ABORIGINAL HEALTH HUMAN RESOURCES: MORE THAN A SIMPLE DETERMINANT OF HEALTH Emily Lecompte, First Nations and Inuit Health Branch, Health Canada Mireille Baril, First Nations and Inuit Health Branch, Health Canada Canadian Public Health Association 2008 Annual Conference Public Health in Canada: Reducing Health Inequalities Through Evidence & Action Halifax, Nova Scotia June 1st – 4th, 2008

SOCIAL DETERMINANTS OF HEALTH Aboriginal Culture and Health Determinants The Lalonde Report (1974) – factors determining individual health Lifestyle Environment Human biology Access to health services Culture Other factors influencing population health (PHAC, 2004) Income and social status Social support networks Education and literacy Employment and working conditions Social environments Physical environments Personal health practices and coping skills Healthy child development Biology and genetic endowment Health services Gender Culture

SOCIAL DETERMINANTS OF HEALTH Health Care Systems and Access to Health Care: The Importance of Geography Impact of Access on Aboriginal Health: According to the National Aboriginal Health Organization (NAHO) (2002), “one third of Aboriginal communities are remote, isolated or semi isolated” (p.18). As a result, this hinders the access of the Aboriginal population to adequate health care and may discourage individuals from using health resources at all. Although NAHO (2002) reports improvements to the access of health information of communities by way of innovative means such as Telehealth and E-Health resources, access to culturally appropriate health human resources is still lacking.

Aboriginal Health Human Resource Initiative (AHHRI) The Aboriginal Health Human Resource Initiative, a Federal initiative, focuses on: increasing the number of Aboriginal people working in health careers; adapting health care educational curricula to support the development of cultural competencies; and improving the retention of health care workers in Aboriginal communities. In 2001, 1.57% of Canadian health care providers self-identified as Aboriginal. Of this, approximately 50% were First Nation, while 43% were Métis, and 3%, Inuit. Upward trends can be noted in the field of registered nursing, midwifery and practitioners of natural healing, dieticians and nutritionists, and physicians.

RESEARCH OBJECTIVES To gain a better understanding of the 2001 labour force characteristics, as they affect the First Nation, Inuit, Métis and Non Aboriginal workers, specifically those in health care. To paint a provincial, territorial, and nation wide portrait of Aboriginal and non Aboriginal workers based on age, gender, area of residence, geographic location, employment status and potential representation in health care occupations. To highlight past, present and possible future outcomes in the health care field based on certain trends with regards to the supply and demand of health care providers in various fields across Canada.

METHODOLOGY Data source: The data are from the long form (20% data sample) of the 1996 and 2001 national census results from Statistics Canada. The census long form is given to one in every five households across Canada. Analytical techniques: Descriptive statistics are used to illustrate trends in health occupations over the 1996 and 2001 census periods. Analyses are drawn from census results over the five year span, as gathered by Statistics Canada. Several variables were examined such as Aboriginal identity, geographic region, area of residence, and occupation.

RESULTS The Distribution of Canadian Aboriginal Health Providers: 2001 Census 1996 Census Quantity of Persons Quantity of Persons Adapted from Statistics Canada, Population 15 years and over, excluding institutional residents, by Aboriginal Identity (8), Sex (3), Age (5) by Selected Historical Occupations (SOC 1991) (51) showing Area of Residence (7).

RESULTS (con’t) Aboriginal Non-Aboriginal Aboriginal & Non-Aboriginal Workers and Area of Residence: -20 -10 10 20 30 40 50 60 Non-Aboriginal Aboriginal On-Reserve Rural, Non-Reserve Urban, Non-Census Metropolitan Area Adapted from Statistics Canada, Population 15 years and over, excluding institutional residents, by Aboriginal Identity (8), Sex (3), Age (5) by Selected Historical Occupations (SOC 1991) (51) showing Area of Residence (7).

RESULTS (con’t) Alternate VS. Mainstream Health Care: Aboriginal persons in health occupations Health Occupation Title 1996 Census 2001 Census Difference Registered Nurses 2 335 3 250 + 915 Midwives and Practitioners of Natural Healing 55 185 + 130 Dieticians & Nutritionists 25 110 + 85 General Practitioners & Family Physicians 65 135 + 70 Specialist Physicians 70 + 45 Occupational Therapists 30 50 + 20 Adapted from Statistics Canada, Population 15 years and over, excluding institutional residents, by Aboriginal Identity (8), Sex (3), Age (5) by Selected Historical Occupations (SOC 1991) (51) showing Area of Residence (7).

RESULTS (con’t) Trends: The 1996 census indicates that Aboriginal health care providers represented 78.46% of the on-reserve Ontario workforce. In 2001, these numbers increased to 90%. The number of Aboriginal physicians, dentists and veterinarians has nearly doubled, from 145 in 1996 to 280 in 2001. The number of off-reserve, Aboriginal pharmacists, dieticians and nutritionists has quadrupled over 5 years (from 40 to 160).

LIMITATIONS Due to the quantity of Aboriginal communities that were incompletely enumerated, this excludes important data from being considered by researchers and evaluators and from being presented to policy-makers Due to the under representation of certain Aboriginal communities, this may modify the accuracy of local community or regional profiles that are deduced from gathered data. 20% sampling population: this is why we speak of trends due to the sampling size – it simply gives an idea but may have a degree of error in interpreting reality. Certain Aboriginal groups consider more than the normative Western gender identity of Male and Female; some identify being two-spirited or transgendered (this concept is not considered in the census questionnaire of either year).

FUTURE STEPS IN HEALTH CARE: RECOMMENDATIONS & CONCLUSION More research: consideration and understanding the supply and demand of health professionals, more specifically Aboriginal health human resources. Assessment of community needs on an ongoing basis. Evaluation of current programs and services that are geared toward the recruitment and retention of health care workers. Assessment of the distribution of health care workers across local communities, urban and rural areas, Aboriginal reserves, provincial and territorial areas as well as across national jurisdictions.

FOR MORE INFORMATION ON AHHRI OR FIRST NATION AND INUIT HEALTH: FNIHB: http://www.hc-sc.gc.ca/fnih-spni/index_e.html First Nations Health Managers Fact Sheet: http://www.fnhealthmanagers.ca/docs/e/FNHM_Factsheet.pdf First Nations and Inuit Health Program Compendium: http://www.fnhealthmanagers.ca/docs/e/FNIHB%20Program%20Compendium%202007_e.pdf Definitions, data sources and methods used by Statistics Canada: http://www.statcan.ca/english/concepts/index.htm

REFERENCES National Aboriginal Health Organization (NAHO). (2002). Strategic directions for an evidence-based decision making framework at NAHO, Ottawa Author. Public Health Agency of Canada (PHAC). (2004). Social Determinants of Health. Retrieved January 5th, 2008 from http://www.phac-aspc.gc.ca/ph-sp/phdd/determinants/determinants.html Statistics Canada. (2008). Aboriginal Peoples in Canada in 2006: Inuit, Metis and First Nations, 2006 Census. Catalogue no. 97-558-XIE. Retrived May 15th, 2008 from http://www12.statcan.ca/english/census06/analysis/aboriginal/pdf/97-558-XIE2006001.pdf Statistics Canada. (2005). Retrieved May 20th, 2008 from http://www42.statcan.ca/smr08/smr08_007_e.htm Statistics Canada. n.d. Population by Aboriginal Groups and Sex, