THE HEALTH STATUS OF CANADA'S FIRST NATIONS, MÉTIS AND INUIT PEOPLES A background paper to accompany Health Care Renewal in Canada: Accelerating Change (January 2005) Suite Eglinton Avenue East

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THE HEALTH STATUS OF CANADA'S FIRST NATIONS, MÉTIS AND INUIT PEOPLES A background paper to accompany Health Care Renewal in Canada: Accelerating Change (January 2005) Suite Eglinton Avenue East Toronto, Ontario M4P 2Y Acknowledgements: The would like to acknowledge the following individuals for their contributions to this report. First, it thanks the members of the Council s Healthy Canadians Working Group: Roberta Jamieson (Chair), Bernie Blais, Nellie Cournoyea, Jose Kusugak, Brian Postl, and Verda Petry for their guidance. The report was prepared by Claudette Dumont-Smith and Nancy Gibson provided insightful comment. Kathryn MacDonald, a member of Council staff, provided support to the Working Group. Please note that the information contained in this report was gathered in the months up to September Production of this report has been made possible through a financial contribution from Health Canada. The views expressed herein represent the views of the acting within its sole authority and not under the control or supervision of Health Canada and do not necessarily represent the views of Health Canada or any provincial or territorial government. Table of Contents Page Executive Summary Foreword 2. Introduction 3. Demographic profile of Canada s Aboriginal population 4. The health status of the what is known 5. Health indicators Determinants of health 7. Where are the gaps in information on health status? Aboriginal Health Reporting Framework update. 9. Next steps.. Conclusion & recommendations. Best practices: Eskasoni primary care project.. Appendices. References Executive Summary The intent of this report is to present a detailed account of the current health status of the peoples in Canada. Information to develop this report was gleaned from various federal/provincial/territorial sources, as identified in section four of the report. However, due to the varied ways that information is collected, or not collected in some instances, an accurate assessment of the health status of Aboriginal peoples remains beyond reach at the present time. Métis, First Nation[s] and Inuit Peoples are distinct from each other and each has a unique history. There is also significant intra-group diversity. Most of the existing Canadian data on Aboriginal Peoples are derived from the Registered Indian population. This can present significant challenges in trying to understand the overall health of Aboriginal Peoples in Canada (CIHI 2004). In spite of this hindering fact, however, health data that have been collected at the national and provincial/territorial levels indicate that the health status of First Nations, Inuit and Métis is well below that of the rest of Canadians. Aboriginal peoples in Canada were in good health upon the arrival of the Europeans, as confirmed in various historical documents. A special relationship was established between Aboriginal peoples and the Crown concerning the provision of health care. This relationship was confirmed through the signing of specific treaties which, for Aboriginal peoples, signifies their ongoing right to health care. However, some treaties, such as Treaty 6 (the Medicine Chest Clause ), have created ambiguity around responsibility for the health needs of Aboriginal peoples. The effects of colonization and other policies, like the residential school and Indian Act, have, over the years, eroded the traditional way of life for many Aboriginal persons. This erosion has had a negative impact on the health and well-being of individuals, their families and communities. In section three, a demographic profile of the Aboriginal peoples in Canada is presented. The information in this section was obtained primarily from the most recent census data and from Indian and Northern Affairs Canada and specifies the current number of people living in Canada. A brief description of each group is provided in this section including their place of residency and population age distribution, which is dissimilar to that of the general Canadian population. The populations are 3 much younger than the Canadian population as a whole a fact to be considered when making health forecasts and program planning. Section four is the focal point of this report. Health information on the health status of Aboriginal people is gathered from various sources. These include the National Aboriginal Health Organization, federal government departments such asike Health Canada, Indian and Northern Affairs Canada and Statistics Canada, as well as some provinces and territories. However, information is mainly collected on the status First Nations and the Inuit with very little data specific to the Métis population. As noted by federal sources, some of the impediments to reviewing First Nations and Inuit data have been that: In many cases, Aboriginal peoples access health care services from hospitals or private practice physicians under provincial jurisdiction; the data relating to these services do not necessarily identify the clients as either First Nations or Inuit; With the exception of communicable disease data, 1 between 1993 and 1999, information about the health status of the First Nations and Inuit was not compiled at the national level; The collection of vital statistics, and the reporting of these to Health Canada, varies across the country: The Atlantic Canada, Quebec and Ontario jurisdictions do not provide vital statistics reports to Health Canada. In these areas, statistics are generally obtained from the community health nurses 2 where coverage of statistical information for the Aboriginal population ranges from 90% for Atlantic Canada to 50% for Quebec; Nunavut is unable to provide Inuit-specific data as the vital statistics system is not yet developed; The Yukon and Northwest Territories provide vital statistics to Statistics Canada on the whole population and not on specific populations like the First Nations, Inuit and/or Métis; Immunization rates for the on-reserve First Nations population are provided annually to Health Canada. For the off-reserve population, this 1 Federal case report forms for tuberculosis and AIDS cases were used during this time period in all provinces and indicated the Aboriginal ancestry of the person - Status Indian, Inuit or Métis. For tuberculosis, the report forms also indicated if the (Status Indian) person resided on or off-reserve (Health Canada, 2003b). 2 Community health nurses are the primary health care providers in most First Nations communities. 