Health Promotion and

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Health Promotion and Chronic Disease Prevention
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Where were going

• Evidence
• FNIHB Capacity
• Recommendations
• Proposed approach
• Next steps

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Introduction

• What are chronic diseases?
• Largely preventable, non-communicable or
  degenerative diseases characterized by
• Multiple risk factors
• Long latency period
• Prolonged illness
• Non-contagious origin
• Functional impairment
• Incurability

• Focus on four groups of chronic diseases
• Cancer
• Respiratory
• Cardiovascular
• Musculoskeletal

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Sources of data

• Health services utilization
• Mortality
• Drug expenditures
• Disease registries
• Health surveys
• Taken together, even these major data sources
  dont provide a complete picture. There are still
  significant knowledge gaps

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Evidence

• How big is the problem?
• Cancer Respiratory
• -- breast -- chronic obtrusive pulmonary
  disease
• -- cervix -- asthma
• -- colon
• -- lung
• Musculoskeletal Cardiovascular
• -- arthritis -- ischemic heart disease
• -- stroke

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Evidence

• Scope of the problem
• Aboriginal population undergoing health
  transition shift from infectious to chronic
  diseases
• Rates of major chronic diseases exceed Canadian
  average
• Increased rates of important causes of mortality,
  morbidity, disability, and reduced quality of
  life
• Serious social and economic impact
• Likely to get worse before getting better

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Evidence
Cardiovascular disease

• Ischemic heart disease (IHD) is directly related
  to socio-economic changes
• Age-adjusted prevalence of IHD among First
  Nations is slightly higher than that of all
  Canadians
• Risk factors hypertension, hyperlipidemia,
  diabetes, obesity, smoking

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Evidence

• Cancers
• Historically, First Nations people had lower
  rates of most types of cancer
• Since 1970s, traditional cancers have been
  replaced by modern cancers such as breast,
  cervix, colon, and lung
• Cancer is the third leading cause of death
• Gaps in cancer screening mean that many types of
  cancer may not be diagnosed

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Evidence

• Respiratory diseases COPD
• Leading cause of illness, disability, and
  mortality
• Recent FNIHB data show First Nations
  hospitalization rate for all chronic obtrusive
  pulmonary disease was double the non-First
  Nations rate

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Evidence

• Musculoskeletal Arthritis
• Very little historical information about
  arthritis in Aboriginal peoples
• Recent Regional Health Surveys found
  higher-than-average rates in First Nations
  people, regardless of sex and age
• Risk factors not well understood
• Need more data

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Evidence
Costs

• Direct
• Hospitals
• Drugs
• Physicians
• Other institutions

Indirect Lost productivity due to
mortality and disability
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Evidence
Rates of hospitalization by primary diagnosis
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Evidence
Mean annual utilization rate for selected drug
classes First Nations, 1999/2000 to 20003/04
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FNIHB Capacity for Public Health Programs

• Strengths of FNIHB response capacity
• Some programs (diabetes) well developed in
  regions
• Interest in chronic disease preventionwould like
  to do more
• Some skill sets present, but limited time for
  public health chronic disease
• Aware of deficiencies and would like resources to
  do more
• Effective mechanisms to plan and liaise with
  provincial or territorial governments in some
  regions
• Effective planning with Aboriginal organizations
  in some regions
• Collaboration with provincial/territorial programs

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FNIHB Capacity for Public Health Programs

• Challenges of FNIHB response capacity
• Planning public health programs
• Lack of focus on prevention and framework for
  public health
• Inadequate overall planning
• Significant variation across regions
• Lack of evidence-based planning
• Funding regions and communities
• Silo funding
• Limited resources for programs
• Lack of program funding to support regions
• Organization of services
• Regional programs based on national decisions
• Transfer roles and responsibilities
  unclearlittle possibility for FNIHB specialists
  to have input
• Regional offices seen as funding agencies only
• No access by community members to provincial
  prevention programs

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FNIHB Capacity for Public Health Programs

