an introduction to aboriginal health: what determines aboriginal health in canada and around the...

An Introduction to An Introduction to Aboriginal Health: What Aboriginal Health: What

Determines Aboriginal Health Determines Aboriginal Health in Canada and Around the in Canada and Around the

World?World?

Brown Bag Speaker Series on Aboriginal HealthBrown Bag Speaker Series on Aboriginal HealthOctober 14, 2010October 14, 2010

Centre fro Aboriginal Health ResearchCentre fro Aboriginal Health Research

Jeff Reading PhDJeff Reading PhDProfessor and Director,Professor and Director,

Centre for Aboriginal Health ResearchCentre for Aboriginal Health ResearchSchool of Public Health and Social PolicySchool of Public Health and Social Policy

University of VictoriaUniversity of Victoria

Chronic DiseasesChronic Diseases

In 2005 of the 58 million deaths worldwide In 2005 of the 58 million deaths worldwide approximately 60% were due to chronic approximately 60% were due to chronic diseasesdiseases

4 out of 5 deaths will be in low and 4 out of 5 deaths will be in low and middle income countriesmiddle income countries

In these countries people tend to develop In these countries people tend to develop diseases younger, suffer longer, and die diseases younger, suffer longer, and die sooner sooner

Chronic DiseasesChronic Diseases

In Canada Aboriginal people face a similar In Canada Aboriginal people face a similar situationsituation Earn less than the non-Aboriginal Earn less than the non-Aboriginal

populationpopulation Suffer from higher rates of many chronic Suffer from higher rates of many chronic

diseases and associated risk factorsdiseases and associated risk factors Have a shorter life expectancyHave a shorter life expectancy

Internationally Canada ranks highly in Internationally Canada ranks highly in health and well being, while the health and well being, while the Aboriginal population is much less Aboriginal population is much less fortunatefortunate

DiabetesDiabetes

Historically of low prevalence in the Historically of low prevalence in the Aboriginal populationAboriginal population

Changes in lifestyle and diet, adoption of Changes in lifestyle and diet, adoption of Western habits has resulted in an increase Western habits has resulted in an increase in diabetesin diabetes

Similar trajectory to Cardiovascular Similar trajectory to Cardiovascular Disease and other chronic conditionsDisease and other chronic conditions

Diabetes Risk factorsDiabetes Risk factors

Not all risk factors have been well Not all risk factors have been well studied in the Aboriginal populationstudied in the Aboriginal population

Less is known about risk factors in the Less is known about risk factors in the urban Aboriginal population urban Aboriginal population

Chronic Disease Risk Chronic Disease Risk FactorsFactors

The most common risk factors for Chronic The most common risk factors for Chronic disease studied among Aboriginals are: disease studied among Aboriginals are: Impaired glucose tolerance (IGT); Impaired glucose tolerance (IGT); Type 2 diabetes; Type 2 diabetes; Obesity (over-eating and lack of exercise);Obesity (over-eating and lack of exercise); Cigarette smoking.Cigarette smoking.

Diabetes Risk FactorsDiabetes Risk Factors

Diabetes prevalence is much higher in the Diabetes prevalence is much higher in the Aboriginal population than the non-Aboriginal population than the non-Aboriginal populationAboriginal population

Diabetes occurs at a much younger ageDiabetes occurs at a much younger age

Incidence is increasingIncidence is increasing

Diabetes Prevalence Diabetes Prevalence RatesRates

25-3435-44

45-5455-64

65+

Can-M

Can-F

FN-M

FN-F

0

5

10

15

20

25

30

35

40

45

%

Age

Diabetes

First Nations and Labrador Inuit to the Canadian Population,Age-gender-specific prevalence (%)

(Source: FNIRHS Steering Committee & Canadian data from the NPHS, 1994/95)

Can-M

Can-F

FN-M

FN-F


25-3435-44

45-5455-64

65+

Can-M

Can-F

FN-M

FN-F

0

5

10

15

20

25

30

35

40

45

%

Age

Diabetes

First Nations to the Canadian Population,Age-gender-specific prevalence (%)

(Source: RHS 2002/03 & CCHS 2001)

Can-M

Can-F

FN-M

FN-F


Diabetes

First Nations to the Canadian Population,Age-gender-specific Difference in Prevalence (%)

(Source: FNIRHS & NPHS, 1994/95 to RHS 2002/03 & CCHS 2001)

-5

0

5

10

15

20

25-34 35-44 45-54 55-64 65+

Age

%

Can-M

Can-F

FN-M

FN-F


46% of First Nations people are daily 46% of First Nations people are daily smokerssmokers

This rises to 54% in the 18-29 age group This rises to 54% in the 18-29 age group and if occasional smokers are included and if occasional smokers are included rises to 70%rises to 70%


In youth the rates are also very highIn youth the rates are also very high Occasional and daily smokers 16 years of Occasional and daily smokers 16 years of

ageage 44% male and 67% female44% male and 67% female

Occasional and daily smokers 17 years of Occasional and daily smokers 17 years of ageage 56% male and 67% female56% male and 67% female


