Aboriginal Health and Wellness Plan 2002/ /06

Transcription

1 Aboriginal Health and Wellness Plan 2002/ /06 Interior Health Authority Our Vision: Health and Wellness for Aboriginal People Our Mission: To create a respectful, trusting, responsible partnership between Aboriginal People and Interior Health to support the development of a holistic health and wellness system which is responsive to the needs of the Aboriginal Community. Submitted to the Ministries of Health Services and Health Planning Original: September 2002 Revised: February 2003 Submitted by Interior Health Authority in Partnership with the Interior Health Aboriginal Health and Wellness Advisory Committee

2 TABLE OF CONTENTS (APPENDICES A to U ARE FOUND IN A SEPARATE DOCUMENT) INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN 2002/ /06 Revised: February TABLE OF CONTENTS... 2 EXECUTIVE SUMMARY INTRODUCTION Who Are Aboriginal Peoples? Background on Aboriginal Health HEALTH SERVCES PLAN REPORT Aboriginal Community Input Partnerships/Committees Personnel ABORIGINAL HEALTH SPECIFIC VISION ABORIGINAL HEALTH SPECIFIC MISSION ABORIGINAL COMMUNITY POPULATION PROFILE Overview of the Communities Ktunaxa Nation Secwepemc (Shuswap) Nation Okanagan Nation Tsilqot in Nation Nlaka pamux Nation St at imx Nation St Wixt (Stuwix) Nation Carrier Nation Métis Health Status Sources of Information Missing Information Population Demographics The Health Status Gap Determinants of Health Utilization of Services INVOLVEMENT AND PARTICIPATION PROCESS EXISTING SERVICE SYSTEM FOR THE ABORIGINAL COMMUNITY...31 Optional Federal First Nations Health Programs...32 Available to Status Indians resident on reserve only...32 HEALTH SERVICE TRANSFER...32 May include:...32 Dental...32 Medical Equipment...32 Prescriptions...32 Optical...32 NIHB restricted to reserve residents...32 INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

3 Patient travel...32 Drinking Water...32 Environmental...32 Brighter Futures...32 Patient travel Culturally Relevant Health Related Services Analysis of the Service Delivery System PRIORITY HEALTH ISSUES TO ADDRESS Holistic System Community Need Relationships/Partnerships Other GOALS AND OBJECTIVES...42 Strategies/Objectives...42 Strategies/Objectives...44 Strategies/Objectives EVALUATION COMMUNICATIONS PLAN...49 Verbal Communication...49 Action OTHER PLANNING ISSUES Human Resource Planning Funding to Develop Aboriginal Health and Wellness Plan Needs Assessments CONCLUSION...54 INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

4 EXECUTIVE SUMMARY This Aboriginal Health and Wellness Plan is composed of a synopsis of information from previous Aboriginal Health and Wellness Planning documents created prior to the formation of Interior Health as well as information stemming from discussions at the Interior Health, Aboriginal Health and Wellness Advisory Committee (AHWAC) meetings. The composition of the AHWAC consists of representation from each of the nine Nations within Interior Health including Shuswap, Okanagan, Ktunaxa, Tsilhqot in, Nlaka pamux, St Wixt, Carrier, St at imx and Métis; Urban Aboriginal organizations; Interior Health staff; and Interior Health Board of Directors. This Aboriginal Health and Wellness Plan imparts a holistic approach to planning. Where issues of a holistic nature are concerned, they will require the active participation of multiple levels of government, provincial ministries, and other key stakeholders involved with Aboriginal peoples. It is well known that the health status of Aboriginal People in Canada and British Columbia is far below that of the general population. Despite many services provided by Interior Health, the people from the Aboriginal communities still measure poorly on many of the health indicators such as life expectancy and mortality rates. For example, in Interior Health, infant mortality rates for Status Indians for 2001 vary from 1.9 times as high as others to a low of.9, a rate that is actually lower than that of the surrounding population. These statistics highlight the need for developing this three-year plan. This Aboriginal Health and Wellness Plan has been developed for the Aboriginal people living within Interior Health and for submission to the Ministry of Health Planning. It has been structured according to the Ministry of Health Planning, Aboriginal Health and Wellness Planning Policy, Requirements and Guidelines 2001/ /2004 and to the recommendations made by the Provincial Aboriginal Governors Group. It is expected that this plan will also be consistent with Interior Health s Redesign Plans that include the sectors of Public Health, Mental Health, Acute Care, Community Care and Residential Long Term Care. This Aboriginal Health and Wellness Plan is a living document that is based on the need of Aboriginal Communities within Interior Health. It is the result of a collaborative effort between Interior Health and the representatives of Aboriginal communities who live within its boundaries. This plan represents their commitment to work together to improve Aboriginal health. Interior Health and the AHWAC are dedicated to seeing this plan become practical and sustainable. It is anticipated that there will be continual revisions of goals, objectives, and strategies as the plan is implemented. Success will be measured by the extent to which there is follow through with proposed strategies, action taken on what has been planned, and results documented. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

5 The AHWAC conducted planning sessions where a number of Aboriginal Health issues were identified and prioritized. The following is a list of the top four priority issues: Lack of awareness/information Mental health Youth & elderly specific services Disconnected programs & services A number of goals, strategies and objectives were developed to address these four priority health issues over the three year planning period. The following is a list of the goals to be achieved: Service providers are aware of Aboriginal health issues and culture in Interior Health Clarify Interior Health, provincial and federal roles and ensure Aboriginal people understand, are aware of and access existing services and programs Aboriginal youth develop skills to earn a living, have hobbies and give back to the community Provide Aboriginal youth of Interior Health with high quality, culturally appropriate and holistic centred care that is sustainable and affordable Provision of high quality, culturally appropriate and holistic centred care for elderly that is sustainable and affordable There is improved access to health and other programming information Improve connection/link between Interior Health and Aboriginal communities Maximize the successful mental health programs and services for Aboriginal people within Interior Health There is a human resource plan in place that proposes to increase the number of Aboriginal people working in the health care system within Interior Health. It is the expectation of Interior Health and the AHWAC that addressing the priority health issues and achieving desired goals will enable Aboriginal people to receive high-quality, culturally appropriate and holistic centred care, leading to their improved health and wellness and to the creation of a sustainable and affordable public health system. The content of this plan includes an Aboriginal community population profile, a list of priority Aboriginal health issues, and the goals and strategies to address them, followed by an overview of the evaluation and communication processes to be conducted. The plan concludes with a section on other planning issues. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

6 1.0 INTRODUCTION This Aboriginal Health and Wellness Plan has been developed for the Aboriginal people living within Interior Health and for submission to the Ministry of Health Planning. The information provided in this plan arises from the Interior Health Aboriginal Health and Wellness Advisory Committee and a synopsis of information from Aboriginal Health documents developed prior to the formation of Interior Health. It has been structured according to the Ministry of Health Planning, Aboriginal Health and Wellness Planning Policy, Requirements and Guidelines 2001/ / and to the recommendations made by the Provincial Aboriginal Governors Group. 2 It is expected that this plan will also be consistent with Interior Health s Redesign Plans that include the sectors of Public Health, Mental Health, Acute Care, Community Care and Residential Long Term Care. This Aboriginal Health and Wellness Plan imparts a holistic approach to planning. Where issues of a holistic nature are concerned, they will require the active participation of multiple levels of government, provincial ministries, and other key stakeholders involved with Aboriginal peoples. The content of this plan includes an Aboriginal community population profile, a list of priority Aboriginal health issues, and the goals and strategies to address them, followed by an overview of the evaluation and communication processes to be conducted. The plan concludes with a section on other planning issues. 1.1 Who Are Aboriginal Peoples? Aboriginal Peoples are indigenous to North America (refer to Appendix A for a historical background on Aboriginal peoples in Canada and British Columbia). The Canadian Constitution Act (1982) recognises three separate groups of Aboriginal people, the Indians, the Métis and the Inuit. Each group has unique heritages, languages, cultural practices and spiritual beliefs. Members within all three of these groups live within the boundaries of Interior Health. A list of definitions for terms referred to throughout this document has been provided in Appendix B. 1.2 Background on Aboriginal Health It is well known that the health status of Aboriginal People in Canada and British Columbia is far below that of the general population. Despite many services provided by Interior Health, the people from the Aboriginal communities still measure poorly on many health indicators such as life expectancy and mortality rates. The division of responsibility for Aboriginal Health is one factor in this complex problem. The federal government has fiduciary and legislative 1 Ministry of Health Planning, Aboriginal Health and Wellness Planning: Policy, Requirements and Guidelines, 2001/ / Aboriginal Governors Working Group (December 1999) Achieving a Balance of Wellness for All British Columbians: Aboriginal People and Regionalization. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

7 responsibility for some health services for Status Indians, as defined by the Indian Act, and the provincial government provides health services for all British Columbians with services and facilities designed for the mainstream population. 3 These health services should be well integrated however there are gaps that have contributed to the poorer health status of Aboriginal people. This poorer health status is reflected in the following characteristics that apply to Status Indians or First Nations in BC. 4 High rates of teen pregnancy High birth rate High infant mortality rate High potential years of life lost High rate of accidental and violent death High death rates related to alcohol and drugs High rates of disability and chronic health condition High hospitalization rate Low education levels Low income levels The factors affecting Aboriginal health are many and a comprehensive approach must be taken to begin to fully address their health issues. Aboriginal people view health from a holistic perspective, encompassing the emotional, physical, mental and spiritual aspects of an individual. With this grounding, Aboriginal Health and Wellness Planning in Interior Health can move forward to improving the health of its Aboriginal population. 2.0 HEALTH SERVCES PLAN REPORT Prior to the creation of the Interior Health Authority in December of 2001, the area of Interior Health was represented by a number of regional health boards, community health councils, and community health service societies. These organizational structures had taken a variety of approaches to address Aboriginal Health. The following is a summary of the initiatives and projects undertaken over the past three years. 2.1 Aboriginal Community Input The former Thompson Health Region (THR) and former Thompson-Okanagan- Kootenay Aboriginal Health Council created a draft Aboriginal Health Care Issues document in February The purpose of this document was to highlight how well the regional health care system was meeting the needs of its Aboriginal people. To gather information for this report, a series of focus group consultations were conducted with Aboriginal health care providers from four areas of the region: Merritt, Lillooet, Kamloops and Lytton. A copy of the draft report has been provided in Appendix C. 3 The Aboriginal Health Association of BC Aboriginal Health Handbook 4 Thompson Okanagan Kootenay Aboriginal Health Council Aboriginal Health Care Issues, February 1998 and Aboriginal Health Association of BC, Aboriginal Health Handbook INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

8 2.2 Partnerships/Committees A number of collaborations with Aboriginal communities were formed in order to address Aboriginal health. These partnerships and committees provided an appropriate forum through which Aboriginal communities and the respective Health Service organization structure could openly discuss Aboriginal health matters. The former THR established many partnerships to address Aboriginal health. Firstly, in October of 2001, they established an ongoing Aboriginal Health Quality Improvement Committee, which has representation from all of the Aboriginal bands and organizations within its boundaries. The Aboriginal Health Quality Improvement Committee is committed to enhancing the ability of Aboriginal communities in the current Thompson Cariboo Shuswap Health Service Area to identify and address specific health issues that will result in positive health outcomes for Aboriginal peoples. The roles of the committee are to engage Aboriginal Community members in the identification of health needs and priorities and to make recommendations concerning identified health needs, issues and priorities to the senior leadership of the health service area. Secondly, at the time of Interior Health formation, the former THR was working towards a Memorandum of Understanding with First Nations and Inuit Health Branch (FNIHB), Health Canada regarding environmental health services on reserve. Thirdly, recent collaborative efforts between the former THR and the Qwemtsin Health Society (who provides services to five bands of the Shuswap Nation) have also resulted in letters of agreements in the delivery of community medicine consultation, public health nursing, clinical supervision, and home care. Finally, the Spallumcheen community, in the current Thompson Cariboo Shuswap Health Service Area, has reached an agreement with one of the Medical Health Officers of Interior Health to be their Community Medicine Consultant. In 2001, the former Okanagan Similkameen Health Region established an Aboriginal Health Working Group. This group had developed four draft goals and strategies regarding Aboriginal health in the area (Refer to Appendix D). The region had also established ongoing partnership discussions to be held between Public Health Nursing and the five Bands of the South Okanagan. In March/April of 2001, a Memorandum of Understanding was partially signed between the former East Kootenay Health Authorities and the Ktunaxa/Kinbasket Tribal Council. This Memorandum of Understanding was to confirm the commitment of both parties to work together to establish a joint process that would allow them to engage in dialogue on a broad range of policies related to health and other social, economic and environmental issues. Refer to Appendix E for a copy of this document. The former Kootenay Boundary Community Health Services Society (KBCHSS) began a Community Enterprise Program that was focused on empowering marginalized people by involving them in community development and training. The KBCHSS initiated a regional network with 9 community coalitions from the INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

9 various communities in the area. The Aboriginal community coalition elected to participate in this project as a separate community in order to best meet the Aboriginal people s needs regarding self advocacy and health. The KBCHSS sponsored the Aboriginal Community Health Capacity Initiative that was completed by the Lower Columbia River All First Nations Council. The goal for the project was to broadly reach out to the Aboriginal people in the region and establish a mechanism for dialogue with health service providers on important issues related to Aboriginal health and well being. This project assisted in building and maintaining working relationships between health service providers and the Aboriginal Community and provided an opportunity for the First Nations organizations to work with the Métis Association on health and self advocacy issues. An extension for the project had been requested. Refer to Appendix F for a copy of this document. 2.3 Personnel Interior Health has created various Aboriginal Health positions to facilitate the improvement of Aboriginal Health. The Thompson Cariboo Shuswap Health Service Area has hired two Aboriginal Mental Health Liaison persons and has posted an expression of interest for an Aboriginal Liaison Position. These positions were created in order to facilitate communications between the health service area and the Aboriginal communities. In the former North Okanagan Health Region, two Aboriginal Health personnel changes occurred. Firstly, to better meet client needs, the Mental Health Aboriginal Liaison position was increased from 0.5 full time equivalent to 1.0 full time equivalent. Secondly, as a result of the draft Aboriginal Health and Wellness Plan the region created, a federal grant was awarded to the Vernon Social Planning Council for a contract person to develop an Aboriginal Community Capacity Building Model for health planning. Interior Health as a whole has also created two positions that focus on Aboriginal Health and Wellness Planning and Administration. These positions include a Coordinator for Aboriginal Health and Planning and an Aboriginal Contract Manager. In addition to creating specific positions, Interior Health has appointed a Senior Medical Health Officer and a Medical Health Officer who are responsible for Aboriginal Health, as well as appointed contacts for Aboriginal health issues in each of its health service areas. 3.0 ABORIGINAL HEALTH SPECIFIC VISION Health and Wellness for Aboriginal people. As defined by the AHWAC. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

