Aboriginal health human resources:
Access to health, healing and wellness
                          Emily Lecompte
     Health Canada, First Nations Inuit Health Branch (FNIHB)
Presented at the National Aboriginal Health Organization Conference
                     November 24th - 26th, 2009
Presentation Overview

•   Background
•   Research Objectives
•   Research Methodology
•   Results: Census Statistics
•   Difficulties related to data collection
•   Limitations
•   Strengths
•   Online Information Resources
•   Contact Information
Geographic Supply & Distribution of AHHR

 Background

• Literature recognizes the disproportionately high rates of ill
  health among Aboriginal people compared to their non-
  Aboriginal counterparts (Tookenay, 1996; Durie, 2004).

•To better address the needs and concerns of First Nations,
 Inuit and Métis people, one must understand the issues that
 have dramatically affected their culture, values, traditions,
 lifestyles and families.
Growth of the Canadian Aboriginal Population

BACKGROUND
Canadian Aboriginal identity is on the rise (1996 – 2006):
Canadian Aboriginal people now account for 3.8% of the national population

                      1500000
   # of individuals




                      1250000

                      1000000                                 Métis
                                                              Inuit
                      750000
                                                              First Nations
                      500000                                  Total

                      250000

                           0
                                 1996     2001    2006

                                                   (Statistics Canada, 2008b; 2005)
Geographic Supply & Distribution of AHHR

Participation of Indian reserves in the Census is improving


                              90
       # of Indian reserves




                              80
                              70
                              60
                              50                                 Incompletely
                              40                                 enumerated
                                                                 Indian Reserves
                              30
                              20
                              10
                               0
                                    1996     2001    2006



                                                        (Statistics Canada, 2008)
Geographic Supply & Distribution of AHHR

 Project Rationale:

• The Aboriginal Health Human Resource Initiative (AHHRI)
  seeks to increase the representation of Aboriginal people
  (First Nations, Inuit, and Métis) in health careers across
  geographic locations through programs and strategies that
  respond to the needs of Aboriginal Canadians.

• By increasing the number of skillful, knowledgeable, and
  certified Aboriginal and non-Aboriginal HHR, health service
  delivery may be provided in a more culturally respectful
  way.
Geographic Supply & Distribution of AHHR

  RESEARCH OBJECTIVES

1. To examine labour force characteristics and Census data in order to better
   illustrate and explain trends in health care occupations

2. To provide a more complete portrait of the Aboriginal and non-Aboriginal
   workforce in health occupations with the use of census data collected on
   three separate occasions from 1996 to 2006.

3. To highlight cumulative tendencies in the field of heath care as a means to
   better understand and predict future outcomes in the supply, demand,
   recruitment and retention of health care providers.
Geographic Supply & Distribution of AHHR

METHODOLOGY

Data source:
   • Results from the long form questionnaires (20% data sample) of the 1996,
      2001, and 2006 national censuses from Statistics Canada were utilized.
      The long form of the Census questionnaire is given to one in every five
      households (20%) across Canada.

Analytical techniques:
   • Descriptive statistics are used to illustrate trends in health occupations
      over the three consecutive census periods (1996, 2001, and 2006).
Geographic Supply & Distribution of AHHR
          1996, 2001 & 2006 CENSUS STATISTICS

              Non-Aboriginal Aboriginal Health
                                                  Total Health Human
              Health Human Human Resources
                                                   Resources (HHR)
                Resources        (AHHR)

                 757 995           8 840                 766 830
1996 Census
                  (98.8%)          (1.2%)                 (100%)

                 844 675          13 980                 858 655
2001 Census
                  (98.4%)          (1.6%)                 (100%)

                 990 805          21 805                1 012 610
2006 Census
                 (97.85%)          (2.15%)                (100%)

                                  (Statistics Canada, 2003a; 2003b; 2008)
http://www.scholastic.ca/bookfairs/contact/images/map_of_canada_english.gif


             Distribution of the 2006 AHHR across Canada

Distribution of AHHR
             285                          120
 105

                                                               2 190


                                                                               475


                                                                                       30

 3 065
                                                                                  530
         3 230                 4 035                                   305
                   2 020                         5 415

