Finding A Way in First Nations, Inuit and Métis HealthFrom a crisis of chronic disease among Aboriginal peoples to lung cancer rates among Inuit that are the highest in the world, the health challenges are critical, complex, and rooted in historical, political and social factors. A key task for the NCCAH is to ensure a greater understanding among varied audiences of unique Aboriginal contexts related to health issues. This in turn can support programs, services and interventions that are culturally appropriate, community-based, respectful and relevant.
Highlighting the ChallengesNews stories and journal articles continue to highlight the health gaps and inequities experienced by First Nations, Inuit and Métis populations. In 2010, for example, these issues made headlines:
· Among Inuit in the North, endemic overcrowding and poverty have been linked in new studies that show Inuit infants die at 3.6 times the rate of other Canadian babies and that 70 per cent of Inuit preschoolers live in homes where there isn't always enough food (Globe and Mail, 2010; Canadian Medical Association Journal, 2010).
· Information released in 2010 found the tuberculosis rate among Inuit has doubled in the past four years – to 185 times the rate of Canadian-born non-aboriginals – at a time when the national rate is declining (Public Health Agency of Canada, 2009).
· An epidemic of type 2 diabetes mellitus is affecting many of Canada's First Nations, with a trend toward earlier age at onset. (Reading, 2009).
· Health is linked to environmental issues such as safe drinking water. As of April 30, 2010, there were 116 First Nations Communities across Canada under a drinking water advisory (Health Canada 2010).
· A steady rise in the proportion of reported AIDS cases and positive HIV tests has been reported among Aboriginal persons in Canada, with an “explosive spread of infection in the Aboriginal community across the Prairies” (Public Health Agency of Canada, 2007; Centre for Aboriginal Health Research, 2010).
Recent national and international studies
Recent books and reports also point to health challenges unique to Aboriginal peoples. The Chief Public Health Officer of Canada, Dr. David Butler-Jones, released his second report on the state of public health in Canada in 2009, focusing on childhood. Although targeting all children in Canada, he consistently drew attention to indicators where Aboriginal children fare worse than the general population. He found that “inequalities are evident even at the earliest stages of life, particularly among children who are Aboriginal, who have disabilities, or who are part of families with low income.” The health officer warned that Canada “may fail these children” without concerted action.
The World Health Organization in a groundbreaking report in 2008 outlined ways to close the global health gap by addressing the social determinants of health such as poverty, housing, education and early childhood development. The report, "Closing the gap in a generation: Health equity through action on the social determinants of health," by the Commission on Social Determinants of Health, found that Indigenous Peoples have distinct status and specific needs relative to others, and that “toxic” policies, laws and regulations uniquely target Indigenous peoples. Among the report's recommendations was a call for national governments to “acknowledge, legitimize and support Indigenous Peoples in policy, legislation and programs that empower them to represent their needs, claims, and rights.” (CSDH, 2008).
Also on the international front, the Lancet, known as the world's leading general medical journal, recently featured a two part series on Indigenous health that highlighted international trends toward obesity, cardiovascular disease and type 2 diabetes, along with physical, social and mental disorders linked to misuse of alcohol and other drugs. The authors (Dr. Malcolm King, PhD, Department of Medicine, University of Alberta, and Michael Gracey MD, Unity of First Peoples of Australia, Perth, WA) called for increased awareness, political commitment, and recognition “rather than governmental denial and neglect” of the serious and complex problems. In the second part of the review, the authors sought to address underlying causes of health disparities between Indigenous and non-Indigenous people, drawing from a Canadian perspective. They focused on Indigenous perspectives on the causes of poor health – including factors such as colonization, migration, loss of language and culture, and disconnection from land.
Similarly, Dr. Jeff Reading, of the Centre for Aboriginal Health Research at the University of Victoria, found that chronic disease among Aboriginal peoples, from mental illness to diabetes, is on the rise and will require both urgent action and social change to end an inter-generational cycle of illness and disease. In his book “The Crisis of Chronic disease Among Aboriginal Peoples: A Challenge for Public Health, Population Health and Social Policy,” released in late 2009, Reading details the latest research and concludes that the traditional health emphasis on treating adult risk factors for chronic disease falls short when “subsequent generations grow up in the same conditions that fostered the onset of chronic disease in their parents.”
Understanding the Challenges
While the health challenges are great, the opportunities for change are also great. The NCCAH is committed to being part of a transformation that will lead to equity and optimal health and well-being for First Nations, Inuit and Métis peoples in Canada. This includes highlighting approaches to health that situate Aboriginal issues in historical, social, political and economic context. This past year, for instance, our centre staged a training session introducing First Nations, Inuit and Métis health issues and perspectives at the Summer Institute 2009 in Mont-Ste. Anne, Quebec, to policy makers, practitioners and researchers. Our powerpoint presentation: "Connections to the Past: An Introduction to the Health of First Nations, Inuit and Metis Peoples" touches on issues of colonization, the fragmented nature of policy development in Canada leading to gaps and jurisdictional conflicts in health care for various Aboriginal populations, and the underlying causes of illness and disease.
