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However, we should avoid diagnosing this problem merely as a failure of law enforcement. Murders represent the tip of an iceberg of problems related to endemic violence in communities. Many Aboriginal women and girls, and indeed men and boys, live each day under the threat of interpersonal violence and its myriad consequences.

Initial statements from the three federal ministers tasked with leading the forthcoming inquiry — the ministers of Indigenous and Northern Affairs, Justice and Status of Women — suggest that its purpose is to achieve justice, to renew trust between indigenous communities and the Canadian government and law enforcement bodies, and to start a process of healing.

The inquiry surely must also endeavour to lay the groundwork for a clear plan to address the broader problem of interpersonal violence, which, in turn, is rooted in several key determinants. Addressing interpersonal violence is not merely an issue of justice; it is also a public health concern.

Factors associated with both the experience and perpetration of interpersonal violence are manifold. They include but are not limited to mental health issues, drug and alcohol misuse, unemployment, social isolation, low income and a history of experiencing disrupted parenting and physical discipline as a child. The Truth and Reconciliation Commission’s report has highlighted that many of these factors are widespread in the Aboriginal populations of Canada.4 Many of the same factors contribute to disparities between Aboriginal and non-Aboriginal peoples in areas such as education, socioeconomic circumstances and justice. T

here is also substantial overlap with identified determinants of poor health in Aboriginal communities both in Canada and elsewhere.5,6 These are the factors associated with higher rates of youth suicide, adverse birth outcomes and tuberculosis, and poorer child health. It’s clear that a common web — woven of a legacy of colonization and cultural genocide, and a cumulative history of societal neglect, discrimination and injustice — underlies both endemic interpersonal violence and health disparities in Canada’s indigenous populations. There is no conversation to be had about one without a conversation about the other — if the aim is healing — because the root causes are the same.

The World Health Organization (WHO) is currently engaged in developing a global plan of action to strengthen the role of health systems in addressing interpersonal violence, particularly that involving women and girls.7 A draft report by the WHO acknowledges interpersonal violence as a strongly health-related issue that nevertheless requires a multisectoral response tailored to the specific context. Evidence from Aboriginal community models in Canada gives hope for healing.

A recent report from the Canadian Council on Social Determinants of Health highlighted important strides that some Aboriginal communities have made to address the root causes of, and to mitigate, inequities through efforts to restore the people’s connection with indigenous culture.8 Increasing community control over social, political and physical environments has been linked to improvements in health and health determinants.

The public health sector in many parts of Canada has embraced the need for strong community involvement in restoring Aboriginal people to the health that is their right. In many community-led projects over the past few decades, the health care sector has worked with others to address common proximal and distal determinants of disparities.

We are presented with not just an opportunity for renewing trust between indigenous communities and the Government of Canada but also for extending the roles of public health and the health care sector in the facilitation of trust and healing. There is much that the health sector can contribute to the forthcoming inquiry. Health Canada should be involved from the start to ensure that public health is properly represented

The inquiry should seek to understand, and to remedy, how a painstakingly built program to bring evidence to prescribing could be undone so quickly and, based on the government's own public statements, mistakenly," they say in an open letter to Mr. Lake. "It should recommend how to restore public confidence that the government is fully engaged in ensuring the safety and effectiveness of prescription medicines."

The provincial government has apologized for the firings and acknowledged it overreacted to a data breach involving patient information. An independent review could not determine who was responsible for the firings or why they occurred.

The health ministry staff and contractors were helping an independent agency called the Therapeutics Initiative develop evaluations of the effectiveness and safety of prescription drugs

The information was used to determine if those pharmaceuticals should be eligible for coverage under the publicly funded PharmaCare program. Last week, Mr. Lake said he is still trying to find a way to release more information about what happened, but is constrained by privacy laws and a wrongful dismissal lawsuit.

On Tuesday, Finance Minister Mike de Jong said a public inquiry would be too expensive, costing "millions upon millions of dollars." "The desire to ensure that employees are being treated fairly and that there are proper processes in place to guarantee that fact is not, in my view, dependent upon a public inquiry," Mr. de Jong told reporters.

