The First Nations Health Plan identifies that traditional lifestyles have been altered dramatically since contact. In many cases leading to more sedentary lifestyles and reduced access to traditional foods and medicines. Levels of physical activity, access to nutritional foods, connection to traditional medicines, the condition of our lived environments, and our abilities to prevent and manage common health conditions found in First Nations communities all form the larger picture of public health.
The drastic changes that have occured over the past 130 years have led to disproportionately high incidences of preventable disease among First Nations. For example, First Nations in BC have diabetes rate 40 percent higher than the rate of the general population. Additionally, First Nations populations have higher levels injuries such as motor vehicle crashes, as one of the leading causes of injury and death. First Nations peoples have higher rates of arthritis; high blood pressure; diabetes; asthma; heart disease; cataracts and chronic conditions. Food insecurity is a major issue and a precursor to many health problems such as malnutrition, low birth weight babies, unhealthy pregnancies and poor health in seniors. Deaths due to medically treatable diseases are higher among First Nations than the rest of the population, mainly due to untimely access to medical intervention. Deaths for HIV are higher as are rates of HIV per capita.
First Nations people have a right to universal and timely access to health services regardless of their economic status, age or gender or place of residence (First Nation Submission on Health Blueprint). There is a need for First Nations participation in mainstream initiatives such as injury prevention, home care, housing needs for First Nations with disabilities, health promotion, disease prevention and midwifery. The blueprint submission identifies the priorities of the document, those being; the children, women, families, elders and people with disabilities - and a holistic approach to meeting their needs.
Feedback from the Health Blueprint for British Columbia 2005; Gathering Wisdom for a Shared Journey (2007, 2008 & 2009); Health Directors Forum (September 30 – October 1 2008); BC First Nations Health Regional Caucuses minutes 2008-2010; Environmental Scan on Chronic Disease Programs and Services for First Nations and Aboriginal Communities in BC (2008) have been collected below:
If the issues below can be addressed by the various levels of Government working with community partners – these will go a long way to addressing current barriers and gaps, and building a PC & PH system that supports Aboriginal communities in the future in a positive, holistic and culturally competent way.
- Jurisdictional issues – the jurisdictional (including First Nations, Province and Federal) barriers between services for First Nations people living on and off reserve. Services are denied. Access is limited.
- Cultural Competency - The lack of cultural competence of many care providers in provincial and regional health services, private practice (physicians), labs, pharmacies, outpatient services is a significant barrier for First Nations people in their attempts to access health services in BC.
- Remote, rural and isolated regions – Geographic barriers for First Nationss in rural, remote and isolated regions of BC are significant with respect to the availability of health services for their people and many have to leave their communities to access basic health care.
- Traditional practices – the minimal recognition and coverage of traditional / non medical interventions and alternative therapies by Canada and British Columbia is a gap in service delivery.
- Resourcing – the resourcing of small independent First Nations in BC is inequitable and does not adequately address diseconomies of scale and is a significant barrier to local services.
- NIHB- is insufficient to meet the needs of First Nations (particularly transportation costs). Funding has not increased with growing demands.
Based on the information gathered, the following recommendations are seen as a priority for further work in the area of Primary health:
- Take a community development approach that builds on assets and strengths of healthy families and communities
- All jurisdictions must consider a fundamental shift in the focus of health care delivery from “individual as the client” to the “community as the client”
- All jurisdictions must commit to the basic requirement of culturally competent service providers.
- Be owned and driven by First Nations and Aboriginal peoples
- Provide an over-arching vision and direction for improving the plight of chronic illness among First Nations and Aboriginal communities – without interfering with communities own governance and rights to implement CDM programs and services at local level as they see fit. The strategy should be an ‘enabler’ for communities and aim to remove barriers and impediments by strategically supporting local solutions and local delivery
- Support more strategic investment of Federal and Provincial funds into services for communities to help them become more sustainable, comprehensive and equitable across the province;
- Encourage engagement by physicians, primary care services, mainstream agencies and Health Authorities to work with and support local communities with resources, advice, mobile and outreach services and specialist(s)
- Support workforce development for all communities in this area
- Support the adaptation of evidence-based models of care for application by communities as they see fit
- Recognize the importance of resourcing cultural interventions to build up protective factors in the population
- Recognize the important of resourcing comprehensive service teams for all communities in an equitable manner across the province
- Be supported by evidence-based best practice and evaluation
Specific Health Actions from the TCA: FNHP and TFNHP
TCA # 7 – Lead the development of a specific Aboriginal ActNow program
TCA # 12 – Improve primary care services on reserve to match or exceed off-reserve services
TCA # 13- Improve the First Responder program in rural and remote communities
TCA # 14 – Introduce campaign to raise awareness on seatbelt use and safe driving
TCA # 17 – Implement a northern region chronic disease management pilot
TCA # 22 – Introduce integrated primary health services and self-management programs for chronic health conditions
TFNHP – Develop and implement an Injury prevention strategy
NEW (2008) – Develop and implement an HIV/AIDs strategy
NEW (2008) – Support pandemic planning in First Nations communities (including H1N1)
NEW (2009) – Support and advocate for Traditional Medicines and Practices