ESTABLISHING FIRST NATIONS HEALTH & WELLNESS INDICATORS ...gathering-wisdom.ca/wp-content/.../GWVIII-CMO-PHO-Presentation-20… · establishing first nations health & wellness indicators

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ESTABLISHING FIRST NATIONS HEALTH & WELLNESS INDICATORS FOR THE NEXT 10 YEARS

Gathering Wisdom

Dr. Perry Kendall and Dr. Evan Adams

November 30, 2016

Image credit: Juan Solorzano

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Live Graphic Recording From the Chief Medical Officer of FNHA & Provincial Health Officer Partnership Workshop - March 2016 (Sam Bradd) 2

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• Aboriginal Health Physician Advisor Position

• Deputy Provincial Health Officer Position

• PHO:FNHA Partnership (MOU)

• FNHA Chief Medical Officer Position

PARTNERSHIP BASED ON

TRUST AND RESPECT

AN EMERGING PARTNERSHIP

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STRONGER TOGETHER: PHO & FNHA PARTNERSHIP

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THE TEAM

• Collaboration between the Office of the PHO, Office of the CMO and other FNHA departments.

• Project leads: Lindsay Beck, Kathryn Berry, Adrienne Bonfonti and;

• Working Group Members: Dr. Shannon McDonald, Dr. Shannon Waters, Harmony Johnson, Judith Eigenbrod, Laurel Lemchuk-Favel, Rebecca Love, Ashraf Mohammed, Megan Misovic, Anita Christoff

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TODAY MARKS A MILESTONE MOMENT

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Support FNHA’s vision for Healthy, Self-Determining, &

Vibrant BC First Nations Children, Families, & Communities

by:

• Establishing a renewed set of 15 indicators, that we

will measure and report on for the next 10 years.

• Building off the 7 health indicators established in the

Transformative Change Accord First Nations Health

Plan.

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ORIGINAL 7 TRANSFORMATIVE CHANGE ACCORD FN HEALTH PLAN INDICATORSIndicator Source

Infant mortality Vital Statistics

Children with healthy Body Mass Index (BMI)

(Note: This indicators was previously obese children)

Survey/Canadian Community Health

Survey

Youth suicide Vital Statistics

Diabetes prevalence Ministry of Health

Age-standardized mortality rate Vital Statistics

Life expectancy Vital Statistics

Number of practicing, certified FN HCPs To be determined

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* The final interim update is scheduled for release in 2017 to report on data up to 2015.

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YOUTH SUICIDE RATE( R AT E PER 10,0 00 P OPULATI ON)

P rog ress s in c e

B a selin e

P ro jec ted to meet Ta r g et

PRO JECTIO NS:

SI b efo r e TCA: 3 .53

Cu r r en t: 2 .23

P rev io u s (2 0 1 0 ) : 2 .1 8

Ta rg et: 2 .1 0

O R b efo re TCA: 0 .66

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DIABETES AGE-STANDARDIZED INCIDENCE RATE( R AT E PER 100 POPULATION)

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BRINGING TOGETHER KNOWLEDGE

The renewed set of indicators and

associated reports will bring together

knowledge to support and inform

policy, initiatives and approaches at

various levels (community, Nation,

within and across sectors and levels of

government).

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First Nations Perspective on Wellness

SETTING A VISION FOR FUTURE WORK

•We were challenged to set a vision for

future work.

•Recommendations, targets and actions to be

developed.

•Reports on progress to be issued every 2

years.

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DEVELOPING THE SET OF INDICATORS THROUGH TWO-EYED SEEING

Two-Eyed Seeing is “learning to see from one eye with the strengths of

Indigenous knowledges & ways of knowing, & from the other eye with

the strengths of Western knowledges & ways of knowing…& learning

to use both these eyes together, for the benefit of all,” championed by

Elder Albert Marshall (Mi’kmaw Nation).

Source: Stiefel M, Nolan K. 2012. IHI Innovation Series

white paper. Cambridge, Massachusetts: Institute for

Healthcare Improvement.

First Nations Perspective on Wellness 13

PEELING BACK THE LAYERS:TOWARDS DEVELOPING THE INDICATORS

Image credit: University of Northern British Columbia

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ROOTS OF RESILIENCE: ENHANCING WELLNESS & REDUCING INEQUITIES

LINKED TO IMPROVED

HEALTH AND WELLNESS OUTCOMES

• First Nations are taking back control &

are acting to address the structural origins of these inequities, by increasing local control over land, resources, services & decision-making structures.

• Existing strengths, such as Aboriginal

ways of knowing & being, including connection to land, culture, language, community, & family balance, self-reliance etc.

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SHIFTING THE PARADIGM: SICKNESS TO WELLNESS, DEFICITS TO STRENGTHS

Many First Nations have especially good health and wellness outcomes.

