. First Nations built their own homes,
had a traditional lifestyle, and spoke their own
language. Being raised as one of a people of the
land, ms. Keeper knew that her way of life was
good, and that people were gentle, kind, strong
and resilient.
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ms. Keeper expressed how she was honoured
to participate in the conference, and acknowledged
ms. Keeper commented on what had happened
in one generation due to Canadian policy, due to
the intrusion of natural resource development
within communities in manitoba, and because of
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12
the experience of First Nations having lost control
of their lives. She acknowledged that the history
was different in BC, and that the sense was that
the new way forward was to organize.
She spoke of the impacts of residential school
and the impacts of the loss of land. There was
a need to find a way to care for a group within
the communities of First Nations that was made
ill by what happened historically ... “we all love
somebody who is either living that way, or who has
died that way, someone who has been made very
ill by all this trauma.”
“Gathering Wisdom for a Shared Journey”
speaks to the knowledge that First Nations Elders
hold. One of the greatest gifts First Nations have
is an understanding that manifests in a very loving
and gentle way. Health is inextricable from love
and care.
ms. Keeper commented that proposal-driven
funding does not work because most often the
people that need the funding the most do not have
the capacity to write proposals. Legal obligations
aside, she noted that there was a moral obligation
to deal with this. Health practitioners and
politicians need to discuss the issues of love and
caring as a way to move forward. She did not want
to look forward to a future where First Nations
were giving up their collective rights and identity
as Aboriginal peoples.
ms. Keeper added that First Nations were at
a turning point. Dialogue was begun and needs
to be driven by the knowledge acquired from the
grassroots level - particularly the Elders. She spoke
of a colleague in Aboriginal Health working with
First Nations in the north who was not allowed
to speak Cree because she was not hired as an
interpreter. This is a concrete example of the
constrictions that continue to exist within the
current system. She emphasized the need to think
outside of the box, and to challenge the system.
Working in television ms Keeper had met many
non-native Canadians who felt that they knew her
because they knew her television character. She’d
had the opportunity to speak to many people who
shared what they thought about the show, First
Nations people, or Canadians and their relationship
to First Nations. She had learned that people
really were good at heart; that colonial rule was
a tradition of the British which they imposed on
others as ‘part of their way‘.
ms. Keeper recalled the story of a Cree
character created out of the experience of
starvation, called the Windigo, which represented
the spirit of greed or rage. She had felt like a
Windigo during her first years on Parliament Hill.
She had grown up in a privileged life on the land,
but was shocked by the level of privilege that
non-First Nations people enjoyed in Canada. First
Nations had the ability to speak together and
needed to speak in a good way. First Nations had
to insist on what they wanted in moving forward.
In response to a question, ms. Keeper
confirmed that she was part of the parliamentary
Aboriginal Affairs Committee and worked closely
with the Health Committee. A driving force that
encouraged her to get into politics was First Nation
health issues and the reality that there was no
legislation for First Nations health in Canada. There
continued to be a significant discrepancy and lack
of jurisdictional clarity surrounding Aboriginal
health issues. There were human rights violations
in terms of delivering health services for First
Nations. Some of her opportunities as a First
Nation member of Parliament included becoming
aware of the issues; making her caucus members
aware of the issues; inviting people to present
at Standing Committees; and participating in the
introduction of private members bills and motions.
ms. Keeper concluded with a note that the
Tripartite First Nations Health Plan model was
very exciting because there was a whole new
generation of Aboriginal youth, the fastest growing
sector of the population - there was a need to
find a way to take care of them. She wished
participants the best, and thanked the forum for
the opportunity to speak.
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SECONd ANNUAl FORUm

CLOSING KEYNOTE SPEAKER
Dr. Martin Brokenleg, Professor of First Nations
Ministry and Theology,
Vancouver School of Technology
“If we plan to be whole we have to stop
looking at woundedness and instead focus on
wholeness.”
“First Nations include spirituality in everything
that they do. Most groups back away from
spirituality, but not Native people, because
spirituality is their fundamental strength.”
“Belonging is so powerful that it will heal any
wounds you’ve been carrying with you and will
give you the courage to walk through fire if
necessary. All of us feel on the inside the power
that belonging has – it creates strength and
energy.”
“Mastery creates strength of spirit. It is not just
getting something done, but discovering what
you can do.”
Dr. Brokenleg shared that the median age in
native communities was typically between the ages
of 12 and 14 years old, with 50% of the population
being older and 50% of the population being
younger. In Saskatoon and Regina public schools,
60% of the children were Aboriginal.
Dr. Brokenleg discussed the Circle of Courage
psychology for dealing with youth and adults,
noting that in order to be whole, it was necessary
to stop looking at woundedness and to instead
focus on wholeness. He shared that fundamentally,
culture was in place not lost, although it could
take some work to find it and dig it out again. He
emphasized that in looking at the First Nations’
wellness legacy over thousands of years, the last
200 years lost their importance.
An overview of an Aboriginal childcare
philosophy taken from the green book “Reclaiming
Youth at Risk” provided best practices for working
with kids, using four spiritual strengths that existed
in all Aboriginal communities: belonging, mastery,
independence, and generosity.
Belonging was the need to be significant
and important – like the killer whales that were
always in pods. In Sioux culture there were no
clans or crests, but there were relatives that did
everything together. For example, Dr. Brokenleg
shared that hospitals in South Dakota dropped
the requirement for native patients to limit their
number of visitors. He spoke of the reality that a
baby crawling on the floor in a room of strangers
would crawl directly to its mother. Babies were
designed to belong. In fact, regardless of their age,
everyone wanted to belong.
Dr. Brokenleg discussed his icons of belonging,
which were his mother and father who married on
may 1, 1937. To celebrate 60 years together, they
invited the community to witness them renew
their vows. They fed 4,000 people and asked for
no gifts or money. Five months later on a Friday
afternoon, Dr. Brokenleg was beside his father
when he suffered a stroke and right side paralysis.
When his mother arrived and called his father
by her special name for him he smiled, and then
closed his eyes. He lingered six more days. There
were 70 people there when he took his last breath.
Dr. Brokenleg shared that when a parent died,
the whole world seemed to change. Two hours
after his father died, his mother said that she was
also ready to go. She was miserable for five more
months and then they buried her as well.
It was observed that schools typically
responded to those in difficulty with “unbelonging”
or “time outs”. Other groups however,
accepted people when they were ‘going down in
flames’, because they knew that nothing happened
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VANCOUVER, bC • mAY 20 - 21 , 2008

14
until belonging happened. That’s true for youth
and adults. Dr. Brokenleg added that if it was
possible to make belonging happen, it was possible
to make anything happen. Canada was in major
danger, as Canadian families were coming apart
-belonging was more necessary than anything
else. In times of crisis, it was important to tell the
person in crisis that nothing they could do would
break their love for them.
Belonging remained one of the greatest
strengths that Aboriginal communities possessed.
It was a gift that could be given to the world. Doing
so would strengthen people and help see them
through any crisis.
Mastery was the second theme discussed,
depicted by ravens. Dr. Brokenleg shared that
ravens were an appropriate reference when
considering the story of a hotel doorman who
would toss acorns near the entrance to attract
squirrels, which entertained the hotel guests.
Ravens would pick up the acorns and drop them
from high above so they would break open on the
sidewalk.
Dr. Brokenleg noted that many reserves gazed
at problems and had forgotten what they could do.
Instead they should glance at problems and gaze at
solutions, to create resiliency. He spoke of a school
where the kids were not getting an afternoon
recess because they were taking too long to eat
lunch. The kids were challenged to come up with
a solution. They determined that if there were
condiments on each table it would make lunch go
faster. As such, they held a fundraiser and used the
money earned to buy condiments for each table.
The kids learned through this process that if they
had a problem they could fix it.
He explained that most arguments with a three
year old were about whether or not they would
be allowed to do something themselves. This was
exactly what a 16 year old argued for, and the
same thing that a nursing home resident wanted.
There was a universal need for people to have
mastery.
Independence was the third theme that Dr.
Brokenleg discussed, which was represented by the
image of an eagle. Independence was not about
being alone and self-sufficient, it was about being
responsible for oneself - about empowerment.
He shared the story of his son, who at the age of
five had a fever and needed to take medication.
While he took the first dose willingly, he had to
be forced to take the second dose because of
the terrible flavour. For the third dose, his father
offered him the choice of taking the medication on
a fancy spoon or a plain one. The child chose the
fancy spoon and then willingly took the medicine.
The story illustrated that providing choices was
effective, although care was needed in considering
the choices offered.
Dr. Brokenleg shared that discipline was
empowering as it taught people to be responsible
at one level so they could go on to the next. He
noted that empowerment was the experience of
one’s own power, achieved through discipline and
allowing a child more and more responsibility,
similar to the old potlatch tradition of borrowing
blankets and paying back one or two more than
were borrowed.
Dr. Brokenleg discussed the fourth theme of
Generosity, which fulfilled the human need to
know one’s own goodness and was represented by
the wolf, who did not eat alone. He added that the
first thing a person lost in a crisis was the sense of
their own goodness.
In conclusion, Dr. Brokenleg explained that the
four themes depicted by the killer whale, wolf,
eagle and raven, comprised the major First Nation
crests. Addressing all four themes created a person
whose strength was on the inside, so that they
did not have to be controlled from the outside.
Anyone could face life with these four themes. Dr.
Brokenleg offered that the job of First Nations was
to teach children to be strong on the inside, and to
know that adults needed these experiences as well.
In his first book “Dancing Healers”, Dr. Brokenleg
wrote about coming from a non-native world
to dealing with native clients. “Theft of the Spirit”
was an account of caring about children. He emphasized
that the Circle of Courage psychology
would create strong youth, as it was the wisdom of
First Nation ancestors, verified even by science as
a best practice. Children were acknowledged as a
reward and the promise of what was yet to come.
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SECONd ANNUAl FORUm