10 4.0 ABORIGINAL HEALTH SPECIFIC MISSION To create a respectful, trusting, responsible partnership between Aboriginal People and Interior Health to support the development of a holistic health and wellness system which is responsive to the needs of the Aboriginal Community. As defined by the AHWAC. 5.0 ABORIGINAL COMMUNITY POPULATION PROFILE Interior Health provides services over a vast region of the province, stretching from Williams Lake to the US border, and from Tatla Lake in the Chilcotin to the Alberta border (Map of Interior Health provided in Appendix G). The total population of this area is approximately 720,000 with projected growth to around 760,000 by the year The geographical area of Interior Health contains nine Nations including the Shuswap, Okanagan, Ktunaxa, T silhqot in, Nlaka pamux, St Wixt, Carrier, St at imx and Métis. These nations are comprised of approximately 54 communities and have developed over 70 Aboriginal organisations that are widely dispersed throughout the area. Appendix H provides a detailed list of many of the Aboriginal councils, organizations, communities, services etc. within Interior Health. 5.1 Overview of the Communities The Aboriginal Communities that fall within the boundaries of Interior Health are distinct and unique peoples. Although there are a number of issues and concerns that are common, each community has its own definite experiences and challenges. Due to the considerable number of Aboriginal communities throughout Interior Health, this section will only provide an overview of the Inuit people and the nine Nations within Interior Health. Inuit People Inuit origins in Canada date back at least 4,000 years. Inuit developed skills and technology uniquely adapted to one of the harshest and most demanding environments on earth. Before the creation of permanent settlements, the Inuit moved with the seasons. They established summer and winter camps to which they returned each year. Co-operation and sharing were and remain the basic principles in Inuit society. The Inuit share the food they have hunted, and everyone does his or her part to assist those in need. Inuktitut is still spoken in all Inuit communities. Oral traditions and story telling are still very much alive in Inuit culture, with tales having passed down through the centuries. The first regular contact between Inuit and Europeans began in the mid-1700s when European whalers arrived in the Arctic. In the 1940s and the 1950s, the government encouraged Inuit to live in permanent settlements, instead of their seasonal camps. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

11 5.1.1 Ktunaxa Nation Ktunaxa is what the people of the nation have always called themselves. The language spoken, Ktunaxa, is an isolated language in that it is not linked to any other. 5 Composition The Ktunaxa Nation is characterized by two distinctive groups the Upper and Lower Ktunaxa. It is a small nation that encompasses 7 bands, 5 in Canada and 2 in the United States (known as tribes). The five bands in Canada include Columbia Lake, Lower Kootenay, St Mary s, Shuswap and Tobacco Plains. The traditional territory is the entire land of the Kootenay (Both East and West) in Southeast British Columbia. In 2001, there were approximately 1,200 registered members of the Ktunaxa Nation excluding those who do not register in the Canadian Government Indian Registry and those who are members of the Ktunaxa American tribes. A large proportion, 40-55% of the population is under the age of 25 years. Organization The Ktunaxa bands primarily work together through the Ktunaxa/Kinbasket Tribal Council and the Ktunaxa/Kinbasket Treaty Society. The bands in the Ktunaxa have actively built their economy through business initiatives mainly in housing developments and the tourism industry Secwepemc (Shuswap) Nation Secwepemc is an ancient name expressing the relationship between the people and the waterways. 6 The Secwepemc, in terms of traditional land base and population, are one of the largest First nations groups in BC. 7 The traditional lands occupy 105,000 sq. km. The total population is 8,475 of which 4,221 live on reserve. Composition The Secwepemc Nation is comprised of 16 bands that are dispersed over approximately 18% of the total area of British Columbia, in the South Central Interior. The Nation is comprised of two distinct groups, Northern and Southern Secwepemc. The member communities of the Southern Secwepemc include: Adams lake Bonaparte Kamloopa (Kamloops) High Bar First Nation North Thompson Neskonlith Whispering Pines Skeetchestn 5 Cheryl Coull, 1996, A Traveller s Guide to Aboriginal BC 6 Ibid. 7 INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

