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  • 1. Launched December 2011 Our Health CountsSunday, February 26, 2012 1
  • 2. Unique Partnership Our Health Counts was a collaborative effort by: • Ontario Federation of Indian Friendship Centres (OFIFC) • Métis Nation of Ontario (MNO) • Ontario Native Women’s Association (ONWA) • Tungasuvvingat Inuit (TI) Urban First Nations Health - Research Project Team • De dwa da dehs ney>s Aboriginal Health Access Centre • Hamilton Executive Directors Aboriginal Coalition • Centre for Research on Inner City Health (CRICH) - Led by Dr. Janet Smylie • Multiple funders: OFIFC, MOHLTC, AHTF, CRICH • Data linked to Institute for Clinical & Evaluative Sciences (CEIS)Sunday, February 26, 2012 2
  • 3. First Nations Partners Hamilton site was selected because: • Large First Nations Pop. (>13,735 based on 2006 Census) • Strong Native organizational infrastructure • Well developed networks • Implications relevant to all urban settings Research partners: • De dwa da dehs ney>s Aboriginal Health Access Centre • Hamilton Executive Directors Aboriginal CoalitionSunday, February 26, 2012 3
  • 4. Unique Approach • Community-based urban setting • Participatory research design • Multi-sector collaboration • Shared decision making • Respondent driven sampling • Community capacity building • Trained First Nations interviewers • Reflective of Aboriginal beliefs • Concept mapping - health dimensions • Holistic - health linked to social determinants • Respectful engagement vs rapid responseSunday, February 26, 2012 4
  • 5. ‘Ways of Knowing’ Use of ‘concept mapping’ Community partners worked with researchers to develop a ‘concept map’ to inform survey design • Aligns with traditional Aboriginal tools • 102 health ‘concepts’ identified by group • Sorted into 10 domains • Questionnaire built on community priorities • Ensures meaningful info is gathered • Assesses both strengths & vulnerabilities • Reflects Aboriginal world-view - health & wellbeing is a balance of physical, mental, social & spiritual dimensionsSunday, February 26, 2012 5
  • 6. Research Findings • Historic Study • A lack of population-based health data for First Nations people - leading to poor planning & policy neglect • Confirms community’s belief regarding poor health status • Results significantly higher than Statistics Canada figures • 790 people recruited (554 adult, 236 child) • 92% participant allowed link to OHIP • Allowed access to detailed health information through the Institute for Clinical Evaluative Science (ICES). First time access to more robust health informationSunday, February 26, 2012 6
  • 7. Demographics • 13, 735 people in Hamilton report Aboriginal ancestry (Census 2006) - significant underestimation • First Nation’s people represent 2.8% of Hamilton’s population • OHC population much younger than general pop. • 51% report being Registered Indians (under the Indian Act) • 95% most often speak English at homeSunday, February 26, 2012 7
  • 8. Housing Impacts Health I live entirely off food banks, that’s where nutrition comes in, no choice over food • 90% moved at least once in 5 years - vastly higher than non Natives • 50% have move 3 or more times • 13% report being homeless or in ‘transition’ • 74% live in crowded conditions (using Stats Canada definition) • Housing is inadequate and in disrepair • 70% people live in poorest neighbourhood in Hamilton (3% general pop.) • High mobility tied to cycle of poverty • 63% give up important things - food - to afford housing • 22% report they do not have enough to eatSunday, February 26, 2012 8
  • 9. Education/Employment Low levels of formal education: • 57% First Nations adults over 18 completed some high school • 20% report completing high school • 5% completed some/all university • Women trend to more education Income & employment: • 28% income from wages & salaries, 8% from self-employment • 69% provincial/municipal social assistance, 10% EI, 17% Child Tax Benefits, 13% other income sources • 18% earn less than $4,999, 22% between $5,000 & $15,000, 15% earn between $15,000 & $20,000 • Only 22% earn over $20,000 (compared to 57% of Hamilton residents) • Only 2% First Nations in highest income quartileSunday, February 26, 2012 9
  • 10. Social Determinants of Health First Nation people have less access to social determinants of health • Structural & institutional inequalities can’t be solved at individual level - policy, practice and legal changes needed • Striking levels of poverty • Housing & food instability • Lower levels of education & employment • Less access to public transportation - impacts employment/inclusion • Poorer health status - more chronic illnesses • Racism, social exclusion & discrimination • Unequal access to health, supports & servicesSunday, February 26, 2012 10
  • 11. Impact of Colonization The legacy of colonization & residential schools has a serious impact on health, wellbeing & family cohesion • 6% were students at residential schools • 40% have family member • 65% felt personal negative impacted • 34% felt impact as family • 40% report child protection was part of their childhood care • 35% report their children have been involved with child protection • 49% felt this has negatively affected their overall health/wellbeingSunday, February 26, 2012 11
  • 12. Impact of Colonization Violence & abuse • 58% report violence is part of their community • 95% report violence is related to crime with their neighbourhood • 81% reported lateral violence - between First Nations peers • 67% reported violence related to racism & discrimination • 60% reported family violence • 96% mental/emotional abuse • 90% physical • 52% sexual abuse • Women experiencing more violence than men.Sunday, February 26, 2012 12