We have also supported more formal training in “cultural competency” that promotes effective interactions between people of different cultures, with a focus on health. Our partnership with the Canadian Paediatric Society through the Many Hands, One Dream initiative led in 2010 to curriculum supporting cultural awareness and education of paediatric residents at universities across Canada in the care of Aboriginal children and youth. The education module is currently being adapted to train other professional groups.
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As two recent articles in the journal, Canadian Family Physician, indicate, there is a growing awareness of the challenges. Ann C. Macaulay suggests that health care professionals, whether in rural, urban or tertiary care settings, can best promote improved Aboriginal health in Canada by adopting a holistic approach in offering advice and care. For authors Catherine Elliott and Sarah de Leeuw, the generalization that Aboriginal peoples have poor health status and experience substandard social and economic conditions can, in many cases, be a barrier to optimal care. They suggest that understanding the complexities of the history and context that Aboriginal patients bring with them to encounters with family doctors is important to improved care that breaks through such stereotypes.
The NCCAH is also helping address the need for comprehensive information on Aboriginal health in Canada. We are completing a high level summary detailing what is currently known and being done for the health of First Nations, Inuit and Métis peoples in Canada, a project undertaken in partnership with the Public Health Agency of Canada. Our document, The State of Knowledge on Aboriginal Health, explores provincial, national, and international Aboriginal public health programs, as well as challenges and extenuating factors such as poverty and overcrowded housing that play such a critical role in health outcomes. The document, along with accompanying fact sheets, will be disseminated in 2010-2011.
Sharing Knowledge – The NCCAH at Events and Conferences
The population health focus of the NCCAH requires a multifaceted approach to our knowledge-sharing activities in order to reach audiences that have an interest in Aboriginal Health. While we continue to develop innovative means of dissemination, through documentary films that respect and extend the link between oral cultures and technology, through social media, and through virtual networks, we also place an emphasis on direct contact with communities and organizations. We particularly benefit from the help of our NCCAH advisory committee members, who generously continued in 2009/2010 to provide their expertise and leadership on behalf of the NCCAH at a variety of events and deliberations across the country and internationally. Highlights of our participation in conferences and events follow.
International
As a country with an important Indigenous population, Canada has the potential to command respect and influence when it comes to addressing the serious public health issues facing many of the world's 370 million Indigenous people living in marginalized circumstances[1]. The NCCAH helps ensure a Canadian Indigenous voice internationally in such venues as the United Nations Permanent Forum on Indigenous Issues, the World Health Organization's Commission on Social Determinants of Health, the Pan American Health Organization, and in international policy dialogues. In 2009/2010, the NCCAH continued its longstanding work on the United Nations General Comment on the Rights of Indigenous Children, for example, and made several presentations at the 14th Congress on Circumpolar Health in Yellowknife, an event aimed at improving the quality of life in circumpolar regions.
In addition, NCCAH Academic Leader Dr. Margo Greenwood was a keynote speaker at the Fifth International Policy dialogue on HIV/AIDS and Indigenous Persons (see final report), presenting on Indigenous Social Determinants of Health and HIV/AIDS. Hosted by the International Affairs Directorate, Health Canada, this 2009 dialogue was part of a global commitment to halting and reversing the spread of HIV/AIDS among Indigenous peoples and achieving universal access to treatment. Through the Partnership Arrangement with UNAIDS, Health Canada held the event to help address issues leading to levels of exclusion and disparity among Indigenous peoples that in turn can increase susceptibility to HIV/AIDS. Discussions also explored possible areas for further policy discussion and intervention.
National
The NCCAH continues to strengthen links with public health organizations, government representatives, researchers, and institutions. We are regular participants in national conferences such as the Canadian Public Health Association and the National Aboriginal Health Organization, and participate in numerous national committees and working groups. As members of the Institute Advisory Board of the Canadian Institutes of Health Research, Institute of Aboriginal Peoples' Health, we help set strategic directions for Aboriginal health research in Canada.
Local and Regional
The northern B.C. home of the NCCAH is a dynamic region of innovation and leadership in Aboriginal health. The NCCAH has worked with leading health agencies in the region, including:
· Carrier Sekani Family Services – a frontline community services organization serving more than 10,000 people in nearly two dozen Indian Bands or First Nations in a territory of 76,000 kilometres.
· Northern Health Authority – as the largest health authority in B.C., this organization provides health services to 300,000 people over an area of 600,000 square kilometers. Thirteen per cent of the population is Aboriginal – the highest proportion in the province.
· Central Interior Native Health Society – unique in the north and rare in Canada, this Aboriginal-run Society operates a downtown clinic providing primary health care services for individuals living on or close to the street, primarily the Aboriginal population, and includes a methadone clinic and a team of doctors, nurses, social workers and specialists serving more than 1,000 clients. The Society uses a holistic approach to health care that promotes physical, spiritual, emotional and cultural harmony with all Aboriginal people who reside in north central B.C.
The NCCAH continues to contribute regularly to the
BC Rural and Remote Health Research Network conferences and to other local and regional initiatives, while leading or collaborating with several provincial and regional networks.