Image credit: Juan Solorzano ESTABLISHING FIRST NATIONS HEALTH & WELLNESS INDICATORS FOR THE NEXT 10 YEARS Gathering Wisdom Dr. Perry Kendall and Dr. Evan Adams November 30, 2016 1 Live Graphic Recording From the Chief Medical Officer of FNHA & Provincial Health Officer Partnership Workshop - March 2016 (Sam Bradd) 2 1
AN EMERGING PARTNERSHIP Aboriginal Health Physician Advisor Position Deputy Provincial Health Officer Position PHO:FNHA Partnership (MOU) FNHA Chief Medical Officer Position PARTNERSHIP BASED ON TRUST AND RESPECT 3 STRONGER TOGETHER: PHO & FNHA PARTNERSHIP 4 2
THE TEAM Collaboration between the Office of the PHO, Office of the CMO and other FNHA departments. Project leads: Lindsay Beck, Kathryn Berry, Adrienne Bonfonti and; Working Group Members: Dr. Shannon McDonald, Dr. Shannon Waters, Harmony Johnson, Judith Eigenbrod, Laurel Lemchuk-Favel, Rebecca Love, Ashraf Mohammed, Megan Misovic, Anita Christoff 5 TODAY MARKS A MILESTONE MOMENT 6 3
Support FNHA s vision for Healthy, Self-Determining, & Vibrant BC First Nations Children, Families, & Communities by: Establishing a renewed set of 15 indicators, that we will measure and report on for the next 10 years. Building off the 7 health indicators established in the Transformative Change Accord First Nations Health Plan. 7 ORIGINAL 7 TRANSFORMATIVE CHANGE ACCORD FN HEALTH PLAN INDICATORS Indicator Infant mortality Children with healthy Body Mass Index (BMI) (Note: This indicators was previously obese children) Youth suicide Diabetes prevalence Age-standardized mortality rate Life expectancy Number of practicing, certified FN HCPs Source Vital Statistics Survey/Canadian Community Health Survey Vital Statistics Ministry of Health Vital Statistics Vital Statistics To be determined * The final interim update is scheduled for release in 2017 to report on data up to 2015. 8 4
YOUTH SUICIDE RATE ( R AT E PER 10,0 00 P OPULATI ON) P r o g r es s s in c e B a s elin e P r o jec ted to meet Ta r g et PRO JECTIO NS: SI b ef o r e TCA: 3.5 3 Cu r r en t: 2.2 3 P r ev io u s ( 2 0 1 0 ) : 2.1 8 Ta r g et: 2.1 0 O R b ef o r e TCA: 0.6 6 9 DIABETES AGE-STANDARDIZED INCIDENCE RATE ( R AT E PER 100 POPULATION) 10 5
BRINGING TOGETHER KNOWLEDGE The renewed set of indicators and associated reports will bring together knowledge to support and inform policy, initiatives and approaches at various levels (community, Nation, within and across sectors and levels of government). First Nations Perspective on Wellness 11 SETTING A VISION FOR FUTURE WORK We were challenged to set a vision for future work. Recommendations, targets and actions to be developed. Reports on progress to be issued every 2 years. 12 6
DEVELOPING THE SET OF INDICATORS THROUGH TWO-EYED SEEING Two-Eyed Seeing is learning to see from one eye with the strengths of Indigenous knowledges & ways of knowing, & from the other eye with the strengths of Western knowledges & ways of knowing & learning to use both these eyes together, for the benefit of all, championed by Elder Albert Marshall (Mi kmaw Nation). First Nations Perspective on Wellness Source: Stiefel M, Nolan K. 2012. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. 13 Image credit: University of Northern British Columbia PEELING BACK THE LAYERS: TOWARDS DEVELOPING THE INDICATORS 14 7
15 ROOTS OF RESILIENCE: ENHANCING WELLNESS & REDUCING INEQUITIES First Nations are taking back control & are acting to address the structural origins of these inequities, by increasing local control over land, resources, services & decision-making structures. Existing strengths, such as Aboriginal ways of knowing & being, including connection to land, culture, language, community, & family balance, selfreliance etc. LINKED TO IMPROVED HEALTH AND WELLNESS OUTCOMES 16 8
SHIFTING THE PARADIGM: SICKNESS TO WELLNESS, DEFICITS TO STRENGTHS Many First Nations have especially good health and wellness outcomes. We will focus on wellness outcomes, not only health or disease/illness. outcomes. We will explore and celebrate their sources of strength & resilience build, share & spread those successes! 17 RENEWED POPULATION HEALTH AND WELLNESS INDICATORS: THE FRAMEWORK 18 9
