Manitoba First Nations: Health

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Manitoba First NationsHealth Health Care in
an Aboriginal Population
Patricia J. Martens Ruth-Ann Soodeen
MANITOBA CENTRE FOR HEALTH POLICY Winnipeg,
Manitoba, Canada
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This lecture is based on the report, The Health
and Health Care Use of Registered First Nations
People Living in Manitoba A Population-Based
Study by Patricia J. Martens, Ruth Bond, Laurel
Jebamani, Charles Burchill, Noralou Roos, Shelley
Derksen, Marcella Beaulieu, Carmen Steinbach,
Leonard MacWilliam, Randy Walld, Natalia Dik,
Doreen Sanderson the Health Information and
Research Committee of AMC, Marilyn Tanner-Spence,
Audrey Leader, Brenda Elias, John ONeil
MANITOBA CENTRE FOR HEALTH POLICY Winnipeg,
Manitoba, Canada
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Collaborators

• Assembly of Manitoba Chiefs
• Collaborative working group
• Chiefs Health Committee
• Health Information and Research Committee
• Centre for Aboriginal Health Research (CAHR)
• Manitoba Health
• First Nations and Inuit Health Branch of Health
  Canada
• Indian and Northern Affairs Canada (INAC)
• Work done at the Manitoba Centre for Health Policy

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Key Terms

• Registered First Nations
• First Nations Community
• Tribal Council (TC)
• Regional Health Authorities (RHAs)

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(No Transcript)
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Data Sources

• Health care administrative data (Fiscal years
  April 1 1994 - March 31, 1999)
• Vital Statistics - (1995-1999)
• Census Data (1996)
• Publicly-available reports from Indian Northern
  Affairs Canada (INAC)
• Status Verification System (SVS) Files
  (1994/95-1998/99)

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Key Measures

• 1. Health status
• 2. Burden of disease
• 3. Preventive care
• 4. Use of physician hospital services

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1. Health Status Indicators

• 1. Life expectancy at birth
• Most common measure
• 2. Premature mortality rate (PMR)
• Death before age 75
• 3. Potential years of life lost (PYLL)
• Similar to premature mortality but gives greater
  weight to death of a younger person

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Key findings

• 1. Life Expectancy at Birth
• RFN 8 years less than for all other Manitobans
• males 68 yrs vs. 76 yrs females 73 yrs vs. 81
  yrs
• 2. Premature Mortality Rate
• Twice as high for RFN vs. all other Manitobans
• 6.6 deaths per 1000 RFN versus 3.3 for all other
  MB
• 3. Potential Years of Life Lost
• Higher risk for RFN
• male RFN 2.5 X higher (158 vs. 63 yrs/1000)
• female RFN 3 X higher (103 vs. 36 yrs/1000)

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2. Burden of Disease

• Two measures of illness injury
• 1. Diabetes - occurs when pancreas doesnt
  produce enough insulin, when cells stop
  responding to the insulin, or temporarily during
  pregnancy glucose in the blood cannot be
  absorbed into the bodys cells
• 2. Injuries - physical damage usually inflicted
  on the body by external force

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Key findings

• 1. Diabetes Treatment Prevalence
• 4.2 times higher for RFN vs. all other Manitobans
  (18.9 vs 4.5)
• Amputation rates - population prevalence is 16
  times higher for RFN
• 2. Injury hospitalizations
• 3.7 times higher for RFN compared with all other
  Manitobans
• RFN 32 due to violence by others and to self
  (vs. 10 for all other Manitobans)

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3. Preventive Care

• 1. Childhood immunization - at ages one and two
  years of age
• 2. Mammography - for women between 50 and 69
  years of age
• 3. Breastfeeding - at hospital discharge for
  newborns

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Key findings

• RFN vs. all other Manitobans
• Lower immunization rates
• Lower mammography rates
• Lower newborn breastfeeding rates

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4. Physician Hospital Services
We examined use (in terms of rates) of several
physician and hospital services.

• Physician Services
• Ambulatory visits
• Consults
• Physician type
• General
• Specialist
• Visit location

• Hospital Services
• Hospital separations
• Length of stay
• Hospital Location

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Key findings

• Physician visit rates
• 6.1 visits per person per year for RFN (probably
  understated) versus 4.9 for all other Manitobans
• Consult rates
• only slightly higher for RFN compared to all
  other Manitobans
• Specialist visit rates
• urban areas have very high rates, but slightly
  lower for RFN in Winnipeg
• In some RHAs, RFN rates are comparatively higher
  than other RHA residents

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Key findings

• Hospital use
• Double the hospitalization rates
• 1.7 times the total days of hospital care
• Location of hospitalizations varies considerably
• Procedure rates
• RFN have higher or similar heart-related surgery
  rates compared to all other MB

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Summary of Key Findings

• Health status of Registered First Nations people
  (RFN) is much poorer
• Big differences in health across Tribal Council
  areas

• Higher overall use of physicians and hospitals
  reflect poorer health status of RFN
• Preventive care rates are lower for RFN

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Final Thoughts

• Health of RFN people - not a good story
• lower life expectancy
• more injury-related hospitalizations
• higher prevalence of diabetes
• How do we improve their health status?
• Are more hospitals needed? More doctors?
• Is there any right answer?

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• Where do we go from here?

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