The NCCAH has played a leadership role in bringing diverse sectors in Canada together to address the social and economic barriers to First Nations, Inuit and Métis health and well-being. We hosted our first forum with National Aboriginal Organizations in Ottawa in 2008 to explore how sectors within and beyond health can support an integrated approach to improving health outcomes. Our second forum, in Vancouver in 2009, explored ways of moving from "visions to actions" for a more wholistic approach to Aboriginal health and well-being. A "social determinants" approach to health can help break the intergenerational cycle of illness and disease that has consistently seen many Aboriginal communities ranked among the unhealthiest in Canada (see, for instance, the Community Well-Being scale and link to the latest report of 2010 showing "little or no progress" since 2001 for First Nation and Inuit communities).
Moving from Visions to Actions - Second National Forum on the Social Determinants of Aboriginal Peoples' Health
June 29, 2009 - More than 130 representatives of sectors as diverse as housing and health, economic development, the environment and sports, convened in Vancouver in 2009 to highlight ways for diverse fields to find common ground and contribute to the health and well-being of First Nations, Métis and Inuit peoples in Canada.
One of the goals of the national gathering, hosted at the Sty-Wet-Tan Longhouse at the University of British Columbia in February 2009, was to identify cross-connections among various sectors in addressing pressing health issues.
Guests at the NCCAH event included leaders from a wide variety of Aboriginal sectors, together with political leaders, youth, health profesionals, community representatives and community activitists. The forum was co-hosted with the National Aboriginal Housing Association, Indigenous Physicians Association of Canada, Aboriginal Health Research Networks Secretariat and Council for the Advancement of Native Development Officers, and focused on promising programs, alliances, and processes that can help support meaningful action on this critical front.
Making the Links
Speakers like Gail Turner, Director of Health Services Nunatsiavut Government, drew attention to TB rates among Inuit that are 90 times higher than national averages, a situation linked to social determinants of poverty, substandard housing, lack of access to nutritious food and unequal access to health care services. Turner said the connection between human rights and geography is a critical issue for the North.
Patrick Stewart, President of the National Aboriginal Housing Association, emphasized housing as a key to health and well-being, noting three urban Aboriginal housing providers in Vancouver have waitlists of 5,000 people, and that homelessness increased in the city by 35 per cent in three years.
Stewart said Aboriginal housing is currently a provincial matter, and urged support for national policy that links all levels of government and includes the private sector. He said projects like the Aboriginal Parents Lodge, the Aboriginal Children's Village, and the Sto:lo Nation's Elders Lodge are innovative models integrating culture and community needs, effectively linking housing to health and well-being. The Stó:lo Elders Lodge, a partnership between the Sto:lo Nation, BC Housing, Fraser Health Authority and the federal government, was designed by Aboriginal Elders and is operated within the traditions and philosophy of the Stó:lo Nation.
Despite the complexity of a multi-sectoral approach to Aboriginal health, clear and concrete actions can be taken at many levels, by many sectors. Dr. Evan Adams, Aboriginal Health Physician Advisor in the BC Ministry of Health, provided an overview of the social determinants relevant to Aboriginal health, moving from historical factors to a list of practical suggestions that can support improved health and well-being. His list of practical steps can be taken by individuals and families, employers, Aboriginal communities and organizations, educators and governments. (View his presentation here.)
Dr. Margo Greenwood, Academic Lead of the National Collaborating Centre for Aboriginal Health, said Indigenous health can be visualized as the interconnected strands of a spider web, in which issues such as poverty, a history of colonization, geographic location, gender, food security, education and other factors, intersect in the lives of individuals, families, communities, nations and peoples.
Greenwood said this more holistic approach to health is rooted in Aboriginal ways of knowing and being, and represents a significant step beyond health conceived as a matter of illness due to bio-medical cause and effect, or lifestyle choices. A diverse, multi-sectoral network can support this broader understanding of First Nations, Inuit and Métis health. "Our collective task is not an easy one. It is going to require structural change," said Greenwood.
Health Determinants in Action
A key goal of the event was to present concrete examples of what a more holistic, comprehensive and coordinated understanding of health might look like in action. The forum opened by showcasing two BC-based initiatives:
Transformative Change Accord: First Nations Health Plan
The internationally recognized collaboration between federal, provincial and Aboriginal leaders in BC, known as the British Columbia Tripartite Accord: First Nations Health Plan, breaks ground by recognizing the rights of First Nations to determine their health agenda, and enhancing First Nations control through new governance structures.
