First Nations and Inuit and the Canadian Health System

1

• First Nations and Inuit and the Canadian Health
  System

Keith Conn, Chief Executive Advisor, First
Nations and Inuit Relations, First Nations and
Inuit Health Branch, Health Canada Roma in an
Expanding Europe June 30 July 1, 2003,
Budapest, Hungary.
2
Overview

• Profile of First Nations and Inuit in Canada
• Health Status of First Nations and Inuit
• Socio-Economic Impacts on Health
• Health Care Responsibilities
• First Nations and Inuit Health Branch (FNIHB)
  Key Objectives
• Historical Context of First Nations and Inuit
  Health Care

• FNIHB Structure, Programs and Resources
• Early Childhood Development
• Telemedicine
• Working Towards Reconciliation
• National and Regional Partnerships
• National Aboriginal Organisations
• What Weve Learned
• Contacts

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Who are the Aboriginal peoples of Canada?

• Descendants of the original inhabitants of North
  America

Canadian Constitution Act, 1982, recognizes
three groups of Aboriginal peoples 1.
Indians 2. Métis 3. Inuit
Status Indians On-Reserve 274,215
Status Indians Off-Reserve 283,960
Métis 292,305
Inuit 45,075
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First Nations Inuit Population
NIHB Eligible Population 721,086 (March 2002)
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Consider the demographics
Rate of population growth compared to rest of
Canada
4½ X
Median Age difference with non-Aboriginal
population
First Nations14 years Inuit 17 years
Population under 20 years of age
gt 40
Live outside of urban areas
First Nations 57 Inuit 73
First Nations communities with 1000 inhabitants
or less
82
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Health Status of First Nations Inuit
6.3 years
Gap in life expectancy
50 higher
Rate of infant Mortality
7.2
of all AIDS cases in Canada
10 X
Rate of Tuberculosis
Rate of Heart Disease and Diabetes
3 X
Suicide and self-injury
Leading cause of deaths for youth
Higher incidence of health problems among
Aboriginal people, compared to the general
population
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Leading Causes of Death among First Nations and
Inuit (by Sex), 1999
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Leading Causes of Death among First Nations and
Inuit (by Age), 1999
Age 20 to 44 Suicide and Self Inflicted Injury
23 Motor Vehicle Traffic Accidents
15 Homicide 7 Accidental
Poisoning by Drugs
6 Drowning and Submersion
5 Other 43
Age 1 to 9 Fire and Flames 26 Motor Vehicle
Accidents 24 Other Injuries
24 Other 26
Age 10 to 19 Suicide and Self Inflicted Injury
38 Motor Vehicle Accidents 30 Drowning and
Submersion 10 Other 23
Age 45 to 64 Ischemic Heart Disease 17 Lung
Cancer 6 Motor Vehicle
Traffic Accidents
5 Diabetes 4 Liver
Disease and Cirrhosis
4 Other 64
Age 65 Ischemic Heart Disease
20 Other Forms of Heart Disease
9 Cerebrovascular Disease 7 Lung
Cancer 7 Pneumonia and Influenza 6 Other
50
Legend N number of deaths
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Annual Number and Percentage of Aboriginal AIDS
Cases 92-01
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Socio-Economic Impacts on Health First Nations
and Inuit Educational Attainment, 1996
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Socio-Economic Impacts on Health First Nations
and Inuit Employment, 1996
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Delivering Health Care is a Shared Responsibility
FederalGovernment
First Nations Inuit
Provincial Territorial Governments
Through collaboration, we will eliminate gaps and
redundancies leading to higher quality services
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Federal Responsibilities

• Delivery of primary health care and community
  health services on-reserve
• Insurance coverage of drug, dental, vision and
  medical transportation for all Status Indians and
  Inuit
• Targeted programs for all Aboriginal people,
  regardless of residency (Aboriginal Diabetes
  Initiative, Tobacco Control Strategy)

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Provincial / Territorial Responsibilities

• Provide access to universal hospitalization and
  physician services to all residents including
  Aboriginals
• Community health programs for people off-reserve
  including Aboriginals
• Health planning and leadership on health services