In their letter, the workers dismissed the argument that B.C.'s privacy laws are a barrier to an independent inquiry, noting that the B.C. Freedom of Information and Protection of Privacy Act excludes public servants from privacy protection in matters concerning accountability for official actions.

They also argue that the cost would be recouped if the inquiry led to a complete renewal of the government's commitment to scrutinizing prescription drugs. Although they are not calling specifically for a full public inquiry, they said the review should be independent, with the authority to call witnesses under oath, and provide funding to cover the legal costs of participants.

"We share the concern about additional costs," they wrote, but said the province would benefit from better health care and lower costs if it can fully restore its drug research efforts.

"Our work ... enabled BC PharmaCare to improve prescribing safety and save over $100-million in the past 20 years by not covering drugs that were later confirmed in other jurisdictions to have caused harm to patients and massive wastage of expenditures."

The workers were suspended and then fired, and left under a cloud for three years after the government said the data breach was so serious that it warranted an RCMP investigation. However, internal e-mails show the RCMP probe, although still not formally closed, never went far.

One of the researchers, Roderick MacIsaac, killed himself after being interrogated by government officials and fired just two days before the end of his student co-op term. His sister Linda Kayfish signed the letter on his behalf. The other workers are Ramsay Hamdi, Robert Hart, Malcolm Maclure, Rob Mattson, David Scott, and Rebecca and William Warburton.

He said he wants an investigation into the events leading up to the decision to terminate the employees and the actions taken by the government afterward. Mr. Lake also rejected the New Democrats' concerns that newly appointed Ombudsperson Jay Chalke could be in a perceived conflict of interest because of his previous employment as the head of a Ministry of Justice branch from 2011 to 2015.

"It's about the office," said Mr. Lake. "It's not about the individual. His job is to be the Ombudsperson, and this kind of review certainly falls within the purview of his office." Members of B.C.'s legislature unanimously approved Mr. Chalke as the new ombudsperson two months ago, and he officially started his new post this month.

Opposition NDP Leader John Horgan said the review is a step forward but he still favours an independent public inquiry. Mr. Chalke has the option to appoint another official from within his office to conduct the review, he said. "I do believe this falls again short of what we've been calling for and what the individuals involved have been calling for, and that's true independence and the ability to have a public and open process here," Mr. Horgan said. The workers were part of a drug-research grant program and were fired in September, 2012, amid allegations of inappropriate and possible criminal conduct.

Then-health minister Margaret MacDiarmid said there were allegations that employees inappropriately accessed sensitive medical records, but charges were never laid and media reports later showed the RCMP never investigated the claims. A government-appointed review concluded last year the firings did not follow existing procedures and reached premature conclusions. Labour lawyer Marcia McNeil's report last December found the investigation was flawed from its start.

The government has consistently rejected calls from the NDP and the fired workers and their families to order an independent public inquiry to unravel the scandal and determine who was responsible for the firings.

Mr. Chalke said the government would have to make it clear to those testifying that they must disclose all information or else change the law to give his office access to information protected by such agreements, as is enjoyed by the "more modern" office of the Representative for Children and Youth. "My concern about this issue is so significant that I would formally ask that the committee not refer this matter to my office unless it is accompanied by a recommendation to government for an urgent legislative amendment," he wrote.

In recent weeks, the B.C. government has been under intense pressure from the fired workers and the family of PhD student Roderick MacIsaac, who killed himself after he was publicly dismissed in fall, 2012. The province has apologized for firing Mr. MacIsaac and has rehired or settled out of court with most of the employees. Lawsuits involving two others are ongoing. When the researchers were fired, the health minister at the time suggested there had been a massive privacy breach, which would be referred to the RCMP. But access-to-information documents have shown the province never gave the Mounties the evidence they required to start an investigation, and one was never conducted.