FINAL WRAP-UP
Dr. Evan Adams, Aboriginal Health Physician
Advisor
Dr. Adams expressed hope that participants
recognized First Nation logic and their ways of
feeling needed were the centre of First Nations
work. Through participation at the 2 nd Annual
Forum he felt energized and filled with wisdom to
carry through to the next year. He hoped that the
participants felt the same way.
He referenced his admiration for the tripartite
leadership who had spoken passionately and
acknowledged the diversity of the teams that were
working together and committing to each other to
achieve change. Dr. Adams acknowledged the keen
interest for there to be more opportunity to talk
about governance at a community level, including
determining how communities would organize
themselves in order to have input and to lead a
community driven process. methods to further
discuss this interest were referenced, including
through the upcoming regional caucuses in the
summer and the possibility that a province-wide
gathering on the subject of governance alone could
be convened as early as the fall of 2008.
Dr. Adams shared that he had attended
a number of different workshops during
the 2 nd Annual Forum, and appreciated the
different approaches of presenters in their
work. He concluded with acknowledgement of
the contributions of presenters and thanked
participants for opening their hearts, for their
generous and kind attention and good work.
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VANCOUVER, bC • mAY 20 - 21 , 2008

GATHERING THE COLLECTIVE WISDOM
16
The Tripartite First Nations Health Plan contains
29 action items divided into four key areas of
action: Health Promotion, Disease and Injury
Prevention; Health Services; Performance Tracking;
and Governance, Relationships and Accountability.
Participants were invited to engage in a
dialogue through a collaborative World Café
discussion process that enabled them to provide
input and share their ideas on up to sixteen of the
specific action items within the First Nations Health
Plan Through these conversations, participants
discussed how to move forward in First Nations
health. What follows is some of the wisdom that
was harvested during those sessions.
OPEN SPACE
Open Space tables provided participants with
an opportunity to record any issue they wished to
raise. The Open Space flip charts also encouraged
people to identify issues they wanted to discuss
and the follow-up they felt could address that
issue. There were four Open Space opportunities
provided during the Gathering, one in each of the
world café breakout rooms. many of the comments
added emphasis to issues already raised in other
parts of the forum (e.g. dentists, on/off reserve,
isolated communities, traditional interventions).
You will find Open Space responses at the end of
each topic.
BREAKOUT GROUP TOPICS
Health Promotion, Disease and Injury Prevention
• Holistic Health Programs
• ActNow – General
• ActNow - Physical Activity
• ActNow – Nutrition
• Injury Prevention
• Traditional medicine
• Food Security
• Open Space
Health Services
• Aboriginal Health Human Resources
• E-Health
• mental Health
• Access for People with Disabilities
• Universal ECD supports
• Dental
• Open Space
Performance Tracking
• Research Infrastructure
• Indicators
• Regional Health Survey
• Community Health Plans
• Open Space
Governance, Relationships and Accountability
(This topic was the subject of a separate breakout
session.)
In each of the rooms the Room Host provided
an overall summary of the key messages emerging
from the individual topic discussions. Table Hosts
provided summary notes for the discussions at
each table.
COMMON THEMES
In the conversations it is immediately apparent
that the action items in the health plan are interrelated.
Themes that emerged throughout the
Forum included:
• more must be done to ensure the long
term sustainability of this effort and various
strategies, initiatives and programs.
• There is a need and desire for significant
enhancements to resources in order to expand
the reach of existing programs, including
funding and coordinated/holistic approaches.
• Develop opportunities and materials to support
training and capacity, particularly in response
to needs at the community/front line.
• Leadership needs to continually demonstrate
its commitment and priorities in this area,
including serving as health role models.
• The approach to implementing the TFNHP and
responses to various health needs must be of
practical use at the community level/front line.
• Increase efforts and supports for building cross
cultural understanding between First Nations
and their non-Aboriginal counterparts and
colleagues.
• Provide adequate support to the critically
important area of education and awareness
within First Nations, Aboriginal and non-
Aboriginal communities.
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SECONd ANNUAl FORUm

APPENDIX A: BREAKOUT GROUP DISCUSSION SUMMARY
During the breakout group discussions the
following key themes about issues and actions
emerged from the topic tables:
• Training for leadership related to Tripartite
Health Plan.
• Create initial and ongoing training to support
new governance structure.
• Lack of education around substance users,
homosexuality/“two spirit peoples”, and HIV.
• Educate/train community leaders and elders
in order to foster community acceptance and
knowledge.
• Needs to be more knowledge about arthritis in
First Nation communities.
• Create an arthritis initiative.
• Health delivery lacking cultural awareness,
cultural safety and cultural competency.
• Provide cross-cultural training,
acknowledgement and incorporation of
traditional health delivery methods.
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HEALTH PROMOTION, DISEASE AND INJURY PREVENTION
18
Community-based health programs are
being developed to assist First Nations to deal
with health promotion and disease and injury
prevention issues affecting their communities, so
that the incidence of preventable diseases and
injuries in the First Nations population becomes
comparable to that of other British Columbians.
Key to the strategy is: Increasing access to
traditional foods and medicines, improving food
security, and developing culturally appropriate
health promotion and prevention tools.
Holistic Health Programs
Although the TFNHP does not have an action
item entitled ‘Holistic Health’ it is clear from
the various actions and strategies contained
within it that the First Nations priority for holistic
approaches is an underlying principle. This
discussion table was convened in order to provide
guidance to how holistic approaches could be more
effectively intertwined with the activities within
the TFNHP.
Question 1: What does holistic health mean to
you?
• Depends on individual, family and community.
• Holistic – integration of all elements of health.
Question 2: What does a holistic health program
look like?
• Include traditional approaches.
• Support ability of Aboriginal frontline staff to
take this message into the homes.
• Provide training on traditional practices.
Question 3: How would we pursue a holistic
health program within the tripartite process?
• Advocate for holistic approaches within
tripartite processes.
ActNow: General
As described in the TFNHP and the First Nations
Health Council’s “Year in Review 2007-2008”
participation in ActNow BC was initiated through
the University of Northern British Columbia,
and is being implemented through First Nations
ActNow specific projects (e.g. Community Tool
Kits), collaborations with other health initiatives
(e.g. Aboriginal Diabetes Initiative, First Nations
Education Steering Committee), and partnerships
with other ActNow BC programs (e.g. Action
Schools BC) to expand First Nations access to
as many ActNow BC programs as possible. In
commenting on how the ActNow Initiative could
respond to Health Promotion and Chronic Disease
prevention issues the participants noted that:
• Community role models/mentors need to be
recognized.
• Community dialogues should take place in
order to identify strategies and plans.
• There needs to be more training on Health
Promotion for community health workers –
needs to be access to Health Promotion tools.
• Leadership needs to put Chronic Disease
Prevention and Health Promotion on their
agendas.
• Leadership needs to live healthy lives since they
are role models.
• mental health should be included in the Action
Health Promotion strategy.
• Provincial First Nation Centre of Excellence
for Chronic Disease Prevention should be
established.
• Research, literature, and health promotion
resources need to be developed at the
community to community level.
• Funding needs to be larger and sustainable for
Health Promotion strategies.
ActNow: Physical Activity
Within the four pillars of ActNow (i.e. Tobacco
Cessation, Healthy Choices in Pregnancy,
Nutrition, and Physical Activity) First Nations have
emphasized Physical Activity and Nutrition as
priorities for action that have the most potential
for improving health outcomes and impacting
on the other pillars of ActNow. During the 2007
Gathering Wisdom forum the physical activity and
nutrition elements were addressed at one table.
For this 2008 Gathering separate table discussions
were convened. In summary the participants
encouraged:
• Validate and include physical activity as an
essential cornerstone to improve health by
including it in the Accord.
• Provide more youth activities that are longterm
not just project based (e.g. Boys Clubs).
Also need Girls Clubs for adolescent girls that
are driven by young women rolemodels. These
clubs can build self-esteem, leaders in training,
activities, etc.
• Community has individual needs and resources
– develop strategic plans suited for community
and to assist in making physical activity a
priority (i.e., needs assessments to know
challenges, weather, respond to community
feedback, generate community support, etc.)
• Ideas to reduce barriers included consideration
of a universal BC passcard to help you go to
II
SECONd ANNUAl FORUm

