1. Presentation to the CAOT June 13, 2008 First Nations and Inuit Health Branch: Program Overview and Communities in Crisis

2. 2 2007 Projected Registered Indian Population 131,910 8,347 127,533 105,592 17,743 72,565 178,080 130,335 33,645 Total: 805,750 Inuit Population (2007) is 48,700 across the four land claims regions: Inuvialuit, Nunavut, Nunavik, and Nunatsiavut

3. 3 Demographic Profile First Nations and Inuit Population 805,750 Projected Registered Indian population (2007) 48,700 Inuit population (2007) First Nations and Inuit population is 2.6% of Canada’s population Projected Average Annual Growth Rate compared to Canada overall ( 2001 to 2017) First Nations: 2.86 times higher Inuit: 3.3 times higher Young Population50% of First Nations are under 25 (Census 2006) 56% of Inuit are under 25 (Census 2006) Communities606 First Nations communities 90% of First Nations communities have a population of under 1000

4. 4 Health Status of First Nations and Inuit Gap in life expectancyRegistered Indians: 5 years (females); 7 years (males) Inuit: 11 years (females); 13 years (males) Infant MortalityFirst Nations infant mortality rate has been declining but remains higher than the Canadian rate HIV infectionsAboriginal Peoples account for an estimated 7.5% of all existing HIV infections in Canada (2005) Rate of DiabetesFN on reserve: 3.8 times higher than the general Canadian pop’n Inuit: 47% lower than the general Canadian population Leading Cause of Deaths in Children and Youths Injury (primarily suicide, motor vehicle collisions and fires) Rate of First Nations youth (10-19 years) suicide is 4.3X greater than for Canada in 2000; suicide rate for Inuit regions (1989- 2003) is 8.3x higher than for Canada

5. 5 Mandate of the First Nations and Inuit Health Branch (FNIHB) With respect to First Nations and Inuit: improving health outcomes; ensuring availability of, or access to, quality health services; and supporting greater control of the health system by First Nations and Inuit.

6. 6 FNIHB: Major Program Areas 1.Health Protection and Public Health 2.Primary Care 3.Community Programs 4.Non Insured Health Benefits (NIHB) Program

7. 7 1. Health Protection and Public Health Communicable Diseases: –communicable disease control and surveillance –HIV/AIDS; TB Environmental Health: –water quality monitoring on-reserve –mould inspections in housing on-reserve 2. Primary Care : Over 670 community health nurses; more than 70 nursing stations; 229 health centres, home care programs in 600+ communities

8. 8 3. Community Programs Mental Health and Addictions: –alcohol and drug prevention / promotion –alcohol and drug / youth solvent abuse in-patient treatment centres –youth suicide prevention Chronic Disease and Injury Prevention –Aboriginal Diabetes Initiative –nutrition and physical activity promotion Children and Youth –Maternal/Child Health –Aboriginal Head Start –Prenatal supports –FASD

9. 9 Aboriginal Diabetes Initiative (ADI) diabetes among First Nations reaching epidemic proportions -for FN/I 3 to 5 times national rates in 2006 $190M invested over 5 years in community-based diabetes initiatives ADI objective: reduce type 2 diabetes in Aboriginal pop’n thru: -promotion -prevention -screening -treatment -delivered mostly by trained community-based workers >600 FN/I communities are funded for ADI projects ~50 projects target Métis, off-reserve FNs and urban Inuit

10. 10 Payer of last resort for approx. 780,000 First Nation and Inuit beneficiaries for: 4. Non-Insured Health Benefits (NIHB)  drugs  medical supplies and equipment  dental  medical transportation  vision care  mental health counseling  provincial health care premiums (BC, AB),  co-insurance payment deductibles

11. 11 Draft Vision of Health Canada’s First Nation Communities in Crisis Initiative Through strategies aimed at strengthening community resilience, First Nation community wellness is enhanced (thereby minimizing the incidence of communities being at-risk or in crisis).

12. 12 Initial Plan of Action data collection analysis Expert Advisory Committee framework consultationdevelopment

13. 13 Data Collection literature reviews commissioned studies lessons learned from formal evaluations: watching brief on parallel initiatives community profiles

14. 14 Community Resilience as BALANCE among a set of categories of Determinants of Community Health self-determination economic development social development environmental development community development

15. 15 Examples of Determinants of Community Health Self-Determination control over local services and programs cultural continuity colonialism/dependence on govt. nature of justice system/ restorative justice Economic Development equitable distribution of household income diversity of economic resources in the community equitable distribution of economic opportunities/jobs in the community equitable distribution of economic “power” within families labour force capacity, ie. levels of educational attainment incidence of welfare recipients Social Development social capital traditional spirituality culture and language cultural safety overcoming the residential school experience / truth and reconciliation incidence of suicide and suicide ideation incidence of addictive & abusive behaviour Environmental Development sustainability existing or emerging human risk quality of water/sewage infrastructure quality of housing stock Community Development basic community capacities governance capacity leadership

16. 16 Social Development Desired outcomes (protective factors) Evidence-based strategiesApplicable circumstances high level of social capital at community level 1. 2. 3. low levels of suicide and addictions 1. 2. 3. high level of practice of traditional spirituality 1. 2. 3. high level of intergenerational transfer of traditional language 1. 2. 3.

17. 17 community development economic development environmental development social development spiritual physical mental emotional COMMUNITY RESILIENCE AS A BALANCE AMONG COMPONENTS OF THE MEDICINE WHEEL community self-determination continuum healing / wellness resilience

18. 18 thank you / merci