• Challenges of FNIHB response capacity
• Surveillance and evaluation
• Inadequate evaluation of programs
• Inadequate knowledge of community activities and
  staffing
• Lack of data for surveillance and health
  assessment
• No reporting requirement for transferred
  communities
• Communication and information systems
• Lack of effective information system to track
  activities in public health
• Lack of computer access to communities for
  communication and education of staff
• Human resources
• Staff turnover lack of dedicated staff
• Lack of time for planning inadequate resources
  at community level

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Recommendations

• 1. Integrated population health approaches
• Develop integrated population health approaches
  to chronic disease prevention tailored to unique
  needs of community in collaboration with
  community and in consideration of existing
  provincial and territorial initiatives
• 2. Prepare an action plan
• Prepare an action plan for Public Health programs
  for the Integrated Prevention of Chronic Health
  Problems in collaboration with Aboriginal
  organizations

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Recommendations

• 3. Develop capacity
• Develop the capacity to develop, implement and
  evaluate public health programs for the primary,
  secondary, and tertiary prevention of chronic
  health problems and injuries human resources,
  ongoing training, technical resources

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Recommendations

• 4. Improve surveillance capacity
• Improve capacity for collaborative population
  surveillance based on existing initiatives, such
  as the Regional Health Survey and administrative
  databases
• 5. Develop information systems
• Develop information systems with both transferred
  and non-transferred communities to identify
  present activities and the capacity for
  prevention programs

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Integrated Approach

• Addresses common risk factors
• Comprehensive approach
• Policy development
• Capacity building, partnerships
• Informational support at all levels
• Inter-sectoral action
• Population and high-risk approaches linking
  prevention action in health system
• (WHO-CINDI Project)

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Senior Management Committee
PublicHealthAgency
Federal Departments Agencies
Provinces
DG Steering Committee on Public Health
Public Health Program for Chronic Disease
Prevention A team approach
Non-communicable Disease Regional Working Group
Aboriginal communities
Non-communicable Disease Study Advisory Group
Aboriginal organizations
Public sector
Chronic Disease Prevention Division, FNIHB
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An Integrated Approach to Chronic Health Problems
Achieve Health Goals for all Ages
More people have good quality of life, are
contributing members of society, and health
inequities are reduced
Fewer people develop health complications,
disabilities or die prematurely from chronic
health problems
Fewer people develop chronic health problems
With Action in Four Areas
Health promotion Address social determinants
Primary prevention (Minimize risk)
Secondary prevention (Detect early)
Tertiary prevention (Manage chronic health
problems)
Through an integrated population and high risk
approach to address health determinants

• Healthy growth and development
• Community , social and economic
  
  
  environments
• Physical environment

• Behavioural risk factors
• Biological risk factors
• Occupational and environmental risk factors

Chronic health problems
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Health Promotion and Prevention of Chronic Disease

• Focus on Social Determinants of Health

• The social gradient
• Stress
• Early life
• Social exclusion
• Work

• Unemployment
• Social support
• Addiction
• Food
• Transport

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Health Promotion and Prevention of Chronic Disease
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Health Promotion and Prevention of Chronic Disease
Focus on Secondary prevention
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Health Promotion and Prevention of Chronic Disease
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Next steps

• Action plan
• Prepare Action Plan for an integrated approach to
  address major chronic conditions
• Cancer (breast, cervix, colon, lung)
• Cardiovascular (IHD)
• Respiratory (COPD)
• Musculoskeletal (arthritis)
• Community involvement
• Engage Aboriginal national and regional
  organizations in a dialogue on chronic disease
• Develop and strengthen strategic partnerships and
  linkages with key stakeholders

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Next steps

• Leadership and support
• Build national expertise on chronic disease to
  provide support and information to regional
  offices and Aboriginal communities
• Evidence
• Increase knowledge of major chronic disease
  incidence, prevalence, complications, and
  effective interventions in Aboriginal communities

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Thank you