Grand Chiefs Ed John and Stewart Phillip, and Assembly of First Nations Regional Chief Shawn Atleo, recounted the history of the transformation in BC politics, when in the past five years, First Nations political leaders set aside differences to work together for their communities.
"Our strategy is really driven by the communities," said Grand Chief Ed John."The priority of our work is to make sure our peoples' concerns become legitimate public policy priorities. I am optimistic we are in an important time of change and transformation."
Aboriginal ActNow BC
B.C. Minister for Health Living and Sport, Mary Polak, is responsible for a new model in health promotion called ActNow BC, a cross-government, multi-sectoral initiative aiming to reduce chronic disease and smoking, encourage more physical activity and better nutrition, and support pregnant women.
Critical to the success of the Aboriginal version of the program is a strong community-based approach to health promotion. A highly successful annual training program (Honour Your Health Challenge) draws community "champions" from across the province to learn skills, formulate goals, and return to their communities to inspire change. For more about the NCCAH-supported Aboriginal ActNow BC initiative, click here.
Polak applauded the "huge successes that result from empowerment," as in the BC Transformative Change Accord, and encouraged forum participants to use of "public health levers" to effect change.
Aboriginal Health and the Environment
The forum also provided concrete examples of cross-sectoral tools that include health as a factor to consider in economic, municipal and other developments. Increasingly, mechanisms are being developed and used to bring Indigenous concerns forward. This is particularly the case where mines, hydro-electricity, pipelines and other major resource initiatives affect land upon which Aboriginal people rely for food, medicine and spiritual connection.
Health Impact Assessment (HIA)
HIA is a process that provides decision-makers with information about how a policy, program or project may affect the health of people. It allows those who may be impacted, particularly vulnerable populations, to participate in the development and implementation process.
Josie Auger, CEO of the Nechi Training, Research and Health Promotions Institute in Alberta, explained how the Bigstone Cree Nation intends to monitor impacts arising from proposed projects on traditional territory in Alberta. The Bigstone Cree are integrating an indigenous model of health to collect baseline environmental, social and health data. In the process, the community has been guided by the use of medicine wheels, an understanding of the role of land and language, and increased community participation, to broaden the understanding of the impacts of development.
For general information, see Health Canada's "Canadian Handbook on Health Impact Assessment" which includes a section on Aboriginal peoples. Available at: Health Canada - Canadian handbook on health impact assessment (113 pages). See also the National Collaborating Centre for Healthy Public Policy and its work in HIA by clicking here.
Human Environmental Health Impact Assessment
Health is not always a required consideration in environmental assessment. Three case-studies with First Nations affected by major developments involving human environmental health impact assessments are currently underway. The results will be synthesized to develop a new framework for First Nations communities to use when assessing the potential benefits and risks of proposed developments within their territories.
Please visit the First Nations Environmental Health Innovation Network for more information. The network is hosted by the NCCAH, involves nine partners, and is designed to facilitate the exchange of environmental health knowledge in First Nations communities across Canada.
Including Voice
Youth representatives at the forum urged inclusion of their voice in deliberations, and demonstrated just how effective a youth role in spearheading initiatives can be. Todd Alec, from Prince George, B.C., drew attention to a youth-driven call for increased access to sport and recreation in communities throughout the province - an initiative uniting BC Métis, urban and First Nations youth in a common cause. BC Aboriginal leaders took up their call, developing the "Five Pillars Document" to guide a strategy in support of their aspirations. Read the Aboriginal Youth Sport and Recreation Declaration here.
Similarly, Kiera Kolson, of the Youth Council of the Native Women's Association of Canada, drew attention to a youth-created toolkit on violence prevention for young women. She said more than 300 young people have been trained to use the kit, and that the House of Commons acknowledged the significance of the initiative with a standing ovation.
Throughout the two-day event, Métis, Inuit and First Nations representatives consistently emphasized the importance of inclusion in cross-sectoral alliance addressing health, guided by respect for geographic, cultural, and historical differences.
.
