AFN Presentation to Standing Committee on Health Regional Chief Katherine Whitecloud

1. Protecting our Gifts and Securing Our Future:Fighting the Growing Epidemic of First Nations Childhood Obesity AFN Presentation to Standing Committee on Health Regional Chief Katherine Whitecloud Chair, Chiefs Committee on Health

2. The Legacy of Colonization • A movement away from traditional foods to more processed foods • Restrictions to hunting, fishing and gathering of foods and limited organized physical activities • Poor understanding of nutrition and nutritious food choices as a result of Indian Residential School experiences and • Depression, addiction and other mental health issues, again resulting from intergenerational impacts 2

3. A Growing Epidemic • Over half of First Nations children are either overweight (22.3%) or obese (36.2%) • 4 out of 10 First Nationschildren sometimes eat a nutritious, balanced diet • Nutritional and dietary practices are similar among children of all BMI categories; however, overweight or obese children are more than twice as likely to report engaging in physical activity less than once a week (compared with normal weight children). • Older children are less likely than their younger counterparts to participate in daily physical activity 3

4. A Growing Epidemic (ctd) 70% • Younger children are more likely to be obese • Older children are more likely to be overweight 61.8% 60.7% 55.2% 60% 50% 26.4% 41.2% 40% 48.7% 30% 20% 28.8% 10% 19.5% Obese 13.1% Overweight 0% 3-5 6-8 9-11 4 Age Group

5. Poverty among First Nations Children • Direct correlation between family income, overcrowding, poor nutrition, lower levels of physical activity and educational achievement: • 1 in 3 First Nations children live in an overcrowded home • 1 in 4 First Nations children live below the poverty line • Children in lower income families do not participate as frequently in physical activity (10% vs. 4.2%) • Comprehensive community development that reinforces the capacity of First Nations governments to respond to the needs of children is essential to achieve marked improvements in First Nations children’s health and well-being 5

6. Health and Social Fiscal Imbalance • Since 1997-98, arbitrary 2% cap on all First Nations social programming • Since 1996-97, 3% cap on all First Nations health programming • Caps ignore basic cost drivers such as population growth and inflation • Caps represent less than one-third of the average 6.6% increase that most Canadians will enjoy through the CHSTs in each of the next five years • When adjusted for inflation and population growth over time, the total budget for INAC has decreased by 3.5% since 1999-2000 • Core program budgets, incl. social development and capital, have decreased by almost 13% since 1999-2000. • If communities had been funded in alignment with population growth and inflation, their budgets would be 45.5% higher than they are today. • Close to $2 billion in health funding shortfalls over the next 5 years 6

7. A Bleak Future • Human Cost • Greater prevalence of chronic diseases (such as diabetes, high blood pressure, cardiovascular disease, asthma, orthopedic problems, obstructive sleep apnea, menstrual abnormalities, neurological disorders and cancer); social and emotional problems; difficulties in school • Fastest growing population in Canada will lack opportunities to contribute to the cultural fabric and overall Canadian economy. • Financial Cost • Failure to act will result in greater burden on the Canadian health system, and overall productivity: • Royal Commission on Aboriginal Peoples: cost of status quo was $7.5 B in 1996, climbing to $11B by 2016 due to net cost of foregone production and government revenues, and extra costs of remedial programs and financial assistance • Royal Bank of Canada: costs of implementing RCAP are more affordable in the long-run than “maintaining the status quo, the truly daunting cost of doing nothing“ (1997) 7

8. Protecting Our Gifts • Physical Activity • Lower levels of activity are related to poor nutrition and reduced consumption of traditional foods • Children 9-11 yrs are unlikely to be physically active daily • Boys are more engaged in traditional physical activities, team sports and activities of greater intensity • Breastfeeding • Numerous studies have linked breastfeeding with the reduction of obesity later in life • Prevalence of breastfeeding among First Nations infants has increased from 50% to 62.5% in 5 years • Nutrition • Children living in smaller communities are more likely to eat a traditional, protein-based diet, and less likely to be obese • Children who always or almost always eat a balanced and nutritious diet are more likely to get along with the rest of the family very well 8

9. Protecting Our Gifts (ctd) • Understanding First Nations children’s physical activity and dietary patterns flow from an ecological and cultural framework that considers several factors: • Physiological: level of growth, development • Psychological: motivation, self-esteem • Socio-cultural: role of family, poverty • Environmental: climate, food security 9

10. Securing Our Future A First Nations Wholistic Policy and Planning Model • Community at Core • “Total Person” Lifespan • Emphasizes all non-medical determinants • Self-government as key to promoting positive health outcomes • Linkages within, across and outside First Nations communities must be considered 10

11. Securing Our Future (ctd) • First Nations Wholistic Health Strategy endorsed at the First Minister Meeting on Aboriginal Issues (2005) • Key Principles: • First Nations driven • Community health approach • Building on successes • Wholistic approach to healthy living • Adequate funding to support infrastructure, programs and resources • Inclusive of solutions around non-medical determinants specific to First Nations 11

12. Securing Our Future (ctd) • More targeted strategy could be specifically aimed at First Nations children and obesity, including: • Improving access to safe and minimal/no cost opportunities for physical activity (traditional activities and walking) • Encouraging nutritious foods during a child’s critical growth period • Minimizing exposure to food advertising and marketing that targets children • Improving access to a safe, secure, inexpensive and nutritious food supply, including traditional foods • Supporting the home and family environment • Reducing socio-economic disparities and improving community support in encouraging healthy lifestyle practices 12

13. Recommendations • Community-based, wholistic approach to children’s obesity prevention programming involving the meaningful engagement of First Nations governments in related FPT initiatives • First Nations-developed strategies focused at multiple levels to address significant health disparities due to non-medical determinants of health including poverty and social conditions (e.g. overcrowding) • Resources that match cost drivers and needs (incl. community size and location) • Leverage existing successful programming • Aboriginal Head Start expanded as a universal program and its “Nutrition” component changed to “Nutrition and Physical Activity”, as well as expansion of “Health Promotion” component 13

14. Recommendations (ctd) • Minimize exposure to marketing of non-nutritious, energy-dense foods to children, and instead, market enhanced healthy eating and physical activity within the home and family environment (“Retail-based nutrition intervention”) • A Health Human Resource Policy to address nutrition capacity in First Nations communities • First Nations-driven research to identify appropriate measures of First Nations children’s health and of effective practices • Policies and programs for supportive school environments 14