Who we are: [Inuit Tuttarvingat webpage] Inuit Tuttarvingat is the Inuit-specific centre of the National Aboriginal Health Organization (NAHO). Mission Inuit Tuttarvingat will advance and promote the health and well-being of Inuit individuals, families and communities by working in strong partnerships to collect information and share knowledge.
This map depicts the four Inuit Regions in Canada: The Inuvialuit Settlement Region in the Northwest Territories, the territory of Nunavut, Nunavik in northern Quebec, and Nunatsiavut in northern Labrador. (Source: Inuit Tapiriit Kanatami (ITK)). We are governed by Canada’s Inuit organizations: Nunavut Tunngavik Inc., Inuvialuit Regional Corporation, Nunatsiavut Government, Makivik Corporation, Inuit Tapiriit Kanatami, Pauktuutit Inuit Women of Canada, National Inuit Youth Council. Most Inuit must fly out of their home communities for diagnostic and screening services, medical treatments, palliative services, and other forms of health care, resulting in significant social and emotional costs, as well as financial burdens for families and for the health care system.
Just as a reminder, KT “ is defined as a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system” (CIHR) We work mainly as knowledge users and as knowledge brokers. We give a forum to Inuit voices on issues of well-being, health and paths to recovery -- For example, we organized a panel on Inuit healing practices as shared by female Inuit elders and prepared video clips that are available on our website. We capture indigenous voices (community, individual) And deliver to indigenous community, service providers, researchers – for example, we prepared a report of the 2008 workshop on housing and are now preparing one from the 2012 workshop. We use tools such as workshops, research reports, fact sheets, presentations, radio spots, video clips to reach our many audiences. NAHO is publisher of the Journal of Aboriginal Health and we have a call for papers out for the u pcoming special JAH issue on Inuit health research and community innovations. We work on a wide range of topics such as housing, food security, economic development, mental wellness, maternal and child health, men’s health, and youth health. Our materials are used by community health workers, colleges and training programs, regional Inuit organizations and provincial/territorial governments.
The World Health Organization defines the social determinants of health as “ the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices” (World Health Organization 2010). Loppie Reading and Wien noted in 2009 that a social determinants of health framework highlights how “individuals, communities and nations that experience inequalities in the social determinants of health not only carry an additional burden of health problems, but they are often restricted from access to resources that might ameliorate problems” (Loppie Reading and Wien 2009, 2). For example, Inuit have limited access to appropriate and affordable housing, leading to overcrowding, and thus making Inuit more vulnerable to communicable diseases such as tuberculosis. (Cameron 2010) The report “If Not Now … When?” Addressing the ongoing Inuit housing crisis in Canada, the latest in our series, presents 3 sections: Research evidence relating inadequate housing conditions to ill-health Contextual information on the state of Inuit housing Discussion of the determinants of health framework as research to action tool in the context of Inuit housing .
Inuit are not as healthy as the rest of Canada – that is at least according to indicators of health used to measure national and international health. In almost every indicator of health, Inuit score lower than the Canadian population. For example: Life expectancy - Definition: The number of years a person is expected to live from the day he or she is born based on mortality statistics at the time. In 1994-1998, life expectancy at birth was significantly higher for Canada as a whole than for residents of Inuit Nunangat, with an overall difference of 10 years. This is also the case in 1999-2003, where life expectancy at birth was 12.2 years higher in Canada as a whole than in Inuit Nunangat. This change is the result of an improved life expectancy in Canada as a whole (from 78.3 to 79.5 years), and a decline in the life expectancy in Inuit Nunangat (from 68.3 to 67.3 years). Infant mortality Definition: Number of infants who die in the first year of life, expressed as a rate per 1,000 live births. When compared to Canada as a whole, the infant mortality rate was 3.3 times higher over the period 1994-1998 and 2.8 times higher over the period 1999-2003. Mortality rate Definition: Age-standardized rate of death from all causes per 100,000 population Mortality rate in Inuit Nunangat was much higher than that for Canada – 2.7 times higher for the period form 1999-2003. The highest cause of death in the Inuit homelands is unintentional injury, followed by suicide/self-inflicted injury and then respiratory disease. Lung cancer rates among Inuit in Canada are the highest in the world.