From the 2002/03 Regional Health SurveyFrom the 2002/03 Regional Health Survey 42% of men and 31% of women are overweight42% of men and 31% of women are overweight 29% of men and 34% of women are obese29% of men and 34% of women are obese 3% of men and 7% of women are morbidly 3% of men and 7% of women are morbidly

obeseobese


According to the 2002/03 Regional Health According to the 2002/03 Regional Health Survey First Nations peoples self reported Survey First Nations peoples self reported rate of hypertension rate of hypertension 20.4% vs. 16.4% in the non-Aboriginal 20.4% vs. 16.4% in the non-Aboriginal

populationpopulation In the 50-59 age group this rises to 30.5% In the 50-59 age group this rises to 30.5%

vs. 22.4%vs. 22.4%

Adult Risk FactorsAdult Risk Factors

Attempts to address problems of chronic Attempts to address problems of chronic diseases usually focuses on changing diseases usually focuses on changing patterns of adult risk factorspatterns of adult risk factors

Unfortunately this does not address the Unfortunately this does not address the next generation and prevention of chronic next generation and prevention of chronic diseasedisease

Life Course Life Course EpidemiologyEpidemiology

Life course epidemiology has been defined Life course epidemiology has been defined as the study of long-term effects of as the study of long-term effects of physical or social exposures during physical or social exposures during gestation, childhood, adolescence, young gestation, childhood, adolescence, young adulthood, and adult life on one’s adulthood, and adult life on one’s developmental health and later disease developmental health and later disease risk risk

Diabetes, Chronic Disease and Diabetes, Chronic Disease and Life Course EpidemiologyLife Course Epidemiology

Life course epidemiology goes beyond Life course epidemiology goes beyond traditional risk factors and questions the traditional risk factors and questions the importance of intrauterine nutrition, importance of intrauterine nutrition, birth weight, childhood obesity, smoking birth weight, childhood obesity, smoking initiation ages and rates, adolescent initiation ages and rates, adolescent blood pressure, and socioeconomic status blood pressure, and socioeconomic status across an individual and community’s life across an individual and community’s life course. course.

Life Course Life Course InterventionIntervention

The Goal:The Goal:

To optimize the developmental trajectory To optimize the developmental trajectory over entire life courseover entire life course

Life Course Life Course InterventionIntervention

What matters:What matters:

Address the complex interaction of health Address the complex interaction of health determinants, in particular Aboriginal determinants, in particular Aboriginal contexts, over entire life coursecontexts, over entire life course

Life Course Risk Life Course Risk FactorsFactors

Birth weightBirth weight Low birth weight has been associated with Low birth weight has been associated with

an increased risk of heart disease and an increased risk of heart disease and hypertensionhypertension

Low or high birth weight has been Low or high birth weight has been associated with increased risk for diabetesassociated with increased risk for diabetes

First Nations babies are twice as likely to First Nations babies are twice as likely to be high birth weight babiesbe high birth weight babies


Maternal DiabetesMaternal Diabetes Gestational diabetes rates are higher in Gestational diabetes rates are higher in

Aboriginal womenAboriginal women Children born to diabetic mothers are at Children born to diabetic mothers are at

increased risk for impaired glucose increased risk for impaired glucose tolerance, childhood obesity, and diabetestolerance, childhood obesity, and diabetes


Childhood and adolescent obesityChildhood and adolescent obesity Increases the risk for adult obesityIncreases the risk for adult obesity

Aboriginal children are lacking in sports Aboriginal children are lacking in sports and recreation facilities in their and recreation facilities in their communitiescommunities

Social Determinants Social Determinants of Healthof Health

That population level factors which That population level factors which determine health and well-being for any determine health and well-being for any collectivity have their origins in collectivity have their origins in upstream historic, cultural, social, upstream historic, cultural, social, economic and political forces affecting economic and political forces affecting the lives of Indigenous peoples, has been the lives of Indigenous peoples, has been articulated for almost a decade. articulated for almost a decade.

* Young, 1988; Young, 1994; INAC, 1996. * Young, 1988; Young, 1994; INAC, 1996.

Many determinants of health are Many determinants of health are beyond the scope of the health beyond the scope of the health

care system:care system:

Changing diets from traditional to non-Changing diets from traditional to non-traditional foodstraditional foods

Food insecurityFood insecurity

Stress due to economic factorsStress due to economic factors

PollutionPollution

Global capitalism etc...Global capitalism etc...

A word about WordsA word about Words

Social ExclusionSocial Exclusion

MarginalizationMarginalization

InequalityInequality

RiskRisk

VulnerabilityVulnerability

Social Determinants Social Determinants of Healthof Health

The social determinants are often referred The social determinants are often referred to as the “causes of the causes” to as the “causes of the causes”

Affect rates of individual level risk Affect rates of individual level risk factors such as smoking, obesity, factors such as smoking, obesity, substance abusesubstance abuse

Social determinants require social remediesSocial determinants require social remedies

END POVERTYEND POVERTY NOW!! NOW!!

