Ontario Public Health Relations with First Nations An Assembly of First Nations Perspective

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Ontario Public Health Relations with First
NationsAn Assembly of First Nations Perspective

• Dr. Kim Barker, Assembly of First Nations
• February 8, 2008

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Outline

• Context
• Challenges
• Successes
• Key Steps Forward

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Context

• Limited human resources
• There are no multidisciplinary teams in community
  nursing stations comparable to provincial
  hospital/clinical settings
• Geographic distance
• Limited medical transportation
• High curative burden
• Few linkages in planning, program development and
  resource allocation with health determinants
• Impeded by administrative and funding agreements
• Jurisdictional barriers in primary and
  secondary/tertiary care systems
• Fiscal imbalance

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Context (ctd)

• No regional or a national community development
  plan for First Nations health
• Fragmented program development some
  improvements made under Upstream Investments
• No study or data indicating the impact of
  under-serviced First Nations populations in
  Canada
• 3 cap on federal funding envelope on April 1/06
  versus 6.5 annual growth in Canada Health and
  Social Transfers
• Pilot projects by First Nations in the Health
  Integration Initiative have demonstrated benefits
  of collaboration and co-operation in delivering
  health services to First Nations across
  jurisdictions, e.g.
• The Vancouver Island project adapted a chronic
  illness model at the community level
• Elsipogtog used a population health model for
  mental health services and,
• North Peace Tribal Council developed case
  management tools with diabetic passports for
  clients to carry.

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Challenges with Current Relationships in Ontario

• Public Health Agency of Canada
• Health Canadas First Nations and Inuit Health
  Branch
• Disease Surveillance in Ontario
• Public Health Capacity in Ontario
• Health Human Resource Crisis
• Jurisdictions including the new LHINs
• Health Protection and Promotion Act
• Mandatory Public Health Programs

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Challenges Federal Agencies

• The Creation of the Public Health Agency of
  Canada
• The long term vision of First Nations and Inuit
  Health Branch of Health Canada
• The role of Indian and Northern Affairs Canada
• Why does this make relationship building in
  Ontario Challenging?

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Challenges Disease Surveillance in Ontario

• Dependency on paper based reporting by nursing
  stations and health centers who are understaffed
• Lack of inclusion early on in the development of
  i-phis and now Panorama in the implementation
  plan and lack of clear funding options at the
  outset
• Stories of duplicate vaccination on and
  off-reserve
• Why does this become a challenge for relationship
  building?

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Challenges Building Capacity

• Lack of opportunities for training and skill
  building in partnership with local public health
  units
• Lack of time by the Public Health Units to assist
  with building capacity
• Lack of Boards of Health prioritizing capacity
  building as an upstream investment
• Absence of comprehensive plan that would
  determine a vision of public health units and
  FNIHB public health employees identifying
  capacity needs and development of a plan

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Challenges with Relationships defined by
Jurisdictions

• A well known story to this audience which is
  complicated by personal opinions of some Medical
  Officers of Health in the Province translating
  into unclear Provincial mandate.
• Equal issues on both sides where some Public
  Health Units feel unwelcome on reserve

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Challenges Human Resource Crisis

• With no shortage of jobs it comes as no surprise
  that employers that can pay more will be more
  attractive
• Up until recently the role of Telehealth has not
  been used to the extent that it could in the
  areas of public health service and training

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Challenges with Relationships where there is no
Public Health Legislation

• It often appears that money dictates public
  health reactions rather than legislation
• Ongoing debate as to whether HPPA applies on
  reserve
• Again challenges on both sides in the areas of
  tobacco control
• Water has been another example

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Challenges with Relationships where Mandatory
Programs exist

• Mandatory
• Some programs lack community cultural sensitivity
  eg HPV
• Duplication in services and complexities in
  provincial services communicating back to health
  care providers on reserve to ensure continuity

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Potential Successes Surveillance

• Immunization work with Chiefs of Ontario
• Inclusion of Chiefs of Ontario in the Panorama
  role out and implementation
• Participation by Ontario in the Client Registry
  Project
• Supports First Nations data ownership and
  capacity building in public health, research and
  surveillance
• Supports concurrent pan-Canadian surveillance
  projects

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FN Client Registries
In each P/T but FN owned
P/T and FN in Bilateral Agreement to External
Data Warehouse
EMPI Enterprise Master Patient Index
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Potential Successes FN PH Programming

• Values tradition and culture
• Emphasizes connectedness and works to restore
  balance
• Supports nurturing and mutually respectful
  relationships
• Honors the central place of women
• Are accessible and portable
• Unique to the needs of First Nations both in
  their communities and away from home
• In collaboration with P/T Public Health Programs
  to ensure seamless delivery

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Potential Successes Legislation

• Greater emphasis on tripartite agreements as a
  potential next step
• Greater capacity building to encourage Band
  Councils to pass public health laws
• Need for early inclusion in the development of
  Federal legislation which is anticipated by PHAC

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Potential Successes Funding and Capacity
Maintain Fiduciary Relationship with Federal
Government Transferred communities recognize the
need for them to make public health activities a
priority Potential Role of Joint Purchasing of
Services with Public Health Units egg Northern
Manitoba
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PHF Funding and Capacity (ctd)

• Funding to Reflect
• Total population base
• Age and gender of population base
• Socio-economic composition of the population base
• Services communities provide to residents of
  other communities
• Remoteness factor
• Local cost of living
• Population growth
• Local needs, e.g. workload measurement and health
  status

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Potential Successes HHR Considerations
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Key Steps Forward

• Public Health Framework pilots in three regions
• Joint Workplan with AFN-HC
• Cross-jurisdictional agreements
• Sustainability
• Management and Accountability
• Data Infrastructure
• Legislative Base for Public Health
• Joint submissions to address current key
  programming gaps, e.g. mental health, food
  security, injury prevention, continuing care
• Fostering transfer of funding and capacity to
  First Nations health authorities
• Promoting innovation in new Upstream Investments,
  AHTF and AHHRI

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Pilot Status

• Year one began May 2007
• Four Arrows MB, Kenora ON, File Hills QuAppelle
  SK
• Year one is focusing on (1) governance including
  the agreement of the content of a tripartite
  agreement with Prov, Feds and FN (possible
  quad-partite in ON with the Public Health Unit,
  (2) identification of programs and services to be
  included in years 2-5 and (3) phase 0 of the
  Canada Health Infoway sponsored Client Registry
  project

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Next Steps

• Increased collaboration between the COO public
  health initiatives and the Kenora Project with
  Provincial and Public Health Unit services may
  inform us the way forward
• Evaluation of year one activities in Kenora
• Proposal to be submitted for next phase of Client
  Registry with Canada Health Infoway