Why should we be concerned? Health of Aboriginal People in Canada. What are the stats? Relation to other vulnerable groups

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1 Why should we be concerned? Health of Aboriginal People in Canada David Burman CCNM October 225 th 2005 The health of the most vulnerable groups is an indicator of the health of the society as a whole. Just as a person cannot be healthy if an aspect of their being is unwell, when there is great disparity in wealth and health status within a population, it is an indication that the whole society is unwell. Relation to other vulnerable groups The elderly, children, immigrants (especially of visible minorities) are all more vulnerable to illness than the majority population. By taking the case of the most vulnerable, comparisons can be drawn to generalize to other groups. For example, while children are vulnerable, the vulnerability of Aboriginal children is much greater. What are the stats? Although improvements have been achieved, the health status of Aboriginal peoples in Canada continues to lag behind that of other Canadians. Special Meeting of First Ministers and Aboriginal Leaders Ottawa, Ontario - September 13, XIE/health.htm Comparison of self-rated health between First Nations People and all Canadians Health of the Off-Reserve Aboriginal Population Aboriginal people who live off-reserve in cities and towns are generally in poorer health than the non-aboriginal population, according to a first-ever study using new data from the 2000/01 Canadian Community Health Survey (CCHS). 1

2 Health of the Off-Reserve Aboriginal Population The study compared the off-reserve Aboriginal population with the non- Aboriginal population on the basis of four health status measures: self-perceived health, chronic conditions, long-term activity restriction and depression. The gap between reported health for Aboriginal and for non-aboriginal people persisted at all income levels. Health of the Off-Reserve Aboriginal Population All data were age-standardized and compared with findings for the non-aboriginal population. Data were also adjusted for differences in socioeconomic and health behaviour factors The study found that inequalities in health persisted between Aboriginal people who lived off-reserve and other Canadians after socioeconomic and health behaviour factors were taken into account. Health of the Off-Reserve Aboriginal Population Excellent or very good self-rated health status, Canada, 2001 When a range of behaviours such as smoking, obesity and heavy drinking, more prevalent in the off-reserve Aboriginal population, were taken into account, offreserve Aboriginal people were still 1.3 times more likely than non-aboriginal people to report fair or poor health. Self reported fair or poor health Determinants of self reported health status of Aboriginal people (NAHO, not age standardized) 2

3 Chronic diseases Among the adult population, 19.3% of the non-reserve Aboriginal population reported arthritis or rheumatism, nearly twice the proportion of 11% among the total Canadian population. Similarly, 12.0% of the Aboriginal population reported high blood pressure, compared with 8.7% among the total population, while 11.6% of the Aboriginal population reported asthma, slightly higher than the 10.3% for the total population. Comparison of chronic conditions: off rez Aboriginal/ total Canadian Aboriginal Canadian arthritis/rheumatism hyperstension asthma Chronic conditions, Aboriginal identity nonreserve population, 15 years and over, Canada, 2001 Diabetes prevalence Access to needed medical care First Nations respondents were moderately more likely to have experienced an occasion, in the previous year, when they did not receive needed health care, than the Canadian population in general. Access to care Eighteen per cent (18 per cent) of First Nations respondents in the NAHO poll, 18 years of age and older, reported they had not obtained needed health care. In comparison, 12.5 per cent of the Canadian population, 12 years of age and older, surveyed as part of the CCHS reported they had not received needed health care in the previous 12-month period. Figures have not been adjusted for the differences in sample age groups. 3

4 First Nations People and all Canadians who reported not receiving needed health care in the previous year. Access to care For almost one-half of First Nations respondents (47 per cent) who said they did not receive needed health care in the previous year, the care in question dealt with a physical health problem. For 23 per cent, it dealt with a regular medical visit. For 12 per cent, it was for an injury. And for seven per cent, it was a mental health problem. Contact with health professionals, Aboriginal identity non-reserve population, 15 years and over Why the disparity? Economic Among Aboriginal people in metropolitan areas, 41.6% were living in low income (2004), more than double the national average for metropolitan areas. 07a.htm Although even when income is controlled for, Aboriginal people still had poorer health status Determinants of economic disparity To understand why Aboriginal peoples have been marginalized economically, socially and politically (in other words, disempowered), we need to look at history. Impact of disease From estimated 500,000 people before contact, to just over 100,000 by In northern Canada, the major impact of the disease epidemics came later Until the 1930s, children in residential schools were kept in unsanitary, crowded conditions, rife with TB Dead or dying children were returned to their families to spread the disease further 4

