Copy of A First Nations Approach to Health Indicator Development

A First Nations Approach to Health Indicator Development Assembly of First Nations (AFN) North America Region Purpose Leading up to FMM 2005, AFN initiated indicators development: – To measure progress in meeting the 10-Year Plan to “close the gap” in quality of life between FNs and other Canadians Momentum to decolonize information and research for FN individual and collective benefit – Challenging status quo by proposing alternative approach FN Policy Development Three broad processes in existence: – First Nations controlled – Controlled by other Governments – Joint First Nation Policy Development Model – Combines strongest elements from the above processes – Evidence-based research and best practices FN Policy Development Model Must respond to, and be directed by, First Nations – FN leadership and independent research and expertise must play a central role in directing change in order to achieve sustainable solutions Must secure clear political commitment and mandates for change Joint, principled policy engagement to develop options for the consideration and adoption of FN governments First Nation Policy Development Model Successful First Nation Policy Development 1. First Nation leadership 2. National Dialogue 3. Independent Expertise 4. Clear Mandate For Change 5. Joint Principles Policy Processes Wholistic Policy Development FN Policy Development Model sets the process – the content is based on First Nation wholistic perspective Policy Context – Royal Commission on Aboriginal Peoples (RCAP) • Nine years later, there has been no significant measurable quality of life improvements for First Nations. – UN Human Development Index (HDI) • First Nation populations continue to lag significantly behind the rest of Canada on this international index. – INAC Community Well-Being Index (CWI) • 92 First Nations communities are part of the bottom 100 Canadian communities. – Canada is signatory to the UN Millennium Declaration • One of the goals is the eradication of extreme poverty and hunger. FN Wholistic Policy & Planning Model Key is First Nations Self-Government: – First Nations~Federal Crown Political Accord – The UN Human Development Report confirms that transformative change be achieved by restructuring the underlying social and economic framework. – Harvard Project (2002-03) and Chandler and Lalonde (1998) report that self-government is the key to economic self-sufficiency and improved health. FN Wholistic Policy & Planning Model FN Wholistic Policy & Planning Model 14 Key Determinants: – – – – – – – – – – – Self-Determination Health Care Education/Lifelong Learning Housing Economic Development Environmental Stewardship Employment Lands/Resources Justice/Corrections Social Services Languages, Heritage and Culture – Cross-cutting Determinants • Gender • Rural/Urban • On/Away from Reserve Community at Core Four directions Governance components: – Self-government – Fiscal Relations – Collective and Individual Rights – Capacity Social capital – Bonding (within community) – Bridging (among communities) – Linkages (outside community) Indicators Applied to First Nations Limited data sources: – FN Regional Longitudinal Health Survey (onreserve) – Census – Aboriginal Peoples Survey (off-reserve) – INAC Departmental Data – Health Canada, FNIHB In-house statistics – Other federal departments and P/Ts – data generally not disaggregated Potential Indicators Applied to FN: Link to FMM Health Care – – – – – – Individual Health – Morbidity and Mortality Individual Health – Well-Being and Quality of Life Health Determinants – Personal Choices Community Health – Self-Determination Health Services – Traditional Services Health Services – Western-Based Services Education/Lifelong Learning – First Nations Education Index • • • • Sovereignty Implementation Index Educational Capacity Index Language and Cultural Index Learner Achievement Index. Potential Indicators Applied to FN: Link to FMM Housing – Proportion of adequate housing on reserve – Housing market on-reserve as an economic engine creating value – Prevalence of Social Capital advancements – Proportion of First Nations communities with at least 90% of homes serviced by centralized water treatment plants and community sewage disposal systems – Adequate long term base of serviceable land – Frequency of household overcrowding (> 1 persons per room) Economic Development – – – – Labour Force and Productivity Gap via Income levels Economic Participation Community Development and Economic Infrastructure Access and Control over Resources and Resource Revenue Sharing Next Steps Internal FN development process – – Led by FN and supported by FN institutional and organizational expertise Thorough national and regional dialogues Other governments’ mandate for change in how they measure their performance towards services and resources they provide to First Nations Pilot project or case study mechanism to explore indicators development options in a non-prejudicial fashion A principled and objective driven national forum to discuss and ultimately