Module 8: Cancer and The Risk Factors Among FNIM People

1. Module 8: Cancer and The Risk Factors Among FNIM People

2. Welcome to Cancer and Risk Factors Among FNIM People. This course takes 45 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. Select the arrow keys at the bottom of your screen to move forward and move back, or to stop and start the module.

3. Course Learnings By the time you complete this learning module, you will be able to: Understand Aboriginal Cancer Statistics Identify Risk Factors Cancer and The Risk Factors Among FNIM People

4. Acronyms Used in This Learning Module • CCO: Cancer Care Ontario • FNIM: First Nations, Inuit, Métis This list can be printed if you want to refer to it throughout the module.

5. Insert Pre-Test Quiz Slide Q: Name the Top (most common) Cancer for FNIM People A:____________________________________ Move forward to begin Chapter 1

6. You will learn about: • Risks and circumstance • Statistics broken down Part I: Aboriginal Cancer Statistics Part I of the learning module provides an overview of cancer statistics in FNIM communities.

7. Chapter 1: Risks and Circumstances

8. Risks A shift in disease patterns is evident for First Nations, Inuit and Métis (FNIM) populations over the past several decades, away from infectious diseases and toward chronic conditions such as cancer and diabetes. Studies invariably show that cancer incidence has risen dramatically in each of the FNIM populations over the past few decades. From being nearly unknown a few generations ago, cancer is now among the top three causes of death among FNIM people.

10. From being nearly unknown a few generations ago: * Source: Mortality of Métis and Registered Indian adults in Canada: An 11-year follow-up studyby Michael Tjepkema, Russell Wilkins, SachaSenécal, ÉricGuimond and Christopher Penney, December, 2009

11. About 50%of all cancer deaths are related to commercial tobacco use, diet and physical inactivity. Smoking rates among FNIM people are much higher than in the remaining Canadian population. Lack of consumption of fruits and vegetables, and physical inactivity are also reported to be higher among FNIM people.

12. Cancer survival is worse for FNIM than for other Ontarians. Some reasons include: • FNIM people are diagnosed with later stage cancers. • Access to screening and treatment is difficult for many FNIM people living in rural and remote communities.

13. Challenges within the health system in Ontario:

14. Circumstance: Shift from Traditional Diet and Lifestyle

15. Shift from Traditional Diet and LifestyleFNIM people in Canada traditionally consumed a wide variety of foods harvested and gathered from the land and water.

16. Foods harvested from the local environment, such as fish and marine mammals, game meat, plants, and berries are highly nutritious and sustained FNIM people for many generations.

17. Traditional foods are significant to FNIM people not only because of their health benefits, but also because the act of harvesting, collecting, preparing, and sharing food. plays an important role in maintaining a lifestyle with strong connections with the land and cultural identities.

18. In post-contact era, the types of food consumed by FNIM people changed significantly. Traditional food use diminished as a result of: Concern about environmental contaminants Relocation into settlements Decreased access to land Depletion of game

19. In post-contact era, the types of food consumed by FNIM people changed significantly. Traditional food use diminished as a result of: Fewer harvesting skills Less time and energy Costs of hunting Restrictions on hunting

20. Many FNIM communities transitioned from traditional foods to store-bought and processed foods. As a result of: • declining availability and access to traditional foods • increased convenience and availability of store-bought foods Many FNIM communities transitioned from traditional foods to store-bought and processed foods. As a result of:

21. Processed foods are the only foods that many families can afford. For example, packaged foods such as Kraft dinner. Making the situation more difficult: the food mail subsidy program that provided food to people in need ended. Weather also impacts access to food. If planes can’t land and there is no road access for a period of time – food does not reach communities.

22. Effects of History on Perception and Health The effects of colonization have been compared to being similar to post-traumatic stress disorder.

23. Generations of FNIM children were born into communities where hopelessness and discrimination were common, and there were many barriers to building healthy communities.

24. Insert pop up exercise box • This is a non-scoring exercise • [Add in a pop-up: Write down two barriers to building healthy communities and a short strategy to help break down each barrier (no more than two sentences).

25. In the last few decades in particular, governments have been trying to rebuild the relationships with FNIM communities but there are still activities that occur that have left FNIM people wary.

26. Some examples include:

27. Increased isolation has occurred over generations based on a variety of reasons. Some of which include: Feeling of persecution from some non-Aboriginal Canadians Stereotyping and discrimination Remote living areas Cross-cultural communication who have misconceptions about how history has shaped FNIM perspectives. Source: Aboriginal Cultural Safety Initiative, Anishnawbe Health Toronto, 2008

28. These events and circumstances shape FNIM people’s level of trust and ability and desire to seek out health care from non-Aboriginal providers.

29. FNIM people ‘s views of cancer are heterogeneous, like many Canadians: For some, there is a belief that cancer is an unavoidable death sentence. Cancer education, prevention and treatment programs. These and other views have implications on receptiveness to, and participation in: In some FNIM communities, cancer is a taboo subject surrounded in secrecy and fear. Personal Views of Cancer Speaking explicitly about terminal illness and death may hasten death. Traditional spirituality, (important to a majority of FNIM people): May contribute to beliefs about cancer. For example, the Dene Nation in the Northwest Territories believes that:

30. FNIM people’s cultural conceptions of cancer may help in part to explain lower rates of participation in prevention, early diagnosis, and treatment programs. Cancer information resources generally do not address the uniqueness of FNIM cultures. Therefore FNIM people may be unaware of the existence or benefits of these programs. Those in rural and remote communities may also have difficulty accessing the relevant resources to inform themselves.

