Comparison between Alberta and Ontario in relation to Indigenous Health Care
The health of indigenous populations in Canada has been improving in recent years however First Nations, Inuits and Metis peoples continue to experience poorer health outcomes than non-Indigenous Canadians (NCCAH, 2013). Indigenous populations continue to carry a high burden of disease reflective of social, economic, cultural and political inequities identified below. (NCCAH, 2013).
Social Determinants of Health (SDOH) Factors for FN:
Insufficient education resulting in poor literacy, making it difficult for individuals to access and interpret health-related information and is closely related to employment opportunities.
Indigenous language knowledge is a strong predictor of FN well-being. Language, Cultural Continuity and Self-Determination Cultural continuity, including Indigenous language use, refers to the level of cultural connectedness within a community.
Self-determination is exercised when a community plans and controls activities (for example, community-based health programs) according to its own priorities and its own cultural and social needs. It influences all other determinants of health, including education, employment, housing, safety, and social and health services.The benefits of self-determination are particularly evident in the context of transferred First Nations communities across the country.
Physical environment for FN families living on-reserve are often crowded conditions impacting play and study time for children (can influence behavioural and learning difficulties) and increase the risk of disease transmission.
Poor-quality housing can result in a lack of ventilation, with resulting mold growth that can contribute to a variety of health conditions, including asthma and allergies, particularly among children.
Environmental factors for good health include access to safe drinking water which requires investment into routine water sampling.
Colonialism and Residential Schools influences the well-being of those who experienced the Indian Residential School System.
These inequities can be attributed to Indigenous health policy in Canada which has been described as a “patchwork” of policies, legislation and agreements that delegate responsibility between federal, provincial, municipal and Indigenous governments in different parts of the country (Palmer, Tepper & Nolan, 2017). With population surveillance data and knowledge of the SDOH, services and programs can be planned to better address the major policy gaps contributing to disparity in health.
New Federal funding has recently been announced ($5 billion) for First Nation, Métis and Inuit peoples and communities to address the SDOH and will include initiatives for child welfare services, governance structures outside of the Indian Act, nursing and critical care services in isolated FN communities, and addiction services (Barrera, 2018). More specific health related targets include tuberculosis in Inuit communities, development of a First Nations and Inuit Non-Insured Health Benefits program, development of FN health models and Inuit-focused health research (Barrera, 2018). Funding is also attached to health care support for Indian residential school survivors (Barrera, 2018). Additionally, $400 million toward housing improvement in Inuit regions of Nunavik, Nunatsiavut and the Inuvialuit region is reported (Barrera, 2018).
MOHLTC, Ontario's First Nations Health Action Plan is investing up to 222 million dollars over 3 years (2016/17 to 2018/19) and 104.5 million annually thereafter to promote reconciliation and health outcomes (2018). Funding allocations have been and are guided by the recommendations of the Chiefs of Ontario, Political Territorial Organizations First Nations, Inuit partners and Inuit service organizations (2018).
As noted work is being done at all levels and we will look at initiatives and strategies happening in Alberta and Ontario to close the inequities and health care gaps for Indigenous peoples.
Ontario Overview
The Ontario Aboriginal and Wellness Strategy launched in 1994 shared a commitment between the Ontario government and First Nations, Metis and Indigenous peoples to reduce family violence, improve Indigenous healing, health and wellness through culturally sensitive programs and services (MOHLTC, 2018). Born from the Aboriginal and Wellness Strategy in 2000 was Aboriginal Health Access Centers in Ontario based on Community Health Centers that have significantly impacted Indigenous health and well-being by integrating mainstream health care and community based care including clinical services, integrated chronic disease prevention and management, family focused maternal child health care, addictions counseling, traditional healing and mental health care (MOHLTC, 2018). Despite both the AWS and AHACs there continues to be gaps related to the social determinants of health outside of access to health care (MOHLTC, 2018).