4 information is managed at the provincial level, may not reflect First Nation status, and is inaccessible to Health Canada; In most regions in Canada, community health nurses provide reportable diseases information to regional offices of the First Nations and Inuit Health Branch (FNIHB). In Manitoba, the provincial public health department monitors First Nations reportable diseases information. Such information is unavailable for the First Nations who live off-reserve; Three provinces British Columbia, Alberta and Manitoba can, to some extent, distinguish and analyse First Nations health information by way of their hospital databases. At present, only the Pacific regional office of FHIHB publishes First Nations hospital utilization reports on a regular basis (Health Canada 2003b). Health Canada also indicates that very little health information outside of Non- Insured Health Benefit records is collected for the Inuit population. Neither Health Canada nor Indian and Northern Affairs collects health information on the Métis population. Some provinces and territories collect health statistics on the Aboriginal population but their methods, including specific health indicators, differ. Those provinces and territories that have provided health statistics on the Aboriginal population indicate, in most instances, that the health status of the Aboriginal peoples in their respective jurisdictions is below their provincial and territorial counterparts. Based on the list of comparable health status indicators approved by the Conference of Deputy Ministers of Health in 2004, the health of Aboriginal people is well below that of the rest of Canadians. Life expectancy for First Nations and Inuit is lower compared to their Canadian counterparts at the national, provincial and territorial level. First Nations infant mortality rates are higher compared to national and provincial rates and are even higher for the Inuit in Nunavik, Nunavut and the Northwest Territories. Based on national information, the incidence of infants with low birth weight is increasing in the First Nations population compared to the rest of Canada. The highest incidence is among Inuit populations. The crude mortality rate for First Nations is higher compared to the Canadian and available provincial rates. The four leading causes of death in the First Nations are: injury and poisoning, circulatory diseases, cancer, 5 and respiratory diseases. The mortality rate of the residents of all territories is expected to rise between 2000 and 2006 unless conditions change. Lung cancer is the most common type of cancer for all Aboriginal peoples, followed by prostate and colorectal cancer for men and breast and colorectal for women. Ischemic heart disease is the primary cause of death for First Nations people 45 years of age and older, according to national statistics, and is cited as the number one cause in British Columbia and Saskatchewan. Suicide is the leading cause of potential years of life lost in both the First Nations and Inuit populations. Tuberculosis is still evident in the First Nations and Inuit populations; it is six times higher and 17 times higher, respectively, than in the rest of Canada. Sexually-transmitted infections like genital chlamydia and HIV are higher in the First Nations and Inuit populations as reported at the national and provincial/territorial levels. Diabetes is steadily rising in the First Nations and Inuit population but is much higher in the former group. The Métis diabetes rate is similar to the First Nations rate. More smoke; the teenage smoking rate is also higher than the Canadian average. Residents of NWT tend to be more active than the rest of the Canadian population. The Inuit of Nunavut have an activity level that is similar to the rest of Canadians. According to the National Aboriginal Health Organization, major depression is a problem in the First Nations. Inuit Tapiriit Kanatami has named mental health and suicide prevention as the number one health concern for Inuit. Obesity rates in First Nations are twice as high in comparison to the rest of Canadians. Many older First Nations and Inuit adults do not receive needed home care services. 6 To address these disparities, the suggests that a population health approach be adopted to plan for improvements to the health status of Aboriginal peoples. The underlying philosophy of the population health approach takes the broader determinants of health into account. It is highly supportive of the Aboriginal belief that to be healthy one must achieve balance in all spheres the spiritual, mental, emotional, physical and social. The approach is predicated on the principles that: Health is determined by the complex interactions between individual characteristics, social and economic factors and physical environments; The health of a population is closely linked to the distribution of wealth across the population; Strategies to improve the health of a population must address the entire range of factors that determine health; Important health gains can be achieved by focusing interventions on the health of the entire population (or significant sub-populations) rather than individuals; and, Improving health is a shared responsibility that requires the development of healthy public policies in areas outside the traditional system. The Council also advises that systems be put into place to provide the necessary information to accurately assess the current health status of the First Nations, Inuit and Métis. The Council advocates the implementation of the following measures to overcome inter-jurisdictional and infrastructural challenges to address the health disparities that are common to populations: 1. Enable, expect and respect as full partners with federal, provincial and territorial jurisdictions in developing and implementing the Aboriginal Health Reporting Framework. Enable Aboriginal populations to collect health information which establishes an accurate baseline; permits the comparison and monitoring of their health status within and between their populations and with the rest of Canadians; meets the information needs of community leaders; and reflects the unique realities of Aboriginal peoples. 2. Adopt a population health model to address the health disparities of the population. Enable and require all federal, provincial and territorial departments/agencies to work in partnership with Aboriginal organizations that oversee, manage or advise on programs and 7 services, in order to address the determinants of health which have an impact the Inuit, Métis and First Nations populations. 