Our health counts powerpoint

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Summary presentation of the Our Health Counts Urban Aboriginal Health Research Project completed in April 2011 - launched Dec. 2011.

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Our health counts powerpoint

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