Mr. Chalke's conditions for accepting the case also include a supplemental budget from the Finance Ministry so that no other investigations are displaced, as well as an unlimited amount of time to examine the firings. Mr. Chalke, a former assistant deputy minister of justice, began his term last week by contradicting predecessor Kim Carter's assertion that the Ombudsperson's office would be equipped to look into the health firings scandal. In her reply to his letter, Attorney-General Suzanne Anton sent a letter to the legislative committee Wednesday stating that many of Mr. Chalke's concerns would present challenges to any public inquiry into the matter.

She said the Ombudsperson could notify the legislative committee if his investigators were hamstrung by any confidentiality agreements and those concerns could be addressed by redacting names or any other information that would violate those agreements. George Heyman, an NDP MLA and member of the committee communicating with the Ombudsperson, said the Attorney-General's letter did not allay his concerns. "At first blush, it appears to be an attempt to very quickly brush off the concerns of the Ombudsperson," Mr. Heyman said Wednesday evening. Health Minister Terry Lake has repeatedly said a public inquiry would be too costly and slow. Mr. Lake declined an interview request Wednesday, but a spokesperson sent an e-mail saying the government "recognizes the public's desire to fully understand what took place in regard to this issue."

Seven health researchers fired by the B.C. government, and the sister of an eighth who killed himself after he was fired, have banded together to demand a public inquiry into the case. The group has written an open letter to Health Minister Terry Lake demanding an inquiry into what happened. It's believed to be the first joint statement by the researchers since their termination in 2012.

"Alberta's private clinics do not offer as extensive a range of user-pay surgical interventions as the private clinics in some other provinces, particularly British Columbia and Ontario," said a report prepared by Saunders

Dr. Paul Parks of the Alberta Medical Association’s emergency section requested an arm’s length review of more than 300 complaints of compromised care

a closed inquiry to be conducted by the Alberta Health Quality Council

all the leaders of the opposition parties — Wildrose, New Democrats, Liberals and the new Alberta Party — got together with Sherman for a news conference. This had never happened before in Alberta.

Brian Jarman, director of the Dr Foster Unit at Imperial College London, told the inquiry that hospitals with poor staff ratios had higher hospital standardised mortality ratios.

more doctors per bed

the Care Quality Commission made it clear that it does not want to see minimum staffing ratios

Mr Kark said that although he recognised that the number of patients on some wards often changed, making the setting of minimum staffing ratios a complex business, certain wards were less susceptible to such change and would benefit from some guidance, particularly elderly care wards and accident and emergency departments.

guidelines are merely that and one-off failure to comply would be unlikely to attract disproportionate attention from the regulator

Ms. Kayfish's letter was released as part of an effort by the families of those dismissed to push for a public inquiry into the firings. The government has repeatedly said a public inquiry would be too costly and slow. Instead, the province said last week it would hand the matter to B.C.'s Ombudsman for review. Neither Health Minister Terry Lake nor the Premier were available for an interview Tuesday regarding Ms. Kayfish's allegations. But Mr. Lake's spokeswoman said in an e-mailed statement that the minister is confident the Ombudsman would complete a "thorough" investigation in "a timely and cost-effective way." Mr. MacIsaac, a doctoral candidate, had only three days left in his research placement when he and seven other health-ministry workers and contractors were fired in late 2012.

At the time, the B.C. government said the workers were dismissed due to inappropriate conduct related to the private medical information of millions of British Columbians. The minister at the time suggested the RCMP were investigating, but access-to-information documents uncovered last month showed the RCMP never began a probe. The province has apologized for firing Mr. MacIsaac and rehired or settled out of court with most of the employees. Lawsuits involving two others are ongoing.