5 Royal commission on Aboriginal Peoples, 1995 The transformation of Aboriginal people from the state of good health that had impressed travellers from Europe to one of ill health, for which Aboriginal people were (and still are) often held responsible, grew worse as sources of food and clothing from the land declined and traditional economies collapsed. It grew worse still as once-mobile peoples were confined to small plots of land where resources and opportunities for natural sanitation were limited. It worsened yet again as long-standing norms, values, social systems and spiritual practices were undermined or outlawed Royal commission on Aboriginal Peoples, 1995 Traditional healing methods were decried as witchcraft and idolatry by Christian missionaries and ridiculed by most others. Ceremonial activity was banned in an effort to turn hunters and trappers into agricultural labourers with a commitment to wage work. Eventually, the Indian Act prohibited those ceremonies that had survived most defiantly, the potlatch and the sun dance. Many elders and healers were prosecuted. In these ways, Aboriginal people were stripped of selfrespect and respect for one another. (RCAP, Vol. 2:113) Spiritual demoralization Loss of annual cycle of ceremonies marking the critical passages of life and significant religious observances which served as a constant reminder to participants of spiritual purpose, moral boundaries, duties and responsibilities to self and to the community, and the sacredness of life. Spiritual demoralization When this framework was removed and not replaced with anything that effectively achieved the same goals, many people were uprooted from the very foundations of healthy living with no guidance and no idea where to turn for guidance. Perhaps this was the greatest loss of all. Spiritual demoralization Coercive conversions to Christianity introduced spiritual and cultural selfdoubt and distrust of one's own experiences, traditional wisdom, teachings and ways of understanding the world. Economic marginalization Traditional economies shifted from mutual responsibility and sharing as a prime value to individualized wealth and poverty. The Indian Act (1871) made Aboriginal people wards of the state, which set the stage for later welfare dependency. 5

6 Cultural diminishment Education used as a tool to Europeanize Aboriginal people Based on belief that Aboriginal cultures, spirituality and language were primitive and inferior. Assimilation was the conscious goal of education. Native people were to become absorbed into the dominant culture. They would cease to exist as distinct cultural entities. Cultural diminishment When churches convinced government to make education mandatory, whole generations of children were sent away to residential schools Often forbidden to see their parents until they were dead or dying of TB. Social ostracism Many children learned to be ashamed of their own identity, and to distrust and disbelieve in the value of the traditional past. Cut off from their own past and Native identity but not accepted in the white world, many of these children grew up caught "between two worlds." Social ostracism Traditional community norms and boundaries were never internalized in these children. They never learned traditional concepts of respect and how to view everything as "relations." Wide-spread physical and sexual abuse were introduced into the behaviour patterns. Social ostracism Powerlessness leads to internalized rage expressed as depression, substance abuse and violence Coercive removal from parents to residential schools led to generations without effective parenting, perpetuating the cycle of despair So, what s being done? The seeds of trust and awakening were always present, planted by wise elders generations before, in stories, songs, ceremonies, and sacred teachings. Much of those old ways had gone underground because of religious and legal persecution as well as political repression. 6

7 Revival of traditional teachings Young people are seeking spiritual teachers from across the continent to spread teachings to communities that had lost their own Aboriginal spiritual teachings and practices Sometimes, as the teachings and songs of another nation were introduced into a community, the elders would begin to share their own heritage which they had hidden away in their hearts for so many years. Every elder has one or several teachers Addictions and human potential movement 12 step programs Strategies addressing substance abuse, sexual abuse, family violence Meditation, yoga, other eastern healing practices Health promotion Healthy communities Access to traditional healers According to CCHS about 31% of the nonreserve Aboriginal population had access to First Nations, Métis or Inuit traditional medicines, healing or wellness practices in their city, town or community, according to the 2001 APS. The highest percentage was found in urban areas, where 34% of the population reported having access to traditional medicines, compared with 26% in rural areas and 14% in the Canadian Arctic. Access to traditional healers While one-third of the urban Aboriginal population reported having access to traditional healing practices, just as many reported that they did not know if such health practices were available in their community. Access to traditional healers About 7% of the urban Aboriginal population had contacted a traditional healer about their physical, emotional or mental health in the 12 months prior to the survey. Government programs The Canadian Diabetes Strategy, announced in the 1999 Federal budget, created a five year, $115 million strategy to begin to deal with the issue of diabetes. Over the five years, $58 million has been allocated to the Aboriginal Diabetes Initiative (ADI) to begin to address the epidemic of diabetes in Aboriginal communities. Focusses on diet, exercise, lifestyle promotion hc-sc gc ca/fnihb- 7

8 Aboriginal Head Start A Health Canada Program to address educational and economic determinants of health Works within the holistic of the medicine wheel: balance of the physical, emotional, mental, and spiritual aspects of wellbeing AHWS The Aboriginal Healing and Wellness Strategy promotes a culturally appropriate approach to healing and wellness. It is unique in Canada, and has become a source of innovative expertise in Aboriginal healing and health services across North America. Conclusion By understanding the historical, political, economic and social determinants of a population s health status, we can begin to be effective as doctors and healers. We can then apply these determinants of health to other groups. Without these understandings, we risk inadvertently doing harm. 8