First Nations involvement in health policy decision-making : the paradox of meaningful involvement

Alongside consistent reporting on health inequities affecting Indigenous peoples in Canada, Indigenous people have been routinely excluded from health policy decision-making. This pattern of exclusion perpetuates health policy decisions that are often ineffective at addressing the root causes of persistent health inequities. Despite Indigenous peoples’ repeated calls to be meaningfully involved, and the emergence of health policy initiatives that include Indigenous peoples, the influence of neoliberalism and neocolonialism in the Canadian policy sphere continues to undermine self-determination and limit Indigenous peoples’ involvement in health policy processes. Those advocating for Indigenous health equity are left wrestling with the question: What constitutes, and what can foster, meaningful involvement in the contemporary health policy climate? This exploratory qualitative research aims to provide a window of insight into this urgent social justice question by exploring the perspectives of twenty leaders and decision-makers in First Nations health and other areas of health policy, with a view to understanding what constitutes meaningful involvement of First Nations peoples in health policy decision-making in BC and Canada. A critical analysis of these data reveals that meaningful involvement is often experienced as a paradox where Indigenous people are excluded via processes of inclusion, and that fostering meaningful involvement requires attuning to the underlying power dynamics inherent in policymaking and taking action to decolonize and transform the policy system itself. Based on this analysis, I articulate a new conceptualization of and framework for meaningful involvement, which is rooted in seven key elements: Recognizing and Representing Indigenous Peoples; Interrupting and Re-imagining Relationships; Preparing Agreements; Practicing Protocols; Leveraging Power; Exerting Community Authority; and Shifting Social Structures. This dissertation concludes with a discussion on the significance and implications of these findings and strategic directions and recommendations for meaningfully involving urban First Nations people in health policy decision-making in BC and beyond.Graduate and Postdoctoral StudiesGraduat