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Fulfilling Our Federal Responsibilities
Supplementary Health Insurance
Health Care Services
1.4B Budget in 2002-03 ( 900M , 240.8B HUF)
Health Promotion Prevention
Environmental Health
Currency Conversion ( as of June 26, 2003) 1
Canadian Dollar () 0.647272 Euro ()
171.983 Hungarian Florint (HUF)
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Health Canadas First Nations and Inuit Health
Branch (FNIHB)

• Key Objectives of FNIHB
• To assist First Nations and Inuit communities to
  improve their health
• To ensure the availability of, or access to,
  quality health services
• To facilitate First Nations and Inuit control of
  health programs and services

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Federal health services to First Nations and
Inuit a Brief History

• The Government of Canada has provided health
  services to First Nations and Inuit for many
  years
• Involved in health services delivery since 1904
• First of several hospitals built in 1917 well
  before modern Medicare
• First nurses hired in 1922 by 1924 all reserves
  had doctors on part time service
• System of nursing stations developed in 1950s
• Role evolved in the 1980s to promote more
  involvement of First Nation and Inuit
  organizations in the delivery about 80 of
  community based services now managed by First
  Nations and Inuit

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Health Policy

• The 1979 Indian Health Policy is built on three
  principles
• (1) Community development
• Both socio-economic and cultural-spiritual
• To remove conditions of poverty and apathy which
  prevent members of the community from achieving a
  state of physical, mental and emotional
  well-being
• (2) Traditional relationship of Aboriginal People
  to
• the Federal Government
• Federal government acts as advocate of the
  interests of Aboriginal communities to the larger
  Canadian society
• It promotes the capacity of Aboriginal
  communities to achieve their aspirations
• (3) Canadian Health System

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Health Service Transfer

• 1988 Indian Health Service Transfer Policy
• Enables First Nations and Inuit communities to
  design,
• health programs, establish services and
  allocate
• funds according to community priorities
• Emphasis on increased First Nations and Inuit
  control
• of their health services is a first step in
  recognizing
• that environmental factors, rather than
  individual and
• cultural pathologies, form the basis of health
  problems
• Approximately 82 of community-based health
• services are managed by First Nations and
  Inuit

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First Nations and Inuit Health Branch

• 3 Major Program Directorates
• Community Programs
• Non-Insured Health Benefits Program
• Primary Care and Public Health
• Including
• Over 800 community health nurses
• 82 nursing stations
• 202 health centres
• 54 alcohol/drug abuse in-patient treatment
  centres
• 10 youth solvent abuse in-patient treatment
  centres
• 166 Aboriginal Head Start on-reserve projects

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FNIHB Program Responsibilities
All Eligible First Nations and Inuit People On All First Nations Reserves In Isolated and Remote Communities
- Vision-care - Dental treatment - Drugs Crisis mental health Provincial health premiums Prevention and promotion programs Public health Alcohol/drug addiction prevention Medical transportation program Nurse practitioners and physicians emergency services primary care (assessment, diagnosis and referral to other health care services)
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Forecast 2002-03
Anticipated Expenditures 1,462.4M
Cdn (946.8M ,
251.7B HUF) Community Health Programs
704.7M Cdn
(456.3M ,121.3B HUF) Non-Insured Health Benefits
684.1M Cdn
(442.9M ,117.7B HUF) Hospitals
23.8M Cdn
(15.4M , 4.1B
HUF) Program DeliveryAdministration 49.8M
Cdn (32.3M
, 8.56B HUF)
Prog Del Admin 3.4
Hospitals 1.6
NIHB 46.8
CHP 48.2
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Public Environmental Health
On-reserve Public / Environmental Health
ENVIRONMENTAL HEALTH Environmental Health
Program Environmental Contaminants Program
COMMUNICABLE DISEASE Communicable Disease
Control HIV/AIDs Strategy Tuberculosis
Elimination Strategy
Drinking water quality monitoring Infectious
disease control
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Health Promotion Prevention
Upstream investments aimed at improving health
outcomes, and reducing health risks
COMMUNITY HEALTH SERVICES Brighter
Futures Building Healthy Communities Dental/Oral
Health Strategy FNI Home and Community Care
CHILDREN Aboriginal Head Start
On-Reserve Canada Prenatal Nutrition
Program FAS /FAE Fetal Alcohol Syndrome
/Effects Initiative
ADDICTIONS National Native Alcohol and Drug Abuse
Program Solvent Abuse Program Tobacco Control
Strategy
CHRONIC DISEASE Aboriginal Diabetes Initiative
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Supplementary Health InsuranceNon-Insured Health
Benefits (NIHB)

