An Introduction to Aboriginal Health: What Determines Aboriginal Health in Canada and Around the World?

1. An Introduction to Aboriginal Health: What Determines Aboriginal Health in Canada and Around the World? Brown Bag Speaker Series on Aboriginal Health October 14, 2010 Centre fro Aboriginal Health Research Jeff Reading PhD Professor and Director, Centre for Aboriginal Health Research School of Public Health and Social Policy University of Victoria

2. Chronic Diseases • In 2005 of the 58 million deaths worldwide approximately 60% were due to chronic diseases • 4 out of 5 deaths will be in low and middle income countries • In these countries people tend to develop diseases younger, suffer longer, and die sooner

3. Chronic Diseases • In Canada Aboriginal people face a similar situation • Earn less than the non-Aboriginal population • Suffer from higher rates of many chronic diseases and associated risk factors • Have a shorter life expectancy • Internationally Canada ranks highly in health and well being, while the Aboriginal population is much less fortunate

4. Diabetes • Historically of low prevalence in the Aboriginal population • Changes in lifestyle and diet, adoption of Western habits has resulted in an increase in diabetes • Similar trajectory to Cardiovascular Disease and other chronic conditions

5. Diabetes Risk factors • Not all risk factors have been well studied in the Aboriginal population • Less is known about risk factors in the urban Aboriginal population

6. Chronic Disease Risk Factors • The most common risk factors for Chronic disease studied among Aboriginals are: • Impaired glucose tolerance (IGT); • Type 2 diabetes; • Obesity (over-eating and lack of exercise); • Cigarette smoking.

7. Diabetes Risk Factors • Diabetes prevalence is much higher in the Aboriginal population than the non-Aboriginal population • Diabetes occurs at a much younger age • Incidence is increasing

8. Diabetes Prevalence Rates

9. Diabetes Prevalence Rates

10. Diabetes Prevalence Rates

11. Chronic Disease Risk Factors • 46% of First Nations people are daily smokers • This rises to 54% in the 18-29 age group and if occasional smokers are included rises to 70%

12. Chronic Disease Risk Factors • In youth the rates are also very high • Occasional and daily smokers 16 years of age • 44% male and 67% female • Occasional and daily smokers 17 years of age • 56% male and 67% female

13. Chronic Disease Risk Factors • From the 2002/03 Regional Health Survey • 42% of men and 31% of women are overweight • 29% of men and 34% of women are obese • 3% of men and 7% of women are morbidly obese

14. Chronic Disease Risk Factors • According to the 2002/03 Regional Health Survey First Nations peoples self reported rate of hypertension • 20.4% vs. 16.4% in the non-Aboriginal population • In the 50-59 age group this rises to 30.5% vs. 22.4%

15. Adult Risk Factors • Attempts to address problems of chronic diseases usually focuses on changing patterns of adult risk factors • Unfortunately this does not address the next generation and prevention of chronic disease

16. Life Course Epidemiology • Life course epidemiology has been defined as the study of long-term effects of physical or social exposures during gestation, childhood, adolescence, young adulthood, and adult life on one’s developmental health and later disease risk

17. Diabetes, Chronic Disease and Life Course Epidemiology • Life course epidemiology goes beyond traditional risk factors and questions the importance of intrauterine nutrition, birth weight, childhood obesity, smoking initiation ages and rates, adolescent blood pressure, and socioeconomic status across an individual and community’s life course.

18. Life Course Intervention The Goal: To optimize the developmental trajectory over entire life course

19. Life Course Intervention What matters: Address the complex interaction of health determinants, in particular Aboriginal contexts, over entire life course

20. Life Course Risk Factors • Birth weight • Low birth weight has been associated with an increased risk of heart disease and hypertension • Low or high birth weight has been associated with increased risk for diabetes • First Nations babies are twice as likely to be high birth weight babies

21. Life Course Risk Factors • Maternal Diabetes • Gestational diabetes rates are higher in Aboriginal women • Children born to diabetic mothers are at increased risk for impaired glucose tolerance, childhood obesity, and diabetes

22. Life Course Risk Factors • Childhood and adolescent obesity • Increases the risk for adult obesity • Aboriginal children are lacking in sports and recreation facilities in their communities

23. Social Determinants of Health That population level factors which determine health and well-being for any collectivity have their origins in upstream historic, cultural, social, economic and political forces affecting the lives of Indigenous peoples, has been articulated for almost a decade. * Young, 1988; Young, 1994; INAC, 1996.

24. Many determinants of health are beyond the scope of the health care system: • Changing diets from traditional to non-traditional foods • Food insecurity • Stress due to economic factors • Pollution • Global capitalism etc...

25. A word about Words • Social Exclusion • Marginalization • Inequality • Risk • Vulnerability

26. Social Determinants of Health The social determinants are often referred to as the “causes of the causes” Affect rates of individual level risk factors such as smoking, obesity, substance abuse Social determinants require social remedies

27. END POVERTY NOW!! Poverty eradication as the most important determination of health, because it is through income that other determinants of health are purchased, such as adequate housing, access to health services and education, potable water and nutritious food etc.

28. % Experiencing Major depressive Episode by household Low income level and off-reserve health status* * Charlotte Loppie Reading and Fred Wein, Health Inequities and Social Determinants of Aboriginal peoples Health. NCCAD, PHAC, 2009

29. % Experiencing Major depressive Episode by household Low and High income level and off-reserve health status* * Charlotte Loppie Reading and Fred Wein, Health Inequities and Social Determinants of Aboriginal peoples Health. NCCAD, PHAC, 2009 Low Medium High

30. Social Determinants of Health • Many studies have demonstrated a connection between socioeconomic status and health • Aboriginal population has lower levels of education, income, and employment • These conditions are associated with increased rates of obesity, chronic conditions and diabetes

31. Social Determinants of Health • Can observe a health gradient within the Aboriginal population - poorer health associated with lower SES • Effects of colonialism • Effects of residential school system

32. Demographic Trends • Aboriginal population is much younger than the rest of Canada • Risk factors are more prevalent and increasing and occurring in ever younger Aboriginal people • As the youthful Aboriginal population ages increased rates and numbers of people with diabetes and chronic conditions disease can be expected

33. Actions • Seek commitment to a multi-year dialogue to explore common issues and agendas for action in Aboriginal health and well being. • Facilitate and accelerate the dissemination, transfer and translation of knowledge into potential applications and benefits through policies, interventions, services and products. • Encourage multi-lateral collaborative ventures among communities and institutions concerned with improving the health and well being of Indigenous peoples. Promote multi-disciplinary, multi-institutional, and multi-sectored collaborations and to build upon existing networks of policy-makers and researchers to further develop capacities on Indigenous peoples’ health in areas of mutually shared priorities.

34. Conclusion • A plethora of health indicators demonstrate that Aboriginal Peoples’ in Canada endure a profound public health and socioeconomic burden when compared to mainstream populations. • Such a pattern is observed globally as Aboriginal populations are the poorest of the poor and correspondingly vulnerable to high rates of preventable disability, disease and premature death.

35. How to Contact Us • If you would like to visit our website and sign up for our mailing list please visit: http://cahr.uvic.ca • Recordings of the entire “Brown Bag Aboriginal Health Speaker Series” will be posted online on our website • (for our online viewers if you would like to fill out a feedback form and be entered in our draw please email Bianka at bsaravan@uvic.ca)