The rate of hospitalization in the Baffin Region reaches 300 per year for each 1,000 infants. Treatment often requires an expensive and disruptive flight for the child and family to a southern Canadian hospital” (CMHC 2005) dampness and moulds – often indicating structural weakness and need for repair in the building. Problems associated with this are : asthma, respiratory tract infection, respiratory symptoms, rheumatic fever and psychological distress (Hwang 1999) There is a strong association between indoor CO2 levels and the risk of lower respiratory tract infection among Inuit infants and young children
Between 2004 and 2008, tuberculosis doubled among Inuit. Between 2004 and 2008, tuberculosis doubled among Inuit. The Canadian Tuberculosis Reporting System indicates Inuit having 155.8 incidents per 100,000 individuals, while the overall tuberculosis incidence rate in Canada stands at 4.7 per 100,000 persons. The lowest rate among Inuit is found in Ontario, where the rate of 52.8 per 100,000 persons is sadly still more than 10 times the Canadian rate. Tuberculosis rates are directly related to inadequate and overcrowded housing, food insecurity, and access to health services (Turner 2010). An article in today’s Nunatsiaq News (March 1, 2012) reports that, f aced with high numbers of active tuberculosis cases, Nunavut’s health department plans to boost its TB screening, prevention and treatment efforts into 2013.
Crowded living conditions have been a challenge Inuit have had to deal with for generations. According to the 2006 Census, and using the ‘person per room’ measurement, one in three Inuit (31 per cent) in Canada live in crowded conditions.
“ In 2006, the Inuit were the youngest Aboriginal identity group, with a median age of 22 years vs. a median age of 40 for Canada. By 2031, the Inuit population would have aged, but it would still be the youngest Aboriginal identity group. The median age of the Inuit population would be between 31 and 32 . ” - Canada, b y 2036, the median age of the population would range between 42 and 45 years, (Source: Statistics Canada-projections) The majority of Inuit are under the age of 25, which means that program and service needs are greatest in the areas of child health, education, and youth.
In Inuit Nunangat (the four Inuit regions combined) half (49%) of all children under 6 years of age, are living in crowded dwellings. (Nunavik highest 59%) The Nunavut Inuit Child Health Survey 2007-2008 found that the numbers of children living in crowded conditions are even higher if considering preschoolers only. The survey identified that 54 per cent of pre-schoolers living in 16 Nunavut communities were living in crowded homes. Crowding and infectious diseases Problems associated are colds, coughs, influenza, cramped muscles, cold sores, tuberculosis, skin problems, lack of sleep, anger, depression depression (Tester 2006)
Crowded living conditions have been a challenge Inuit have had to deal with for generations. According to the 2006 Census, and using the ‘person per room’ measurement, one in three Inuit (31 per cent) in Canada live in crowded conditions. There is large gap in research on housing and education/ skills development and employment outcomes for vulnerable groups (Canada Mortgage and Housing Corporation. 2010. Overview of the current state of knowledge on societal outcomes of housing.)
Need to consider the fact that people go through multiple traumas Need addiction treatment facility and programs
Many obstacles exist in repair and maintenance of buildings: lack of public and private funds for repair Low incomes Absence of temporary housing to relocate residents during maintenance and repair operations Erosion and permafrost melting making buildings unstable Damages / decline due to weather conditions and the high number of occupants
A third (29%) of all children under 6 years of age live in dwellings requiring major repairs. (Nunavik highest 45%) (2006 Aboriginal Children’s Survey)
Homeless people are at a greater risk of acquiring tuberculosis and other respiratory infections, HIV/AIDS and hepatitis C. Ottawa In Ottawa, Mamisarvik (part of Tungasuvvingat Inuit) runs the city’s first transitional housing for Inuit. There is a need to document the nature of Inuit communities in urban Canada. Inuit population listed with urban centre is over 1500, we don’t have statistics on the number nor on the characteristics of the urban Inuit population.