any event/access (i.e., leisure access card, golf
course access, etc.), lowering gas prices
• Determine what are the Best Practices and
promote them (e.g. How do other First Nations
communities succeed? more training that is
culturally appropriate - e.g. FKC)
• Increase awareness of mainstream funding and
grants
• Provide promotional materials (e.g. brochures,
DVDs, and “cool stuff” for kids)
• A number of ideas suggest the need to develop
a broader strategy around physical activity that
includes:
• famous athletes and speakers in materials (i.e.,
NHL)
• all-native hockey tournament
• women’s soccer players highlighted
• support for organized sport-paid coaches for
soccer and basketball
• update facilities and equipment
• help with wildlife programs
ActNow: Nutrition
Nutrition and physical activity are seen to
go hand in hand in many respects, and this is
particularly true in terms of work within the
Aboriginal Diabetes Initiative. When asked
to provide guidance on how best to promote
healthy eating in First Nations communities the
participants stressed that it will be important to
address issues and actions in the areas of access,
traditional foods, education/awareness, and school
based approaches:
Access:
• Lack of resources to purchase healthy foods.
• Cost (isolated communities).
• Traditional Food Promotion:
• Seasonal traditional food preparation.
• Researching nutritional value (i.e. Ca2+).
• Food security.
• Food safety preparation (legislation).
• School-based Policies and Promotion:
• Healthy menu development.
• Serving traditional foods.
• Serving healthy foods.
• Education:
• Small, gradual steps to sustainability.
• multi-media.
• Practical activity sheets.
• Community-based training.
Injury Prevention
The TFNHP sets as one of its goals the
establishment of appropriate programs to assist
First Nations to deal with the most pressing health
promotion and disease and injury prevention
issues affecting their communities, so that the
incidence of preventable diseases and injuries in
the First Nations population becomes comparable
to that of other British Columbians. The input
from the 2007 Gathering encouraged that ‘injury
prevention’ be reframed to include a wider
number of injuries than the initial items identified
in the TFNHP. Consistent with that, the participants
at the 2008 Gathering defined effective injury
prevention within a tripartite process in broader
terms focusing on a wide variety of ‘risks’:
Injury prevention is seen to include:
Suicide:
• Alcohol, copycats, bullying, self-harm, intent to
self-injure.
• motor Vehicle:
• Car seat, booster seat, drugs, alcohol.
Alcohol:
• Water safety, domestic violence, family
violence.
• Home Safety:
• Access to cleaning agents, fire, electrical.
Child Safety:
• Young age drinking.
• Trapped in old fridges and cars.
• Playground equipment.
• Bike safety.
Effective Strategies include:
• NAYSPS/ASCIRT/FAST.
• Education.
• media.
• Enforcement.
• Community ownership.
• Holistic approach – include arts, contemporary,
traditional.
• Traditional intergenerational teaching.
• Community based activities such as clean-ups,
and funding workshops.
FNHC can address injury prevention within the
TFNHP by emphasizing:
• Culture.
• Dedicated funding.
• Surveillance.
• Database.
• Getting funding where needed.
• Youth involvement at tripartite level.
• more human resources.
• Offering solutions rather than just presenting
statistics.
• Experiential messages from people who
survived.
• media campaign.
Traditional Medicine
Reduced access to traditional lifestyles, food
and medicine has contributed directly to the
diabetes epidemic in First Nations communities.
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20
Though often overlooked by the health care
system First Nations have consistently worked to
maintain, and where necessary, rebuild traditional
medicine knowledge and practices. Efforts
continue to integrate traditional medicine into
the health care system. The First Nations Health
Council is pursuing several strategies to ensure that
traditional medicine is an integral part of efforts to
improve the health and wellbeing of First Nations
(e.g. data base of traditional healers and centres,
discussion groups, surveys, etc.). Participants
in this table discussion examined the critical
role of the philosophy, protocols and impact of
traditional medicine and the ‘knowledge keepers’
in their communities, practical ways of weaving
traditional and western practices (e.g. Cowichan,
Alert Bay), and policy and program changes that
demonstrate respect for traditional medicines,
support its practitioners and engage a broader
audience (e.g. youth, community exchanges). The
ideas highlighted from the discussion notes provide
advice on how the FNHC might modify its current
activities in this area:
• Limited awareness in the community of
traditional medicines.
• Knowledge is held by individual families.
• Some commercialization happening (individuals
selling medicines).
• Forums for both traditional/alternative
practitioners, and conventional doctors.
• Teaching the community traditional/alternative
medicines – focus on youth programs, and
summer camps, etc.
• Documentation/database/book/Elders
(recordings of them speaking) – some
concerns about knowledge ownership (i.e.
pharmaceuticals).
• Community must drive policy change.
• Options: providing choice.
• Traditional healer forums – recognition.
• Liability issues regarding traditional medicine
in health centres – funding for training in
traditional medicine.
• Environmental protection (including financial
support to maintain plants).
• Integrating traditional knowledge into school
system.
Food Security
The issue of ‘Food Security’ refers to addressing
the barriers that limit or threaten a community’s
access to adequate healthy food sources. In a First
Nations context this often includes consideration
of the shift away from traditional practices to
supermarket foods, access to land, contaminants
and other environmental conditions. BC First
Nations have been very active in addressing food
security issues and participants identified actions
that could be taken to improve First Nations
people’s access to, and knowledge about, healthy
food. In summary this includes:
• Diffusion of innovation.
• Community Champions.
• Increase access:
• Community kitchens.
• Community gardens.
• Flexible funding program.
• Food boxes.
• Breakfast school program.
• Community food co-op.
• Increase knowledge:
• Community sharing of traditional and nontraditional
knowledge.
• Peers teaching peers.
• Regional food forums.
• Increase tools:
• Community freezers, stoves, fridges, pots and
pans.
Open Space Responses
• Stigma within the community around substance
users and related sexual issues
• At present, contribution agreements limit use of
traditional models
• Needs to be more attention paid to number of
FN with arthritis, i.e., Arthritis Initiative
• Respect for two spirit peoples health issues/
Homophobia is a main concern in Aboriginal
communities
• Knowledge about HIV, HEPC, STIs needs to be
taught to all people in communities
• Right to clean water!
• Create groups of young girls/teens/women/
elder women to create opportunity for coming
of age education
• Home care centre and detox unit, that are
culturally appropriate, in the northeast
• Leadership must encourage, support and model
real meaningful youth engagement
• C’iiq’ciiga quuquulaca – our languages
• Return to 100% fluency = health
• In community health plans, look at options to
use traditional medical interventions as well as
western interventions
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SECONd ANNUAl FORUm

HEALTH SERVICES
The underlying goal of the Health Services
component of the TFNHP is to support the
ability of First Nations to increase their direct
participation in the delivery of health services to
their people and communities.
Health Human Resources
The Transformative Change Accord identifies
“Practising, certified, First Nations health
care professionals” as one indicator that will
demonstrate that progress is being made. The First
Nations Health Council “Year in Review Report”
notes that “…health care professionals are the
gatekeepers to our complex medical system,
Health Human Resources is one of the key drivers
to address health…”. It is also clear from some of
the goal and outcome statements in the TFNHP
that increasing the number of people, especially
Aboriginal people, that are pursuing health careers
and securing the required accreditation is a strong
priority and requirement if First Nations are to
administer their own health services delivery.
The FNHC has secured resources for staffing and
projects as part of the Aboriginal Health Human
Resource Initiative. Participants were asked to
provide input on how the TFNHP could better
address barriers and priorities for health careers.
Barriers
• Support for students
• Information to students, communities, and
potential employees
• The level of cultural competency in post
secondary schools & institutional racism
• Lack of focus on off-reserve people
• Reduced capacity in remote communities
Priorities
• Focus on the educational system (e.g. cultural
competency for staff and better support for
students when in school)
• Focus on communication/information sharing
(community hubs and connections between
schools and reserves)
• Focus on children & youth (guide them from an
early stage, role modeling, esteem building)
e-Health
First Nations, the bC ministry of Health and
Health Canada are working collaboratively to
implement this area of the TFNHP. This includes
the establishment of a First Nations Centre of
Excellence for e-Health and work to continue
the expansion of tele-health infrastructure into
all First Nations communities and First Nations
participation in other e-Health initiatives, including
a seat on the provincial health Strategy Council
and a public health surveillance project. The
participants identified ways in which e-Health is
supporting the community and look to the TFNHP
to continue to expand access:
How e-Health will support the community:
• provide technical assistance in communities
when needed
• assist in training community health workers
• help to reduce patient travel by having clinical
support in the community
How TFNHP can support e-Health:
• Ensure communities have high speed internet
that supports video conferencing
Mental Health
Addressing mental health issues within First
Nations communities in a holistic manner has
been consistently identified as an issue in the
Transformative Change Accord, the TFNHP and
the 2007-2008 Year in Review report. building
on the guidance provided during the 2007
Gathering Wisdom forum work is underway
through the Aboriginal Reference Group to the
ten-year bC mental Health and Substance Abuse
Plan to develop and implement the “Aboriginal
mental Health and Addictions Plan” called for in
the TFNHP. During this 2008 Gathering Wisdom
forum participants provided guidance about
what communities can do to develop coordinated
mental health approaches and how that would link
to a tripartite mental health plan:
Better Coordination
• A need for children and youth mental health
services to be addressed as one.
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22
• Need to identify policies and regulations in the
system that inhibits creative ways of addressing
mental health and addictions issues (e.g. Folks
on mental health medication cannot enter
addictions treatment programs).
• Needs and capacity of communities vary
greatly and there needs to be the flexibility
for tailoring an approach to mental health
services as well as support to the community
to even develop what they think they need (the
program needs to fit the community not the
community fit the programs).
Key Components
• Need to find a way to capture the wisdom
and traditions of our aging elders, more value
needs to be placed on traditional medicine and
practices (culture/tradition = mental health)
• Need to put in place better process (wrap
around services) for when individuals are
discharged from hospital of treatment
programs.
• Need to address the ability of rural
communities to access qualified mental health
staff and resources.
• Need to address the mental health knowledge/
awareness of family members, community
members and staff from many other social
programs who often end up with mental health
clients (e.g. maternal health staff work with
pregnant mom with a mental health issue).
Access for People with Disabilities
Advocates have consistently urged that
the needs and circumstances of Aboriginal
peoples living with disabilities be included in the
discussions and strategies, in not only health, but
in all aspects of life. A specific discussion table was
convened to examine how to ensure that people
with disabilities aren’t overlooked in the work
to improve the health outcomes of First Nations
people.
How to ensure they’re not overlooked?
• Give persons with disabilities a forum to give
input on what they require
• Support/create advocacy and build capacity for
self-advocacy
• Provide more thorough and consistent criteria
– provide better definitions around disabilities
• Create community “hubs” for people to come
together for information on disabilities and
activities
How to incorporate into TFNHP?
• This topic needs to be addressed by chiefs and
council
• Give the disabled a FORmAl voice –someone
at the governance table who specifically speaks
for true disabled community members
Universal ECD Supports
Both the federal and provincial governments
have been engaged in initiatives to support
Aboriginal Early Childhood Development. While
the 2005 and 2006 federal budgets announced
significant investments in First Nations early
learning and child care there has been a consistent
concern that funding and other supports
are inadequate to address the level of need,
particularly for children with special needs, in
on and off-reserve First Nations communities. In
the area of ‘universal ECD supports’ the FNHC is
analyzing current ECD programs and services as
part of determining the minimum standards for
programs and services that are needed to allow
First Nations children reach their full potential.
Participants examined what aspects of ECD need to
be addressed by the FNHC within the TFNHP:
Issues and Considerations
Status is an issue – some services are not
funded for non-status
• On reserve/off-reserve (e.g. would be good to
be able to amalgamate)
• Training and education for educators, families
and communities
• Reconsider subsidy cutoff level and level of
support
• Cannot only focus on children – need to
support family with basic necessities - need a
variety of programs accessible to families and
kids
How can FNHC support work of universal ECD?
• FNHC could advocate for ECD funding,
especially for smaller communities.
• FNHC could encourage communities and
create awareness of benefits so communities
would include this in health plans and lobby for
programs. Preventative potential is huge.
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SECONd ANNUAl FORUm