  • 13. Being Out of Balance • First Nations people see health as more than physical wellness • Includes physical, mental, emotional and spiritual dimensions • 43% feel ‘in balance’ in the four aspects of wellness • 37% balanced some of the time, 20% little/no balance all of the time • Women less likely to feel balanced than men (28% vs 14%) • 42% report having a psychological or mental health disorder • Men more physically active than women (30 min. daily exercise) • Older adults (50+) report zero / 1 day exercise per week • 54% drink more than 5 drinks at least once a month vs 27% general population • 87% smoke (higher underage of 50 years), same for men and women vs 24% of general Hamilton populationSunday, February 26, 2012 13
  • 14. Chronic Disease & Disability First Nations people carry a greater health burden, at a younger age, that limits functional activity • 16% have diabetes (3 x general pop.) • 26% high blood pressure (20% general pop.) • 31% have arthritis (20% general pop.) • 9% Hepatitis C (> 1% within the general population) • 36% report their health is fair to poor • 1/2 - 3/4 adults have limitations due to illness • First Nations men feel their health is better than women • 18% of First Nations women feel health is excellent/good vs 61% women within general population.Sunday, February 26, 2012 14
  • 15. Health Care Access “Our health deserves appropriate and dedicated care” Urgent need for improved health care access • 40% rate access to health care as fair to poor Barriers to care reported: • Long waiting lists - 48% • Access to transportation - 35% • Can’t afford direct costs - 32% • Doctors not available • 24% report a lack of trust in health care providers • Stigma & discrimination contributing role We need more Aboriginal people in health care, education, places where people are looking up to other people. More native role models.”Sunday, February 26, 2012 15
  • 16. Emergency Room Use First Nations more likely to use Emergency Room • Using emergency department for acute & non-acute illness • 50% report using ER in past year (22% general population) • 11% had more than 6 visits (< 2% general population) • ER use holds for both children and adults Children less likely to be admitted • Compared to non native children - lower rates of admission • With comparable or more severe symptoms of illness • Is there a systemic bias toward admitting non-native children?Sunday, February 26, 2012 16
  • 17. Challenges & Strengths Main challenges people identified • Drugs & alcohol are main concerns - 68% • Housing - 61% • Crime, poverty, & employment - 60% Community strengths • Strong family values - 53% • Awareness of First Nations culture - 41% • Community health programs/ traditional ceremonies - 38% • Presence of elders within community - 36% • Social connections within the community - 35%Sunday, February 26, 2012 17
  • 18. Reclaiming identity Strong sense of identity as First Nations people • Over 93% of people feel it is import/very import for their children learn their language and culture • 1/3 people report using traditional medicine • Hamilton’s First Nation’s community has remarkable cultural continuity, resilience & hope - despite alarming inequalitiesSunday, February 26, 2012 18
  • 19. Whole Government Approach Problems facing Urban Aboriginals in Hamilton are complex Solutions require a whole government approach - working with First Nations leaders • Our Health Data demonstrates increasing disparities in the social determinants of health for urban Aboriginals • Needs inter sectorial partnerships to resolve • Requires urban Aboriginal specific, cultural based, community driven strategy • Address inequalities in accessing social determinants of health in accordance with human rights legislation (housing, food security) • Chronic disease & disability is disproportionally felt. Requires municipal & provincial governments working with Aboriginal community to set priorities, preventative action & health promotion plansSunday, February 26, 2012 19
  • 20. Whole government cont... Work with Aboriginal community leaders municipal, provincial & federal governments to... • Collaborate to remove barriers to equitable access to community health care, emergency departments & inpatient hospital services • Fund the development & expansion of culturally reflective, community based traditional family treatment centres, mental & maternal health programs & services • Build cultural safety & competence skills recognizing Aboriginal world-view & healing practices • Promote self-determination in health care delivery, governance, research, planning, development, delivery & evaluationSunday, February 26, 2012 20
  • 21. Child Health Approach Our children are our future... a shared commitment to their health & wellbeing is critical • Support children’s language & cultural programming - include Aboriginal organizations & school boards • Eliminate barriers to primary health care, reduce wait lists, target health concerns in culturally sensitive ways • Support First Nations families in parenting their children in culturally supportive ways • Accord Aboriginal children their human right to live in healthy homes & attend schools/ programs which do not worsen their healthSunday, February 26, 2012 21
  • 22. Research & Planning ‘Our Health Counts’ demonstrates that research can be done by Aboriginal people for the community’ benefit • Fund First Nations led applied service research • Planning is best done in respectful partnership • Support interagency collaboration & cooperation • Work with Aboriginal agencies & organizations to gain knowledge, promote self-determination in planning, design, development & delivery of culturally specific health services programs & policiesSunday, February 26, 2012 22