Ecosystem Health in Ecosystem Health in Northern Aboriginal Northern Aboriginal

Communities in Communities in ManitobaManitoba

Shirley ThompsonUniversity of ManitobaS_thompson@umanitoba.caSLESH conference 2006

QuestionQuestion Are sustainable livelihoods and Ecosystem Are sustainable livelihoods and Ecosystem

health approaches appropriate in Canada health approaches appropriate in Canada (for Northern Aboriginal Communities)?(for Northern Aboriginal Communities)?

AgendaAgenda

IntroductionIntroduction Health indicatorsHealth indicators Ecosystem healthEcosystem health Case study: TB and HousingCase study: TB and Housing Case study: Water qualityCase study: Water quality ConclusionsConclusions

Four key challenges for an Four key challenges for an Ecosystem Approach to Human Ecosystem Approach to Human HealthHealth

finding a shared vision;finding a shared vision; assuring community access;assuring community access; gaining credibility; and,gaining credibility; and, measuring success.measuring success.

Traditional Knowledge reveals the complexity of traditional approaches to environmental systems.

Elder Robin Greene teaches the traditional ways. Photo by: Randy Paishk

Medicine WheelMedicine Wheel

Morale

ValuesReligion

Politics

Environment

Economics Spirituality

Responsibility

Intellectual

Visceral

SpiritualCorporal

Community Health

Morale

ValuesReligion

Politics

Environment

Economics Spirituality

Responsibility

Intellectual

Visceral

SpiritualCorporal

Community Health

TO BE REPLACED BY UPDATED SLIDE

Community Food SecurityCommunity Food Security“ “ a condition in which all residents obtain a safe, a condition in which all residents obtain a safe,

culturally appropriate, nutritionally sound diet culturally appropriate, nutritionally sound diet through an economically and environmentally through an economically and environmentally sustainable food system that promotes sustainable food system that promotes community self-reliance and social justice!”community self-reliance and social justice!”

Hamm & BellowsHamm & Bellows

HealthHealthNot only the absence of disease but also “the extent to which an individual or group is able to on the one hand to realize aspirations and satisfy needs and on the other to change or cope with the environment.”

•“State of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It is not “an objective for living, but a resource for everyday life.”WHO

Source: Millenium Ecosystem Assessment

Age-standardized Leading Causes Age-standardized Leading Causes of Death, First Nations (2000) and of Death, First Nations (2000) and Canada (1999)Canada (1999)

260.3

162.9

125.0

65.551.553.0

195.8180.1

41.753.2

20.920.6

0

50

100

150

200

250

300

Digestivediseases

Endocrine andimmune

Respiratorydiseases

Injury andpoisoning

Cancer Circulatorydiseases

Mortality rate per 100,000 population

First Nations

Canada

Used to compare rates across groups with different demographic characteristicsUsed to compare rates across groups with different demographic characteristics Reduces the effects of very old or young population age differencesReduces the effects of very old or young population age differences

Potential Years of Life Lost (PYLL) Potential Years of Life Lost (PYLL) by Cause of Death, First Nations by Cause of Death, First Nations (2000) and Canada (1999)(2000) and Canada (1999)

4,304

978

828

469

404

324

293

284

274

219

185

1,260

907

1,555

128

171

143

189

210

112

140

58

5,000 4,000 3,000 2,000 1,000 0 1,000 2,000 3,000

Injury

Circulatory

Cancer

Ill-defined

Digestive

Endocrine

Respiratory

Perinatal

Infectious

Nervous system

Mental

PYLL per 100,000 population

First Nations Canada

Calculates the number of years of life lost assuming an average lifespan of 75 yearsCalculates the number of years of life lost assuming an average lifespan of 75 years Expressed as a rate per 100,000 population (similar to death rates)Expressed as a rate per 100,000 population (similar to death rates)

Increased risk of suicide at all ages for First Nations up to 65 years of age; highest for young males and females. Source: Health Status of First Nations in Canada (1999)

Infant Mortality Rates, Infant Mortality Rates, Manitoba, 1991 to 2001Manitoba, 1991 to 2001

0

2

4

6

8

10

12

14

16

18

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Year

Dea

ths

per

1,0

00 li

ve b

irth

s

On Reserve Off Reserve Manitoba CanadaLinear (On Reserve ) Linear (Off Reserve )