Dental
The First Nations Regional Longitudinal Health
Survey (RHS) identified that dental treatment is
“The number one reason for day surgeries for
children in B.C. (and that) First Nations Children are
four times more likely to require such treatment
than non-First Nations children. The TFNHP sets
out to address the financial and access barriers
to dental services, particularly at the community
level, and to ensure that every Aboriginal child on
and off reserve receives dental (as well as vision
and hearing) screening through the province’s
Vision, Hearing and Dental Screening Initiative. The
input provided at both Gathering Wisdom forums
will continue to help shape the roll out of this
initiative.
Priority Areas
• Lack of coverage
• Dentists who do not accept NIHB clients
• Ineffective appeal process
• Administrative process needs improvement.
Currently it results in delayed treatment or
deteriorated oral health
• Need for more oral health education in the
community
Innovative Dental Services
• Increase the Health Authority’s ability to
provide public health dental programs and/or
encourage Health Authority collaboration with
FNIH
• Utilize patient health advocates
• FNHC advocacy including FNHC setting
standards for claims processing & influence
policy change
• Utilize incentives for dentists to work with First
Nations
• Encourage community members to become
oral health practitioners
• mobile dental service
Open Space Responses
• Respectful workplaces for staff and community
members where leadership, administration
and clients are involved and aware of policies,
procedures and consequences
• Better access to crisis funding and support
services such as adequate training – culturally
appropriate and peer support (crisis
intervention)
• Mental health issue – Prime Minister’s apology
- How do we support our people through this?
Common viewing space – food, counseling
• I heard Health Canada is going to phase out
CHR positions. So, with all the training we’ve
done, what are we supposed to do? I’m too old
to train to be a LPN
• Include education about homosexuality in all
health policies (in tripartite)
• Please invite Aboriginal nurses to the health
table
• We need to get aboriginal treatment centres to
begin dealing with core issues
o Sexual abuse/historical abuse
o Trauma
o Child sexual abuse and incest
• Need for more Elders services including
reconnecting with youth and respite services in
communities
• Develop partnerships with colleges and
associations to provide respite education
and training needed for frontline workers in
communities
• As I sat at the mental health issues circle – I saw
how close minded the workers were. So hung
up on their titles and trying to “fix” a person
with MENTAL HEALTH problems - Out of this, if
I may, I would like to suggest that the “health
services plan” take away the label “mental
health services” because that title alone slams
the door on a lot of people who want help but
not under that term.
• www.fnwaccb.ca (First Nations Wellness/
Addictions Counsellor Certification Board
• Harm reduction should be in every community
– needle exchange/free condoms/testing/pipe
exchange.
23
VANCOUVER, bC • mAY 20 - 21 , 2008

PERFORMANCE TRACKING
24
The intent of the performance tracking
component of the TFNHP is to ensure that all
parties have access to data necessary to measuring
progress towards its overall goals and those of the
Transformative Change Accord, namely to improve
health outcomes for First Nations people and close
the gap between First Nations and the rest of the
population in BC.
Research Infrastructure
The 2007-2008 Year in Review Report states
that “because research drives policy, it is important
to have control over how First Nations data is used
and interpreted. In addition, First Nations need to
be armed with accurate information to effectively
plan and implement programs and services at a
community level.” In discussing the supports and
protocols needed the participants identified the
need to:
• Support community ownership and capacity,
professional database protocols
• Provide supports/tools/resources for
communities to drive their own research
• Ensure a First Nation community capacity/
resources to own their data and use it for their
purposes
• Provide training for community members,
community workers, and leadership on purpose
of research, use of research and developing
research capacity
• Share knowledge/information between First
Nations, between First Nations and government
service providers/ministries, and between First
Nations and research grant providers
• Ensure that there is a strong link between
communities and that the research benefits
First Nations
• Develop a professional research database for
First Nations to use; it would include qualified
professionals trusted by First Nations
• Develop and promote protocols for data/
research management and acquisition of First
Nation individual, families and community
data/research
• Develop a standardized data set, policies and
protocols between all information partners
to use First Nations information to drive
health programming and services in First
Nation regional health authorities (i.e. ethics
templates)
• Ensure OCAP principles remain intact to
manage data security
• Work together for positive partnerships
Health Indicators
Each key area of the TFNHP and TCA (e.g.
Health Services; Health Promotion, Injury and
Disease Prevention, etc.) identifies what will be
different by 2015. The section entitled ‘measuring
Progress’ identifies targets for seven indicators
initially set out in the Transformative Change
Accord (i.e. life expectancy, mortality, youth
suicide, infant mortality, diabetes, childhood
obesity, and health care professionals). Participants
provided input on what indicators of wellness/
health are being used at the community level; the
information needed to measure progress on these
indicators; and where the needed information
might be located:
• Participants spoke to the importance of a
variety of wellness indicators and variation
from community to community including:
- Culture and language
- Spirituality
- Physical health
- mental health
- Infrastructure
- Social determinants
• Importance of individual stories, gathering
themes from qualitative narratives to develop
indicators.
Regional Health Survey
First Nations in BC have actively participated
in the First Nations Regional Longitudinal Health
Survey (RHS) and it is identified as one of the
key data sources to be developed and utilized to
measure progress. Data collection for the next
iteration of the RHS is expected to begin shortly
in 77 BC First Nation communities. Participants
provided additional input into how the principles
of Ownership, Capacity, Access and Possession
(OCAP) to information is defined and applied, and
how the TFNHP can continue to address OCAP
issues:
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SECONd ANNUAl FORUm

• Develop our own research policies, programs
and a First Nations Research Centre of
Excellence
• Research must adhere to the principles of OCAP
• Develop First Nations policies and program
development related to First Nations research
• Develop BC First Nations Research Centre of
Excellence
Community Health Plans
As a result of current health programming
many First Nations have developed various forms
of Community Health Plans. The TFNHP identifies
the need for these community plans to support
better coordination with the Aboriginal Health
Services Plans that the Regional Provincial Health
Service Authorities are to develop consistent with
the TFNHP priorities and First Nations involvement
in decision making about health service delivery.
The discussion at the 2008 Gathering Wisdom
forum sought to contribute to clarifying what the
components a ‘community health plan’ are and
whether there is a connection between them and
performance tracking.
• Direction for planning and wants, social
determinants, holistic, cultural foundation that
meets needs
• Does the direction for planning and wants for
communities look at all social determinants of
health?
• It is a holistic approach which has a cultural
foundation that meets the community needs
component
• Definition of “health”, “community” and
“Community Health Plans”
• Principles, vision, mission statement
• Evaluation framework
• Statistics from programs/services
• Causal factors
• Traditional and contemporary practices
• Staff retention/mentoring/leadership/
recruitment
• Accountability framework
• Reciprocal accountability
• Knowing when you have been successful
• Evaluation of programs and services
Open Space Responses
• FNIHB provide a summary report of the Pilot
Projects Flexible Transfer Process: report will
include: activities, funding, challenges, positive
impact, and identified new opportunities for
these communities. This report made available
to all First Nations communities.
• Consultation process needs to change,
community members need to be informed at
the community level.
• Recommendation: First Nations Health Council
should apply knowledge management principles
and process to collect, analyze and assimilate
knowledge on aboriginal health topics in an
effective and efficient manner; otherwise, how
can First Nations benefit? We have limited
time and resources. A lot of great work has
been done on indigenous health. Learn what
knowledge management is and how to do it.
Topics as directed by First Nations. Caring for
first Nations Children Society of Canada does
knowledge management well – be as good.
25
VANCOUVER, bC • mAY 20 - 21 , 2008