Population Factors obtained from Ontario Ministry of Finance (2016)
Indigenous people represent 2.8% of the province’s total population and increase from 2.4% in 2011
Between 2011-2016 Ontario’s Indigenous population grew 23.1% much faster than the non-Indigenous population which grew 4.2%
14.5% of all Indigenous people in Ontario lived on reserves in 2016, down from 15.9% in 2011
The Indigenous population is younger than the non-Indigenous population. Almost a third (32.5%) of the Indigenous population consists of children and teenagers aged 19 and under compared with 22.55 of non-Indigenous
The share of seniors in the Indigenous population in 2016 up to 7.9% from 6.7% in 2011
63% of First Nations off reserve and 61% of metis suffer from one or more chronic disease compared to 47% if general population
Immediate action needs to take place to address the SDOH for the long term while health systems interventions are needed for the shorter term
Ontario has made it a priority to improve social, economic and health outcomes for Indigenous people by partnering with Indigenous communities to improve access to care and develop future health services (MOHLTC, 2018). Although the majority of focus has been in northern communities, Ontario's First Nations Action Plan includes opportunities for investments across Ontario in key areas such as home and community care, primary care and disease management (MOHLTC, 2018).
Alberta Overview
The First Nations Health Status Report for the Alberta region describes important demographics of the total First Nations (FN) population registered to bands in Alberta and key determinants impacting their health In 2011, the total population of 46 FN groups (located in three treaty areas) was 111,691 as identified through the FN registry which includes anyone ever having registered with the Alberta Health Care Insurance Plan (AHCIP) as either status FN or Inuit and other Alberta residents from out-of-province bands. Alberta does not identify non-status Indians and Métis through the AHCIP data base (Government of Canada, 2013).
Population Factors:
The First Nations (FN) population registered to bands in Alberta has increased over time
Alberta FN represents approximately 13% of the total First Nations population registered to bands in Canada.
The growth of the FN population registered to bands in Alberta (27%) is comparable to growth of the First Nations population registered to bands across Canada (26%).
From 2001 to 2011, the FN population residing off-reserve grew approximately twice as fast as the FN population residing on reserve and Crown land in Alberta (41% vs. 20%) and in Canada (37% vs. 18%).
The population pyramids for FN registered to bands living on reserve and Crown land in Alberta (Figure 1.3) and Canada (Figure 1.4) both display narrowing bases, indicating declining birth rates and slowing population growth.
For FN in Alberta, and in Canada, the largest population segment is the 15- to 19-year-old age group.
Changing population demographics will require health programming that meets the needs of a rapidly increasing elderly cohort (growth rate was 56% for those over 65)
FN have significantly higher cancer-related death rate than non-First Nations in the 30- to 39-year-old age group yet for those over 80 years of age, the death rate was significantly lower than non-First Nations. Inadequate access to cancer screening services for First Nations individuals was an identified concern in the First Nations Regional Longitudinal Health Survey of 2002–03.
The presence of and access to a spiritual component in cancer treatment is essential for First Nations people. Given the aging First Nations population living in Alberta and the increase in age-associated chronic illnesses, such as cancer, the need for access to end of life care is anticipated to grow.
Stemming from the First Nations Health Status Report review, Alberta Health Services has created and bolstered programs and services to address health navigation issues (cultural & language barriers), improve access to primary care in communities and on reserve and developing continuing care services to address the unique needs of Metis and FN communities (AHS, 2018).
Recent engagement with Metis and FN communities in AB sought to specifically address the need to recognize the health-care rights of Indigenous peoples, the value of Indigenous healing practices, and close the gaps in health outcomes between Indigenous and non-Indigenous communities (AHS, 2018). Continuing care services to support Indigenous people to remain in their community, close to the support of family and friends as they age or as their care needs change has been augmented through collaborations between Alberta Health Services, First Nations and Métis representatives and the Government of Alberta {Ministries of Health, Indigenous Relations, Seniors and Housing}(AHS, 2018).
