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

Chronic Diseases In 2005 of the 58 million deaths worldwide approximately 60% were due to 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 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 In these countries people tend to develop diseases younger, suffer longer, and die sooner

Chronic Diseases In Canada Aboriginal people face a similar situation In Canada Aboriginal people face a similar situation Earn less than the non-Aboriginal population Earn less than the non-Aboriginal population Suffer from higher rates of many chronic diseases and associated risk factors Suffer from higher rates of many chronic diseases and associated risk factors Have a shorter life expectancy Have a shorter life expectancy Internationally Canada ranks highly in health and well being, while the Aboriginal population is much less fortunate Internationally Canada ranks highly in health and well being, while the Aboriginal population is much less fortunate

Diabetes Historically of low prevalence in the Aboriginal population Historically of low prevalence in the Aboriginal population Changes in lifestyle and diet, adoption of Western habits has resulted in an increase in diabetes 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 Similar trajectory to Cardiovascular Disease and other chronic conditions

Diabetes Risk factors Not all risk factors have been well studied in the Aboriginal population Not all risk factors have been well studied in the Aboriginal population Less is known about risk factors in the urban Aboriginal population Less is known about risk factors in the urban Aboriginal population

Chronic Disease Risk Factors The most common risk factors for Chronic disease studied among Aboriginals are: The most common risk factors for Chronic disease studied among Aboriginals are: Impaired glucose tolerance (IGT); Impaired glucose tolerance (IGT); Type 2 diabetes; Type 2 diabetes; Obesity (over-eating and lack of exercise); Obesity (over-eating and lack of exercise); Cigarette smoking. Cigarette smoking.

Diabetes Risk Factors Diabetes prevalence is much higher in the Aboriginal population than the non-Aboriginal population Diabetes prevalence is much higher in the Aboriginal population than the non-Aboriginal population Diabetes occurs at a much younger age Diabetes occurs at a much younger age Incidence is increasing Incidence is increasing

Diabetes Prevalence Rates

Chronic Disease Risk Factors 46% of First Nations people are daily smokers 46% of First Nations people are daily smokers This rises to 54% in the age group and if occasional smokers are included rises to 70% This rises to 54% in the age group and if occasional smokers are included rises to 70%

Chronic Disease Risk Factors In youth the rates are also very high In youth the rates are also very high Occasional and daily smokers 16 years of age Occasional and daily smokers 16 years of age 44% male and 67% female 44% male and 67% female Occasional and daily smokers 17 years of age Occasional and daily smokers 17 years of age 56% male and 67% female 56% male and 67% female

Chronic Disease Risk Factors From the 2002/03 Regional Health Survey From the 2002/03 Regional Health Survey 42% of men and 31% of women are overweight 42% of men and 31% of women are overweight 29% of men and 34% of women are obese 29% of men and 34% of women are obese 3% of men and 7% of women are morbidly obese 3% of men and 7% of women are morbidly obese

Chronic Disease Risk Factors According to the 2002/03 Regional Health Survey First Nations peoples self reported rate of hypertension 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 20.4% vs. 16.4% in the non-Aboriginal population In the age group this rises to 30.5% vs. 22.4% In the age group this rises to 30.5% vs. 22.4%

Adult Risk Factors Attempts to address problems of chronic diseases usually focuses on changing patterns of 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 Unfortunately this does not address the next generation and prevention of chronic disease

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 one’s developmental health and later disease risk 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 one’s developmental health and later disease risk

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 community’s life course. 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 community’s life course.

Life Course Intervention The Goal: To optimize the developmental trajectory over entire life course

Life Course Intervention What matters: Address the complex interaction of health determinants, in particular Aboriginal contexts, over entire life course

Life Course Risk Factors Birth weight Birth weight Low birth weight has been associated with an increased risk of heart disease and hypertension 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 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 First Nations babies are twice as likely to be high birth weight babies

Life Course Risk Factors Maternal Diabetes Maternal Diabetes Gestational diabetes rates are higher in Aboriginal women 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 Children born to diabetic mothers are at increased risk for impaired glucose tolerance, childhood obesity, and diabetes

Life Course Risk Factors Childhood and adolescent obesity Childhood and adolescent obesity Increases the risk for adult obesity Increases the risk for adult obesity Aboriginal children are lacking in sports and recreation facilities in their communities Aboriginal children are lacking in sports and recreation facilities in their communities

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.

Many determinants of health are beyond the scope of the health care system: Changing diets from traditional to non-traditional foods Changing diets from traditional to non-traditional foods Food insecurity Food insecurity Stress due to economic factors Stress due to economic factors Pollution Pollution Global capitalism etc... Global capitalism etc...

A word about Words Social Exclusion Social Exclusion Marginalization Marginalization Inequality Inequality Risk Risk Vulnerability Vulnerability

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

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.

% 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

% Experiencing Major depressive Episode by household Low and High 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 Low Medium High

Social Determinants of Health Many studies have demonstrated a connection between socioeconomic status and health Many studies have demonstrated a connection between socioeconomic status and health Aboriginal population has lower levels of education, income, and employment Aboriginal population has lower levels of education, income, and employment These conditions are associated with increased rates of obesity, chronic conditions and diabetes These conditions are associated with increased rates of obesity, chronic conditions and diabetes

Social Determinants of Health Can observe a health gradient within the Aboriginal population - poorer health associated with lower SES Can observe a health gradient within the Aboriginal population - poorer health associated with lower SES Effects of colonialism Effects of colonialism Effects of residential school system Effects of residential school system

Demographic Trends Aboriginal population is much younger than the rest of Canada Aboriginal population is much younger than the rest of Canada Risk factors are more prevalent and increasing and occurring in ever younger Aboriginal people 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 As the youthful Aboriginal population ages increased rates and numbers of people with diabetes and chronic conditions disease can be expected

Actions Seek commitment to a multi-year dialogue to explore common issues and agendas for action in Aboriginal health and well being. 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. 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. 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.

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. 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. 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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