3. In partnership with the various levels of government, identify the resource requirements to address the particular health needs of First Nations, Inuit and Métis who live in rural, remote or/and socio-economically challenged communities. Address, as a priority, the current and ongoing shortage of health care service providers available to these groups, especially nurses. Ensure that the necessary resources are devoted to implement educational programs that will increase the number of Inuit, Métis, and First Nations health care service providers in the short, medium and longer terms. Recognize that resources have to be available and accessible. Barriers, such as those created through the use of standardized program or funding templates, should be avoided so that resources can be allocated and utilized. Despite the challenges, there are several communities where the Aboriginal people have successfully improved their health status. The Eskasoni First Nations is one such community where partnerships have been developed with federal and provincial agencies to deliver health programs and services that are culturally-specific and appropriate, and are tailored to the needs of the Eskasoni First Nations residents. It appears that this effort has resulted in positive health outcomes for the Eskasoni population. A brief description of this particular project is included in this report. 8 1. Foreword 1.1 History By way of the 2003 Health Accord, the federal/provincial/territorial governments agreed to work in partnership with each other, with health care providers and with Canadians to renew and/or reform the current public health care system. For details on the 2003 Health Accord see Appendix A. For details on the Health Council of Canada see Appendix B. The Health Accord specifically mentions Aboriginal 3 peoples and the particular efforts required by all stakeholders to address and improve their overall health status. Consequently, the federal government has committed to increasing its funding to improve the status quo and to work in collaboration with other jurisdictions as well as with Aboriginal peoples to meet the Health Accord s objectives. These include the three priorities of the Health Reform Fund: primary health care, home care, and catastrophic drug coverage. Further, First Ministers are directing Health Ministers to consult with Aboriginal peoples in order to develop a comparable Aboriginal Health Reporting Framework, to consult on the use of comparable indicators and to develop the necessary data infrastructure. This will serve to establish a baseline against which progress and key outcomes can be measured. The following guiding principle was adopted in preparation for this background paper: The heath of Canadians depends on our ability to effectively deal with disparities of people most at risk, in particular: ; Children and youth; Elderly; and, Mentally challenged people. This report focuses on the health of the. Based on available information about the health of these groups, the report will indicate: What is known; Where are the gaps; What information must be collected to provide a proper framework for reporting for these communities; and 3 In reference to peoples. 9 What is needed to address a key commitment of the Accord: to develop an Aboriginal Health Reporting Framework; and What future actions are recommended. 2. Introduction Currently, Aboriginal people have a health status that is well below the national average. Their socio-economic conditions are often cited as being similar to those in developing countries. This was not always so. At the time of contact with Europeans, Aboriginal people were in good health a fact that is well documented in historical documents and through the findings of paleo-biology efforts (Royal Commission on Aboriginal Peoples, 1996). After the contact period, however, many Aboriginal people became ill and died from infectious diseases that were foreign to them, such as influenza, polio, measles, smallpox and diphtheria (ibid.). Skeletal remains of unquestionably pre-columbian date are, barring a few exceptions, remarkably free from disease. Whole important scourges [affecting Europeans during the colonial period] were wholly unknown There was no plague, cholera, typhus, smallpox or measles. Cancer was rare, and even fractures were infrequent There were, apparently, no nevi [skin tumours]. There were no troubles with the feet, such as fallen arches. And judging from later acquired knowledge, there was a much greater scarcity than in the white population of most mental disorders, and of other serious conditions (RCAP, 1996). Various factors (health determinants) directly influence the health of a person or population. However, the disparities in the health status of the Aboriginal peoples can also be linked or traced back to the beginning of the colonization period. As far back as the 18 th and 19 th centuries, agreements with representatives of the British Crown were initiated and sought by Aboriginal leaders to address the worsening health status of their people brought on by new infectious diseases and poverty. Many treaties 4 Treaty 6 (1876), Treaty 8 (1899), Treaty 10 (1906); and Treaty 11 (1921) were signed by both the federal government and First Nations, stating that the Crown would provide health care to the First Nations people to reimburse them for the use of their land and resources. First Nations 4 Treaties between Aboriginal and European nations were negotiated and concluded through a treatymaking process that had roots in the traditions of both societies. These were the means by which Europeans reached a political accommodation with the Aboriginal nations to live in peaceful co-existence and to share the land and resource of what is now Canada (RCAP, Vol. 1, 1996). 10 people hold to the view that health care is a treaty right that was affirmed in the treaty-signing process and, as such, is legally binding to this day. Furthermore, because of the special relationship that was established through these agreements, Aboriginal people believe that the provision of health care falls under federal jurisdiction as opposed to being a provincial/territorial matter. Further, many First Nations people agreed to live on land set aside for them by the Crown these land bases are known as reserves and still exist to this day (RCAP, 1996). As a result of being confined to a limited land base, resources such as food and clothing materials, normally acquired by hunting, trapping and fishing and used for trading/bartering purposes, quickly shrunk. As access to and availability of these resources declined, major lifestyle, livelihood and diet changes occurred that affected the health status and well-being of the Aboriginal people. Conditions such as diabetes, which is consider
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