Social determinants research is still in its infancy in the Inuit public health sector, as noted by Richmond (2009) and also by Cameron (2011) in her excellent “State of knowledge on Inuit health” document – to help identifying points for intervention to for example, respiratory diseases, this kind of research will be very important. Determinants of health include contextual and historical perspectives on Inuit housing; also need to consider the population-specific demographic profile. Health research on the associations between housing conditions and mental health and problem behaviours Policy research to have an overview of the currently existing policies and identify how existing policies can be adjusted
1. Housing, health and the ongoing crisis for Inuit in Canada Presented by: Cathleen Knotsch Senior Research Officer
2. <ul><li>Who we are and how we work </li></ul><ul><li>Our work on housing </li></ul><ul><li>Our latest report: addressing the ongoing housing crisis for Inuit in Canada </li></ul><ul><li>Some preliminary notes from the 2012 workshop on housing </li></ul><ul><li>Research gaps, needs and recommendations </li></ul>This presentation
4. Promoting Inuit well-being Inuit Nunangat St. John’s Montreal Ottawa Winnipeg Edmonton Yellowknife Vancouver
5. Knowledge Translation Tools Inuit healing practices workshop, 2009 Canada’s peer-reviewed Journal on Aboriginal Health 2008 and 2012 workshop on housing
6. <ul><li>Series began with the 2008 workshop </li></ul><ul><li>Several documents on housing </li></ul><ul><li>2011 report on housing as an important determinant of health </li></ul><ul><li>2012 workshop </li></ul>Health and housing realities for Inuit 2012 WORKSHOP on housing
7. Inuit are not as healthy as the rest of Canada <ul><li>Life expectancy in Inuit Nunangat was an average 12.2 years less than for all of Canada as a whole during 1999-2003, and this gap was shown to have been widening. </li></ul><ul><li>Infant mortality in Inuit Nunangat is almost 3 times that of Canada as a whole. </li></ul><ul><li>The mortality rate for Inuit Nunangat was twice that of Canada as a whole. </li></ul><ul><li>Suicide/self-inflicted injury, respiratory disease, and unintentional injury are among the highest causes of death in Inuit Nunangat . </li></ul>
8. <ul><li>Hospitalization rates for Inuit children with severe lower respiratory tract infections are the highest in the world: </li></ul><ul><li>300 per year for 1,000 infants (Baffin region) </li></ul><ul><li>There is a strong association between indoor CO2 levels and the risk of lower respiratory tract infection among Inuit infants and young children </li></ul>Indoor air quality – infectious diseases
9. Tuberculosis in Canada, 2009 Source: Public Health Agency of Canada, 2010. Tuberculosis in Canada 2009. Ottawa, Minister of Health. Table 3.
10. Source: Statistics Canada, Census of population, 2006, Table 9. Living in crowded dwellings
11. <ul><li>“ In 2006, the Inuit were the youngest Aboriginal identity group, with a median age of 22 years. </li></ul><ul><li>By 2031, […] the median age of the Inuit population would be between 31 and 32. ” </li></ul>Considering demographics
12. Source: Statistics Canada. 2008. Analytical paper – Aboriginal Children’s Survey, 2006: Family, community and child care. Table 3.3, p.43. Children living in crowded dwellings
13. <ul><li>Crowding as a chronic source of stress </li></ul><ul><li>Crowding can lead to frustration, anger, violence, spousal abuse and increase in crime levels </li></ul><ul><li>Crowding has a negative impact on learning outcomes and behaviour </li></ul>Crowding and well-being Hudson’s Bay building
14. <ul><li>Multiple trauma and cumulative impacts at individual levels </li></ul><ul><li>Crowding conditions create (chronic) stress, lead to physical diseases and unhealthy coping behaviours </li></ul><ul><li>Local treatment capacities/facilities lacking in communities </li></ul><ul><li>Language and cultural barriers in urban centres </li></ul>2012 Workshop – mental health
15. <ul><li>Aging dwellings requiring repair </li></ul><ul><li>Wear and tear due to cold climate </li></ul><ul><li>Climate appropriate housing technology means inclusion of local knowledge and practices in construction </li></ul>Housing quality Downtown Iqaluit, Nunavut. Photo: Cathleen Knotsch
16. Source: Statistics Canada. 2008. Analytical paper – Aboriginal Children’s Survey, 2006: Family, community and child care. Table 3.3, p.43. Children living in dwellings requiring repair
17. <ul><li>Crowding contributes to migration to urban centres </li></ul><ul><li>Urban Inuit population is growing fast (about 22 per cent in 2006) </li></ul><ul><li>Homeless population increasing – Montreal action plan against homelessness; Makivik negotiates the first Inuit case worker to help homeless women in Montreal </li></ul>Housing and urban experiences
18. <ul><li>Determinants of health research is still in its infancy (identifying points for intervention ) </li></ul><ul><li>Collaborative health research with communities on housing conditions and their influence on health is sporadic (local relevancy ) </li></ul><ul><li>Policy research is needed (identify existing policies for adjustment to improve the situation) </li></ul>The need for solution-oriented research