From self-determination to community health empowerment: Evolving Aboriginal health services on Manitoulin Island, Ontario

Poor health status and the need for mainstream medical care are two of the many consequences of colonialization affecting Aboriginal communities today. Health services offered to Aboriginal people by the Canadian government have evolved from under-funded medical relief lacking strategic direction to comprehensive primary care. While the Aboriginal health profile has improved as a result, Aboriginal populations are still suffering from health inequalities.; Political gains made by Aboriginal nations in Canada in the progression towards Aboriginal self-determination and self-government, combined with the acceptance of a health promotion and illness prevention model in the Canadian health system in general, have had a tremendous impact on Aboriginal health service development. The transfer of the control over Aboriginal health serviced to Aboriginal people with the goal of improving Aboriginal health status is now an accepted concept with both Aboriginal and Canadian governments. However, the mechanisms by which self-determination is supposed to lead to improvements in health status are still poorly understood and largely undocumented.; Based on research of the Aboriginal health system in the Manitoulin District of North Central Ontario, this thesis identifies two inter-related processes, community-based health research and health service integration, that have great potential to contribute to the goals of self-determination. This study examines the mechanisms by which increased Aboriginal community-based self-determination in health can support service integration and local health research. This research also examines the impact of these processes, both positive and negative, on Aboriginal community health and health empowerment. The mechanisms by which these processes occur are analyzed through case studies of the Aboriginal health services systems on Manitoulin and Aboriginal community-controlled research projects on fetal alcohol spectrum disorder and children's dental health.; This thesis argues that self-determination must be supported by appropriate community processes such as partnership development and capacity building in order to facilitate improvements in community health. Community-controlled health research and inter-sectoral health service integration are necessary to support the goal of self-determination and have great potential to improve Aboriginal community health and community health empowerment.