Health Council of Canada. The health status of Canada’s First Nations, Metis and Inuit Peoples. First Nations Wholistic Policy and Planning Model: Discussion paper for the WHO Commissi

Beating the Drum on Health Inequalities in Canadian Aboriginal People

Ingrid Giesinger, Priya Khemani, Rosemund Ogyaadu, Nisha Rajendran, Jin Zhu

Census of Canada 2001, Geography Division, Statistics Canada 2002

Historical Context: a Distal Determinant of Health

Population Projections of Registered Indians, 2000-2021, Indian and Northern Affairs Canada, 2002; Statistics Canada, Canadian Socio-economic Information Management System Table 051-0001

Demographics

• Younger age distribution among First Nations

Health Council of Canada. The health status of Canada’s First Nations, Metis and Inuit Peoples

Comparing Life Expectancy and Mortality

Life expectancy of Aboriginal and Canadian populations (1980-2000)

Infant mortality (per 1000 live births) of Aboriginal and Canadian populations (1999) (1999, 2003)

A statistical profile on the health of First Nations in Canada: Self-rated Health and Selected Conditions, 2002 to 2005

Age-Standardized Prevalence of Selected Health Conditions, First Nations On-Reserve (2002-2003) and General Canadian Population

(2003), Adults

n/a

n/a

Health Council of Canada. The health status of Canada’s First Nations, Metis and Inuit Peoples. Reading JL, Kmetic A, Gideon V. First Nations Wholistic Policy and Planning Model: Discussion paper for the WHO Commission on Social Determinants of Health

Prevalence of Selected Health Behaviours Among Adult Aboriginals and General Canadian Population

† Heavy drinking defined as consumption of five or more drinks on any single occasion.*Antenatal alcohol use by pregnant women on Vancouver Island.

RHS 2002/03

Obesity Rate in First Nations (%)

Overweight (BMI 25-29.99); Obese (BMI>30)

NAHO 2004e

A Comparison of Diabetes Rate Ratio

Over all, diabetes rate for First Nations adults is more than 3 times the Canadian rate (15.5% versus 4.7%)

Health Council Canada 2005

Prevalence of Diabetes Among First Nations in Canada

• Diabetes is steadily rising in the First Nations and Inuit population

• Age-standardized rate of diabetes in Métis population is three times higher than non-Aboriginal population

• Fifth most prevalent condition

Mental Health

Historical Determinants:•Colonization• Residential school trauma• Loss of land, language and livelihood

First Nations Suicide by Cultural Continuity Factors

Proxy measure of cultural continuity factors: land claims, self-government, education services, police and fire services, health services, and cultural facilities.Reprinted, with permission of the publisher, from Chandler & Lalonde (1998).

First

Nations -

Suicide and self inflicted injuries

•Aboriginal vs Non Aboriginal Males 126 per 100,000 vs 24 per 100,000 Females 35 per 100,000 vs 5 per 100, 000 

• Registered Indian youths (15-24 yrs old)• Inuit youth suicide rate highest in the world Overall, limited available data

University of Calgary: Suicide Rates by Age and Gender First Nations & All Canadians: 1990 - 1994

Reported Suicide

Suicide rates per 100,000 amongst Aboriginalscompared to mainstream Canadians (1996)

Potential life years lost due to suicide: comparing Aboriginal to Mainstream Canadians (1999)

Health Council of Canada. The health status of Canada’s First Nations, Metis and Inuit Peoples

First Nations Regional Longitudinal Health Survey 2002/3

AFN Discussion paper for WHO Commission on SDH, National Collaborating Centre for Aboriginal Health

Social Determinants: SES & Education• Higher SES =

empowerment

• Low levels of education: lower perceptions of proper nutrition, lower skills, low paid jobs and fewer employment opportunities.

National Collaborating Centre for Aboriginal Health

Social Determinants: Self-DeterminationPer cent who strongly agree that: Depressed Not

DepressedI can solve the problems that I have

32.4 38.5

No one pushes me around in life 33.8 41.0

I have control over things that happen to me

28.0 31.1

I can do just about anything I set my mind to

35.2 43.2

I often feel helpless in dealing with the problems of life

7.4 4.1

What happens to me in the future mostly depends on me

37.0 37.6

There’s little I can do to change many of the important things in my life

10.6 5.9

• WHO: aim to equalise health opportunity not health status.

• Aboriginal people do not participate equally in political decision-making; control of land, economies, social and health services.

Social Determinants: Social Exclusion and Racism

• Hierarchal distribution of resources and power.

• Racism: hinders Aboriginal participation and productivity in the national economy.

• Stress of living in a racist environment may lead to negative health outcomes.

National Collaborating Centre for Aboriginal Health

National Collaborating Centre for Aboriginal Health

Social Determinants: Culture and Language

• Rate of suicide varies with “cultural continuity” (Chandler & Lalonde, 1998)

• Traditions, religion and control of health policies, social programs, land rights, education access, etc all extremely important in this context.

Goals of Policy ImplementationSocial inclusion and the Community • “Strength through numbers”• Resources supporting community-based

solutions and activities• Knowledge dissemination in the form

of family and community awareness campaigns

• Decrease stigma through education, ability to recognize risk factors of illnesses

• Suicide prevention programs• Outreach services

Health Canada

National Collaborating Centre for Aboriginal Health

Goals of Policy Implementation• Empowerment

• Increased participation of First Nations in governance and control of health and well being of their people. Ex. The BC Tripartite First Nations Health Plan vision

• Cultural Integration and Sensitivity• Cultural Health Index-tool to understand how Indigenous

people look at environmental change and how they assess that change.