GOVERNANCE, RELATIONSHIPS AND ACCOUNTABILITY
26
Following a presentation by the Co-Chairs of
the FNHC Governance Sub-Committee in plenary
session, a separate breakout was provided
throughout the first afternoon to enable the
participants an opportunity for more extensive
discussion. The breakout session on Governance,
Relationships and Accountability enabled
more discussion of the concept of the Health
Governance Sub-committee and to look at the
need to add regional representatives, the potential
development of regional caucuses and regional
discussion sessions on health governance. The
breakout session offered additional information
and increased clarity about the governance work,
provided opportunity for participants to discuss
these issues further, and considered the role and
composition of the sub-committee.
Opportunities/Recommendations
• Clarify the plan for moving forward including
the process for communities to be engaged.
• Improve communications, including making the
regional discussions a reality.
• A funding formula needs to be developed. One
area of underfunding is patient transportation,
which cannot be allocated on a per capita basis,
and needs to be allocated as needed.
• Community engagement hubs are an issue for
northern communities that are dealing with
issues relative to participation/access.
• There should be elders, women, youth and
all regions also represented on the Sub-
Committee.
• Steps need to be taken to ensure that the
government’s fiduciary responsibilities remain
in tact following the program transition.
• Suggestion that the transition be in stages:
delegation, management and full authority.
• Culture, traditions and language are an
important component of health and need to be
considered.
Open Space Responses
• Government using legislature to control
these important issues now. TSLs are to limit
traditional resources like they do with salmon
and hunting
• What is the Jordan’s Principle?
• First Nations would access the services of
the Health Authorities ending with successful
relationships and TRUST
• Jordan’s Principle: What are the implications for
First Nations health or child welfare agencies?
How do they honour it? Can the FNHC develop
materials, guides, etc.?
• Host two Provincial conferences similar to the
Provincial diabetes conferences – one targeting
health workers and one targeting people living
with arthritis
• When you form the Council have urban as well
as on-reserve representatives
• You cannot give up anymore of our First Nation/
indigenous rights that have already been given
up to the federal, I/we are counting on you –
our representatives – to protect these
• How do the regional health authorities (and
provincial health services authority) factor in
with the new governance structure? Most of
the Aboriginal people in our HA live off-reserve
and we must do a better job of providing service
and reducing the inequities and disparities (i.e.
would like to see lines erased for delivery of care
between the on and off-reserve populations).
• How are decisions made at the First Nation
Leadership Council? Are the reports and
minutes available to the First Nations people?
• Annual conference – next one in Prince
George and then Prince Rupert you need to
accommodate the north
• Not just a shift of system to First Nations
control, but a shift in the system itself (i.e.
traditional values, funding agreement, program
criteria, etc.)
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SECONd ANNUAl FORUm

PROFESSIONAL DEVELOPMENT WORKSHOPS
TRADITIONAL MEDICINE
“You should be responsible for your health –
know everything you’re putting into your body”.
“Honour who you are”.
Dr. Jeanne Paul, Red Shawl Naturopathic Clinic
presented the workshop focusing on the traditional
medicines she brought with her. Key messages
delivered in the workshop included emphasis on
the importance of:
• Integrating ourselves wholly: emotionally,
spiritually, physically – healing the whole of you
• Involving Spiritual aspects to achieve deep
healing
• Achieving a “cure” means you’re finished your
symptoms
• Being clear about your intention behind why
you are making the medicines – gift in all of us,
just have to know how to tap into it
The participant questions and dialogue focused
in some respects on clarifying the relationship of
nutrition as a part of traditional medicine/.
The participant discussion focused on how and
where they could learn more about nutrition and
good eating habits, the importance of dealing with
healthy eating on both a personal and community
level, and concerns from people who aren’t eating
healthy foods (e.g. lots of salt and little vegetables)
yet don’t seem to have health issues.
GETTING ACTIVE
“It is important to understand the world view
of youth in order to understand how to engage
them.”
27
PERSONAL NUTRITION
“Plan and prepare”
“Enjoy every mouthful - Eat it slowly and savour it”.
Suzanne Johnson, Nutritionist, First Nations
Health Council emphasized the following key
points in her presentation of this workshop:
• Personal nutrition requires a planned approach
• There is a First Nations Food Guide available
that discusses the nutritional values of –
traditional foods and portion sizes
• Choose foods with the brightest/darkest colour
• A part of making changes and sticking with
them involves thinking about our reasons for
change and breaking down the change into
small steps
• It is important that you prepare a plan and that
when shopping you are looking further down
the road than your next shopping trip
Rosalin Hannah, Physical Activity Specialist,
First Nations Health Council (pictured above) and
Denise Lecoy, Provincial Coordinator, Honour
Your Health Challenge presented this interactive
workshop. A key point of the presentation involved
identifying some of the key challenges confronting
those interested in getting active or encourage
more active lifestyles in the communities including:
• Circular passing of the buck
• System unresponsive to realities of community
• Assistance available is not aligned with need
VANCOUVER, bC • mAY 20 - 21 , 2008

• Workers become paralyzed with fear/burnout
and feeling helpless
• Don’t know their own skills to fix issues
• We discuss problems and never get to solution
Participant discussion highlighted that:
“This workshop really opened my eyes to the
frustrations that our workers go through every
day. I never really understood this before. This
workshop opened my eyes. What you are doing
here today is just great.”
YOUTH ENGAGEMENT
“Community needs to take ownership and stop
depending on government for everything.”
“Are we enabling this attitude or behaviour?
What do workers need to do to elevate the
community members?”
“Somehow First Nations young people are
supposed to grow up and solve all these problems
in the community as though we are supposed to
be saviours of the community.”
• Health workers care; see community assets and
want to work from within
• Not enough emphasis on self-responsibility and
responsibility of families
• Dependency on funding and services vs.
recognizing our own skills and abilities
28
CULTURAL INVOLVEMENT
“Culture is the defining character of Aboriginal
people rather than race.”
“All Aboriginal Youth must be bicultural at
present, in the future all of us must be multicultural…”
Dr. Martin Brokenleg presented during
which he explored the definition of what culture
is (“a pattern of group behavior), how it works
unconsciously such that when you are following
the rules of your culture you think your acting
normal. He stressed that there is a difference of
ethnic cultural and youth culture and subcultures,
and he provided examples of how this is expressed
in the health of Aboriginal people. He also talked
about the ten most common findings in the
published research and noted that culture is
expressed in four areas:
• Artifacts, technology, architecture, clothing,
tools, food, clothing;
• Actions – ceremony, specific ceremonies,
daily ceremonies; Kinetics (internal rhythms of
patterned group behavior)
• Speech – what language is spoken, reality exists
in language (you only will see what you have
words for…)
• Thought – attitudes (words), values (feelings),
ethics, religion, metaphysics
Special recognition is given to the actors: Evan
Adams, Simon Baker, Delana Bowen, Dustin Rivers,
Renae morriseau and Dakota Prince. Particular
admiration is extended to those participants who
provided solutions and special acknowledgement
is given to britannia High School teacher matt
Chenoweth, and the students of the Outreach
Program, who made it possible for student
Dakota Prince to receive course credit for her
participation.
Renae morriseau facilitated Youth Engagement
by using Forum Theatre as a tool to engage
participants in an interactive conversation of
youth issues. Forum Theatre, also described as
‘theatre of the oppressed,’ political theatre, and
guerilla theatre involves the presentation of a
skit that highlights a number of youth issues and
problems encountered by youth, family members,
and community workers. Participants are then
engaged, either by acting out, or discussing
possible solutions and alternative approaches.
In this workshop the skit focused on how youth,
health workers, parents in the community and
Health Canada officials deal with a tragic drinking
and driving death of a young gay community
member.
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SECONd ANNUAl FORUm

This interactive forum theatre facilitated
dialogue about all of the environments that First
Nations youth move through. The issues and
solutions identified during the workshop related
to:
• Workers so focused on funding issues and lack
of resources that they lose sight of the people
in crisis
• No/little on-reserve programming
• Community workers often related to community
and always responding to crisis get burned
out – there is no relief in sight
• When a person comes to you with an issue find
out how that issue is affecting them and help
that person address those as well. Often this is
quite different than the problem they initially
came to speak about.
• Funding formulas do not allow small bands to
get and maintain clinicians to support front line
workers, or to have early response capacity.
• Family and band can get together to support
the people who have suffered loss by making
ceremonial practices part of the response.
• Sharing of a personal stories that were reflected
in the forum theatre skit:
• Those who are struggling in their positions or
with these issues are our teachers and need
to be encouraged to never quit. As a newly
elected band councilor who wasn’t mentored
someone needs to mentor and honour our
young people as they being to deal with these
issues and take these roles in our community.
• Youth have to take it upon themselves to begin
asking for guidance/advice of the Elders.
• Youth just want some adult to take the time to
talk with them.
• Youth engagement has to be meaningful and
real, and this can be accomplished by involving
them from the start and ensuring that they
understand the process they are to be involved
in …otherwise it’s just activities.
• Ensure there is follow-up whenever is an indication
of hopelessness or suicide ideation.
• One person interjected the voice of the youth
that had committed suicide, encouraging those
left behind to go forward with a voice of kindness
not a voice of hurt and anger.
• Utilize education and awareness to help people
understand and know how to deal with their
issues.
• Staff need to demonstrate that they love their
work and are committed to deal with the communities
issues – in order to do this the staff
need to be able to air their concerns and ideas
so they can work on a level playing field.
• Two approaches are in play – dealing with the
problems that exist in the short term; and engaging
in long term prevention work.
• Creating a direct relationship with senior officials
at all levels, especially outside of your
area, so that there is the possibility of a quicker
response.
29
VANCOUVER, bC • mAY 20 - 21 , 2008

