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ESTABLISHING FIRST NATIONS HEALTH & WELLNESS INDICATORS FOR THE NEXT 10 YEARS
Gathering Wisdom
Dr. Perry Kendall and Dr. Evan Adams
November 30, 2016
Image credit: Juan Solorzano
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Live Graphic Recording From the Chief Medical Officer of FNHA & Provincial Health Officer Partnership Workshop - March 2016 (Sam Bradd) 2
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• Aboriginal Health Physician Advisor Position
• Deputy Provincial Health Officer Position
• PHO:FNHA Partnership (MOU)
• FNHA Chief Medical Officer Position
PARTNERSHIP BASED ON
TRUST AND RESPECT
AN EMERGING PARTNERSHIP
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STRONGER TOGETHER: PHO & FNHA PARTNERSHIP
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THE TEAM
• Collaboration between the Office of the PHO, Office of the CMO and other FNHA departments.
• Project leads: Lindsay Beck, Kathryn Berry, Adrienne Bonfonti and;
• Working Group Members: Dr. Shannon McDonald, Dr. Shannon Waters, Harmony Johnson, Judith Eigenbrod, Laurel Lemchuk-Favel, Rebecca Love, Ashraf Mohammed, Megan Misovic, Anita Christoff
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TODAY MARKS A MILESTONE MOMENT
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Support FNHA’s vision for Healthy, Self-Determining, &
Vibrant BC First Nations Children, Families, & Communities
by:
• Establishing a renewed set of 15 indicators, that we
will measure and report on for the next 10 years.
• Building off the 7 health indicators established in the
Transformative Change Accord First Nations Health
Plan.
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ORIGINAL 7 TRANSFORMATIVE CHANGE ACCORD FN HEALTH PLAN INDICATORSIndicator Source
Infant mortality Vital Statistics
Children with healthy Body Mass Index (BMI)
(Note: This indicators was previously obese children)
Survey/Canadian Community Health
Survey
Youth suicide Vital Statistics
Diabetes prevalence Ministry of Health
Age-standardized mortality rate Vital Statistics
Life expectancy Vital Statistics
Number of practicing, certified FN HCPs To be determined
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* The final interim update is scheduled for release in 2017 to report on data up to 2015.
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YOUTH SUICIDE RATE( R AT E PER 10,0 00 P OPULATI ON)
P rog ress s in c e
B a selin e
P ro jec ted to meet Ta r g et
PRO JECTIO NS:
SI b efo r e TCA: 3 .53
Cu r r en t: 2 .23
P rev io u s (2 0 1 0 ) : 2 .1 8
Ta rg et: 2 .1 0
O R b efo re TCA: 0 .66
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DIABETES AGE-STANDARDIZED INCIDENCE RATE( R AT E PER 100 POPULATION)
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BRINGING TOGETHER KNOWLEDGE
The renewed set of indicators and
associated reports will bring together
knowledge to support and inform
policy, initiatives and approaches at
various levels (community, Nation,
within and across sectors and levels of
government).
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First Nations Perspective on Wellness
SETTING A VISION FOR FUTURE WORK
•We were challenged to set a vision for
future work.
•Recommendations, targets and actions to be
developed.
•Reports on progress to be issued every 2
years.
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DEVELOPING THE SET OF INDICATORS THROUGH TWO-EYED SEEING
Two-Eyed Seeing is “learning to see from one eye with the strengths of
Indigenous knowledges & ways of knowing, & from the other eye with
the strengths of Western knowledges & ways of knowing…& learning
to use both these eyes together, for the benefit of all,” championed by
Elder Albert Marshall (Mi’kmaw Nation).
Source: Stiefel M, Nolan K. 2012. IHI Innovation Series
white paper. Cambridge, Massachusetts: Institute for
Healthcare Improvement.
First Nations Perspective on Wellness 13
PEELING BACK THE LAYERS:TOWARDS DEVELOPING THE INDICATORS
Image credit: University of Northern British Columbia
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ROOTS OF RESILIENCE: ENHANCING WELLNESS & REDUCING INEQUITIES
LINKED TO IMPROVED
HEALTH AND WELLNESS OUTCOMES
• First Nations are taking back control &
are acting to address the structural origins of these inequities, by increasing local control over land, resources, services & decision-making structures.
• Existing strengths, such as Aboriginal
ways of knowing & being, including connection to land, culture, language, community, & family balance, self-reliance etc.
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SHIFTING THE PARADIGM: SICKNESS TO WELLNESS, DEFICITS TO STRENGTHS
Many First Nations have especially good health and wellness outcomes.
•We will focus on wellness outcomes, not only “health” or disease/illness. outcomes.
•We will explore and celebrate their sources of strength & resilience —build, share & spread those successes!
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RENEWED POPULATION HEALTH AND WELLNESS INDICATORS:THE FRAMEWORK
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INDICATOR DEVELOPMENT
•From over 50, down to 15 indicators
•Informed by previous FNHA Wellness Indicator Work (regional engagement sessions, Gathering Wisdom)
•Informed by innovative public and population health policy and discourse
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OTHER INDICATORS CONSIDERED• Violence Against Women: Covered in the PHO/FNHA CMO Aboriginal Women’s Health Report & the Murdered &
Missing Indigenous Women’s Inquiry.