                                                 (Statistics Canada, 2008)
Geographic Supply & Distribution of AHHR
                                  Geographic Supply & Distribution of AHHR

  CENSUS STATISTICS
                          Distribution of Aboriginal Canadians in health careers:
                           On-Reserve                                          Off-Reserve
                2800
                2400
                                                      Métis
# of People




                2000                                  Inuit
                1600                                  First Nations

                1200
                 800
                 400
                   0
                        1996      2001      2006

              NB: Health Canada fully recognizes that the Inuit people do not reside in on-reserve areas
              however, Statistics Canada does not make this distinction and include both Inuit and Métis
              people in on- and off-reserve areas of residence.
                                                         (Statistics Canada, 2003a; 2003b; 2008)
Geographic Supply & Distribution of AHHR

  GENDER IN THE WORKPLACE

              Distribution of Aboriginal Men and Women in health careers:

              20000
              18000
              16000
# of People




              14000
              12000                                     Aboriginal Men
              10000                                     Aboriginal Women
               8000
               6000
               4000
               2000
                  0
                       1996       2001      2006

                                               (Statistics Canada, 2003a; 2003b; 2008)
Geographic Supply & Distribution of AHHR
GENDER DISTRIBUTION IN HEALTH CAREERS
(Total population)                                                  94% ♀

     100%

      80%

      60%
                                                                  Women
      40%                                                         Men

      20%

       0%
            Specialist   GP & Fam.    Registered   Dentists
            Physicians   Physicians    Nurses



                                                   (Statistics Canada, 2008)
Proportion of AHHR growth in Canada
              between 1996Supply & Distribution of AHHR
                 Geographic – 2001 & 2001 - 2006
                  Aboriginal Health Human Resources

Health Care Occupation ‘96 Census ‘01 Census ‘06 Census      96 – 01   01 – 06

   Registered Nurses         2 335   3 250       5 360       ↑39%      ↑65%

Midwives & Practitioners
  of Natural Healing
                              55      185         285       ↑236%      ↑54%

Dieticians & Nutritionists    25      110         140       ↑340%      ↑27%

 General Practitioners &
   Family Physicians
                              65      135         225       ↑108%      ↑67%

  Specialist Physicians       25       70         100       ↑180%      ↑43%

 Occupational Therapists      30       50          70        ↑67%      ↑40%

                                     (Statistics Canada, 2003a; 2003b; 2008)
Proportion of AHHR growth in Canada
                Geographic Supply &–Distribution of AHHR
                    between 1996 2006
                 Aboriginal Health Human Resources
                                                  # of position
                                                                  % increases
Health Care Occupation ‘96 Census    ‘06 Census     increases
                                                                    96 – 06
                                                   since 1996

   Registered Nurses         2 335     5 360         ↑3 025         ↑130%

Midwives & Practitioners
  of Natural Healing
                              55        285           ↑230          ↑418%

Dieticians & Nutritionists    25        140           ↑115          ↑460%

 General Practitioners &
   Family Physicians
                              65        225           ↑160          ↑246%

  Specialist Physicians       25        100           ↑75           ↑300%

 Occupational Therapists      30         70           ↑40           ↑133%

                                        (Statistics Canada, 2003a; 2008)
AHHR
Age distribution of health care providersAHHR
            Geographic Supply & Distribution of                        HHR
      Census
Age
                   1996               2001                    2006
                48 890 (6.45%)     61 577 (7.29%)         76 985 (7.77%)
15 – 24 yrs.
                 885 (10.01%)      11 855 (8.48%)         2 335 (10.71%)
               450 476 (59.43%)   450 718 (53.36%)       481 927 (48.64%)
25 – 44 yrs.
                5 450 (61.65%)     8 480 (60.66%)        11 945 (54.78%)
               244 908 (32.31%)   317 766 (37.62%)       407 914 (41.17%)
45 – 64 yrs.
                2 470 (27.94%)     4 234 (30.29%)         7 305 (33.50%)
                13 719 (1.81%)     14 613 (1.73%)         23 977 (2.42%)
 65 yrs +
                 354 (0.40%)        797 (0.57%)            220 (1.01%)
                  x / 757 995        x / 844 675             x / 990 805
Total people
                   x / 8 840          x / 13 980             x / 21 805

