Manitoba's premier says a recent letter he wrote to the prime minister was an effort to "make the best of a bad situation."
In the March 1 letter obtained by CBC News, Brian Pallister addresses Prime Minister Justin Trudeau directly and asks for a strong federal partner to help address key issues for the province.
Specifically, Pallister says the province needs more money to improve health outcomes for Indigenous people and to fight diabetes.
The Prime Minister's Office confirmed it received the letter.
Press secretary Andrée-Lyne Hallé said in a written statement that federal Health Minister Jane Philpott and Finance Minister Bill Morneau have been working "constructively" with provinces and territories to "put to work" $11 billion in mental health and home care spending.
"So far, they have successfully achieved health care financing agreements with nine provinces and territories and look forward to working with each interested jurisdiction to improve care for Canadians," she wrote.
Pallister focuses on two main issues he would like addressed before signing a deal: the disparity of health care between Indigenous and non-Indigenous Manitobans, and funding for diabetes.
According to the Canadian Diabetes Association, the proportion of Manitobans with diabetes is expected to reach 37 per cent by 2027. Already, about 121,000 people in the province have the metabolic disease, which affects blood sugar levels and can lead to kidney damage.
"By 2024, more than 3,000 Manitobans will need treatment for kidney failure, either by dialysis or transplant," Pallister wrote.
"These human sufferings are borne disproportionately by Manitoba's Indigenous people, who face the onset and prevalence of end-stage disease at a rate two to three times higher than faced by other population segments."
The province is asking Ottawa to invest $6 million per year over 10 years to address chronic kidney disease. The diabetes association said it estimates diabetes costs the provincial health-care system $114 million every year.
In his letter, the Progressive Conservative premier praises the Liberal government, and says it has "admirably championed reconciliation."
In that light, Pallister said, the province requires help addressing long-standing inequalities between Indigenous and non-Indigenous peoples in terms of health outcomes.
"This may include support for patient navigators trained in cultural safety and patient-centred care, and to provide vital ancillary service support through discharge planning, language interpretation and transportation," he wrote.
'Shouldn't be anything about us without us'
Manitoba Keewatinowi Okimakanak, the advocacy group representing 30 Cree, Oji-Cree and Dene First Nations spanning nearly two-thirds of the province, expressed dismay her organization was not consulted before Pallister wrote to Trudeau.
Grand Chief Sheila North Wilson said she has been asking to speak with the premier for some time to discuss health care in First Nations, and her requests have been ignored.
"There shouldn't be anything about us without us," North Wilson said Friday. "We need to work together to come up with solutions."
The time when governments made decisions about the future of Indigenous peoples without consultation is long over, she added.
"If they do have a plan I wish they would share it with us so we can collaborate."
North Wilson said while the kidney disease support is important, remote and northern First Nations have other priorities. Emergency care could be improved along with access to healthy, affordable food, she said. Also, tuberculosis rates and mortality rates are stubbornly high in the north.
"He can't talk about Indigenous people and how sick they are without talking to the Indigenous people themselves to find out what's making them sick and what they see the solutions are."
Feds offer home care, mental health funds
Manitoba, Ontario, Quebec and Alberta, are the last hold outs to sign onto Ottawa's health-care offer.
Recently, British Columbia signed on after the federal government promised $10 million to help the province address its opioid crisis. Saskatchewan signed after Ottawa agreed to give the province one year to prove its private MRI clinics do not negatively impact the public health-care system.
Pallister said home care and mental health are priorities but the federal funding on the table does not make up for lost funding through the Canada Health Transfer.
On April 1, the Canada Health Transfer is set to increase by three per cent instead of the previous six per cent.
"We'd like to see some help and partnership," Pallister said in an interview with CBC News Friday.
"There hasn't been a negotiation. Premiers have been asking for a meeting with the prime minister for two years and there hasn't been a meeting," he said.