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Aboriginal Child Health

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Title: Aboriginal Child Health


1
Aboriginal Child Health
  • What role can pediatric health care institutions
    play?

M Moffatt Winnipeg Regional Health Authority
University of Montreal
2
Outline
  • Identify aboriginal children
  • Health indicators
  • Current system(s) of delivery
  • Likely future trends
  • Quality health care for Aboriginal children
  • Where do CAPHC institutions fit in?

3
Who and where are aboriginal children?
  • 1 million Aboriginal people (gt 40 children)
  • First Nation (62)
  • On reserve
  • Off reserve
  • gt50 now live in urban areas
  • Status vs. non status
  • Inuit (5)
  • Métis (32)

4
(No Transcript)
5
Urban Aboriginal children
2 groups
Educated, employed parents
Poorly educated, Often unemployed parents
Inner city, Ghetto, Poverty, ? morbidity
6
Profile of urban Aboriginal people
Source Statistics Canada. Aboriginal Peoples
Survey 2001
7
Health status
8
Regions with gt19 Aboriginal population
  • PYLL 50 greater

Source Allard et al. Health Reports 20041551-60
9
PYLL by cause
10
Diabetes Mellitus Type II new cases in Manitoba
11
Canadian BMI data
  • Young 1990 Mb and NW Ont.. - adults
  • BMIgt30 - 27.3
  • Young, Dean et al 1999 (unpublished)- Mb children
  • BMI gt 95 - girls 40
  • boys 34
  • BMI predictive of diabetes
  • Hanley 2000 NW Ont BMI gt 85 girls 34, boys 28

12
Child Hunger
  • 16 Aboriginal off-reserve families vs. 3.9
    others

Source McIntyre L et al. CMAJ 2000163961
13
Social Determinants or health care?
  • Poverty, lack of power and control, low education
  • There seems no excuse for complacency we ought
    to speak out.
  • But
  • The high levels of morbidity make it unethical
    not to provide the best possible care.
  • Health care has a small (but measurable)effect

14
Usual existing delivery system
  • ON-reserve/remote
  • Federal (except Quebec and territories)
  • Nurse clinician model
  • GP support
  • Some areas tied into systems of specialist
    support
  • On-reserve not remote
  • PH services in community
  • Use adjacent communities for acute and primary
    care
  • Urban
  • Use existing services

15
Gaps in current system
  • Assumption if services are close, access occurs.
    Not valid
  • Remote/rural
  • Staff turnover/human resources shortage
  • limited or no access to allied health
  • Federal-provincial wrangling
  • Handicapped children
  • Lack of community control

16
Falling between the cracks
Case 1 An 11 month old girl with a birth
defect of her heart, corrected surgically,
remains on a respirator has a tracheotomy and is
fed through GT tube. Brain is normal no
cognitive impairment expected. In hospital all
her life, now ready for discharge. Needs a
medical foster home and parents, who remain
involved, agree.Although a good home is found,
placement has been denied by the First Nations
Child and Family Services Agency, on the strength
of a directive indicating that INAC and FNIHB
will not fund the costs. Parents faced with the
option of giving up rights to the child so she
becomes a ward of the province. Ultimately this
child stays in hospital for 14 months before the
issues are resolved.
Case 2 A child with a complex genetic disorder
who is also severely developmentally delayed .
Languished in hospital for 18 months after ready
for discharge. VPA held up because no one would
agree to pay the costs.
17
Issues
  • Federal? Provincial downloading
  • Piece-meal approach to funding
  • Uninsured services (often require individual item
    approval)
  • Lack of a patient-centred approach
  • First Nations agencies caught in between

18
Characteristics of a good health system
  • Access 24/7
  • Continuity
  • Seamless integration
  • Full range of services
  • Patient-centred
  • Evidence-based
  • anticipatory

19
Evolving Aboriginal health system
  • Nunavut and NT
  • Quebec
  • Individual Community examples of excellence
  • Eskasoni
  • Kahnawake
  • Urban Aboriginal systems

Lemchuk-Favel and Jock J Aboriginal Health Vol. 1
Jan 2004
20
Community-controlled aboriginal health services
characteristics
  • Self-empowerment
  • Holistic approach
  • Synergy of traditional and western
  • Primary care
  • Collaboration with provincial services
  • Integrated
  • Administrative reform

Lemchuk-Favel and Jock J Aboriginal Health Vol. 1
Jan 2004
21
Community control and health
22
Effectiveness of Specialist outreach visits
  • Cochrane review (Gruen et al)
  • Some evidence that outreach improves access and
    quality, particularly if done in a multi-faceted
    manner
  • Main evidence from urban non-disadvantaged
    populations

23
Highest premature mortality
24
CAPHC and Aboriginal health
  • Most of tertiary resources for children
  • Unique knowledge base
  • Telehealth technology
  • Networks
  • RHAs
  • formal
  • Multiply handicapped children remain in our
    institutions

25
What can we do?
  • Support Aboriginal control of services
  • Develop partnerships with aboriginal groups
  • Provide new, or link with existing outreach
    programs
  • Insist that these be multi-faceted
  • Think outside the box!
  • Make services client-centred
  • Connect with evolving primary care
  • Provide interpreter services

26
What can we do?
  • Foster cultural awareness
  • Aboriginal employment
  • zero tolerance for prejudice
  • Take a stand on repatriation of multiply
    handicapped children
  • Offer services by telehealth
  • But must link with existing care system
  • Think outside the box
  • Lobby for social and political change
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