INDICATOR DEVELOPMENT From over 50, down to 15 indicators Informed by previous FNHA Wellness Indicator Work (regional engagement sessions, Gathering Wisdom) Informed by innovative public and population health policy and discourse 19 OTHER INDICATORS CONSIDERED Violence Against Women: Covered in the PHO/FNHA CMO Aboriginal Women s Health Report & the Murdered & Missing Indigenous Women s Inquiry. Social, Cultural, Economic, Environmental Land, Nations, Community, Family Mental, Physical, Spiritual, Emotional Health & Wellness Outcomes Health System FNHA Programs Justice Air and water quality Nurturing spirit: Balance Chronic diseases/conditions Cancer screening Physical Activity Programs Income Number of Aboriginal Businesses Investment in Training / Infrastructure Collaboration between different organizations & agencies Housing in need of minor and/or major repairs Access to private/public transportation Children in care Elders sharing knowledge with community Perceived community safety, strengths, challenges, progress/change, participation in cultural events Self-rated overall health Body Mass Index Immunizations Positive Mental Health Scale Diabetes and related comorbidities Social and community support Mental Mastery Scale Hospitalizations of children Forums for sharing best practices Number of communities with completed Comprehensive Community Plans Community Gardens Self-identified healers in community Illicit drug use Healthy eating: Fruits and vegetables Exposure to second hand smoke Growth chart Communicable diseases HIV Cascade of Care Access to maternal supports and services Attachment to a primary care provider Resource intensity for hospitalized person Confidence to ask questions relating to my or my family's wellbeing Number of steps from Fitbit challenges Medical transportation First Responder Training Traditional medicines benefits coverage Aboriginal Head-start program Health Education Programs in Community Pre and post-natal education 10
Education: Graduation rates Food security Adequacy of housing Ministry of Education Regional Health Survey (RHS) or Canadian Community Health Survey (CCHS) Census To be determined stories, art, songs, traditional ecological knowledge 21 Image credit: Native Education College Cultural Wellness - a combined indicator of: Traditional language Traditional foods Traditional medicine/healing Sense of belonging to one s community RHS To be determined stories, art, songs, traditional ecological knowledge 22 11
Cultural Wellness - a combined indicator of: Traditional language Traditional foods Traditional medicine/healing Sense of belonging to one s community RHS To be determined stories, art, songs, traditional ecological knowledge 23 Image credit: Simon Fraser University, 2015 Cultural Wellness - a combined indicator of: Traditional language Traditional foods Traditional medicine/healing Sense of belonging to one s community RHS To be determined stories, art, songs, traditional ecological knowledge 24 Image credit: Aboriginal Tourism BC 12
Cultural Wellness - a combined indicator of: Traditional language Traditional foods Traditional medicine/healing Sense of belonging to one s community RHS To be determined stories, art, songs, traditional ecological knowledge 25 Cultural Wellness - a combined indicator of: Traditional language Traditional foods Traditional medicine/healing Sense of belonging to one s community RHS To be determined stories, art, songs, traditional ecological knowledge 26 13
HEALTH SYSTEMS Experience of cultural safety & humility in receiving health services Avoidable hospitalizations (ambulatory care sensitive conditions) In-patient survey among hospital patients (PREMS) Ministry of Health To be determined stories, art, songs, traditional ecological knowledge 27 Decision-making, human and economic capacity Ecological health: % of undisturbed habitat Abundance of culturally important species (salmon, moose, elk) # of animals that can be harvested in a season Index using multiple sources To be determined To be determined stories, art, songs, traditional ecological knowledge 28 Image credit: World Wildlife Foundation 14
Level of physical activity Number of children with healthy teeth (no cavities) Smoking commercial tobacco RHS/Canadian Community Health Survey (CCHS) Health Canada RHS/CCHS To be determined stories, art, songs, traditional ecological knowledge 29 Image credit: Spirit Magazine HEALTH & WELLNESS OUTCOMES Healthy infant birth weights Alcohol-related deaths Serious injuries requiring hospitalization Self-reported mental/emotional well-being Perinatal Services BC Vital Stats Agency Ministry of Health RHS/CCHS To be determined stories, art, songs, traditional ecological knowledge 30 15
SETTING A VISION Establishing knowledge and a system of measurement and reporting that reflects the First Nations Perspective of Wellness to measure our progress over the next 10 years. Moving us from deficits to strengths, from sickness to wellness. Towards our vision of Healthy, Self- Determining, & Vibrant BC First Nations Children, Families, & Communities. 31 I AM NISGA A: I AM ROSE, WALKING IN WELLNESS 32 16