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Canadian Heart Health Strategy

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46% of FNs adults smoke daily (54-29 yrs) ... The index was developed in 1990 by the Pakistani economist Mahbub ul Haq, and ... – PowerPoint PPT presentation

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Title: Canadian Heart Health Strategy


1
Question Driven Approach
Canadian Heart Health Strategy
Promising Practices
Addressing and Enhancing Aboriginal/Indigenous
Cardiovascular Health
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
2

Question Driven Approach
  • What is the burden of CVD in the Indigenous
    community?
  • What are the most promising practices with
    respect to Indigenous heart health?
  • What strategic directions must the CHHS pursue to
    best serve Indigenous Canadians?

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
3
Question Driven Approach
Promising Practices
  • Aboriginal values and worldviews,
  • cultural/personal safety
  • skilled practitioners cognizant of their
    strengths and limitations
  • portability or flexibility
  • historical and contextual influences
  • choice of traditional, western or blended
    approaches
  • evidence informed intervention

Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
4
Question Driven Approach
1) Kahnawake Schools Diabetes Prevention Project
2) Sandy Lake Health and Diabetes Project 3)
Cape Breton Island, Nova Scotia 4) New South
Wales Aboriginal Vascular Health Program
5) United States Strong Heart Study 6) Diabetes
Risk Evaluation and Microalbuminuria 7) BRAID
(Believing We Can Reduce the Aboriginal
Incidence of Diabetes) 8) Food Security in
Canadas North 9) Heart and Stroke Foundation
Saskatchewan
Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
5
Question Driven Approach
  • Conceptual tension
  • Circulatory diseases gt 30 of all deaths in 2000
  • Rapid westernization changing risk gt North
  • Hospitalization rates 76 to 186 per 10,000
  • Diabetes epidemic 19.7 FN adults (35 gt 55 yrs)
  • Oji-Cree 40 adults 5x higher 80 (50-64 yrs)

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
6
Question Driven Approach
Question Driven Approach
  • no or very crude health services
  • tertiary care closer to home
  • lifestyle modification campaigns limited success
  • smoking and poor diet well-entrenched
  • 46 of FNs adults smoke daily gt (5418-29 yrs)
  • smoke free life is best established before
    addiction sets
  • variation in risk between communities

Promising Practices
Promising Practices
Promising Practices
Problem Statement
Problem Statement
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
7

Question Driven Approach
  • Glaring Omissions
  • Acute, rehabilitative or palliative care
  • Rural and remote access
  • Gender
  • Mental health issues,
  • Systemic racism
  • Pregnancy and infancy

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
8
  • Key elements of promise
  • responding to community initiative
  • appreciative focus
  • multiple components gt context
  • capacity building
  • service access generated through partnerships
  • evidence for efficacy of nurse practitioners
  • cultural competency of non-indigenous health
    professionals
  • traditional practices
  • large scale longitudinal genetically focused
    research

Question Driven Approach
Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
9
Question Driven Approach
Promising Practices
  • Social determinants
  • Relationship to the land is central
  • Visibility and outcome orientation
  • High degree of cultural competence
  • Contemporary effects of colonial history
  • Internal moral authority by responding to
    community initiative
  • Appreciative model

Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
10
Question Driven Approach
Policy
Promising Practices
  • Response to community initiative
  • Collaboration between Aboriginal communities
  • Cross-jurisdictional arrangements
  • Remote and rural access fund
  • Heart and Stroke Foundation

Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
11
Services
Question Driven Approach
  • Continuum of care
  • Create synergy with other chronic disease and
    early development initiatives
  • Life course approach.
  • Traditional and more nutrient rich foods.
  • CVD management algorithm

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
12
Question Driven Approach
Human Resources
Promising Practices
  • Extend training and expertise
  • Cultural competency
  • Treatment algorithm
  • Nurse practitioners
  • Outreach, training and support

Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
13
Research
Question Driven Approach
  • Trans-theoretical model
  • Addresses the individual in context
  • Evaluate food security
  • Multi-component health promotion
  • Screening, surveillance and monitoring systems
  • Database

