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

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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

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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

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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

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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

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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

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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.

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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

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Diabetes Prevalence Rates
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Diabetes Prevalence Rates
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Diabetes Prevalence Rates
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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

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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

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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

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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

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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

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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
  ones developmental health and later disease risk

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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 communitys life
  course.

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Life Course Intervention

• The Goal
• To optimize the developmental trajectory over
  entire life course

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Life Course Intervention

• What matters
• Address the complex interaction of health
  determinants, in particular Aboriginal contexts,
  over entire life course

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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

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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

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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

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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.

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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...

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A word about Words

• Social Exclusion
• Marginalization
• Inequality
• Risk
• Vulnerability

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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

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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.

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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

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Experiencing Major depressive Episode by
household Low and High income level and
off-reserve health status
Low Medium High

• Charlotte Loppie Reading and Fred Wein, Health
  Inequities and Social Determinants of Aboriginal
  peoples Health. NCCAD, PHAC, 2009

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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

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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

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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

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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.

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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.

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How to Contact Us

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  please email Bianka at bsaravan_at_uvic.ca)