Global Context
Canada's national discussions with Aboriginal organizations and sectors is part of a broader movement taking place internationally. Spearheaded by the World Health Organization's Commission on Social Determinants of Health, a global momentum is building to find solutions to address health inequities. Dawn Walker, of the First Nations and Inuit Health Branch, noted Canada, through the National Collaborating Centre for Aboriginal Health, has played a leadership role in supporting inclusion of Indigenous voices and perspectives in the recently released WHO report, "Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health." Read more here.
Marissa Nahanee, a youth ambassador from the Squamish and Nisga'a Nations, joined Canadian representatives at a Pan American Health Organization meeting in late 2008. Delegates gathered to discuss Indigenous perspectives in the global move to address social determinants of health. In Ecuador, Nahanee was particularly impressed by ways in which traditional healing practices were combined with Western medicine. One health centre had a shaman as well as a doctor, nutritionist, psychiatrist and naturopath on staff, while a birthing centre encouraged traditional birthing rituals, leading to a drop in mortality rates, she said. Nahanee said for Indigenous people, home is a place where people and culture are rooted in land and a holistic world view.
When it comes to Indigenous peoples around the world, additional considerations must be taken into account to address generally lower health status, as noted in the WHO report. These include factors such as:
· self determination
· cultural continuity
· a holistic worldview
· land and environment
· language preservation
· implementation of traditional knowledge and practices
Next Steps
While the focus of the Vancouver forum was to move from visions to actions on social determinants issues, each of the forum's guest speakers -- leaders, experts, and activitists -- clearly embodied commitment to action in their chosen fields. For instance:
· Mike deGagne heads the Aboriginal Healing Foundation which has funded 1500 projects for residential school survivors over the past 10 years.
· Warner Adam of Carrier Sekani Family Serivces in Prince George B.C., said the organization began with three people and is now responsible for child welfare research and development for 12 nations and 14 villages, with 135 staff.
· Cindy Blackstock of the First Nations Child and Family Caring Society of Canada has been active in national and international campaigns to ensure First Nations children have equal access to needed health and education services. View her presentation here, and read about "Jordan's Principle," putting children's health needs first in cases where there are jurisdictional disputes about funding.
The momentum toward a strategic alliance that can bring about structural change is building. Peter Dinsdale, of the National Association of Friendship Centres, said sectors across Canada will need guidance from national leadership on broader policy collaboration. "We need to engage in partnerships to make sure that we're all paddling our canoes in the same direction so that, at the end of the day, [we] have better outcomes."
Professor Jeff Reading, co-director of the Centre for Aboriginal Health Research at the University of Victoria, emphasized the centrality of poverty to so many of the health challenges Aboriginal peoples experience. "Social determinants require social remedies and those social remedies have to come in the form of policy." Participants at the forum and in sectors across the country were challenged to move beyond existing divisions to create strategic alliances to make change happen.
Métis scholar and educator Don Fiddler said health is everyone's business. "We need to go to the bankers, the union halls, to the schools and workplaces and talk about population health. When people start to understand that everyone is in the health profession, we will make progress."
Discussions continue, with plans for regional workshops in 2009/2010 now underway at the National Collaborating Centre for Aboriginal Health to support alliances in key strategic areas of health, and to build a network for the next national gathering. Suggested next steps included:
· bring together stakeholders to develop and implement a national social determinants of health strategy
· implement a whole of government approach to Aboriginal health
· facilitate regional workshops to address key social determinants of health issues
· host a third national forum to build on the momentum for a comprehensive, coordinated and integrated approach to Aboriginal health and well-being.
Grand Chief Stewart Phillip honored the work of each of the participants, and told the gathering: "You have each committed to a different path but we are all here for a common purpose. You are all healers."
.
With Thanks
The Second Forum with National Aboriginal Organizations on the Social Determinants of Aboriginal Health was co-hosted by representatives of the housing sector, the economic development sector, health practitioners, and research institutions. This year, the NCCAH worked with the:
· National Aboriginal Housing Association
· Council for the Advancement of Native Development Officers
· Indigenous Physicians Association of Canada
·Aboriginal Health Research Networks Secretariat
The NCCAH event was supported by the First Nations and Inuit Health Branch (Health Canada), the National Collaborating Centre for Determinants of Health, and Aboriginal ActNow BC.