Life Expectancy at Birth, by Sex, Life Expectancy at Birth, by Sex, First Nations and Canada, 1980, First Nations and Canada, 1980, 1990 and 20001990 and 2000

60.9

66.968.9

71.874.3

76.3

68.0

74.076.6

79.080.8 81.8

55

60

65

70

75

80

85

1980 1990 2000

Age

(Yea

rs)

First Nations males Canadian malesFirst Nations females Canadian females

Projected Number of People with Projected Number of People with DiabetesDiabetesMB First Nations, 1996-2016MB First Nations, 1996-2016

2,590

7,656

4,732

13,468

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Num

ber of

Diabe

tes Cas

es

Males Females

1996 2016

Source: http://www.gov.mb.ca/health/publichealth/ epiunit/docs/storm.pdf

Diabetes – Implications for Diabetes – Implications for Health CareHealth Care

Persons with diabetes account for:Persons with diabetes account for:• 91% of lower limb amputations91% of lower limb amputations• 60% of hospitalizations for heart disease60% of hospitalizations for heart disease• 50% of hospitalizations for stroke50% of hospitalizations for stroke• 41% of hospital days41% of hospital days• 30% of all hospitalization 30% of all hospitalization

(Strategy Steering Committee, 1998)(Strategy Steering Committee, 1998)

First Nations patients with diabetes in Manitoba First Nations patients with diabetes in Manitoba have longer hospital stays with an increased have longer hospital stays with an increased intensity of care, and there is an increase in intensity of care, and there is an increase in obstetrical admissions (Dow, 1999)obstetrical admissions (Dow, 1999)

Health Health Facilities Facilities

and and HospitalsHospitals

NIHB Expenditures In Manitoba NIHB Expenditures In Manitoba Region by Benefit Region by Benefit (FY 2003/2004(FY 2003/2004

Transportation42%

Pharmacy38%

Health Care4%

Vision2%

Dental14%

$2.8M

$17.3M

$53.5M

$5.6M

$48.5M

Total: $127.8 M

Environmental Change Environmental Change driversdrivers

Case Study: HousingCase Study: Housing

Shelter:Shelter: Only 56.9% of homes Only 56.9% of homes

in FN communities adequatein FN communities adequate (not needing major repair or (not needing major repair or

replacement) (1999/2000)replacement) (1999/2000)

Pukatawagan Pukatawagan RemediationRemediation

The houses condemned and knocked down because of the fuel spill have not been The houses condemned and knocked down because of the fuel spill have not been replaced, leaving only 299 residences for 2,600 people, with an average of nearly replaced, leaving only 299 residences for 2,600 people, with an average of nearly nine occupants per house.nine occupants per house.

Rates of Tuberculosis, 1994 to 2004* Rates of Tuberculosis, 1994 to 2004* in Manitobain Manitoba

0

20

40

60

80

100

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Rate

per

100

,000

pop

ulat

ion

On Reserve Off Reserve Non First Nations

* 2004 Data is preliminary

Tuberculosis Notification Rates, by Tuberculosis Notification Rates, by Community Housing Density, First Community Housing Density, First Nations, 1997-9Nations, 1997-9

0

18.9 19.5 25

49.4 49.7

106.5

134.5

181.1

0

20

40

60

80

100

120

140

160

180

200

0.4 0.5 0.6 0.7 0.8 0.9 1 1.1 1.2+

Community housing density (average number of people per room)

Population (1,000)

0

20

40

60

80

100

120

140

160

180

200

Population

Notificationrate

Notification rate per 100,000 population

Tuberculosis

Host

Environment Agent

Inadequate housing

Case study: water qualityCase study: water quality

Determinants of Health –Water Determinants of Health –Water and Sanitationand Sanitation

Water QualityWater Quality: Only 41.4% of FN communities : Only 41.4% of FN communities

reported at least 90% of homes connected to reported at least 90% of homes connected to

water treatment plant (1999/20)water treatment plant (1999/20) Sanitation:Sanitation: Only 33.6% of FN communities had Only 33.6% of FN communities had

at least 90% of homes connected to community at least 90% of homes connected to community

sewage disposal system (1999/2000) sewage disposal system (1999/2000) Source: A Statistical Profile on the Health of First Nations in Canada, 2003, Statistics Canada 2001 CensusSource: A Statistical Profile on the Health of First Nations in Canada, 2003, Statistics Canada 2001 Census