APPENDIX B: FEEDBACK
“Some of the things I found useful were:
identifying people who are working on projects
we have prioritized and becoming better
acquainted with the developments in areas I’m
interested in.”
- Gathering Wisdom participant
30
In your work place, what is your primary role?
Other 23%
Community
Member 3%
Government
Employee 3%
Management such
as health director,
band manager, etc.
52%
Political Representative,
(Chief or Band Councillor) 9%
Community Health
Representative 9%
Note: Among the” other” professions listed, 45% served in a managerial mangerial role
in health services delivery.
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SECONd ANNUAl FORUm

# OF RESPONSES
“Getting a sense of where the process is going
and how important on-going input at the
community level is was valuable to me.”
-Gathering Wisdom participant
What were two key hopes or expectations
for attending the Gathering Wisdom Forum?
80
70
60
31
50
40
30
20
10
Update on Tripartite First Nations Health Plan
0
To attend the professional development sessions
To network with other health professionals
To find out what opportunities are available for my community
through the Tripartite First Nations Health Plan
To provide feedback to FNHC and/or their Tripartite partners
VANCOUVER, bC • mAY 20 - 21 , 2008

“Clarity of the information and recognition of
the challenges and community driven process is
very important if we want this to work.”
- Gathering Wisdom participant
To what extent has the Gathering
Wisdom Forum met those expectations?
32
Almost all of my needs
have been met 22%
Most of my needs
have been met 48%
Only a few of my
needs have been
met 29%
0 10 20 30 40 50
“The solutions to health problems need to
come from each community - they cannot
be generalized across the province - and
community involvement is the key!”
- Gathering Wisdom participant
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SECONd ANNUAl FORUm

“The one thing I liked the best was the
cultural involvement- I think this is the
KEY for our people.”
- Gathering Wisdom participant
Did the session(s) provide you with information or tools that were useful?
No, definitely not 0%
No, not really 7%
33
Yes, generally 70%
Yes, definitely 23%
0 10 20 30 40 50 60 70 80
“Very useful to hear that the struggles of
other communities are similar to ours...”
- Gathering Wisdom participant
VANCOUVER, bC • mAY 20 - 21 , 2008

HOW HAS YOUR KNOWLEDGE CHANGED?
About the First Nations Health Council
First Nations Health Plan- Governance
50
61%
35
46%
40
30
30
25
20
28%
20
24%
15
20%
10
5%
10%
10
5
6%
34
0
I’m more confused now than I was before
0
I’m more confused now than I was before
It has not changed
It has not changed
It has improved
It has improved
It has dramatically Improved
It has dramatically Improved
About the Tripartite First Nations Health Plan
Cultural Involvement - Dr. Martin Brokenleg
50
40
62%
60
50
74%
30
40
20
18%
30
20
23%
10
10%
11%
10
0
0
1.5% 1.5%
I’m more confused now than I was before
It has not changed
It has improved
It has dramatically Improved
I’m more confused now than I was before
It has not changed
It has improved
It has dramatically Improved
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SECONd ANNUAl FORUm

“Experimental learning on getting active,
and the importance of cross-cultural
understandings was useful .”
- Gathering Wisdom participants
Overall Forum Evaluation
Design and Content
Aim, objectives/putcomes o were clear
Facilitators were well prepared
Facilitators were knowledgeable
35
Session(s) were interesting
Hotel accommodations
accomodations
Lunches and tea breaks
0 20 40 60 80 100
Poor
Satisfactory
Excellent
What I found helpful was identifying people
who are working on projects we have
prioritized. Becoming better acquainted with
the developments in areas I’m interested in.
- Gathering Wisdom participant
VANCOUVER, bC • mAY 20 - 21 , 2008

APPENDIX C: LIST OF PARTICIPANTS
Registrant
Type
Name Position Organization City/Town Telephone
36
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SECONd ANNUAl FORUm

Delegate Cross, Nicole
Laxgalts'ap Community Health Coordinator & Laxgalts'ap Village
Aspiring Physician
Government
Greenville (250) 6213437
Delegate Crossland, Cindy CHR McLeod Lake Indian Band McLeod Lake (250) 750-4415
Delegate Crouse, Priscilla Community Representative Lake Babine Nation Burns Lake (250) 692-3640
Delegate Cutler, Allison
Executive Director, Primary Health Care, Vancouver Island Health
Population and Family Health
Authority
Nanaimo (250) 739-5922
Delegate Dale, Lesley Program Manager
First Nations Agricultural
Association
Kamloops (250) 314-6804
Delegate Daniels, Rain Aboriginal Community Developer
Pathways Aboriginal Centre at
Richmond Youth Service Richmond (604) 271-7600
Agency
Delegate Davidson, Terrie Manager Boothroyd Band Boston Bar (604) 867-9211
Delegate
Dawson, Molly
Administrator, Health Representative for Health
Da'naxda'xw First Nation Alert Bay (250) 974-7006
Advisory Committee with Kwakiutl District Council
Delegate Dean, Karen Health Advisor /
Xaaynangaa Naay / Skidegate
Burnaby
Health Centre
(604) 817-5673
Delegate Dobmeier, Teresa Injury Prevetion Manager Interior Health Kamloops (250) 314-2567
Delegate Doxtator, Luke Health Director Toosey Indian Band Riske Creek (250) 659-5655
Delegate Edzerza Fox, Stacey Barrister & Solicitor Morgan & Associates West Vancouver (604) 9269903
Delegate Eichstaedt, Carol M. Health Director Hagwilget Village Council New Hazelton (250) 842-6258
Delegate Elliott, Andrea Tsartlip Health Center Manager Tsartlip First Nation Brentwood Bay (250) 652-3988
Delegate Faithful, Laverne Gitxaala Nation Council Gitxaala Nation Kitkatla (250) 848 2214
Delegate Fox, Terry Executive Director Inter Tribal Health Authority Nanaimo (250) 753-3990
Delegate
Delegate
Fraser, Tina
Froste, Josephine
BC Initiatives Research Manager for Aboriginal
Health
Health Director / Home and Community Care
Coordinator / Community Health Representative
BC Initiatives for Aboriginal
Health
Prince George (250) 960-5294
Ts'kw'aylaxw First Nation Lillooet (250) 256 - 1367
Delegate Gagnier, Janine Health Care Director Pacheedaht First Nation Port Renfrew (250) 647-5521
Delegate Garbitt, Nicole Director of Health and Family Services Saulteau First Nations Moberly Lake (250) 788.7282
Delegate Garbitt, Sandra Health Administration Services Treaty 8 Tribal Association Fort St. John (250) 785 - 0612
Delegate Genaille, Valerie Acting Executive Director
Association of BC First Nations
Vernon
Treatment Programs
(250) 503-1135
Delegate George, Lillian President United Native Nations Vancouver (604) 688-1821
Delegate
Girling-Hebert, Aboriginal Health and Wellness Strategies
Shannon
Coordinator
Ktunaxa Nation Health Cranbrook (250) 489-4563
Delegate Glendale, Joan band delegate Da'naxda'xw First Nation Alert Bay (250) 974-2179
Delegate Gohn, Judith Health Director
Ts'ewulhtun Health Centre of
the Cowichan Tribes
Duncan (250) 746-6184
Delegate Good, Sandra Health Administrator Snuneymuxw First Nation Nanaimo (250) 740-2336
Delegate Good, Terrilyn Youth Coordinator Gitanyow Human Services Kitwanga (250) 849-5572
Delegate Gottfriedson, Cathy Health Manager
Lower SImilkameen Indian
Band
Keremeos (250) 707-0095
Delegate Grant, Teena Health Services Administrator
Kitamaat Village Council /
(250) 639-9361
Kitamaat Village
Haisla Health Centre
ext. 351
Delegate Greene, Sandra Community Health Worker
Pacific Association of First
Nations Women
Vancouver (604) 688-1821
Delegate Greenwood, Margo Scientific Director
National Collaborating Centre
for Aboriginal Health
Prince George (250) 960-5986
Delegate Gregg, Judy Health Director Ulkatcho Indian Band Anahim Lake (250) 742-2090
Delegate Groves, Juniper Communication Manager Squamish Nation North Vanocuver (604) 980-4553
Delegate Hamilton, Margaret Health Program Manager Soowahlie Indian Band Cultus Lake (604) 858-4603
Delegate Happynook, Tom President Nuu-chah-nulth Tribal Council Port Alberni (250) 724-5757
37
VANCOUVER, bC • mAY 20 - 21 , 2008