12 Little Shuswap Shuswap Spallumcheen The member communities of the Northern Secwepemc include: Canim Lake Esketemc First Nation Soda Creek Canoe Creek Indian Band Williams Lake Organization A chief and council govern each of the 16 Secwepemc communities. The Secwepemc member communities are affiliated with the Shuswap Nation Tribal Council and the Cariboo Tribal Council. The Secwepemc have taken steps to rebuild their Nation, communities and people and have increasingly regained control and responsibility over their own land, resources and rights. They have made many achievements in areas such as economic development, social development and the Secwepemc language and culture. The Secwepemc people have signed and enacted upon various declarations. They have also established a number of organizations, institutions and initiatives such as the Secwepemc Cultural Education Society. The Secwepemc Cultural Education Society is a non-profit organization that is mandated to: preserve, record, perpetuate and enhance the language, culture and history of the Secwepemc people; build the capacity of, primarily but not solely, Aboriginal peoples toward selfreliance and self-determination through training and higher education; and foster relationships between Secwepemc and other cultures. The Northern Secwepemc communities are also involved in Health Transfer Agreements with First Nations Inuit Health Branch, Health Canada for the delivery of community based health education, prevention and awareness programs. Canim Lake and Esketemc have signed individual transfer agreements while Soda Creek, Canoe Creek and Williams Lake have formed a Society known as Three Corners Health Services. Today all of these First Nations have direct delivery of all of the following programs and services within their respective communities for the on reserve membership. Pre-Natal Nutrition Alcohol and Drug Programs Community Health Representative (liaison) Brighter Futures Solvent Abuse Community Health Nursing Building Healthy Communities Home and Community Care INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

13 The Northern Secwepemc Health Directors and Co-ordinators take great pride in the efforts to create an effective and understanding health care system for the on reserve members to access. The Northern Secwepemc appreciate the opportunity to create new effective relationships for the benefit of the health and wellness of its community members Okanagan Nation The Okanagan Nation is part of the Salishan language family. 8 Composition The Okanagan First Nations people are a branch of the Salishan Family. They reside in the Southern interior of British Columbia. The Okanagan people have not signed a treaty with the Federal Government nor do they recognize the Provincial Government as having jurisdiction within their homeland. These issues are being dealt with at the present time. 9 The presently known Okanagan valley is also known as the Okanagan Indian Nations traditional territory, or as the "Syeelhwh Nation", which means the people who live here. "S-Ookanhkchinx" or Okanagan translates to mean, "transport toward the head or top end". 10 This nation is comprised of 7 member bands including Okanagan (S-Ooknahchinx), Lower Similkameen (Chopaka), Upper Similkameen (Simikameugh), Westbank (Tsinsticeptum), Osoyoos (Inkaneep), Upper Nicola (Nicola) and Penticton (Sn Pint kin). Organization The Okanagan Nation bands are affiliated with the tribal council, Okanagan Nation Alliance. The mandate of the Okanagan Nation Alliance is as follows: Advancement, assertion, support and preservation of the Aboriginal Rights of the Okanagan Nation Promotion, advancement and support of all land claims initiatives undertaken by Member Bands of the Okanagan Nation, as identified by the Okanagan Nation Declaration of August 22, Protection, enhancement and preservation of the peoples, lands and resources of the Member Bands of the Okanagan Nation. Protection, enhancement and preservation of the environment, fish and wildlife resources located within the traditional territories of the Okanagan Nation. Promotion, enhancement and preservation of the Okanagan Native history, language and culture. To collectively undertake and resolve governmental policy issues that may have an overall adverse effect on Member Bands and individuals. 8 Aboriginal Health Association of BC, Aboriginal Health Handbook 9 Okanagan Nation Alliance Cheryl Coull, 1996 INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

14 Promote and create a public awareness of the Okanagan Nation Alliance concerns, position and accomplishments in the areas of political, social, economic and cultural development Tsilqot in Nation Composition The Tsilqot in Nation is comprised of 6 member bands including: /Esdilagh(Alexandria), Tsi Del Del (Alexis Creek), Yunesit in (Stone), Tl etinqoxt in (Anaham), Tl esqox (Toosey) and Xeni Gwet in (Nemiah). The Tsilhqot in Nation continues to stand by the Royal Proclamation of 1763 and its recognition of Aboriginal title. The Tsilhqot in Nation affirm their ownership of the land and resources. Organization The Tsilhqot in National Government represents some of the Tsilhqot in Nation bands. The Tsilhqot in National Government assists and advises its member communities with social development, economic, cultural and educational issues. It provides a united political platform for addressing other governments on the unique needs of the Tsilhqot in people. The Tsilhqot in National Government has a number of departments including Economic Development, Family Care, Tsilhqot in Forest Products, Traditional Use Study and Tsilhqot in Fisheries. They also have a number of affiliated agencies including the Society for Chilcotin Language and Culture Preservation, and the Anaham Elders Care Home Society. The Tsilhqot in National Government also provides programs for its members including the Tri-Nations Health Liaison Program which is focused on improving health care communication and cross cultural awareness through translation and liaison services Nlaka pamux Nation Nlaka pamux means people of the canyon in their spoken language. 11 The territory of the Nlaka pamux is vast. Bands that are part of the Nlaka pamux nation are located from above Lytton to the West and from Ashcroft to the East, then down to Spuzzum where the Canyon opens into Stó:lo territories. The ancient capital of the Nlaka pamux world was Kumsheen, meaning confluence of the rivers, and today, Lytton (formerly known as Kumsheen) is a central location for the contemporary Nlaka pamux communities. 12 Composition The Nlaka Pamux Nation is comprised of 12 member communities including Shtashims (Ashcroft), Boston Bar, Lytton, Siska, Boothroyd, Spences Bridge, 11 Cheryl Coull, Ibid. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

