Why We Didn't Start With a Single "Indigenous" Pathway
It would have been simpler, on paper, to design one pathway meant to serve all Indigenous patients at once. We didn't do that, and the reason comes down to a single idea: a distinctions-based approach.
First Nations, Métis, and Inuit peoples each have their own histories, governance structures, cultural practices, and relationships with the healthcare system. A generic "Indigenous" program risks flattening those differences — treating distinct nations as an undifferentiated group, which is its own kind of erasure. So while the ultimate goal of the Indigenous Pathway is to serve all Indigenous Peoples, we made a deliberate choice to start with a dedicated focus on the Métis Nation, and to progressively build out First Nations and Inuit pathways afterward, each shaped by its own community.
Where This Choice Came From
This wasn't a decision made in the abstract. It came directly out of relationship — specifically, a meaningful partnership with Sally Nystrom, a Red River Métis citizen, patient partner, and cancer survivor in Winnipeg who has been involved in this work from its early stages. Sally's experience and perspective underscored something the CTN team needed to hear clearly: a generic, pan-Indigenous approach was not appropriate.
That guidance shaped the entire structure of the program. Métis-specific barriers are often overlooked in cancer care altogether — including the fact that many Métis patients are excluded from the Non-Insured Health Benefits (NIHB) program, a federal benefit that many people assume covers all Indigenous patients but does not extend the same way to Métis communities. Barriers like this one simply don't surface in a program designed around a single, generalized "Indigenous patient" profile.
What Distinctions-Based Actually Means in Practice
- Being distinctions-based isn't only about better information — it's about accountability. It means:
- Building relationships directly with each nation's patients, navigators, and knowledge keepers, rather than assuming shared solutions
- Listening deeply to community-specific needs, even when that means slower, more deliberate rollout
- Recognizing governance frameworks as distinct rather than interchangeable — for example, applying OCAP® for First Nations data and OCAS for Métis data, rather than a single unified data policy
- Letting each pathway be shaped and led by the community it serves, instead of adapting a Métis-first model wholesale for First Nations or Inuit patients
As one guiding reflection from the program puts it: the choice to start with one community is not about choosing one group over another. It's about honouring the relationships being built, listening deeply to the specific needs of each community, and remaining accountable to the people the program partners with.
Where This Is Headed
The Métis Pathway remains the most developed piece of this work today, but it was never meant to be the whole picture. As the program matures, First Nations-specific and Inuit-specific pathways are being developed in turn — each rooted in its own consultation process, its own governance principles, and its own community leadership, rather than a copy-paste of what came before.