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
The Transformative Change Accord: First Nations Health Plan (TCA:FNHP) of 2005 and the Tripartite First Nations Health Plan of 2007 set out a number of
commitments to action, agreed by the Federal and Provincial Governments and First Nations leaders. As many will know there were 29 specific action items in the
TCA:FNHP and a further number of actions agreed when the Federal Government signed on to create the TCA:FNHP. These commitments to action were grouped
into two main areas – Governance actions and Health Actions. The governance actions relate primarily to increasing First Nations decision-making in health while
the “Health Actions” relate primarily to system transformation through improving health services for First Nations.
Furthermore, it was agreed between management representatives of the 3 partners, that there should be a consistent approach taken to advancing the action
items in each cluster of work so three principles for the work were agreed:
• Increase First Nations decision-making
• Ensure all Tripartite Partner (representatives) are at the table
• Promote systemic change: change services in a way that is sustainable and
improves the system on a long term basis.
In order to begin strategic discussions each of the three partners committed senior level personnel to form Strategy tables for each of the 6 areas. On each table there
are First Nations and Inuit Health, Provincial and IFNHA managers. The report below is an update on the “Tripartite Strategy Council for Primary Care and Public
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
Primary Care & Public Health
The Vision for First Nations Tripartite Strategy Council for Primary Care & Public Health in British Columbia can be summarized as follows:
The Tripartite Strategy Council for Primary Care & Public Health will develop strategic methodologies which allow for the greatest degree of community relevancy for health planning and directives for BC First Nations. The Primary Care & Public Health Strategy Council will work with the various government agencies and First Nations to ensure that the expansive vision of primary and public health is “healthy families, healthy communities and a healthy nation.” A comprehensive framework will ensure a broad vision, endorsing a values shift to a commitment to the collective interest for BC First Nations families and communities.
The Tripartite Strategy Council for Primary Care & Public Health will establish the strategic direction for BC First Nations and shall include First Nations, Federal and Provincial representatives. The work of the Strategy Council shall align wherever possible and practical with current Federal and Provincial planning processes where they meet TFNHP objectives.
Health Lifestyles and Wellness Promotion
The vision for the Tripartite Aboriginal Healthy Lifestyles and Wellness Promotion Planning Committee, sub-section of the Tripartite Strategy Council for Primary Care & Public Health cluster, can be summarized as follows:
The Healthy Lifestyles and Wellness Promotion Planning Committee will identify and / or develop and support strategic methodologies which allow for the greatest degree of systematic change and improvement in chronic disease prevention and wellness promotion for and with BC First Nations communities. The Planning Committee is to work with BC First Nations and the government agencies to identify First Nations initiatives in chronic disease prevention and wellness promotion through promoting Healthy Lifestyles – that are collaborative in nature and well aligned with federal and provincial approaches and strategies, and which address the specific TCA: FNHP health action items which form the underlying focus of this Committee.
A key function of the Planning Committee shall align wherever possible with current Federal, Provincial, municipal and other related health governments planning processes to create strategic direction to set key policies to meet Tripartite First Nations Health Plan, Transformative Change Accord, and Framework Agreement objectives, as well as the 7 Directives from BC First Nations leadership:
1) Community-driven, Nation-based approach,
2) Increase First Nations decision-making and control
3) Improve services
4) Foster meaningful collaboration and partnership with stakeholders and BC First Nations
5) Ensure human and economic capacity with BC First Nations
6) Be without prejudice to First Nations interests
7) Support a high level of operational standards
Physicians, Nursing and Allied Health Planning Committee
The vision for First Nations Physicians, Nursing and Allied Health Planning Committee, sub-section of the Tripartite Strategy Council for Primary Care & Public Health cluster, can be summarized as follows:
The Physician Nursing and Allied Health Planning Committee will identify and /or develop and support strategic methodologies which allow for the greatest degree of systemic change and improvement in primary care for and with BC First Nations communities. The Planning Committee is to work with BC First Nations and the government agencies to identify First Nations initiatives in primary care that are collaborative in nature and well aligned with federal and provincial primary care reforms and strategies, and which address the specific TCA: FNHP health action items which form the underlying focus of this Committee.