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
14
REFERENCE 1 Shah BR, Hux JE, Zinman B
Increasing rates of ischemic heart disease in the
native population of Ontario, Canada. Arch Intern
Med 20001601862. 2 Harris SB, Zinman B,
Hanley A, Gittelsohn J, Hegele R, Connelly PW,
Shah B, Hux JE The impact of diabetes on
cardiovascular risk factors and outcomes in a
native Canadianpopulation. Diabetes Res Clin
Pract 200255165. 3 Young TK, Reading J, Elias
B, O'Neil JD Type 2 diabetes mellitus in
Canada's first nations status of an epidemic in
progress. CMAJ 2000163561-566. 4 Greene C,
Blanchard J, Wajda A Projecting future diabetes
prevalence in Manitoba First Nations. in
Proceedings of the 4th International Conference
on Diabetes and Indigenous People, San Diego,
1997. Tucson, Arizona Native American Research
and Training Center, University of Arizona,
1999. 5 NAHO First Nations Regional
Longitudinal Health Survey (RHS) 2002/2003.
In Committee FNaIRHSNS (ed) RHS. National
Aboriginal Health Organization, 2005. 6 Harris
SB, Gittelsohn J, Hanley A, Barnie A, Wolever TM,
Gao J, Logan A, Zinman B The prevalence of NIDDM
and associated risk factors in native Canadians.
Diabetes Care 199720185-187. 7 Delisle HF,
Rivard M, Ekoe JM Prevalence estimates of
diabetes and of other cardiovascular risk factors
in the two largest Algonquin communities of
Quebec. Diabetes Care 1995181255-1259. 8
Harris SB, Caulfield LE, Sugamori ME, Whalen EA,
Henning B The epidemiology of diabetes in
pregnant Native Canadians. A risk profile.
Diabetes Care 1997201422-1425. 9 Theme
Working Group 4. (2007, April 30 - May 1).
Addressing and Enhancing Aboriginal/Indigenous
Cardiovascular Health. Paper presented at the
Canadian Heart Health Strategy and Action Plan,
First Retreat, Toronto, Ontario. 10Willms, J.
D. "Research Findings Bearing on Canadian Social
Policy." Vulnerable Children Findings from
Canada's National Longitudinal Survey of Children
and Youth. Ed. J. D. Willms University of
Alberta Press, 2002. 331-58. 11Cooper, M.,
Karlberg, A.M., Pelletier Adams, L. Aboriginal
Suicide in British Columbia An Overview,
1992. 12Chandler, M. J., and C. Lalonde.
"Cultural Continuity as a Hedge against Suicide
in Canada's First Nations." Transcultural
Psychiatry 35 (1998) 191-219. 13Sloat, E., and
J. D. Willms. "A Gradient Approach to the Study
of Childhood Vulnerability. , University of
Alberta Press and Human Resources Development
Canada." Vulnerable Children Findings from
Canada's National Longitudinal Survey of Children
and Youth. Ed. J.D. Willms. Ottawa, ON Human
Resources Development Canada, 2000. 14 The UN
Human Development Index (HDI) is a comparative
measure of poverty, literacy, education, life
expectancy, childbirth, and other factors for
countries worldwide. It is a standard means of
measuring well-being, especially child welfare.
The index was developed in 1990 by the Pakistani
economist Mahbub ul Haq, and has been used since
1993 by the United Nations Development Programme
in its annual Human Development Report. See
http//en.wikipedia.org/wiki/Human_Development_Ind
ex 15Cooke, M., Beavon, D., McHardy, M.
(2004). Measuring the Well-Being of Aboriginal
People An Application of the United Nations?
Human Development Index to Registered Indians in
Canada, 1981?2001. Strategic Research and
Analysis Directorate, Indian and Northern Affairs
Canada 1-31. 16 Kishk Anaquot Health Research
(2007) Successful Indigenous Community in
Canada, unpublished manuscript Prepared for the
Strategic Policy and Planning Unit, First Nations
and Inuit Health Branch, Health
Canada 17Mignone, J., O?Neil, J. (2005).
Conceptual Understanding of Social Capital in
First Nations Communities An Illustrative
Description. Pimatziwin A journal of Aboriginal
and indigenous community health, 3(2) 7-44.
18 Commission on the Future of Health Care in
Canada Building on Values The Future of
Health Care in Canada, Final Report, 2002.
Question Driven Approach
Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
15

Question Driven Approach
Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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