Transcript Document

From Visions to Actions:
Social Determinants of
Aboriginal Health Forum II
Thursday, February 19th, 2009
Dr. Evan Adams
Aboriginal Health Physician Advisor
Office of the Provincial Health Officer
BC Ministry of Health Living & Sport, and
Director
Division of Aboriginal People’s Health,
UBC Faculty of Medicine
The Report of the Royal Commission on
Aboriginal Peoples concluded:
“Aboriginal people are at the bottom
of almost every available index of
socioeconomic well-being, whether
[they] are measuring educational
levels, employment opportunities,
housing conditions, per capita
incomes or any of the other conditions
that give non-Aboriginal Canadians
one of the highest standards of living
in the world.”
The Social Determinants of
Indigenous Health
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Poverty
Education
Housing
Self-determination
Culture
Land, Environment, Environmental
Stewardship
• Gender
• Family & Child Welfare
An Overview of Current Knowledge of the Social Determinants of
Indigenous Health (Commission on Social Determinants of Health, WHO)
Historical factors profoundly
affecting health
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The Reservation system
Lost traditional territory
Lost fishing and hunting sites
Lost water rights
Loss of fishing and hunting stocks
Dominance of Canadian foods
Alcohol, cigarettes, drugs
Hygiene
Historical factors profoundly
affecting health
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Overcrowding
Stress
Decreased social and family structure
Decreased wealth
Increased Church control
Decreased economic power
Decreased political power
The Residential School System
& Health
 Exposure to disease
 Overwork
 Underfeeding
 Overcrowding
 Physical abuse
 Cultural abuse
 Emotional abuse
 Assimilation
 Punitive religiosity
 Separation from parents
Conceptual Framework – Aboriginal adolescent mental health
derived from positive youth-development theory
Basic
CONNECTION
Experiences REGULATION
(including
AUTONOMY
coping w/
SELF ADVOCACY
racism &
social order)
Covered
Basic
Needs
OPTIMAL
(positive)
YOUTH
DEVELOPMENT
Parenting
NOURISHMENT
SAFETY
WARMTH
DISCIPLINE
Modeling of
HEALTHY
BEHAVIOR
MONITORING
SUPERVISION
PARENTAL SUPPORT
Youth POSITIVELY
CONNECTED TO
SCHOOL;
ACKNOWLEDGEMEN
T of historical
disconnect
Adequate NUTRITION,
HEALTH, SHELTER,
SAFETY & EQUALITY
Adequate & Appropriate
SUPERVISION and
MOTIVATION
Supportive RELATIONSHIPS
Support for EFFICACY and
opportunities for SKILL BUILDING
Integration of FAMILY,
SCHOOL and COMMUNITY
EFFORTS
Community
Investments
In Youth
STRUCTURAL
RESOURCES
Appropriate
Mechanisms of
CONTROL
CONNECTEDNESS
CULTURE
COMMUNITY
SURVEILLANCE
Microaggressions Concepts
• Being asked if you are “really
Aboriginal” by a nonAboriginal person?
• Being asked regularly about
negative stereotypes around
taxes, free housing, treaties,
etc.
• Feeling “invisible” to nonAboriginal people, at work, at
school, in public?
• Feeling compelled to teach
basic history to non-Aboriginal
people to make your
viewpoint heard?
• Being asked to change your
appearance, practices or apparel
by your employer or agency
• Hearing from non-Aboriginal
people how surprisingly
articulate, well-read, or good
your language skills are?
• Hearing discussions by persons in
authority about Aboriginal people
in a negative light
• Being asked directly – usually
indirectly – if you deserve to be
here
First Nations & Inuit
Health Program (federal)
• Health Canada's role in First Nations and
Inuit health goes back to 1945, when Indian
health services were transferred from Indian
Affairs.
• In 1962, Health Canada provided direct
health services to First Nations people on
reserve and Inuit in the north.
• By the mid 1980s, work began to have First
Nations and Inuit communities control more
health services.
Provincial Role
Health care services include insured primary
health care (such as the services of physicians
& some other health professionals) & care in
hospitals
The provinces & territories also provide some
services & benefits not covered by the Act,
such as prescription drug coverage,
ambulance services, home care, public health,
long term care, etc.