                                     (Statistics Canada, 2003a; 2003b; 2008)
Difficulties related to data collection
• Disagreements about what constitutes indigeneity affect the
  quality of available data.
• Data on individual health outcomes may not reflect the holistic,
  and eco-social or communal, notions of health more likely to
  characterize Indigenous perspectives
• Some countries have initiated a process aimed at addressing the
  consequences of conquest and colonial oppression. This is
  reflected in the greater amount of information available on
  health.


                                  http://www.who.int/social_determinants/resources/indigeno
                                  us_health_adelaide_report_07.pdf
Geographic Supply & Distribution of AHHR

LIMITATIONS

• Undercount of certain Aboriginal settlements and reserves
  may undermine and misrepresent the circumstances and
  needs of concerned areas.

• Generalization of data is limited to Federal/Provincial/
  Territorial level due to concerns of confidentiality

• Set of information collected by the Census regarding
  occupations in health care is limited
Geographic Supply & Distribution of AHHR

STRENGTHS

• Census data attempts to count the entire Canadian
  population through a cross-sectional lens.

• Provides a baseline of data that furthers the understanding
  of trends in health occupations on a national, provincial,
  and territorial basis as well as in on- and off-reserve areas.

• Baseline data is important for planning purposes, thus to
  inform program and policy design
Aboriginal health human resources in Canada

              FOR MORE INFORMATION ON
        AHHRI OR FIRST NATION AND INUIT HEALTH:

AHHRI: http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/ahhri-irrhs_e.html
FNIHB: http://www.hc-sc.gc.ca/fnih-spni/index_e.html
First Nations Health Managers Fact Sheet:
http://www.fnhealthmanagers.ca/docs/e/FNHM_Factsheet.pdf
First Nations and Inuit Health Program Compendium:
http://www.fnhealthmanagers.ca/docs/e/FNIHB%20Program%20Compendi
um%202007_e.pdf
Definitions, data sources and methods used by Statistics Canada:
http://www.statcan.ca/english/concepts/index.htm
Aboriginal Health Human Resource Initiative

          Contact information

                   Emily Lecompte
 Aboriginal Health Human Resource Initiative (AHHRI)
First Nations Inuit Health Branch (FNIHB), Health Canada
            Emily_Lecompte@hc-sc.gc.ca

