1. From Visions to Actions: Social Determinants of Aboriginal Health Forum II Thursday, February 19th, 2009 Dr. Evan Adams Aboriginal Health Physician Advisor Office of the Provincial Health Officer BC Ministry of Health Living & Sport, and Director Division of Aboriginal People’s Health, UBC Faculty of Medicine

3. The Report of the Royal Commission on Aboriginal Peoples concluded: “Aboriginal people are at the bottom of almost every available index of socioeconomic well-being, whether [they] are measuring educational levels, employment opportunities, housing conditions, per capita incomes or any of the other conditions that give non-Aboriginal Canadians one of the highest standards of living in the world.”

4. The Social Determinants of Indigenous Health Poverty Education Housing Self-determination Culture Land, Environment, Environmental Stewardship Gender Family & Child Welfare An Overview of Current Knowledge of the Social Determinants of Indigenous Health (Commission on Social Determinants of Health, WHO)

6. Historical factors profoundly affecting health 1/2  The Reservation system  Lost traditional territory  Lost fishing and hunting sites  Lost water rights  Loss of fishing and hunting stocks  Dominance of Canadian foods  Alcohol, cigarettes, drugs  Hygiene

7. Historical factors profoundly affecting health 2/2  Overcrowding  Stress  Decreased social and family structure  Decreased wealth  Increased Church control  Decreased economic power  Decreased political power

9. The Residential School System & Health  Exposure to disease  Overwork  Underfeeding  Overcrowding  Physical abuse  Cultural abuse  Emotional abuse  Assimilation  Punitive religiosity  Separation from parents

11. Microaggressions Concepts Being asked if you are “really Aboriginal” by a non- Aboriginal person? Being asked regularly about negative stereotypes around taxes, free housing, treaties, etc. Feeling “invisible” to non- Aboriginal people, at work, at school, in public? Feeling compelled to teach basic history to non-Aboriginal people to make your viewpoint heard? Being asked to change your appearance, practices or apparel by your employer or agency Hearing from non-Aboriginal people how surprisingly articulate, well-read, or good your language skills are? Hearing discussions by persons in authority about Aboriginal people in a negative light Being asked directly – usually indirectly – if you deserve to be here

12. First Nations & Inuit Health Program (federal) Health Canada's role in First Nations and Inuit health goes back to 1945, when Indian health services were transferred from Indian Affairs. In 1962, Health Canada provided direct health services to First Nations people on reserve and Inuit in the north. By the mid 1980s, work began to have First Nations and Inuit communities control more health services.

13. Provincial Role Health care services include insured primary health care (such as the services of physicians & some other health professionals) & care in hospitals The provinces & territories also provide some services & benefits not covered by the Act, such as prescription drug coverage, ambulance services, home care, public health, long term care, etc. Delegations of resources & authority to the health authorities

14. Community Role “Transferred” services with heavy admin burden Band administration with revolving leadership Social & economic dev’t departments Embracing traditional heritages to varying degrees Neighbouring communities with competing & similar interests (e.g. water, land, medical services) Local “social net” with variable functionality

16. BC First Nations First Nations Leadership Council First Nations Health Council * BC Assembly of First Nations First Nations Summit Union of BC Indian Chiefs FNLC – Health Lead, Grand Chief Ed John Ex-Officio *Responsible for assisting in TFNHP implementation including capacity building, service and program delivery and support to First Nations Communities

17. Closing the Gap TRIPARTITE FIRST NATIONS HEALTH PLAN

18. Tripartite First Nations Health Plan A 10-year health plan (June 2007 to May 2017) that builds on the TCA Articulates a shared vision between the federal, provincial and First Nations partners Principles include trust, recognition & respect for Aboriginal rights & title, commitment to action, nurturing the relationship, and transparency 18

19. DIALOGUE: GATHERING WISDOM FORUM Key Messages:  Vision of Wellness - embracing all aspects of wellness of the individual, family and community.  Cultural, Holistic approach to health - need paradigm shift from the western medical model of health  Community-driven process - support what is already happening in communities – increase connections between communities. Increased desire for community input.  Common challenges - lack of resources – qualified workers and funding  Need for Communication - transparent and easily accessible communication 19

20. 2 nd Report on Health and Well-being of Aboriginal Population in BC Pathways to Health and Healing 2007 Provincial Health Officer’s Annual Report (Release date: April 2009)

21. The Social Determinants of Indigenous Health Culture Self-determination Land, Environment, Environmental Stewardship Poverty Education Gender Housing Family & Child Welfare An Overview of Current Knowledge of the Social Determinants of Indigenous Health (Commission on Social Determinants of Health, WHO)

22. Solutions - A role for: Clinicians Cultural workers Community-based workers Research Academia Public health Leadership Families A policy of formal consultation? 22

23. Solutions - What Actions Can We Take? Individuals and families can: Actively oppose racism. Find out more about self-governance and other self- determination issues. Invest in educational opportunities. Help monitor those at-risk, maximize self-regulation, autonomy & connectedness Aboriginal communities and organizations can: Work together to overcome disadvantages of small community size, for example, by forming institutional cooperatives to achieve economies of scale. Support local housing initiatives Research the meanings, barriers & protective factors in housing & environment 23

24. Solutions - What Actions Can We Take? Employers can: Examine hiring practices to ensure equality of opportunity. Raise the minimum wage. Support families, women, and lesser skilled workers with fair practices. Educators can: Develop & support culturally-relevant curricula. Engage communities in school activities. Connect with disadvantaged and disconnected youth. Examine admissions, & support services to ensure equality of opportunity. Protect equality and equity. 24

25. Solutions - What Actions Can We Take? Governments and communities can: facilitate the removal of structural impediments to economic development in First Nations Communities. Set clear, measurable goals for employment, income, and education levels of Aboriginal people equal to those within the general population, along with methods for public reporting of results. Support efforts by Aboriginal people to achieve self- determination and a collective sense of control over their futures, in both on- and off-reserve communities. 25

26. Solutions - What Actions Can We Take? Governments and communities can: Invest in adult education opportunities, skills upgrading, training, job preparation, financial assistance for work and work clothing, child care, and stable affordable housing. Ensure that effective programs are in place to support those who have suffered abuse. Encourage participatory research to gain a clearer understanding of the relationship between socio- economic conditions and the health of Aboriginal communities. 26

27. Solutions - What Actions Can We Take? SPEAK UP SHARE COLLABORATE PLAN TAKE ACTION AND MANY OTHERS... 27

28. CONTACT INFORMATION Evan Adams, MD, Aboriginal Health Physician Advisor Ministry of Healthy Living & Sport Office of the Provincial Health Officer evan.adams@gov.bc.ca 250-952-1330