Ms. Kayfish's letter says the family found out about the suicide note shortly after Mr. MacIsaac's death, but the B.C. Coroners Service refused to release it until their investigation was complete. After months of asking, Ms. Kayfish's letter says the coroners service agreed to read the note to the family over the telephone, while keeping any names mentioned in the document anonymous. Ms. Kayfish's letter says the coroners service responded to the family's request for the note with links to the province's access-toinformation laws. By October of 2013, the coroners' final report into the death had been completed and Mr. MacIsaac's computer was released to his family. Ms. Kayfish maintains someone had deleted the document from his computer.

he coroners service said in its statement that a police officer uncovered the note and forwarded the printed version to their investigators several days after the computer was recovered from Mr. MacIsaac's home. The service said it never had an electronic version of the note. Mr. MacIsaac's note does not mention his work or have any personal messages for his family, but it is "clear and concise" and "reflects his frustration with the public dismissals at the Ministry of Health," Ms. Kayfish says in her letter. She said later she would release the note to a public inquiry or the Ombudsman.

It was also a trauma his family would face again, a coroner’s inquest into the 45 suicides in Nunavut in 2013 was told when the inquest began Sept. 14. Three months after Rex’s death, yet another brother — 15-year-old Peter — killed himself. Rex was living with as many as 23 family members in his grandmother’s four-bedroom house in Naujaat, a community of about 1000 people. The family shared eight beds and one bathroom while they waited for subsidized housing.

The evening before he died, Rex played with his cousins and stayed overnight at their home. His aunt and uncle found him and tried to revive him. His family reported not knowing the immediate triggers for Rex’s decision to hang himself. “I don’t know what was wrong with him,” Martha Uttak, Rex’s mother, testified. “He was my baby and he hugged me all the time.”

Five years ago, four partner organizations came together and released a suicide prevention strategy that was visionary and evidence-based in its design. The Government of Nunavut, the Embrace Life Council, the Royal Canadian Mounted Police and Nunavut Tunngavik Inc.’s goal was to reduce the territory’s suicide rate to one commensurate with, or lower than, the rest of the country.

But as the inquest heard, Rex was living with many of the risk factors for suicide that researchers have identified, including repeated exposure to the suicide of others. From 1999 until 2014, Nunavummiut took their lives at a rate of 111.4/100 000 population — nearly 10 times the rate of other Canadians, which stands at 11.4/100 000 according to the most recent Statistics Canada data (2000–2011).

The widespread unresolved grief surfaced again when testimony from Shuvinai Mike, a senior government official who was called to talk about her department’s involvement in cultural activities, devolved into a description of the impact of her own daughter’s suicide. When someone kills oneself, the news spreads rapidly, often via social media, throughout this vast territory of only 36 000 people. Parents live with the constant fear that one of their children will be next

The inquest, which ran Sept. 14 to 25 and included testimony from about 30 witnesses, touched on many underlying issues: poverty, high rates of child sexual and physical abuse, housing shortages, unemployment, educational deficiencies, food insecurity and historical trauma that are the reality for too many Inuit families. It is also exposed the deep divisions among the territorial government and organizations coping with the population-wide damage that suicide inflicts.

Nunavut coroner Padma Suramala, a registered nurse who presides over death investigations in Canada’s newest territory, called the inquest to examine the rate of suicide that has seemingly left no one here untouched. “Nunavummiut are soaked in unresolved grief,” testified Jack Hicks, an expert witness at the inquiry and Nunavut’s former suicide prevention advisor. Hicks helped with a landmark follow-back study interviewing the families and friends of 120 people who committed suicide in Nunavut from 2003–2006 and 120 control subjects.

A year later, in 2011, the territory released and began to implement an action plan with specific goals, assigned responsibilities and time frames in eight different areas. Those areas, including early childhood education and school curriculum programs, gatekeeper prevention training, and mental health and addiction supports, are intended to address the root causes or risk factors that trigger suicide. The need for a strategy is undeniable. Between 1999 and 2014, 436 Inuit completed suicide. Like Rex, 22 of them were children between the ages of 10 and 14.

Before the implementation plan was tabled in the legislature, however, the territorial government stripped out the column stipulating the financial resources required to implement each item, Hicks testified at the inquiry. None of the other partners was consulted. Not only did the Government of Nunavut never allocate a specific pocket of resources, it never asked the federal government for money to tackle this critical public health issue. As a result, “we’ve had to cobble together funding from various sources,” Natan Obed, Nunavut Tunngavik’s director of social and cultural development, testified.