Social, Cultural, Economic,
Environmental
Land, Nations,
Community, Family
Mental, Physical,
Spiritual, Emotional
Health & Wellness
Outcomes
Health System FNHA Programs
Justice Air and water quality Nurturing spirit: Balance Chronic diseases/conditions Cancer screening Physical Activity Programs
IncomeElders sharing knowledge with
communitySelf-rated overall health Body Mass Index Immunizations
Number of steps from Fitbit
challenges
Number of Aboriginal Businesses
Perceived community safety,
strengths, challenges,
progress/change, participation
in cultural events
Positive Mental Health ScaleDiabetes and related
comorbidities
Access to maternal
supports and servicesMedical transportation
Investment in Training /
InfrastructureSocial and community support Mental Mastery Scale Hospitalizations of children
Attachment to a primary
care providerFirst Responder Training
Collaboration between different
organizations & agencies
Forums for sharing best
practices
Illicit drug use Exposure to second hand
smoke
Resource intensity for
hospitalized person
Traditional medicines
benefits coverage
Housing in need of minor and/or
major repairs
Number of communities with
completed Comprehensive
Community Plans
Healthy eating: Fruits and
vegetablesGrowth chart
Confidence to ask
questions relating to my
or my family's wellbeing
Aboriginal Head-start
program
Access to private/public
transportationCommunity Gardens Communicable diseases
Health Education Programs
in Community
Children in careSelf-identified healers in
communityHIV Cascade of Care
Pre and post-natal
education
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Indicator Data Aboriginal Knowledge
Education: Graduation
rates
Ministry of
Education
To be determined – stories, art,
songs, traditional ecological
knowledge
Food security Regional Health
Survey (RHS) or
Canadian
Community Health
Survey (CCHS)
Adequacy of housing CensusImage credit: Native Education College
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Indicator Data Aboriginal Knowledge
Cultural Wellness - a
combined indicator of:
• Traditional language
• Traditional foods
• Traditional medicine/healing
• Sense of belonging to one’s
community
RHS
To be determined – stories, art,
songs, traditional ecological
knowledge
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Indicator Data Aboriginal Knowledge
Cultural Wellness - a
combined indicator of:
• Traditional language
• Traditional foods
• Traditional medicine/healing
• Sense of belonging to one’s
community
RHS
To be determined – stories, art,
songs, traditional ecological
knowledge
Image credit: Simon Fraser University, 201523
Indicator Data Aboriginal Knowledge
Cultural Wellness - a
combined indicator of:
• Traditional language
• Traditional foods
• Traditional medicine/healing
• Sense of belonging to one’s
community
RHS
To be determined – stories, art,
songs, traditional ecological
knowledge
Image credit: Aboriginal Tourism BC24
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Indicator Data Aboriginal Knowledge
Cultural Wellness - a
combined indicator of:
• Traditional language
• Traditional foods
• Traditional medicine/healing
• Sense of belonging to one’s
community
RHS
To be determined – stories, art,
songs, traditional ecological
knowledge
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Indicator Data Aboriginal Knowledge
Cultural Wellness - a
combined indicator of:
• Traditional language
• Traditional foods
• Traditional medicine/healing
• Sense of belonging to one’s
community
RHS
To be determined – stories, art, songs,
traditional ecological knowledge
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Indicator Data Aboriginal Knowledge
Experience of cultural
safety & humility in
receiving health services
In-patient
survey among
hospital
patients
(PREMS)
To be determined – stories, art,
songs, traditional ecological
knowledgeAvoidable hospitalizations
(ambulatory care sensitive
conditions)
Ministry of
Health
HEALTH SYSTEMS
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Indicator Data Aboriginal Knowledge
Decision-making, human
and economic capacity
Index using
multiple sources
To be determined – stories, art, songs,
traditional ecological knowledge
Ecological health:• % of undisturbed habitat
• Abundance of culturally
important species (salmon,
moose, elk)
• # of animals that can be
harvested in a season
To be
determined
Image credit: World Wildlife Foundation28
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Indicator Data Aboriginal Knowledge
Level of physical activity RHS/Canadian
Community
Health Survey
(CCHS)To be determined – stories, art,
songs, traditional ecological
knowledge
Number of children with healthy
teeth (no cavities)
Health Canada
Smoking commercial tobacco RHS/CCHS
Image credit: Spirit Magazine29
Indicator Data Aboriginal Knowledge
Healthy infant birth weights Perinatal
Services BC
To be determined – stories, art,
songs, traditional ecological
knowledge
Alcohol-related deaths Vital Stats
Agency
Serious injuries requiring
hospitalization
Ministry of
Health
Self-reported
mental/emotional well-being
RHS/CCHS
HEALTH &
WELLNESS
OUTCOMES
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Establishing knowledge and a system of
measurement and reporting that reflects
the First Nations Perspective of Wellness
to measure our progress over the next
10 years.
Moving us from deficits to strengths, from
sickness to wellness.
Towards our vision of “Healthy, Self-
Determining, & Vibrant BC First Nations
Children, Families, & Communities.”
SETTING A VISION
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I AM NISGA’A: I AM ROSE, WALKING IN WELLNESS
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