Difficulties with building Difficulties with building adequate infrastructure for adequate infrastructure for Safe water on ReservesSafe water on Reserves

technical difficult and costly to develop infrastructure technical difficult and costly to develop infrastructure in isolated areas, often having difficult terrain (e.g., in isolated areas, often having difficult terrain (e.g., permafrost, swamp) and often having drinking water permafrost, swamp) and often having drinking water source off-reserve; source off-reserve;

limited access to financing and recovery of costs due limited access to financing and recovery of costs due to poor economic conditions; to poor economic conditions;

lack of qualified personnel in environmental service lack of qualified personnel in environmental service delivery; delivery;

high birth rates in these communities expanding high birth rates in these communities expanding infrastructure needs rapidly; and infrastructure needs rapidly; and

unclear technical standards with limited support for unclear technical standards with limited support for standards and enforcement mechanisms. standards and enforcement mechanisms.

Why the safety of First Nations Why the safety of First Nations drinking water is drinking water is compromised?compromised?

No laws and regulations govern the provision of drinking No laws and regulations govern the provision of drinking water in First Nations communities. water in First Nations communities.

INAC and Health Canada implement policies, INAC and Health Canada implement policies, administrative guidelines, and funding arrangements with administrative guidelines, and funding arrangements with First Nations inconsistently and piecemeal.First Nations inconsistently and piecemeal.

Action with First Nation communities is not being taken Action with First Nation communities is not being taken to: to:

1.1. assess the capacity and support that First Nations need assess the capacity and support that First Nations need to deliver safe drinking water in their communities; to deliver safe drinking water in their communities;

2.2. establish the institution or institutions that could establish the institution or institutions that could consolidate these capacity-building and support functions consolidate these capacity-building and support functions for all First Nations; and for all First Nations; and

3.3. define the information needed to demonstrate that the define the information needed to demonstrate that the drinking water is safe (Gelinas 2005). drinking water is safe (Gelinas 2005).

http://www.oag-bvg.gc.ca/domino/reports.nsf/html/c20050905ce.htmlhttp://www.oag-bvg.gc.ca/domino/reports.nsf/html/c20050905ce.html

Drinking water at risk in Drinking water at risk in First Nations First Nations communitiescommunities In 2001, Indian and Northern Affairs (INAC) found a In 2001, Indian and Northern Affairs (INAC) found a

significant risk to the quality or safety of drinking water significant risk to the quality or safety of drinking water in three-quarters of the systems (Gelinas 2005). in three-quarters of the systems (Gelinas 2005).

In Manitoba 5 northern First Nations are on boil-water In Manitoba 5 northern First Nations are on boil-water advisories one with a reported case of advisories one with a reported case of E. coliE. coli contamination (Water Stewardship Branch 2005) contamination (Water Stewardship Branch 2005)

Assembly of Manitoba Chiefs spokesman, Michael Assembly of Manitoba Chiefs spokesman, Michael Hutchinson, reported that many as 25 Manitoba First Hutchinson, reported that many as 25 Manitoba First nations have varying degrees of water quality problems nations have varying degrees of water quality problems (CanWest 2005).(CanWest 2005).

Kashechewan First Nation’s storyKashechewan First Nation’s story http://www.cbc.ca/story/canada/national/2005/10/28/kashechewan-evacuation051028.html

Multiple Barrier Approach to Multiple Barrier Approach to Safe Drinking WaterSafe Drinking Water

(1) source: the best possible raw water quality should be maintained and protected

(2) treatment: effective treatment should be designed, operated and maintained

(3) distribution: secure storage and distribution of treated water should be provided

(4) monitoring: appropriate and effective monitoring should be performed

(5) response: appropriate and effective responses to adverse monitoring or adverse circumstances are needed.

Thank you. Questions?Thank you. Questions?

Are sustainable livelihoods and Are sustainable livelihoods and Ecosystem health approaches Ecosystem health approaches appropriate in Canada (for Northern appropriate in Canada (for Northern Aboriginal Communities)?Aboriginal Communities)?