•We will focus on wellness outcomes, not only “health” or disease/illness. outcomes.

•We will explore and celebrate their sources of strength & resilience —build, share & spread those successes!

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RENEWED POPULATION HEALTH AND WELLNESS INDICATORS:THE FRAMEWORK

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INDICATOR DEVELOPMENT

•From over 50, down to 15 indicators

•Informed by previous FNHA Wellness Indicator Work (regional engagement sessions, Gathering Wisdom)

•Informed by innovative public and population health policy and discourse

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OTHER INDICATORS CONSIDERED• Violence Against Women: Covered in the PHO/FNHA CMO Aboriginal Women’s Health Report & the Murdered &

Missing Indigenous Women’s Inquiry.

Social, Cultural, Economic,

Environmental

Land, Nations,

Community, Family

Mental, Physical,

Spiritual, Emotional

Health & Wellness

Outcomes

Health System FNHA Programs

Justice Air and water quality Nurturing spirit: Balance Chronic diseases/conditions Cancer screening Physical Activity Programs

IncomeElders sharing knowledge with

communitySelf-rated overall health Body Mass Index Immunizations

Number of steps from Fitbit

challenges

Number of Aboriginal Businesses

Perceived community safety,

strengths, challenges,

progress/change, participation

in cultural events

Positive Mental Health ScaleDiabetes and related

comorbidities

Access to maternal

supports and servicesMedical transportation

Investment in Training /

InfrastructureSocial and community support Mental Mastery Scale Hospitalizations of children

Attachment to a primary

care providerFirst Responder Training

Collaboration between different

organizations & agencies

Forums for sharing best

practices

Illicit drug use Exposure to second hand

smoke

Resource intensity for

hospitalized person

Traditional medicines

benefits coverage

Housing in need of minor and/or

major repairs

Number of communities with

completed Comprehensive

Community Plans

Healthy eating: Fruits and

vegetablesGrowth chart

Confidence to ask

questions relating to my

or my family's wellbeing

Aboriginal Head-start

program

Access to private/public

transportationCommunity Gardens Communicable diseases

Health Education Programs

in Community

Children in careSelf-identified healers in

communityHIV Cascade of Care

Pre and post-natal

education

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Indicator Data Aboriginal Knowledge

Education: Graduation

rates

Ministry of

Education

To be determined – stories, art,

songs, traditional ecological

knowledge

Food security Regional Health

Survey (RHS) or

Canadian

Community Health

Survey (CCHS)

Adequacy of housing CensusImage credit: Native Education College

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Cultural Wellness - a

combined indicator of:

• Traditional language

• Traditional foods

• Traditional medicine/healing

• Sense of belonging to one’s

community

RHS



knowledge

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community

RHS



knowledge

Image credit: Simon Fraser University, 201523








community

RHS



knowledge

Image credit: Aboriginal Tourism BC24

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community

RHS



knowledge

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community

RHS

To be determined – stories, art, songs,

traditional ecological knowledge

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Experience of cultural

safety & humility in

receiving health services

In-patient

survey among

hospital

patients

(PREMS)



knowledgeAvoidable hospitalizations

(ambulatory care sensitive

conditions)

Ministry of

Health

HEALTH SYSTEMS

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Decision-making, human

and economic capacity

Index using

multiple sources

To be determined – stories, art, songs,

traditional ecological knowledge

Ecological health:• % of undisturbed habitat

• Abundance of culturally

important species (salmon,

moose, elk)

• # of animals that can be

harvested in a season

To be

determined

Image credit: World Wildlife Foundation28

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Level of physical activity RHS/Canadian

Community

Health Survey

(CCHS)To be determined – stories, art,


knowledge

Number of children with healthy

teeth (no cavities)

Health Canada

Smoking commercial tobacco RHS/CCHS

Image credit: Spirit Magazine29


Healthy infant birth weights Perinatal

Services BC



knowledge

Alcohol-related deaths Vital Stats

Agency

Serious injuries requiring

hospitalization

Ministry of

Health

Self-reported

mental/emotional well-being

RHS/CCHS

HEALTH &

WELLNESS

OUTCOMES

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Establishing knowledge and a system of

measurement and reporting that reflects

the First Nations Perspective of Wellness

to measure our progress over the next

10 years.

Moving us from deficits to strengths, from

sickness to wellness.

Towards our vision of “Healthy, Self-

Determining, & Vibrant BC First Nations

Children, Families, & Communities.”

SETTING A VISION

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I AM NISGA’A: I AM ROSE, WALKING IN WELLNESS

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ESTABLISHING FIRST NATIONS HEALTH & WELLNESS INDICATORS ...gathering-wisdom.ca/wp-content/.../GWVIII-CMO-PHO-Presentation-20… · establishing first nations health & wellness indicators