The First Nations Health Council (FNHC) was established in 2007 to mirror the membership of the provincial First Nations Leadership Council (FNLC) and included three representatives of the Union of British Columbia Indian Chiefs (UBCIC), three representatives of the First Nations Summit (FNS), and one representative of the British Columbia Assembly of First Nations (BCAFN). The FNHC was not developed as a legal entity, but as a political council to focus on implementation of the Transformative Change Accord: First Nations Health Plan (2006) and the Tripartite First Nations Health Plan (2007) at a political leadership level.

In 2010, by way of resolutions passed through their respective assemblies, Chiefs in Assembly directed the FNS, the UBCIC and the BCAFN to change the membership of the FNHC to fifteen members – three each appointed by the five regional caucuses (Fraser Salish, Interior, Vancouver Coastal, North and Vancouver Island). The resolutions that set out this revised structure stated, "[The FNHC] will be responsible for reporting to Nations within their regions, accountable for progress and processes at all levels, representation, and ensuring that ratification and decision-making processes are community driven, and Nation based.

On October 13, 2011, the signing of the legal British Columbia Tripartite Framework Agreement on First Nation Health Governance (Tripartite Framework Agreement) with the Government of Canada and the Province of BC changed the course of First Nations health in BC. It formally created a new First Nations health governance structure that supported First Nations in BC to participate in the design and delivery of health services. Decision-making was brought closer to home through the recognition and involvement of First Nations decision-making and service delivery processes, structures and institutions at federal, provincial, regional and local levels. The Tripartite Framework Agreement also committed the Parties to evaluate the implementation of the Agreement every five years.

In 2020, the FNHC announced its intention to conduct an external independent evaluation process at Gathering Wisdom X, to support the FNHC’s increased accountability and continuous learning in keeping with the 7 Directives. The evaluation was led by Ference & Company Consulting Ltd. (an independent evaluation and research firm) and the final report was published in Fall 2023.

Over the next two years, Chiefs and leaders will engage to finalize a new First Nations Health Council Terms of Reference, based on the First Nations Health Council Evaluation Results from Ference & Company Consulting Ltd. and ongoing discussions between 2025 and 2027. During this time, Chiefs and leaders will help refine the Terms of Reference, including:

• Clarifying roles and responsibilities
• Defining the First Nations Health Council Representatives’ dual role; and
• Reviewing accountabilities and success measures.

Through ongoing conversations on how to evolve the First Nations Health Governance Structure more broadly and findings derived from the FNHC Evaluation, First Nations and communities are once again shaping the future of health.