• Recognize the knowledge of First Nations people, to observe their experiences and provide management (Maori)

• Respect their health practices

Goals of Policy Implementation• Implementing into school curriculum and to communities,

knowledge on the First Nations community and culture, in order to decrease racism

• Renewed relationship with First Nations and Inuits, building social capital and promoting inclusion

• Build social bridges with the rest of the country. Ex. Reverse integration in schools, or exchange programs for youth.

References

Bartlett JG, Iwasaki Y, Gottlieb B, Hall D, Mannell R. Framework for aboriginal-guided decolonization research involving Métis and First Nations persons with diabetes. Social Science and Medicine. 2007; 65:2371-2382.

Browne AJ, Fiske J, Thomas G. First Nations women’s encounters with mainstream health care services and systems. British Columbia Center of Excellence for Women’s Health. 2000. Chudley AD, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ. 2005; 172: S1-21.Census of Canada 2001, Geography Division, Statistics Canada 2002 http://geodepot.statcan.ca/Diss/Maps/ThematicMaps/aboriginal/National/Cda_Aborig_TABP_Fc_f1.pdfCSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization. Frohlich, Ross, Richmond. Health disparities in Canada today: Some evidence and a theoretical framework. Health Policy. 2006; 79: 132-146. Elsevier Ireland Ltd.

Available at: http://www.sciencedirect.com/science_ob=MiamiImageURL&_cid=271761&_user=7237960&_pii=S0168851005003039&_check=y&_origin=article&_zone=relatedPdf Popup&_coverDate=2006-12-31&piiSuggestedFrom=S0277953601003422&wchp=dGLzVlV-zSkWb&md5=b7f27a67e57d784a4a69ab747f3dbfa9/1-s2.0-S0168851005003039-main.pdfHealth Council of Canada. The health status of Canada’s First Nations, Métis and Inuit Peoples. 2005. Toronto, Canada.Health Canada. First Nations and Inuit health program compendium. 2007: 1-79. Available at: www.hc-sc.gc.ca/fniah-spnia/pubs/aborig-autoch/2007_compendium/ndex-eng.php#a_5_0 Garner R, Carriere G, Sanmartin C. The health of First Nations living off-reserve, Inuit and Métis adults in Canada: the impact of socio-economic status on inequalities in health . Statistica Canada.

June 2010.Lavoie. Looking at Aboriginal health in legislation and policies 1970-2008, the policy synthesis project. National collaborating centre for Aboriginal health. 2011. Available at: http://www.nccah-ccnsa.ca/

docs/1983_synthesisproject_V2.pdfLuo ZC, Kierans WJ, Wilkins R, Liston RM, Uh SH, Kramer MS. Infant mortality among First Nations versus non-First Nations in British Columbia: temporal trends in rural versus urban areas, 1981-2000. IJE. 2004;33:1252-1259.Martens PJ, Brownell M, Au W, MacWilliam L, Prior H, Schultz J, Guenette W, Elliott L, Buchan S, Anderson M, Caetano P, Metge C, Santos R, Serwonka K. Health Inequities in Manitoba: Is the

Socioeconomic Gap Widening or Narrowing Over Time? Winnipeg, MB: Manitoba Centre for Health Policy, September 2010. Martens PJ, Bartlett J, Burland E, Prior H, Burchill C, Huq S, Romphf L, Sanguins J, Carter S, Bailly A . Profile of Metis health status and healthcare utilization in Manitoba: a population based-study.

Winnipeg, MB: Manitoba Centre for Health Policy, June 2010.Ministry of Aboriginal relations and reconcilliation. Tripartite First Nations health plan. 2007:1-7. Available at: www.gov.bc.ca/arr/social/health/down/tripartite_health_plan_signed.pdfMikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. International symposium on the social determinants of indigenous health Adelaide: Commission on social determinants of health. 2007. Social determinants and Indigenous Health: The international

experience and its policy implications. Adelaide, Australia 29-30 April 2007.Pacey M. Fetal alcohol syndrome and fetal alcohol spectrum disorder among aboriginal Canadians: knowledge gaps . National Collaboration Centre for Aboriginal Health (NCCAH). 2010.Reading & Wien (2009), “Health inequalities and social determinants of Aboriginal people’s health”. National Collaborating Centre for Aboriginal Health.

Available at: http://keeptobaccosacred.org/yahoo_site_admin/assets/docs/NCCAH-Loppie-Wien_Report.306133340.pdfReading, Kmetic & Gideon (2007) First Nations Holistic and Planning model. Discussion paper for World Health Organisation Commission on Social Determinants of Health .

Available at: http://ahrnets.ca/files/2011/02/AFN_Paper_2007.pdfRichmond C AM, Ross NA. Social support, material circumstances and health behaviour: influences on health in First Nation and Inuit communities of Canada . Social Science and Medicine. 2008;67:1423-1433.Richmond C AM, Ross NA. The determinants of First Nation and Inuit health: A critical population health approach. Health and Place. 2009; 15:403-411Population Projections of Registered Indians, 2000-2021, Indian and Northern Affairs Canada, 2002; Statistics Canada, Canadian Socio-economic Information Management System Table 051-0001Social determinants of health: First Nations, Inuit and Metis perspectives (2007). National Collaborating Centre for Aboriginal Health, University of Northern British Columbia. Bridgeworks Consulting

inc.Stout MD, Kipling GD, Stout R. Aboriginal Women’s Health research: synthesis project. Centers of Excellence for women’s health. 2001.Strategic Plan: 2010 to 2015 working together to revitalize whole health of First Nations, Inuit and Metis. National Aboriginal Health Organization (NAHO). 2010.

 

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