38
II
SECONd ANNUAl FORUm

VANCOUVER, bC • mAY 20 - 21 , 2008
39

Delegate Moore, James Board Director Nisga'a Valley Health Authority New Aiyansh (250) 633-5000
40
Delegate Moore, Tania Policy Analyst First Nations Health Council West Vancouver (604) 913-2080
Delegate Morgan, Annette Executive Director
Dze L K'ant Friendship Centre
Smithers
Society
(250) 847-5211
Delegate Morgan, Loretta Counselor
Wilp Si' Satxw Community
Healing Centre
Kitwanga, (250) 849-5211
Delegate Morrison, Rose Kispiox Rep - Gitxsan Health Board
Kispioz Rep - Gitxsan Health
Society
Hazelton (250) 842-5165
Delegate Moses, Lorraine Executive Director
Interior Indian Friendship
Society
Kamloops (250) 376-1296
Delegate
Mosterd-Mclean,
Colleen
Community Health Representative Kamloops Indian Band Kamloops (250) 828-9707
Delegate Muldoe, George Kispiox Rep / Gitxsan Health Board Gitxsan Health Society Hazelton (250) 842-5165
Delegate Muldoe, Myrtle Gitanmaax Rep - Gitxsan Health Board Gitxsan Health Society Hazelton (250) 842-5165
Delegate Newman, Connie Board Member R. W. Large Memorial Hospital Bella Bella (250) 957-2527
Delegate Nikal, Juanita Executive Assistant / Band Council Member
Moricetown Health Centre /
Moricetown Band Council
Smithers (250) 847-9328
Delegate O'Donaghey, Dolores Chief Boston Bar First Nation Boston Bar (604) 867-8844
Delegate Oester, Jennifer Director of Health Red Bluff Band Quesnel (250) 747 2900
Delegate Ollinger, Gabrielle Senior Director Programs and Services FNESC West Vancouver (604) 925 6087
Delegate Ota, Marilyn Director, Health Planning & Operations First Nations Health Council West Vancouver (604) 926 9903
Delegate Palmantier, Emma Chair
Northern B.C. Aboriginal
HIV/AIDS Task Force
Prince George (250) 562-3591
Delegate Passmore, Sylvia Manager, Post Transfer Agreements Unit FNIH, Health Canada Vancouver (604) 666-7286
Delegate Passmore, Sylvia Manager, Post Transfer Agreements Unit FNIH, Health Canada Vancouver (604) 666-7286
Delegate Paton, Arlene
Assistant Deputy Minister, Partnerhships and Ministry of Aboriginal Relations
Victoria
Community Renewal Division
and Reconciliation
(250) 356-8750
Delegate Patrick, Betty Chief Lake Babine Nation Burns Lake (250) 692-4707
Delegate Patrick, Carole Manager - Mental Health & Addictions FNIB- Health Canada Vancouver (604) 666-9102
Delegate Paul, Coreen Health Program Manager Musqueam Indian Band Vancouver (604) 263 3261
Delegate Peters, Philly NNADAP Seton Lake Band Seton Portage (250) 2598435
Delegate Peters, Rosemarie Band Manager Chawathil First Nation Hope (604) 869-9994
Delegate Peters, Virginia Program Manager
Lytton First Nation Health
Department
Lytton (250) 455-2115
Delegate Phillips, Gwen Governance Transition Coordinator Ktunaxa Nation - Treaty Cranbrook (250) 417-4022
Delegate Pittman, Charlene Health Director Ashcroft Indian Band Ashcroft (250) 453-9154
Delegate Plummer, Lorraine Program Officer
Health Canada - First Nations
Inuit Health
Vancouver (604) 775-5240
Delegate Point, Liz Health Director Stolo Nation Chilliwack (604) 824-3200
Delegate Pongracz, Ed Executive Director
Lower Columbia All First
Nations
Castlegar (250) 304-2246
Delegate Prince, Aileen Health Director Nak'azdli Band Fort St. James (250) 996-7400
Delegate Prince, Owen Aboriginal Recruitment and Retention Advisor Vancouver Coastal Health Vancouver
(604) 875-5600
ext. 66942
Delegate Read, Simon Director Community & Human Services Nuu-chah-nulth Tribal Council Port Alberni (250) 724-5757
Delegate
Reading, Jeff
Scientific Director / Institute of Aboriginal Peoples'
Health / Canadian Institutes of Health Research
University of Victoria Victoria (250) 526-0624
Delegate Roberts, Kim Program Support KDC Health Campbell River (250) 286-9766
Delegate Robinson, Tina Uchucklesaht Tribe Human Service Worker Uchucklesaht Tribe Port Alberni (250) 720.9563
Delegate Robotham, Candace ECD Program Manager Seabird Island Band Agassiz (604) 796-2177
Delegate Ronnenberg, Doris Councillor Saulteau First Nations Moberly Lake (250) 788-7291
II
SECONd ANNUAl FORUm

Delegate Rosal, Assunta Health and Social Development Advisor Okanagan Nation Alliance Westbank (250) 707-0095
Delegate Russell, Victoria Contractor
BC First Nations Health
Council
South Hazelton (250) 631-7232
Delegate Ryan, Gina Councillor Metlakatla Governing Council Prince Rupert (250) 624-9630
Delegate Sampare, Jennifer Executive Assistant
Glen Vowell Rep - Gitxsan
Health Society
Hazelton (250) 842-5165
Delegate Sampson, Terry Board Director Inter Tribal Health Authority Nanaimo (250) 618-8737
Delegate Schroeder, Leslie Director, Aboriginal Health Fraser Health Surrey (604) 217-3323
Delegate Scudeler, June Policy Analyst United Native Nations Vancouver (604) 688-1821
Delegate Senger, Deborah Contract Coordinator PHSA Aboriginal Program Vancouver (604) 875-2013
Delegate Sherrell, Carolyn
Community Health Nurse/Community Health
Representative
Bonaparte Indian Band Cache Creek (250) 457-9624
Delegate Skin, Bobby Councillor Skin Tyee Nation Burns Lake (250) 692-7059
Delegate Sloot, Lisa Community Health Representative
Lower Columbia All First
Nations
Castlegar (250) 304-2246
Delegate Smith, Cindy Councillor Metlakatla Band Council Prince Rupert (250) 628-3201
Delegate Squinas, Geronimo Chief Lhtako (Red Bluff Indian Band) Quesnel (250) 747-2900
Delegate Starr, Angelika Health Director Quatsino Band Coal Harbour
Delegate
Starr, Bill
First Nations Health Council/Gitxsan Health
Board
First Nations Health
Council/Gitxsan Health Board
(250) 949-7161
ext 231
Hazelton (250) 842-5165
Delegate Sterritt, Jamie Consultant to Inter-Tribal Health Authority Sa'hetxw Consulting Kamloops (250) 877-0585
Delegate Stewart, Farley Executive Director
Friendship House Association
of Prince Rupert
Prince Rupert (250) 627-9488
Delegate Swain, Lerinda Aboriginal Health Program, Program Coordinator
BC Women's Hospital & Health
Vancouver
Centre
(604) 875-3593
Delegate Sweetwater, Indigo Community Health Representative Winterbeach Health Care Kamloops (250) 8515999
Delegate Swendson, Mary Health Director Moricetown Health Centre Smithers (250) 847-9328
Delegate Sxwithul'txw, Steve Communications & Recruitment Officer FNESC West Vancouver (604) 925 6087
Delegate Tabobondung, Lisa Executive Director, Aboriginal Health Northern Health Prince George (250) 565-2134
Delegate Tardiff, Joanne Executive Director
Community Health Associates
Vernon
of BC
(250) 503-1123
Delegate Tatoosh, Susan Executive Director
Vancouver Aboriginal
Friendship Centre
Vancouver (604) 251-4844
Delegate Terbasket, Sandy Diabetes Prevention Coordinator Ooknakane Friendship Centre Penticton (250) 490-3504
Delegate Thomas, Mary M. Health Director Canim Lake First Nation 100 Mile House (250) 397-2717
Delegate Thomas, Tammy Councillor Neskonlith Indian Band Chase (250) 679-3295
Delegate Thompson, Derek Governance Policy Analyst
First Nations Health Council
Union of British Columbia Vancouver (604) 842-0922
Indian Chiefs
Delegate Timbers, Glen CEO
United Church Health Services
Bella coola
Society
(250) 639 6245
Delegate Tommy, Maureen Associate Health Director
Ts'ewulhtun Health Centre of
the Cowichan Tribes
Duncan (250) 746-6184
Delegate Unrau, Dina BSDW/Supervisor ?Esdilagh First Nation Quesnel (250) 992-3009
Delegate Varley, Leslie Director - Aboriginal Health
Provincial Health Services
Authority
Vancouver (604) 267-0014
Delegate
Vickers Hyslop,L.LD,
Dr. Margaret R.
Member Spirit Runner Enterprises Merritt (250) 378-3770
Delegate Vincent, John Community Counselor Chemainus First Nation Ladysmith (250) 245-8551
Delegate Vlahos, Peter Leader, Aboriginal Health Planning Vancouver Coastal Health North Vancouver (604) 983-6011
41
VANCOUVER, bC • mAY 20 - 21 , 2008