15 Oregon Jack Creek, Kanaka Bar, Spuzzum, Nicomen, Cook s Ferry and Skuppah. In addition to the 12 member communities, there are also four communities that collectively identify themselves as the Sce exmx people of the creek. 13 The Sce exmx occupy the upper part of the Nicola River and the communities include Coldwater, Shulus (Lower Nicola), Shackan, and Nooaitch. Organization The member communities Shtashims, Siska, Boston Bar, Lytton, Boothroyd, Spences Bridge and Oregon Jack Creek are closely affiliated with the Nlaka pamux Tribal Council. The Kanaka Bar, Spuzzum, Skuppah and Nicomen are affiliated with the Fraser Canyon Tribal Administration. The Sce exmx communities and Cook s Ferry are affiliated with the Nicola Valley Tribal Council St at imx Nation St at imx means the linkage between the people and the rivers. 14 The language spoken here is St at imcets, a branch of the Interior Salishan language family. 15 Composition The St at imx territory is located approximately 48 km north of Lytton, BC at Texas Creek. The nation is comprised of 11 communities that are located on either side of the Coastal Mountains. These communities are Xwisten (Bridge River), Sekw elw as (Cayoose Creek), Ts kw aylaxw (Pavilion), Tl itl kt (Lillooet), Lil wat (Mount Currie), Shalalth (Seton Lake), N quatqua (Anderson Lake), Samahquam, Xa xtsa (Douglas), Xaxl ip (Fountain) and Ska tin (Skookumchuck). Organization The communities, Xwisten, Sekw elw as, Ts kw aylaxw, Tl itl kt, Mount Currie and Shalalth are affiliated with the Lillooet Tribal Council. While the communities N quatqua, Samahquam, Xa xtsa and Ska tin are affiliated with In-SHUCK-ch Councils Administration St Wixt (Stuwix) Nation The Stuwix Nation is part of the Nicola Valley. They have sometimes been referred to as the little strangers. 16 It has been suggested that the Stuwix people have Athapascan roots with possible ties with the Tsilqot in to the north. It was also suggested that the Stuwix people were Chinookan speakers from the 13 Cheryl Coull, Ibid. 15 Ibid. 16 Ibid. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

16 lower Columbia River. 17 Unfortunately, very limited information exists on the Stuwix people Carrier Nation Composition The Ulkatcho band is part of the Carrier Nation and has chosen to be part of Interior Health. This band has a total population of 848. The Ulkatcho Band is located 328 km west of Williams Lake, next to Anahim Lake. The band is part of the Southern Carrier linguistic group. Organization The members of the Ulkatcho band are affiliated with the Carrier-Chilcotin Tribal Council. Water is supplied to the dwellings on the reserve by unheated main from two reservoirs, two community wells, and individual wells. There are no sewage disposal facilities. The community accesses police protection, postal service, and health care in Anahim Lake. There are a number of facilities available on the reserve including a band office, a store, a student residence, a school, a fire hall, a small carpentry shop, a Federal Nursing Station and a learning centre. Economic activities include the general store, ranching, trapping, a sawmill, and other forestry related activities Métis Composition The Métis are a unique people who are descended from the extensive intermarriages that took place between the First Nations and non-aboriginal people (especially the early French and Scottish fur-traders). They created a distinct culture, language and identity through the blending of their heritages. The Métis are recognized in the Constitution as one of the three Aboriginal peoples of Canada. Although recognized as an Aboriginal people the Métis do not benefit from a special status with the federal government and are rarely eligible for federal programs particularly in the area of health. Organization The Métis are represented by the Métis Provincial Council of British Columbia (MPCBC). The MPCBC is a member of the Métis National Council. The MPCBC has organized the province into seven regions. Each region elects a representative to the council and in addition, a President and Vice-President are elected at large. The governance of the Métis within the Province is currently 17 Cheryl Coull, INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

17 under review. Interior Health has two regions and part of a third within its boundaries. Region 3 covers the Okanagan, Kootenay Boundary and parts of the Cariboo districts. The government of Region 3 has a Director and a Presidents Council which is composed of the Presidents of each local within its borders. Currently there are ten locals in the region. Region 4 is organized on a regional basis with the central office located in Cranbrook. The governing body is composed of the Presidents of the five sublocals in the region as well as regionally elected President, Vice-President, Secretary and Treasurer. Region 5 is located in the North Central portion of the province. Williams Lake and Quesnel are two locals that are part of Interior Health. The governance of Region 5 is similar to Region Health Status The following is an overview of the health status of the members of the Aboriginal Community within the Interior Health geographical area. It includes a summary of the sources of information and missing information, gaps in health status, determinants of health and utilization of services Sources of Information The following is a list of the data sources that provided information for this overview. Refer to Appendix I for some of the limitations in using the data sources. The Statistics Canada 1996 and 2001 Population Census, The Department of Indian and Northern Development Registered Indian Population Projections for Canada and Regions The department of Indian Affairs and Northern Development, in collaboration with Statistics Canada prepares and regularly updates these population projections that are based on the 1998 Indian Register. Health Canada First Nations and Inuit Health Branch (FNIHB) in co-operation with the British Columbia Vital Statistics Agency produced health statistics for the Status Indianon and off reserve population. E.g. Regional Analysis of Health Statistics for Status Indians in British Columbia Provincial Health Officer Annual Report 2002 (pending) This report draws from a variety of sources to paint a picture of Aboriginal health and well-being in BC. The sources include: FNIHB Regional Health Survey-National Report 1999 INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