implement policies entrenching proposed indicators, also agreed to by other governments. Health Reporting Framework Background • Initially driven by a Canadian Government initiative to develop an Aboriginal Health Reporting Framework consisting of 20 common indicators inclusive of the three recognized aboriginal groups, First Nations, Inuit & Métis. • AFN opposed to Pan-Aboriginal approach, propose a specific First Nations Health Reporting Framework. Literature Reviews • Injuries is the largest contributor to premature death of on-reserve First Nations. • Circulatory disease and Cancer are next largest contributors. • Suicide is among the leading causes of death in First Nations for those aged 10-44. Literature Reviews • Significant chronic diseases in the First Nations populations include (in order of magnitude): – Diabetes – Heart Disease – High blood pressure – Cancer – Arthritis and Rheumatism *Rates for all these exceed the rates in the general Canadian population. Literature Review Findings • High rates of infectious diseases (i.e. Tuberculosis) • High rates of sexually transmitted diseases. • High rates of food and waterborne diseases. • Increased rates of overweight and obese individuals. Literature Review Findings • National Aboriginal Health Organization (NAHO): Key health challenge currently facing Aboriginal peoples relate to: – – – – – – Self-determination Physical and human environments Emotional and mental health Chronic diseases and disabilities Health childhoods Access to effective and appropriate services National Dialogue Session Feb. ‘06 Much work is still needed prior to the AFN being able to validate relevant indicators that can be used across the country. Key concerns include lack of capacity by First Nations to collect, manage and analyse data which seriously compromises the ability to develop a wholistic framework representative of First Nations by way of lack of available data to serve as appropriate indicators. Getting to Indicators… • Although the health status of First Nations peoples has been improving, it remains substantially lower than the Canadian average. • The challenge to improving the health of First Nations peoples involves many issues and still unanswered questions. One of the key changes occurring nationally is the recognition of the need to collect and analyze longitudinal First Nations specific health information Principles • The First Nations Health Reporting Framework was developed in accordance with the following principles: – The health reporting framework will have a First Nations focus; – The health reporting framework will be based on the concept of reciprocal accountability; – The framework will be a practical tool used for community planning that will also allow for reporting to federal, provincial and territorial governments; – Framework will allow for comparison with Canadian data Principles • Selected indicators will be tied to data reporting mechanisms that are currently in place or could conceivably be implemented in the near future; • Traditional indicators that are considered immeasurable will be omitted from the framework but referenced in the text for future consideration; • The principles of Ownership, control, access and possession will be respected. Basic Definitions • Health indicator – Represents a variable, susceptible to direct measurement, which reflects the state of health and well-being of persons in a community – Measure data which is translated into usable information • Health reporting framework – A basic conceptual structure and is a way of looking at health and the factors that affect it. Health reporting framework • • • • Individual health Environmental health Community health Social/Cultural health Health Indicators • Individual Health – Morbidity and Mortality – Life expectancy – Diabetes – Unintentional Injuries – Suicide • Individual Health – Well-being and Quality of life – Self-related health and mental health – Impact of residential schools Health Indicators • Health Determinants – Personal Choices – Alcohol/drug consumption – Immunization coverage • Health Determinants – Social and physical environments – Income level – Housing quality – Drinking water quality Health Indicators • Community Health – Self-determination – Community control of health services – Involvement of youth and elders in community decision-making • Community Health – Cultural Continuity – Language knowledge and use – Traditional use of land – Participation in traditional spiritual ceremonies or rituals Health Indicators • Health Services – Traditional Services – Availability and use of traditional healers/medicines – Involvement of youth and elders in community decision-making • Health Services – Western-based Services – Access to primary or mental health care – Access to home care services – Satisfaction with health care services Contact information Jay Lambert Research & Policy Analyst ~ Information Governance Health & Social Secretariat Assembly of First Nations 473 Albert Street, Suite 810 Ottawa Ontario K1R 5B4 Canada Direct Contact: jlambert@afn.ca (604) 628-0304 Questions