31. Placeholder for: interview segment from Alethea re: what providers can do to help support FNIM patients (approx. 1 minute) – replacing text: one First Nations leader said:. ”We need community-based education and culturally responsive resources related to cancer and screening, the role of nutrition and physical activity, and how to develop support groups or talking circles in communities. Resources need to describe that cancer treatments would not hinder or affect First Nations spirituality.”

32. Many health care providers may be unaware of the historical and cultural factors that contribute to FNIM people’s views of cancer, and views of general health care. Cultural differences may create barriers to effective cancer care, as caregivers’ may not understand and are unable to address perceptions of cancer. Move forward to begin the quiz for this chapter

33. Insert Quiz slide: Test for Part I, Chapter 1 This chapter has one question. Q: Name two of the reasons cancer survival is worse for FNIM people than for other Ontarians, as outlined in this chapter. A: __________________________ A: __________________________

34. Chapter 2: Statistics Broken Down Overall FNIM Cancer Stats and How They Compare To Non-Aboriginal Cancer Stats

35. Placeholder for: interview segment(s) from Ontario Regional Chief Stan Beardy and/or Greg Peters

36. Overall Statistics New Cases for Cancers by Sex, Ontario, 2007 - Not Applicable Report date: Sept. 11, Data source, Cancer Care Ontario (Ontario Cancer Registry, 2010 for SEER*Release 8 Feb, 2011).

37. First Nations Male and Female Cancer Statistics First Nations Female First Nations Males Sources: Assembly of First Nations, 2009 from Marret, 2003 and Wiggins, 2008

38. Select Mortality Rates: First Nations On-Reserve vs. Non-Aboriginal Canada Source: Public Health Agency of Canada (2011), using data from 2009-2010 Canadian Community Health Survey; First Nations Information Governance Centre (2011); Social and Aboriginal Statistics Division, Aboriginal Peoples Survey, 2006; Inuit Health and Social Conditions: Ottawa, ON: Statics Canada, 2008.

39. Lung cancer rates for Canadian Inuit males and females are the highest in the world and rising in Inuit men and women at 3.2 and 5.3 times the Canadian averages, respectively. Inuit have had higher rates of nasopharyngeal, salivary gland and esophageal cancers, but rates are decreasing. Rates of lung, breast, colorectal and cervical cancers have increased sharply across all regions.

40. Inuit Male and Female Cancer Statistics Source: Public Health Agency of Canada (2011), using data from 2009-2010 Canadian Community Health Survey; First Nations Information Governance Centre (2011); Social and Aboriginal Statistics Division, Aboriginal Peoples Survey, 2006; Inuit Health and Social Conditions: Ottawa, ON: Statics Canada, 2008.

41. Métis: Cancer Profile The most common cancers among the Métis: • prostate • lung • breast • colorectal This is the same as for other Ontarians. Ontario Métis have a 20% lower incidence of cancer compared to the general population. Except for lung cancer in females: The rate may be as much as 40% higher. Source: The Burden of Cancer Risk in Canada’s Indigenous Population: a Comparative Study of Known Risks in a Canadian Region, Brenda Elias,ErichV Kliewer, Madelyn Hall, Alain A Demers, Donna Turner, Patricia Martens,SayP Hong, Lyna Hart, Caroline Chartrand, and Garry Munro, Oct. 19, 2011

42. Métis Male and Female Cancer Statistics Source: Public Health Agency of Canada (2011), using data from 2009-2010 Canadian Community Health Survey; First Nations Information Governance Centre (2011); Social and Aboriginal Statistics Division, Aboriginal Peoples Survey, 2006; Inuit Health and Social Conditions: Ottawa, ON: Statics Canada, 2008.

43. Métis Risk Modifiers and Common Cancers Move forward to begin the quiz for this chapter

44. Insert Quiz slide: Test for Part I, Chapter 2 This chapter has one question. Q: Name the top two cancers for First Nations men in Ontario. A: __________________________ A: __________________________

45. You will learn about: • First Nations’ risk factors • Inuit risk factors • Métis risk factors Part II: Risk Factors Part II of the learning module provides an overview of the cancer risk factors in FNIM communities.

46. Chapter 1: Overview In this chapter, we will review some of the overall factors that adversely impact FNIM health and can increase probabilities for diseases such as cancer and diabetes. At the end of this learning module, there will be links to additional resources and some information specific to culturally appropriate nutrition guides, tobacco and screening initiatives.

47. Food Security and Nutrition Food security exists when all people, at all times, have the physical and economic access to food that is: • Sufficient • Safe • Nutritious It has to meet dietary needs and food preferences for an active and healthy life. Two key factors are: 1) Income 2) Accessibility of food

48. Given the geographic location of many FNIM communities, lack of access to food results in poorer quality and fewer nutritious options.

49. The link between food security and health is so clear that Health Canada has recognized that “income-related food insecurity is an important public health issue in Canada and is a key social determinant of health” in the Office of Nutrition Policy and Promotion 2007 report.

50. Inuit go hungry more than any other indigenous group: report A Nunavut family's annual groceries cost $19,760, but half of Inuit adults earn less than $20,000 CBC News Posted: Mar 27, 2014 5:54 AM CT Last Updated: Mar 27, 2014 11:02 AM CT A new study released Thursday highlights the fact that people in Nunavut have the highest food insecurity rate for any indigenous population in a developed country at 68%. Source: http://www.cbc.ca/news/canada/north/inuit-go-hungry-more-than-any-other-indigenous-group-report-1.2588107