• Providing medically-necessary health related
  goods and services
• to approx 721,000
• eligible registered Indians,
• and recognized Inuit and
• Innu on or off-reserve
• 722M in 2003/04 (467M
  , 124B HUF)

Drugs Vision Care Dental Medical
transportation Mental Health Premiums in BC AB
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Federal Commitment to Early Childhood Development
through the Aboriginal Head Start Program

• Six components include
• culture and language
• nutrition
• health promotion
• parental family involvement
• social support
• Education

Cooperate with Aboriginal communities and
provinces / territories on the measures required
to reduce the number of Aboriginal newborns
affected by Fetal Alcohol Spectrum Disorder.
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Telemedicine
an example of working collaboratively

• Telemedicine
• To address health inequalities and remote
  populations, many countries are exploring the
  application of new technologies such as
  telemedicine
• Telemedicine and Canadian First Nations and
  Inuit
• Over 1/3 of First Nation and Inuit communities
  are located more than 90 km from physician
  services
• First Nations and Inuit Telemedicine could become
  a distinct component of Canadian telehealth
• Part of larger federal initiatives to assist
  First Nations in developing Health infostructure
  capacity
• Designed and implemented in full partnership with
  First Nations communities
• Community-based technology and Community driven

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Working towards Reconciliation

• Aboriginal Healing Foundation
• Created in 1998 to encourage and support
  Aboriginal people as they address the
  intergenerational legacy of physical and sexual
  abuse in government and church-run residential
  schools
• 350 Million for community-based projects
• Prevention of abuse and process of reconciliation
  between Aboriginal people and Canadians are vital
  elements in building healthy communities

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National and Regional Partnerships
ITK Inuit Tapiriit Kanatami
AFN Assembly of First Nations
National collaboration through Joint Health
Renewal Committee FNIHB Branch Executive
Committee Community Health Program Steering
Committees
Regional collaboration through Contribution
Agreements Regional Planning
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National Aboriginal Organizations
CAP Congress of Aboriginal Peoples Representing
off-reserve Indians and Metis people living in
urban, rural and remote areas throughout Canada
MNC Metis National Council National
representative of the Metis Nation in Canada
NWAC Native Womens Association of Canada A
non-profit organization presenting a national
voice for Native women
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National Aboriginal Health Organization

• Independent, arms-length organization that is
• Of Aboriginal design and control
• Dedicated to improving the physical, mental,
  emotional, social and spiritual health of
  Aboriginal peoples
• Committed to the protection and validation of
  traditional knowledge and
• Linking the Aboriginal community worldwide to
  health information and best practices in order to
  advance Aboriginal healing and wellness practices
• www.naho.ca

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Canadian Institutes of Health Research
The CIHR Institute for Aboriginal Peoples Health
(IAPH) supports research that addresses the
special health needs of Canada's Aboriginal
people.

• IAPH has identified four strategic research
  priorities for 2002-07
• Forge health research partnerships and share
  knowledge
• Respect aboriginal values and cultures
• Build aboriginal health research capacity
• Fund initiatives that address urgent or emerging
  health issues facing aboriginal peoples

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What Weve Learned

• Evidence shows that First Nations and Inuit
  ownership of community-based health programs /
  services leads to better health outcomes
• Work done for communities will fail work done
  with communities
• will succeed
• Constructive, collaborative and early engagement
  of Aboriginal peoples on the design and
  implementation of programs will yield greater
  prospects for success.
• Much of the improvement in health of First
  Nations and Inuit people could be influenced by
  factors outside the health sector, including
  Economic Development Cultural Change Education
  Environment and Aboriginal People Themselves
  (i.e. attitude, hope)
• Achieving real change in health status will
  require integrated strategies that address
  broader socio-economic determinants such as
  economic development, cultural change, education,
  social and physical environments and Aboriginal
  peoples themselves.

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Contacts

• First Nations and Inuit Health Branch
• http//www.hc-sc.gc.ca/fnihb-dgspni
• National Aboriginal Health Organization
• http//www.naho.ca
• Canadian Institutes of Health Research -
  Institute of Aboriginal Peoples Health
• http//www.cihr-irsc.gc.ca/institutes/iaph