42
Delegate Walker, Jennie Director of Programs
Three Corners Health Services
Williams Lake BC
Society
(250) 398-9814
Delegate Walker, Mary Lou
Children's Oral Health Initiative Regional
Coordinator
Health Canada - FNIH Smithers (250) 847-8024
Delegate Ward, Kevin Mental Health Counsellor Upper Nicola Band Health Salmon Arm (250) 833-5033
Delegate Wardrop, Janice Executive Director
Esemkwu Aboriginal Healing &
North Vancouver
Wellness Centre
(604) 904-1253
Delegate
Waterhouse,
Margaret
Community Health Representative Oweekeno/Wuikinuxv Nation Port Hardy (250) 949-5934
Delegate Waters, Shannon Community Medicine Resident, UBC Richmond Health Services Richmond (604) 244-5397
Delegate Whynot, Elizabeth President
BC Women's Hospital & Health
Vancouver
Centre
(604) 875-3566
Delegate
Wickenheiser, Program Consultant Indian Residential Schools First Nations Inuit Health /
Colleen
Resolution Health Support Program
Health Canada / BC Region
Vancouver (604) 666-3751
Delegate Williams, Bev Program Director
Hiiye 'yu Lelum (House of
Friendship)Society
Duncan (250) 748-2242
Delegate Williams, Christa Special Advisor First Nations Summit West Vancouver (604) 926.9903
Delegate Williams, Sally Health Consultant Gwawaenuk Tribe Port McNiell (250) 949 8732
Delegate Willie, Louisa Director of Heiltsuk Health Services
Halika'as Heiltsuk Health
(250) 957-2308 /
Bella Bella
Centre
Ext 230
Delegate Willie, Paul Administrator Wuikinuxv First Nation Port Hardy (250) 949-8622
Delegate Wilson, Dora B. Chief Councillor Hagwilget Village Council New Hazelton, (250) 842-6258
Delegate Wilson, Martha Gitanmaax Rep - Gitxsan Health Board Gitxsan Health Society Hazelton (250) 842-5165
Delegate Wilson, Rosalie Senior Policy Analyst Union of BC Indian Chiefs Vancouver (604) 684-0231
Delegate York, Victor Mental Health Cultural Coordinator
Heskw'en'scutxe Health
Services Society
Spences Bridge (250) 458-2212
Delegate Yu, Jeffrey Manager Ehealth FNIH BC Health Canada FNIH Vancouver (604) 666-0552
Exhibitor Matthew, Stan Outreach Coordinator
Inter Tribal Health Authority /
Nanaimo (250) 753-0590
First Nations House of Healing
Exhibitor White, Marina Outreach Coordinator
Inter Tribal Health Authority /
Nanaimo (250) 753-0590
First Nations House of Healing
Note Taker Allbeury, Jean Health Technology Manager First Nations Health Council West Vancouver (604) 913-2080
Note Taker Anderson, Bradley Aboriginal Engagement Coordinator Interior Health Kamloops (250) 851-7486
Note Taker Halliday, June Operations Manager Aboriginal Health Branch Victoria (250) 952-1629
Note Taker Harb, Jamal Regional Manager, Health Transfer Development Health Canada Vancouver (604) 6669143
Note Taker
Herman, Matt
Director, Healthy Aging and Injury Prevention,
Healthy Children,Women and Seniors
Ministry of Health Victoria (250) 952-2781
Note Taker Holmes, Rosie Executive Assistant to the Health Director Tsawout First Nation Saanichton (250) 652-1149
Note Taker Howell, Selena Program Administrative Assistant
First Nations & Inuit Health,
Health Canada
Vancouver (604) 666-0049
Note Taker Johnny, Rose Youth Suicide Prevention Program Researcher Carrier Sekani Family Services Prince George (250) 562-3591
Note Taker Kenoras, Lynn Councilor Adams Lake Indian Band Chase (250) 679-8841
Note Taker Kim, Shelley Program Assistant FNIH, Health Canada Vancouver (604) 666-9939
Note Taker Lindley, David Aboriginal Strategies Coordinator Interior Health Kamloops (250) 878-2928
Note Taker Mack, Wilma Manager, Community Health Services Inter Tribal Health Authority Nanaimo (250) 753-3990
Note Taker Matthew, Mark Aboriginal Contracts Advisor Interior Health Kamloops (250) 851-7386
Note Taker Mearns, Erin Health Careers Recruitment Officer
First Nations Chiefs' Health
Committee
North Vancouver (778) 340-3039
Note Taker Miller, Shauna A/Director, Health Authority Partnerships Ministry of Health Victoria (250) 952-1821
Note Taker Mitic, Wayne
Director, Chronic Disease Prevention Evaluation /
Ministry of Health
Population Health and Wellness
Victoria (250) 952-2108
Note Taker Riffel, Londea Aboriginal Engagement Coordinator Interior Health Kamloops (250) 851-7394
II
SECONd ANNUAl FORUm

Note Taker Springinotic, Carla
Acting Director, Healthy Children, Women and
Seniors, Population Health and Wellness
Ministry of Health Victoria (250) 952-1111
Note Taker Stewart, Penny Manager, ECD Programs FNIH Vancouver (604) 666-7021
Note Taker Taylor, Denise Director, Aboriginal Health Interior Health Kelowna (250) 870-4688
Note Taker Williams, Amanda Assistant RHS Coordinator FN Health Council West Vancouver (604) 913-2080
Organizer Carpenter, Trina Executive Assistant First Nations Health Council West Vancouver (604) 9269903
Organizer Clellamin, David Regional Health Survey Coordinator First Nations Health Council West Vancouver (604) 9132080
Organizer Degroot, Michelle Director, Health Policy & Advocacy First Nations Health Council West Vancouver (604) 9269903
Organizer Gallagher, Joe Senior Director First Nations Health Council West Vancouver (604) 9269903
Organizer Ivand, Karin Forum Coordinator Bay House Group Inc. Victoria (250) 220-6758
Organizer Joseph, Jordan Ann Executive Assistant First Nations Health Council West Vancouver (604) 913.2080
Organizer Leung, Derek Policy Analyst Health Canada Vancouver (604) 666-4207
Organizer Lewis, Tonya Health Careers Manager FNHC West Vancouver (604) 9132080
Organizer McKenzie, Davis Communications Coordinator First Nations Health Council Vancouver (604) 926.9903
Organizer Nault, Tara R. A/Director, Strategic Initiatives
Aboriginal Health Branch,
Ministry of Health
Victoria (250) 920-9185
Organizer Roggeveen, Marina Assistant Forum Coordinator Bay House Group Inc. Victoria (250) 220-6758
Organizer Schwartz, Deborah Executive Director
Aboriginal Health Branch,
Ministry of Health
Victoria (250) 952-2811
Organizer Spencer, Denelle Aboriginal CYMH Planning Coordinator MCFD Vancouver (604) 775-1716
Organizer Tarbell, Harold MC/Facilitator Gaspe Tarbell Associates West Vancouver (604) 787-8638
Organizer
Whonnock,
Josephine
Reception First Nations Health Council West Vancouver (604) 913-2080
Presenter Abbott, Debbie First Nations Health Council Board Member
FNHC and Nlaka'pamux
Nation TC
Lytton (250) 455-2711
Presenter Adams, Evan Aboriginal Health Physician Advisor
Office of the Provincial Health
Officer, Ministry of Health
Victoria (250) 952-1330
Presenter Baker, Simon Presenter ()
Presenter Brokenleg, Martin Presenter ()
Presenter
Christian, Chief
Wayne M.
Presenter ()
Presenter Hanna, Rosalin Physical Activity Specialist First Nations Health Council West Vancouver (778) 772-5086
Presenter Hazlewood, Andrew Assistant Deputy Minister Ministry of Health Victoria (250) 952-1731
Presenter
John, Grand Chief
Edward
Presenter ()
Presenter Johnson, Suzanne Nutritionist First Nations Health Council West Vancouver (604) 913-2080
Presenter Keeper, Tina MP MP - Churchill MB Ottawa (613) 992-3018
Presenter
Kelly, Grand Chief
Doug
Co-Chair First Nations Health Council West Vancouver (604) 922-7733
Presenter Lappe, Catherine Regional Director General Health Canada Vancouver (604) 775-7003
Presenter Lecoy, Denise Presenter ()
Presenter Morrisseau, Renae Presenter ()
Presenter Myers, Troy First Nations ActNow BC Coordinator First Nations Health COuncil Vancouver (604) 684-0231
Presenter Paul, Dr. Jeannie Presenter ()
Presenter Point, Theresa Presenter ()
Presenter Rivers, Audrey Presenter Squamish Nation ()
Table Host Bortoletto, Carla Table Host Aboriginal Health Branch Victoria (250) 952-1820
Table Host Buchan, Dianne Policy Analyst First Nations Health Council Vancouver (604) 684-0231
Table Host Day, Diana
Community Developer / Aboriginal Health
Initiative Program & SMART Fund
Vancouver Coastal Health Vancouver (604) 708-5328
43
VANCOUVER, bC • mAY 20 - 21 , 2008

44
II
SECONd ANNUAl FORUm

II
Second Annual Forum
Vancouver, BC • May 20 - 21, 2008
SUMMARY DOCUMENT
is a publication of the
First Nations Health Council
1205 - 100 Park Royal South
West Vancouver, BC
V7T 1A2
Tel: (604) 913-2080
Fax: (604) 913-2081
Toll Free: 1-866-913-0033
www.fnhc.ca
November 2008

A publication of the
First Nations Health Council
1205 - 100 Park Royal South
West Vancouver, BC
V7T 1A2
Tel: (604) 913-2080
Fax: (604) 913-2081
Toll Free: 1-866-913-0033
www.fnhc.ca
II