Existing on a Boundary: The Delivery of Socially Uninsured Health Services to Aboriginal Groups in Canada

Abstract

Aboriginal people in Canada suffer persistent health inequalities as a result of individual and structural uncertainty. While in some nations indigenous groups remain uncounted and marginalised, in others, rationing services via an administered identity is an established process, and can result in negative health outcomes. This paper describes such outcomes, concentrating on the delivery of state-financed commercial social goods to Aboriginal groups in Canada. Two case studies are presented: the first focuses on the pharmaceutical care available to state-recognised and -eligible Aboriginal groups; and the second on Aboriginal organisations and their administrative control over programming involving commercial and non-commercial social goods. It is argued that in Canada, health inequalities maintain, in part, due to the socially unclear status of both Aboriginal individuals as citizens with specific rights, and Aboriginal authority as governance with specific decision-making power. As a result, access to health services such as pharmaceutical and dental care can be compromised. In short, individual and structural uncertainty leads to contradictions in jurisdictional oversight and governance, complicating the rights and responsibilities of all parties, hindering service delivery and potential improvements to Aboriginal health.