18 National Population Health Survey, Statistics Canada BC Ministry of Education BC Ministry of Children and Family Development BC Treaty Commission BC Vital Statistics Agency Canada Census, Statistics Canada Tobacco Use in BC, 1997 Heart and Stroke Foundation of BC and Yukon Adolescent Health Survey. McCreary Centre Society Housing and Infrastructure Assets Summary Reports Indian and Northern Affairs Canada Canada Mortgage and Housing Commission (CMHC) Screening Mammography Program of BC Medical Services Plan Hospital Morbidity Database, BC Ministry of Health Services Non-Insured Health Benefits Program, Health Canada, FNIHB Etc. It is not the intent of this document to reproduce this information or to attempt a complete analysis of Aboriginal Health statistics in Interior Health. Rather, under the guidance of the Aboriginal Health and Wellness Advisory Committee (AHWAC), statistics will be selected to illustrate where the most significant gaps in health status between Aboriginal and non-aboriginal people occur, which health issues are seen as priorities within Interior Health, and which statistics might be most useful in demonstrating the anticipated improvements in Aboriginal Health that will flow out of this plan and its implementation over the ensuing years Missing Information Most of the health data that we have access to pertain to registered status Indians only. This creates gaps in our understanding of Aboriginal Health with regard to: BC Aboriginal people who are non-status both on and off reserve Métis people Urban Aboriginal people who may come from outside BC Aboriginal people who are not represented in the Census or other surveys First Nation communities that are now in Health Transfer and do not have the provision or support of the federal statistical system. In addition, the available data on Aboriginal people differs greatly given the difference of registration and membership requirements. While Status Indians have strict membership requirements that must be met there are many other Aboriginal organizations that are not as stringent with membership requirements. Given the above limitations, it is difficult to provide a complete description of Aboriginal health and well-being. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

19 One of the ongoing elements of this Plan to improve the health of Aboriginal people in Interior Health will be the development of new data and health surveillance information in collaboration with the AHWAC and the people they represent Population Demographics Population According to the 1996 Statistics Canada Census Population, in Interior Health there are approximately 28, 370 Aboriginal people, which is approximately 4.3% of the total population. This is composed of 21, 310 North American Indian, 5,890 Métis, 175 Inuit, 245 Multiple and 765 other. There are approximately 9,500 or 33.5% of the Aboriginal population living on reserve. Appendix J provides a table containing the population counts according to the 2001 Statistics Canada Census information for the Indian Reserves located within the Interior Health geographical area. Note that this table is not a complete list and that some reserves may not be connected with Interior Health. Figure 1 below indicates the estimated Status Indian population as a percentage of the total population for each of the former Health Regions (HR) within Interior Health. As the figure indicates, Status Indian people are not distributed evenly throughout Interior Health. Figure 1: Status Indian Population by former HR within Interior Health Estimated Status Indian Population (2002) North Okanagan 3.3 South Okanagan 2.3 East Kootenay 3.7 West Kootenay 1.9 Thompson 9.3 Cariboo 10.1 British Columbia Status Indian Population As % of Total Age and Gender According to the birth related and mortality measures for British Columbia s Status Indian population from the BC Vital Statistics Agency, the Status Indian population is significantly younger than Other BC residents. In 1999, the average age in the Status Indian population was 27.8 years, which was more than nine years younger than the average age of 37.2 years for other BC residents. In addition, less than one in twenty Status Indians was a senior (65 years of age or older), compared to more than one in eight for Other BC Residents. The figure below indicates the population count of Status Indians by gender and age group INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

20 for the former health regions (Cariboo, Thompson, E. and W. Kootenay, North Okanagan, S. Okanagan-Similkameen) within Interior Health, 1999 Figure 2: Status Indian Population Count by Age and gender for the former health regions (Cariboo, Thompson, E. and W. Kootenay, North Okanagan, S. Okanagan-Similkameen) within Interior Health, ,000 1,800 1,600 1,400 1,200 1, < Age Range Total Male Total Female This figure indicates that there is a larger female population between the ages This trend is also reflected in population statistics for British Columbia (refer to Appendix K for the Age and Gender Population Pyramid for British Columbia for 1999, BC Vital Statistics Agency). Population Projections According to a report done by the Department of Indian and Northern Development for the period , there will be a 21.3% increase from the 1998 estimated total population of Registered Indians by on/off reserve for Canada and an 18% increase for British Columbia. Although these are only population projections, the vast difference in live birth rates for Status Indians vs. the Other Residents of Interior Health is indicative of an increasing population. The growth rate for the Status Indian population has been gradual and constant. 18 Overall, between , 27,108 Status Indian babies were born in the province. Each year, there were approximately 3,000 Status Indian live births or 23.3 births for every 1,000 Status Indian residents, which was twice the live birth rate for Other BC Residents. This is also reflective in the statistics for the former health regions within Interior Health with an 18 BC Vital Statistics Agency, Regional Analysis of Status Indians in BC, INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