Nunavut has made progress on implementing pieces of the strategy, according to an independent evaluation. The government’s lack of capacity, poor communication with the other partners and inadequate resources have retarded success, the evaluation states. Nunavut has not yet achieved its overall vision for decreasing suicide rates, denormalizing suicide and keeping children — like Rex — safe.

“It seems to be preferential access for well people while the sick suffer,” says Wendy Armstrong, a researcher with the Consumer Association of Alberta, which has intervenor status at the public hearings.

In his book Seeking Sickness, Alan Cassels of the University of Victoria points out that colon cancer screening by stool sample or colonoscopy only reduces deaths from 8.83 per thousand to 5.88 per thousand, or about 3 per thousand.

The clinic was established after two wealthy Calgarians — John Forzani and Keith MacPhail — donated $2.7 million for pricey technology, the U of C donated some space in a brand-new building, and the health region (medicare in other words) committed to $70 million worth of funding.

Billed as the largest colonoscopy clinic in Canada, it boasts six pre-assessment rooms, six endoscopy rooms, 24 recovery beds and is staffed by 55 health professionals.

Alberta Health Services now covers the entire cost of the Forzani-Macphail Colon Cancer Screening Centre

In recent years, at least four other companies — Helios Wellness Centres, Inliv, Provital Health and Wellness, and Preventous Collaborative Health — have also opened clinics in Calgary

an inquiry into preferential access to health services heard testimony that Helios clients who paid annual fees of up to $10,000 got screening for colon cancer at a public facility within months, while other routine patients waited up to three years.

At a website where consumers can rate their physicians, anonymous comments indicate some doctors have dumped existing patients in the public system so they can take on paying clients at private clinics.

Dr. Trevor Theman, registrar of the College of Physicians and Surgeons of Alberta, said he’s warned doctors joining these clinics that they risk breaking the disciplinary body’s standards of practice if they terminate their relationship with patients based on their socio-economic status.

he’s ready to investigate.

Health Minister Fred Horne urged patients who may have been dumped by doctors joining private clinics to contact his office.

William Lahey, a law professor at Dalhousie University who prepared a report for the public inquiry, says he’s concerned the private clinics may be violating the spirit if not the letter of federal health legislation.

Mr Dilnot said that the imbalance in the amounts of public money currently spent on social care for older people in England (around £8bn a year) and on healthcare (£50bn) was wrong

There is a barrier because of the way the systems work at the moment: the lack of pooled budgets

we are not looking after the market as a whole, we are not getting the diversity and choice that we should expect, and we are not even always giving the right level of sustained support to those who are delivering the care. It is bust in every dimension.

anticipated white paper on social care next April

The inquiry continues.

A group of B.C. health care researchers who were abruptly fired by the B.C. government several years ago has rejected the health minister's decision to have the B.C. ombudsman look into the incident. The seven researchers and the widow of one have been calling for a public inquiry to get to the bottom of the incident, but the call has been rejected by the Health Minister Terry Lake.

"I don't see how we can go another four years with this government, frankly. The past nine years have been disastrous in terms of us as First Nations accomplishing what we set out to do for our peoples. A lot of that has to do with the failure of First Nations policy in this country," said Ghislain Picard, the AFN's regional chief for Quebec and Labrador. Rarely has First Nations anger translated into such pragmatic talk, but aboriginal leaders will have to change a political culture that has traditionally shied away from involvement in federal and provincial politics with just three months left between now and the Oct. 19 election. "I know these are not our governments, but this is a strategic vote," said Grand Chief Patrick Madahbee of the Union of Ontario Indians, which represents 39 First Nations in the province.