Delegations of resources & authority to the
health authorities
Community Role
“Transferred” services with heavy admin
burden
Band administration with revolving leadership
Social & economic dev’t departments
Embracing traditional heritages to varying
degrees
Neighbouring communities with competing &
similar interests (e.g. water, land, medical
services)
Local “social net” with variable functionality
BC First Nations
BC First Nations
First Nations Leadership
Council
First Nations Health Council*
BC
Assembly of First
Nations
First Nations
Summit
Union of BC Indian
Chiefs
FNLC – Health Lead,
Grand Chief Ed John
Ex-Officio
*Responsible for assisting in TFNHP implementation including capacity building, service
and program delivery and support to First Nations Communities
Closing the Gap
TRIPARTITE FIRST NATIONS
HEALTH PLAN
Tripartite First Nations
Health Plan
• A 10-year health plan (June 2007 to May
2017) that builds on the TCA
• Articulates a shared vision between the
federal, provincial and First Nations partners
• Principles include trust, recognition & respect
for Aboriginal rights & title, commitment to
action, nurturing the relationship, and
transparency
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DIALOGUE: GATHERING
WISDOM FORUM
Key Messages:
 Vision of Wellness - embracing all aspects of wellness of the
individual, family and community.
 Cultural, Holistic approach to health - need paradigm shift
from the western medical model of health
 Community-driven process - support what is already
happening in communities – increase connections between
communities. Increased desire for community input.
 Common challenges - lack of resources – qualified workers
and funding
 Need for Communication - transparent and easily accessible
communication
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2nd Report on Health and Well-being of
Aboriginal Population in BC
Pathways to Health and Healing
2007 Provincial Health Officer’s Annual
Report
(Release date: April 2009)
The Social Determinants of
Indigenous Health
• Culture
• Self-determination
• Land, Environment, Environmental
Stewardship
• Poverty
• Education
• Gender
• Housing
• Family & Child Welfare
An Overview of Current Knowledge of the Social Determinants of
Indigenous Health (Commission on Social Determinants of Health, WHO)
Solutions - A role for:
Clinicians
Cultural workers
Community-based workers
Research
Academia
Public health
Leadership
Families
A policy of formal consultation?
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Solutions - What Actions Can We Take?
Individuals and families can:
• Actively oppose racism.
• Find out more about self-governance and other selfdetermination issues.
• Invest in educational opportunities.
• Help monitor those at-risk, maximize self-regulation, autonomy
& connectedness
Aboriginal communities and organizations can:
• Work together to overcome disadvantages of small community
size, for example, by forming institutional cooperatives to
achieve economies of scale.
• Support local housing initiatives
• Research the meanings, barriers & protective factors in housing
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& environment
Solutions - What Actions Can We Take?
Employers can:
• Examine hiring practices to ensure equality of opportunity.
• Raise the minimum wage.
• Support families, women, and lesser skilled workers with fair
practices.
Educators can:
• Develop & support culturally-relevant curricula.
• Engage communities in school activities.
• Connect with disadvantaged and disconnected youth.
• Examine admissions, & support services to ensure equality of
opportunity.
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• Protect equality
and equity.
Solutions - What Actions Can We Take?
Governments and communities can:
• facilitate the removal of structural impediments to
economic development in First Nations Communities.
• Set clear, measurable goals for employment, income,
and education levels of Aboriginal people equal to
those within the general population, along with
methods for public reporting of results.
• Support efforts by Aboriginal people to achieve selfdetermination and a collective sense of control over
their futures, in both on- and off-reserve communities.
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Solutions - What Actions Can We Take?
Governments and communities can:
• Invest in adult education opportunities, skills
upgrading, training, job preparation, financial
assistance for work and work clothing, child care, and
stable affordable housing.
• Ensure that effective programs are in place to
support those who have suffered abuse.
• Encourage participatory research to gain a clearer
understanding of the relationship between socioeconomic conditions and the health of Aboriginal
communities.
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Solutions - What Actions Can We Take?
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SPEAK UP
SHARE
COLLABORATE
PLAN
TAKE ACTION
AND MANY OTHERS...
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CONTACT INFORMATION
• Evan Adams, MD,
Aboriginal Health Physician Advisor
Ministry of Healthy Living & Sport
Office of the Provincial Health Officer
[email protected]
250-952-1330