21 average birth rate for the Status Indians of per 1,000 population vs per 1,000 population for Other Residents during the nine year period The Health Status Gap It is well documented that Aboriginal people in Canada, BC and the Interior do not enjoy the same level of health as the surrounding, non-aboriginal population. For some of the major indicators, most notably infant mortality, the gap has rapidly decreased over the last several decades. In Interior Health, Infant Mortality rates for Status Indians for 2001 vary from 1.9 times as high as others to a low of.9, a rate that is actually lower than that of the surrounding population. Figure 3 highlights the Infant mortality rate for Status Indians and Other BC Residents over the period Figure 3: Infant Mortality Rate for Status Indian and Other BC Residents ( ) Infant Mortality Rate ( ) Status Indian and Other BC Residents North Okanagan South Okanagan East/West Kootenay Thompson Cariboo British Columbia Status Indian Other BC Residents infant deaths / 1000 births Figure 4 shows the ratio between Status Indians and Other BC Residents for several major health indicators for the former health regions within Interior Health. Note that a ratio of 1 indicates equivalency between Status Indians and Others. 19 BC Vital Statistics Agency, Regional Analysis of Status Indians in BC, INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

22 Figure 4: Health Status Ratio between Status Indians and Other BC Residents Kootenays N. Okanangan Ok-Simil. Thompson Cariboo 1 0 Infant Mortality Post Neaonatal Mortality All Cause Mortality External Cause Mortality Potential Years of Life Lost Teen Pregnancy Low Birth Weight Health Indicators Source: Provincial Health Officers Annual Report 2002 (Pending) Figures 5, 6, 7 and 8 provide the age standardized mortality rates, rates for deaths due to injury, alcohol related deaths and HIV/AIDS deaths for Status Indians and Other BC Residents for the former health regions within Interior Health for the period Figure 5: Age Standardized Mortality Rate for Status Indian and Other BC Residents Age Standardized Mortality Rate ( ) Status Indian and Other BC Residents North Okanagan South Okanagan East/West Kootenay Thompson Cariboo Status Indian Other BC Residents British Columbia INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

23 Figure 6: Deaths due to Injury for Status Indian and Other BC Residents Deaths Due to Injury ( ) Status Indian and Other BC Residents North Okanagan South Okanagan East/West Kootenay Thompson Cariboo Status Indians Other BC Residents British Columbia Rate per 10,000 Population Figure 7: Alcohol Related Deaths Alcohol-Related Deaths ( ) Status Indian and Other BC Residents North Okanagan South Okanagan East/West Kootenay Thompson Cariboo Status Indians Other BC Residents British Columbia Rate per 10,000 Population Figure 8: HIV/AIDS Deaths HIV/AIDS Deaths ( ) Status Indian and Other BC Residents North Okanagan South Okanagan East/West Kootenay Thompson Cariboo Status Indians Other BC Residents British Columbia Rate per 10,000 Population INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

24 5.2.5 Determinants of Health Figures 9-14 provide statistical information on the important non-medical determinants of health such as education, housing, and income. While many of these are not directly impacted by the health care delivery system, they emphasize the importance of collaboration between agencies and a holistic, community driven approach to improving Aboriginal health. Figure 9: Percentage of Status Indian Population with High School and Post Secondary Graduation within Interior Health (2000/01) Status Indian: High School and/or Post-Secondary Graduates North Okanagan East Kootenay Thompson British Columbia High School Graduation Post-Secondary Graduation % of Status Indian Population Figure 10: Comparison between Aboriginal and non-aboriginal Grade Completion In 1995, of every 100 students who enter grade 8 the number who Level of Education Aboriginal Non-Aboriginal Source: School Finance and Data Management Branch and Evaluation and Accountability Branch. In BC Ministry of Education, Skills and Training 1995/1996 Annual Report, p.27. INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY

25 Figure 11: Housing Quality and Drinking Water Supplies on Reserve within Interior Health ( ) Housing Quality and Drinking Water Supplies on Reserve ( ) North Okanagan South Okanagan East Kootenay Thompson Cariboo British Columbia Adequate Housing on Reserve Drinking Water Meets DWQ Guidelines % Meeting Guidelines Figure 12: Proportion of the Status Indian population aged 15+ with Incomes < $10,000 Proportion of the Status Indian Population Aged 15+ With Incomes < $10,000 (1995) North Okanagan South Okanagan East Kootenay West Kootenay Thompson Cariboo British Columbia Females Males Total % of Status Indian Population INTERIOR HEALTH ABORIGINAL HEALTH AND WELLNESS PLAN - Revised VERSION FEBRUARY