Aboriginal health human resources: Access to health, healing and wellness

  • 1.
    Aboriginal health humanresources: Access to health, healing and wellness Emily Lecompte Health Canada, First Nations Inuit Health Branch (FNIHB) Presented at the National Aboriginal Health Organization Conference November 24th - 26th, 2009
  • 2.
    Presentation Overview • Background • Research Objectives • Research Methodology • Results: Census Statistics • Difficulties related to data collection • Limitations • Strengths • Online Information Resources • Contact Information
  • 3.
    Geographic Supply &Distribution of AHHR Background • Literature recognizes the disproportionately high rates of ill health among Aboriginal people compared to their non- Aboriginal counterparts (Tookenay, 1996; Durie, 2004). •To better address the needs and concerns of First Nations, Inuit and Métis people, one must understand the issues that have dramatically affected their culture, values, traditions, lifestyles and families.
  • 4.
    Growth of theCanadian Aboriginal Population BACKGROUND Canadian Aboriginal identity is on the rise (1996 – 2006): Canadian Aboriginal people now account for 3.8% of the national population 1500000 # of individuals 1250000 1000000 Métis Inuit 750000 First Nations 500000 Total 250000 0 1996 2001 2006 (Statistics Canada, 2008b; 2005)
  • 5.
    Geographic Supply &Distribution of AHHR Participation of Indian reserves in the Census is improving 90 # of Indian reserves 80 70 60 50 Incompletely 40 enumerated Indian Reserves 30 20 10 0 1996 2001 2006 (Statistics Canada, 2008)
  • 6.
    Geographic Supply &Distribution of AHHR Project Rationale: • The Aboriginal Health Human Resource Initiative (AHHRI) seeks to increase the representation of Aboriginal people (First Nations, Inuit, and Métis) in health careers across geographic locations through programs and strategies that respond to the needs of Aboriginal Canadians. • By increasing the number of skillful, knowledgeable, and certified Aboriginal and non-Aboriginal HHR, health service delivery may be provided in a more culturally respectful way.
  • 7.
    Geographic Supply &Distribution of AHHR RESEARCH OBJECTIVES 1. To examine labour force characteristics and Census data in order to better illustrate and explain trends in health care occupations 2. To provide a more complete portrait of the Aboriginal and non-Aboriginal workforce in health occupations with the use of census data collected on three separate occasions from 1996 to 2006. 3. To highlight cumulative tendencies in the field of heath care as a means to better understand and predict future outcomes in the supply, demand, recruitment and retention of health care providers.
  • 8.
    Geographic Supply &Distribution of AHHR METHODOLOGY Data source: • Results from the long form questionnaires (20% data sample) of the 1996, 2001, and 2006 national censuses from Statistics Canada were utilized. The long form of the Census questionnaire is given to one in every five households (20%) across Canada. Analytical techniques: • Descriptive statistics are used to illustrate trends in health occupations over the three consecutive census periods (1996, 2001, and 2006).
  • 9.
    Geographic Supply &Distribution of AHHR 1996, 2001 & 2006 CENSUS STATISTICS Non-Aboriginal Aboriginal Health Total Health Human Health Human Human Resources Resources (HHR) Resources (AHHR) 757 995 8 840 766 830 1996 Census (98.8%) (1.2%) (100%) 844 675 13 980 858 655 2001 Census (98.4%) (1.6%) (100%) 990 805 21 805 1 012 610 2006 Census (97.85%) (2.15%) (100%) (Statistics Canada, 2003a; 2003b; 2008)
  • 10.
    http://www.scholastic.ca/bookfairs/contact/images/map_of_canada_english.gif Distribution of the 2006 AHHR across Canada Distribution of AHHR 285 120 105 2 190 475 30 3 065 530 3 230 4 035 305 2 020 5 415 (Statistics Canada, 2008)
  • 11.
    Geographic Supply &Distribution of AHHR Geographic Supply & Distribution of AHHR CENSUS STATISTICS Distribution of Aboriginal Canadians in health careers: On-Reserve Off-Reserve 2800 2400 Métis # of People 2000 Inuit 1600 First Nations 1200 800 400 0 1996 2001 2006 NB: Health Canada fully recognizes that the Inuit people do not reside in on-reserve areas however, Statistics Canada does not make this distinction and include both Inuit and Métis people in on- and off-reserve areas of residence. (Statistics Canada, 2003a; 2003b; 2008)
  • 12.
