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
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From Visions to Actions: Social Determinants of Aboriginal Health Forum II Thursday, February 19th, 2009 Dr. Evan Adams Aboriginal Health Physician Advisor.
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From Visions to Actions:Social Determinants of
Aboriginal Health Forum II
Thursday, February 19th, 2009
Dr. Evan AdamsAboriginal Health Physician AdvisorOffice of the Provincial Health Officer
BC Ministry of Health Living & Sport, andDirector
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.”
An Overview of Current Knowledge of the Social Determinants of Indigenous Health (Commission on Social Determinants of Health, WHO)
Historical factors profoundly affecting health 1/2
The Reservation systemLost traditional territoryLost fishing and hunting sitesLost water rightsLoss of fishing and hunting stocksDominance of Canadian foodsAlcohol, cigarettes, drugsHygiene
Historical factors profoundly affecting health 2/2
OvercrowdingStressDecreased social and family structureDecreased wealthIncreased Church controlDecreased economic powerDecreased 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
OPTIMAL (positive)YOUTH
DEVELOPMENT
Conceptual Framework – Aboriginal adolescent mental healthderived from positive youth-development theory
Adequate & AppropriateSUPERVISION and MOTIVATIONSupportive RELATIONSHIPSSupport for EFFICACY andopportunities for SKILL -BUILDINGIntegration of FAMILY, SCHOOL and COMMUNITYEFFORTS
Parenting NOURISHMENTSAFETYWARMTHDISCIPLINEModeling of HEALTHYBEHAVIORMONITORINGSUPERVISIONPARENTAL SUPPORT
Youth POSITIVELYCONNECTED TOSCHOOL;ACKNOWLEDGEMENT of historical disconnect
Community STRUCTURALInvestments RESOURCESIn Youth Appropriate
Mechanisms of CONTROLCONNECTEDNESSCULTURECOMMUNITY
SURVEILLANCE
Microaggressions Concepts
• Being asked if you are “really Aboriginal” by a non-Aboriginal person?
• Being asked regularly about negative stereotypes around taxes, free housing, treaties, etc.
• Feeling “invisible” to non-Aboriginal 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
*Responsible for assisting in TFNHP implementation including capacity building, service and program delivery and support to First Nations Communities
Closing the GapTRIPARTITE 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
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 self-determination 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 & environment
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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.• Protect equality and equity.
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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 self-determination 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 socio-economic conditions and the health of Aboriginal communities.
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Solutions - What Actions Can We Take?
• SPEAK UP• SHARE• COLLABORATE• PLAN• TAKE ACTION• AND MANY OTHERS...
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CONTACT INFORMATION
• Evan Adams, MD,Aboriginal Health Physician AdvisorMinistry of Healthy Living & SportOffice of the Provincial Health [email protected]