1. Manitoba First Nations: Health & Health Care in an Aboriginal Population Patricia J. Martens & Ruth-Ann Soodeen MANITOBA CENTRE FOR HEALTH POLICY Winnipeg, Manitoba, Canada

2. This lecture is based on the report, The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study by: Patricia J. Martens, Ruth Bond, Laurel Jebamani, Charles Burchill, Noralou Roos, Shelley Derksen, Marcella Beaulieu, Carmen Steinbach, Leonard MacWilliam, Randy Walld, Natalia Dik, Doreen Sanderson & the Health Information and Research Committee of AMC, Marilyn Tanner-Spence, Audrey Leader, Brenda Elias, & John O’Neil MANITOBA CENTRE FOR HEALTH POLICY Winnipeg, Manitoba, Canada

3. Collaborators Assembly of Manitoba Chiefs –Collaborative working group –Chief’s Health Committee Health Information and Research Committee Centre for Aboriginal Health Research (CAHR) Manitoba Health First Nations and Inuit Health Branch of Health CanadaFirst Nations and Inuit Health Branch of Health Canada Indian and Northern Affairs Canada (INAC) Work done at the Manitoba Centre for Health Policy

4. Key Terms Registered First Nations First Nations Community Tribal Council (TC) Regional Health Authorities (RHAs)

5. DOTC ILTC IRTC KTC SCTC SERDC WRTC DOTC  ILTC  IRTC  KTC  SCTC  SERDC  IN-N  IN-S  WRTC  Burntwood Norman Interlake Parkland North Eastman Central Marquette Churchill South Westman South Eastman 80080160Kilometers WinnipegBrandon

6. Data Sources Health care administrative data (Fiscal years April 1 1994 - March 31, 1999) Vital Statistics - (1995-1999) Census Data (1996) Publicly-available reports from Indian & Northern Affairs Canada (INAC) Status Verification System (SVS) Files (1994/95-1998/99)

7. Key Measures 1. Health status 2. Burden of disease 3. Preventive care 4. Use of physician & hospital services

8. 1. Health Status Indicators 1. Life expectancy at birth Most common measure 2. Premature mortality rate (PMR) Death before age 75 3. Potential years of life lost (PYLL) Similar to premature mortality but gives greater weight to death of a younger person

9. Key findings 1. Life Expectancy at Birth RFN = 8 years less than for all other Manitobans –males 68 yrs vs. 76 yrs; females 73 yrs vs. 81 yrs 2. Premature Mortality Rate Twice as high for RFN vs. all other Manitobans –6.6 deaths per 1000 RFN versus 3.3 for all other MB 3. Potential Years of Life Lost Higher risk for RFN –male RFN = 2.5 X higher (158 vs. 63 yrs/1000) –female RFN = 3 X higher (103 vs. 36 yrs/1000)

10. 2. Burden of Disease Two measures of illness & injury: 1. Diabetes - occurs when pancreas doesn’t produce enough insulin, when cells stop responding to the insulin, or temporarily during pregnancy; glucose in the blood cannot be absorbed into the body’s cells 2. Injuries - physical damage usually inflicted on the body by external force

11. Key findings 1. Diabetes Treatment Prevalence 4.2 times higher for RFN vs. all other Manitobans (18.9% vs 4.5%) Amputation rates - population prevalence is 16 times higher for RFN 2. Injury hospitalizations 3.7 times higher for RFN compared with all other Manitobans RFN 32% due to violence by others and to self (vs. 10% for all other Manitobans)

12. 3. Preventive Care 1. Childhood immunization - at ages one and two years of age 2. Mammography - for women between 50 and 69 years of age 3. Breastfeeding - at hospital discharge for newborns

13. Key findings RFN vs. all other Manitobans: Lower immunization rates Lower mammography rates Lower newborn breastfeeding rates

14. 4. Physician & Hospital Services Physician Services Ambulatory visits Consults Physician type: –General –Specialist Visit location Hospital Services Hospital separations Length of stay Hospital Location We examined use (in terms of rates) of several physician and hospital services.

15. Key findings Physician visit rates 6.1 visits per person per year for RFN (probably understated) versus 4.9 for all other Manitobans Consult rates only slightly higher for RFN compared to all other Manitobans Specialist visit rates urban areas have very high rates, but slightly lower for RFN in Winnipeg In some RHAs, RFN rates are comparatively higher than other RHA residents

16. Key findings Hospital use Double the hospitalization rates 1.7 times the total days of hospital care Location of hospitalizations varies considerably Procedure rates RFN have higher or similar heart-related surgery rates compared to all other MB

17. Summary of Key Findings Health status of Registered First Nations people (RFN) is much poorer Big differences in health across Tribal Council areas Higher overall use of physicians and hospitals reflect poorer health status of RFN Preventive care rates are lower for RFN

18. Health of RFN people - not a good story: lower life expectancy more injury-related hospitalizations higher prevalence of diabetes How do we improve their health status? Are more hospitals needed? More doctors? Is there any “right” answer? Final Thoughts

19. Where do we go from here? ? ? ? ? ?