    Geographic Supply &Distribution of AHHR GENDER IN THE WORKPLACE Distribution of Aboriginal Men and Women in health careers: 20000 18000 16000 # of People 14000 12000 Aboriginal Men 10000 Aboriginal Women 8000 6000 4000 2000 0 1996 2001 2006 (Statistics Canada, 2003a; 2003b; 2008)
  • 13.
    Geographic Supply &Distribution of AHHR GENDER DISTRIBUTION IN HEALTH CAREERS (Total population) 94% ♀ 100% 80% 60% Women 40% Men 20% 0% Specialist GP & Fam. Registered Dentists Physicians Physicians Nurses (Statistics Canada, 2008)
  • 14.
    Proportion of AHHRgrowth in Canada between 1996Supply & Distribution of AHHR Geographic – 2001 & 2001 - 2006 Aboriginal Health Human Resources Health Care Occupation ‘96 Census ‘01 Census ‘06 Census 96 – 01 01 – 06 Registered Nurses 2 335 3 250 5 360 ↑39% ↑65% Midwives & Practitioners of Natural Healing 55 185 285 ↑236% ↑54% Dieticians & Nutritionists 25 110 140 ↑340% ↑27% General Practitioners & Family Physicians 65 135 225 ↑108% ↑67% Specialist Physicians 25 70 100 ↑180% ↑43% Occupational Therapists 30 50 70 ↑67% ↑40% (Statistics Canada, 2003a; 2003b; 2008)
  • 15.
    Proportion of AHHRgrowth in Canada Geographic Supply &–Distribution of AHHR between 1996 2006 Aboriginal Health Human Resources # of position % increases Health Care Occupation ‘96 Census ‘06 Census increases 96 – 06 since 1996 Registered Nurses 2 335 5 360 ↑3 025 ↑130% Midwives & Practitioners of Natural Healing 55 285 ↑230 ↑418% Dieticians & Nutritionists 25 140 ↑115 ↑460% General Practitioners & Family Physicians 65 225 ↑160 ↑246% Specialist Physicians 25 100 ↑75 ↑300% Occupational Therapists 30 70 ↑40 ↑133% (Statistics Canada, 2003a; 2008)
  • 16.
    AHHR Age distribution ofhealth care providersAHHR Geographic Supply & Distribution of HHR Census Age 1996 2001 2006 48 890 (6.45%) 61 577 (7.29%) 76 985 (7.77%) 15 – 24 yrs. 885 (10.01%) 11 855 (8.48%) 2 335 (10.71%) 450 476 (59.43%) 450 718 (53.36%) 481 927 (48.64%) 25 – 44 yrs. 5 450 (61.65%) 8 480 (60.66%) 11 945 (54.78%) 244 908 (32.31%) 317 766 (37.62%) 407 914 (41.17%) 45 – 64 yrs. 2 470 (27.94%) 4 234 (30.29%) 7 305 (33.50%) 13 719 (1.81%) 14 613 (1.73%) 23 977 (2.42%) 65 yrs + 354 (0.40%) 797 (0.57%) 220 (1.01%) x / 757 995 x / 844 675 x / 990 805 Total people x / 8 840 x / 13 980 x / 21 805 (Statistics Canada, 2003a; 2003b; 2008)
  • 17.
    Difficulties related todata collection • Disagreements about what constitutes indigeneity affect the quality of available data. • Data on individual health outcomes may not reflect the holistic, and eco-social or communal, notions of health more likely to characterize Indigenous perspectives • Some countries have initiated a process aimed at addressing the consequences of conquest and colonial oppression. This is reflected in the greater amount of information available on health. http://www.who.int/social_determinants/resources/indigeno us_health_adelaide_report_07.pdf
  • 18.
    Geographic Supply &Distribution of AHHR LIMITATIONS • Undercount of certain Aboriginal settlements and reserves may undermine and misrepresent the circumstances and needs of concerned areas. • Generalization of data is limited to Federal/Provincial/ Territorial level due to concerns of confidentiality • Set of information collected by the Census regarding occupations in health care is limited
  • 19.
    Geographic Supply &Distribution of AHHR STRENGTHS • Census data attempts to count the entire Canadian population through a cross-sectional lens. • Provides a baseline of data that furthers the understanding of trends in health occupations on a national, provincial, and territorial basis as well as in on- and off-reserve areas. • Baseline data is important for planning purposes, thus to inform program and policy design
  • 20.
    Aboriginal health humanresources in Canada FOR MORE INFORMATION ON AHHRI OR FIRST NATION AND INUIT HEALTH: AHHRI: http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/ahhri-irrhs_e.html FNIHB: http://www.hc-sc.gc.ca/fnih-spni/index_e.html First Nations Health Managers Fact Sheet: http://www.fnhealthmanagers.ca/docs/e/FNHM_Factsheet.pdf First Nations and Inuit Health Program Compendium: http://www.fnhealthmanagers.ca/docs/e/FNIHB%20Program%20Compendi um%202007_e.pdf Definitions, data sources and methods used by Statistics Canada: http://www.statcan.ca/english/concepts/index.htm
  • 21.
    Aboriginal Health HumanResource Initiative Contact information Emily Lecompte Aboriginal Health Human Resource Initiative (AHHRI) First Nations Inuit Health Branch (FNIHB), Health Canada Emily_Lecompte@hc-sc.gc.ca