Poverty eradication as the most important Poverty eradication as the most important determination of health, because it is determination of health, because it is through income that other determinants of through income that other determinants of health are purchased, such as adequate health are purchased, such as adequate housing, access to health services and housing, access to health services and education, potable water and nutritious education, potable water and nutritious food etc.food etc.

% Experiencing Major depressive Episode by % Experiencing Major depressive Episode by household Low income level and off-reserve household Low income level and off-reserve

health status*health status*

* * Charlotte Loppie Reading and Fred Wein, Health Inequities and Charlotte Loppie Reading and Fred Wein, Health Inequities and Social Determinants of Aboriginal peoples Health. NCCAD, PHAC, Social Determinants of Aboriginal peoples Health. NCCAD, PHAC, 20092009

% Experiencing Major depressive Episode by % Experiencing Major depressive Episode by household Low and High income level and off-household Low and High income level and off-

reserve health status*reserve health status*

* * Charlotte Loppie Reading and Fred Wein, Health Inequities and Charlotte Loppie Reading and Fred Wein, Health Inequities and Social Determinants of Aboriginal peoples Health. NCCAD, PHAC, Social Determinants of Aboriginal peoples Health. NCCAD, PHAC, 20092009

LowMediumHigh

Social Determinants of Social Determinants of HealthHealth

Many studies have demonstrated a Many studies have demonstrated a connection between socioeconomic status connection between socioeconomic status and healthand health

Aboriginal population has lower levels of Aboriginal population has lower levels of education, income, and employmenteducation, income, and employment

These conditions are associated with These conditions are associated with increased rates of obesity, chronic increased rates of obesity, chronic conditions and diabetesconditions and diabetes

Social Determinants of Social Determinants of HealthHealth

Can observe a health gradient within the Can observe a health gradient within the Aboriginal population - poorer health Aboriginal population - poorer health associated with lower SESassociated with lower SES

Effects of colonialismEffects of colonialism

Effects of residential school systemEffects of residential school system

Demographic TrendsDemographic Trends

Aboriginal population is much younger than Aboriginal population is much younger than the rest of Canadathe rest of Canada

Risk factors are more prevalent and Risk factors are more prevalent and increasing and occurring in ever younger increasing and occurring in ever younger Aboriginal peopleAboriginal people

As the youthful Aboriginal population ages As the youthful Aboriginal population ages increased rates and numbers of people with increased rates and numbers of people with diabetes and chronic conditions disease diabetes and chronic conditions disease can be expectedcan be expected

ActionsActions

Seek commitment to a multi-year dialogue to explore common Seek commitment to a multi-year dialogue to explore common issues and agendas for action in Aboriginal health and issues and agendas for action in Aboriginal health and well being.well being.

Facilitate and accelerate the dissemination, transfer and Facilitate and accelerate the dissemination, transfer and translation of knowledge into potential applications and translation of knowledge into potential applications and benefits through policies, interventions, services and benefits through policies, interventions, services and products. products.

Encourage multi-lateral collaborative ventures among Encourage multi-lateral collaborative ventures among communities and institutions concerned with improving the communities and institutions concerned with improving the health and well being of Indigenous peoples. Promote health and well being of Indigenous peoples. Promote multi-disciplinary, multi-institutional, and multi-multi-disciplinary, multi-institutional, and multi-sectored collaborations and to build upon existing sectored collaborations and to build upon existing networks of policy-makers and researchers to further networks of policy-makers and researchers to further develop capacities on Indigenous peoples’ health in areas develop capacities on Indigenous peoples’ health in areas of mutually shared priorities. of mutually shared priorities.

ConclusionConclusion

A plethora of health indicators A plethora of health indicators demonstrate that Aboriginal Peoples’ in demonstrate that Aboriginal Peoples’ in Canada endure a profound public health and Canada endure a profound public health and socioeconomic burden when compared to socioeconomic burden when compared to mainstream populations.mainstream populations.

Such a pattern is observed globally as Such a pattern is observed globally as Aboriginal populations are the poorest of Aboriginal populations are the poorest of the poor and correspondingly vulnerable to the poor and correspondingly vulnerable to high rates of preventable disability, high rates of preventable disability, disease and premature death.disease and premature death.

How to Contact UsHow to Contact Us

If you would like to visit our website and If you would like to visit our website and sign up for our mailing list please visit: sign up for our mailing list please visit: http://cahr.uvic.ca

Recordings of the entire “Brown Bag Recordings of the entire “Brown Bag Aboriginal Health Speaker Series” will be Aboriginal Health Speaker Series” will be posted online on our websiteposted online on our website

(for our online viewers if you would like (for our online viewers if you would like to fill out a feedback form and be entered to fill out a feedback form and be entered in our draw please email Bianka at in our draw please email Bianka at [email protected])[email protected])

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