Summary
Although there have been great gains recently for Indigenous health, remaining gaps will need to be closed with mainstream health approaches and integration of Indigenous organizations and communities (Ontario Federation of Indigenous Friendship Centers, 2017). The MOHLTC 2018 strategy Ontario’s First Nations Action builds on Indigenous organizations to plan, design, implement and monitor health initiatives. The Ontario Federation of Indigenous Friendship Centers advocate for changes to mainstream health services to include:
system wide cultural competency training
access to health professionals and services free of discrimination and stigmatization
funding changes to the Non-Insured Health Benefits
funding for community based Indigenous organizations to support Indigenous individuals, families and communities (Ontario Federation of Indigenous Friendship Centers, 2017).
Alberta concedes that health care services account for about 25% of a population’s overall health status yet many issues, such as education, income and housing are beyond the reach of the health system; additionally, a gap remains as the overall data environment for Indigenous peoples (Alberta Government, 2016). The list of policy initiatives included in this document is not exhaustive however it is evident there is a shift toward concrete support for Indigenous people to not only access adequate health care but to also be successful in obtaining health care related education through major academic settings.
With targeted federal funding, it is reasonable to expect that most provinces and territories will have a degree of alignment on priority initiatives and some variance based on the characteristics of their own regional indigenous populations and existing provincial legislation. Our review captures several initiatives that align these federally incented targets of improving home care, primary care and mental health among others. It also highlights increased efforts to improve cultural awareness of the health care sector by offering training and programs to reduce stigmatization and discrimination and education about the history of colonialism and effects of residential schooling. These actions collectively are helping to heal the populations impacted by historical paternalistic laws and our nation.
Christine & Jamie
References
Alberta Government (2016). Indigenous Health in Alberta. Retrieved from http://nadc.ca/docs/05-Lara-McClelland-AH-Indigenous-Health.PDF
AHS. Alberta Health Services (2018). Continuing care in Indigenous communities. Retrieved from https://www.albertahealthservices.ca/assets/info/seniors/if-sen-ccic-guidebook.pdf
Alberta Medical Association (AMA). (2018). Indigenous health. The AMA policy statement on Indigenous health. Retrieved from https://www.albertadoctors.org/leaders-partners/indigenous-health
Barrera, J. (February,2018). Budget boosts funding for First Nations self-government, Indigenous services. CBC News. Retrieved from http://www.cbc.ca/news/indigenous/federal-budget-2018-indigenous-file-1.4552955
First Nations Health Action Plan. Retrieved from https://news.ontario.ca/mohltc/en/2018/02/ontario-taking-action-on-indigenous-health-care.html
Government of Canada. First Nations Health Status Report Alberta Region 2011–12. Report by the Medical Officer of Health. Retrieved from http://publications.gc.ca/collections/collection_2013/sc-hc/H26-4-2012-eng.pdf
Journey Together- Ontario's Commitment to Reconciliation with Indigenous People. Retrieved from https://www.ontario.ca/page/journey-together-ontarios-commitment-reconciliation-indigenous-peoples?_ga=2.96922838.814663909.1521550405-262594096.1521550405
National Collaborating Center for Aboriginal Health (2013). An Overview of Aboriginal Health in Canada. Retrieved from https://www.ccnsa-nccah.ca/docs/context/FS-OverviewAbororiginalHealth-EN.pdf
Ontario Federation of Indigenous Friendship Centers. (2017). Access to Health Services in Ontario for the Urban Indigenous Population. Retrieved from http://ofifc.org/publication/access-health-services-ontario-urban-indigenous-population
Ontario Ministry of Finance (2016). Aboriginal Peoples of Ontario. Retrieved from https://www.fin.gov.on.ca/en/economy/demographics/census/cenhi16-10.html
Palmer, K., Tepper, J., & Nolan, M. (2017). Indigenous health services often hampered by legislative confusion. Retrieved from http://healthydebate.ca/2017/09/topic/indigenous-health