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.
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 We’ve Learned
• Contacts
2
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
Status
Indians
Indians
On-Reserve Off-Reserve
274,215
Métis
Inuit
292,305
45,075
283,960
3
First Nations & Inuit Population
NIHB Eligible Population 721,086
(March 2002)
4
Consider the demographics…
4½ X
Median Age
difference with
non-Aboriginal
population
> 40 %
Live outside
of urban areas
Rate of population growth
compared to rest of Canada
First Nations:14 years
Inuit: 17 years
Population under 20 years
of age
First Nations: 57%
Inuit: 73%
First Nations communities
with 1000 inhabitants or less
82 %
5
Health Status of
First Nations & Inuit
Gap in life expectancy
6.3 years
Rate of infant Mortality
50% higher
% of all AIDS cases in Canada
7.2%
Rate of Tuberculosis
10 X
Rate of Heart Disease
and Diabetes
3X
Leading cause of
deaths for youth
Suicide
and self-injury
Higher incidence of health problems among Aboriginal
people, compared to the general population
6
Leading Causes of Death among
First Nations and Inuit (by Sex), 1999
7
Leading Causes of Death among First
Nations and Inuit (by Age), 1999
Age 20 to 44
Age 1 to 9
Age 10 to 19
Suicide and Self Inflicted Injury
Motor Vehicle Accidents
Drowning and Submersion
Other
38%
30%
10%
23%
Fire and Flames
Motor Vehicle
Accidents
Other Injuries
Other
26%
24%
24%
26%
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 45 to 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
Ischemic Heart Disease 17%
Lung Cancer
6%
Motor Vehicle Traffic
Accidents
5%
Diabetes
4%
Liver Disease and
Cirrhosis
8 4%
Other
64%
Annual Number and Percentage
of Aboriginal AIDS Cases 92-01
9
Socio-Economic Impacts on Health:
First Nations and Inuit Educational Attainment, 1996
10
Socio-Economic Impacts on Health:
First Nations and Inuit Employment, 1996
11
Delivering Health Care
is a Shared Responsibility
Federal
Government
Provincial
& Territorial
Governments
First
Nations
& Inuit
Through collaboration, we will eliminate gaps and
redundancies leading to higher quality services
12
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)
13
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
14
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)
15
Health Canada’s 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
16
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 17
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
18
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
19
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
20
FNIHB Program Responsibilities
All Eligible On All First
First Nations Nations
and Inuit
Reserves
People
- Vision-care
- Dental
treatment
- Drugs
- Crisis mental
health
- Provincial
health
premiums
In Isolated and
Remote
Communities
- Prevention and - Nurse practitioners
promotion
and physicians
programs
- emergency services
- Public health
- primary care
- Alcohol/drug
(assessment,
addiction
diagnosis and
prevention
referral to other
- Medical
health care services)
transportation
program
21
Forecast 2002-03
Anticipated Expenditures
$1,462.4M Cdn
(946.8M €, 251.7B HUF)
Hospitals
1.6%
Prog Del & Admin
3.4%
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 Delivery&Administration
$49.8M Cdn
NIHB
46.8%
CHP
48.2%
(32.3M €, 8.56B HUF)
22
Public & Environmental Health
On-reserve Public / Environmental Health
COMMUNICABLE
DISEASE
ENVIRONMENTAL
HEALTH
Communicable
Disease Control
Environmental
Health Program
HIV/AIDs Strategy
Environmental
Contaminants
Program
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
CHILDREN
COMMUNITY HEALTH
SERVICES
Aboriginal Head Start OnReserve
Brighter Futures
Canada Prenatal Nutrition
Program
FAS /FAE – Fetal Alcohol
Syndrome /Effects Initiative
CHRONIC DISEASE
Aboriginal Diabetes
Initiative
Building Healthy
Communities
Dental/Oral Health Strategy
FNI Home and Community
Care
ADDICTIONS
National Native Alcohol
and Drug Abuse Program
Solvent Abuse Program
Tobacco Control Strategy
24
Supplementary Health
Insurance
Non-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
25
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.
26
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
27
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 churchrun 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
28
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
29
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 Women’s
Association of
Canada
A non-profit organization
presenting a national
voice for Native women
30
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
31
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:
1. Forge health research partnerships and share
knowledge
2. Respect aboriginal values and cultures
3. Build aboriginal health research capacity
4. Fund initiatives that address urgent or emerging
health issues facing aboriginal peoples
32
What We’ve 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.
33
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
34