Madahbee criticized Prime Minister Stephen Harper for signing trade deals that involve resources pulled from the land without the consultation or agreement of First Nations. But such complaints will receive little traction with federal parties if aboriginal people maintain their low-rates of election participation, he said. "The Indo-Canadians, the Chinese Canadians ... There's a whole number of groups that have learned that already. They have mobilized and they have influence. Right now we're being ignored." Bellegarde said the AFN is looking for politicians to implement the recommendations of the Truth and Reconciliation Commission, call an inquiry into the large numbers of missing and murdered aboriginal women and end a 20-year funding freeze for aboriginals that has contributed to problems with aboriginal health, housing and education that other Canadians never have to experience. "Invest in the fastest-growing segment of Canada's population, our young men and women. Invest now and there will be huge rates of return on investment in the future," Bellegarde said.

Both New Democratic Party Leader Tom Mulcair and Liberal Leader Justin Trudeau spoke at the AFN meeting Monday and committed to improving the relationship between the federal government and aboriginal people. Both noted the fact that they had prominent and numerous aboriginal candidates who will be running for their parties in the next election. "Aboriginal Canadians have understood for 10 years now what happens when their voices are not heard by the political process, when they are written off as they are by this Harper government," said Trudeau.

It's a hopeful sign for Tyrone Souliere, of the Garden River First Nation in Sault Ste. Marie, Ont., who has taken it upon himself to lobby chiefs and band councils to get their people registered to vote in the October election. Founded in frustration with the federal Conservative government, Souliere estimates there are some 30,000 eligible aboriginal voters in Ontario alone who could be harnessed to advance the cause of indigenous people in the coming election campaign. His efforts are focused on educating eligible voters about the issues and on what they steps they need to take to ensure they can cast a ballot in the election, following changed to the Elections Act that place higher standards on what can be used to confirm one's identity. "The only way to change how the government treats us is to change the government and to get that message to the politicians that there's a block of votes in Indian country and it will be available to the one party that will best represent treaty, charter and indigenous rights in Parliament," Souliere said.

"That's the goal." What the leaders say Tom Mulcair promises: Every government decision will be reviewed by a cabinet committee to ensure they respect federal responsibilities toward aboriginal people. Increasing federal funding for aboriginal education so that it rivals that spent on non-aboriginal children in Canada. Federal environmental assessments for resource development projects will become more rigorous. Justin Trudeau promises

There will be a legislative review that scraps or amends laws dealing with aboriginals that are deemed to be a violation of a section of the Constitution that affirms aboriginal rights. A guaranteed annual meeting between the prime minister and First Nations leaders. The 2-per-cent freeze on aboriginal funding will be lifted to make more money available of the likes of education, health and housing.

The government announced the firings at a news conference three years ago and maintained until recently that the RCMP were investigating the former workers for a serious breach of personal data. One of the researchers, Roderick MacIsaac, killed himself after being interrogated by government officials and fired just two days before the end of his student co-op term.

Premier Christy Clark and her ministers have since apologized for the firings and acknowledged the government had overreacted to a data breach involving patient information. However, an independent review by an outside lawyer could not determine who was responsible for the firings or why they occurred. The former workers, backed by the opposition New Democrats, have insisted that a public inquiry is required to determine the motivation for the firings and to identify the people responsible.

The Health Ministry staff and contractors were helping an independent agency called the Therapeutics Initiative to develop evaluations of the effectiveness and safety of prescription drugs. The information was used to determine if those pharmaceuticals should be eligible for coverage under the publicly funded PharmaCare program.

The government has consistently refused calls for a public inquiry, saying it would be an expensive and lengthy process. But it was clear on Tuesday that the ombudsperson's work will be neither cheap nor quick. Mr. Chalke said he expects to be back before the finance committee of the legislature next year to seek the funds needed to complete his review.

Mr. Chalke said he has been given wide latitude to investigate not only the firings, but the government's claims around the RCMP investigation, as well as the government's involvement with the pharmaceutical research organizations that were caught up in the affair. And he cautioned that the investigation could easily take more than a year. "My objective is to do a thorough investigation that gets to the bottom of this, rather than to shorten the investigation to meet some arbitrary timeline." Aside from Mr. MacIsaac, the other workers are Ramsay Hamdi, Robert Hart, Malcolm Maclure, Ron Mattson, David Scott, and Rebecca and William Warburton.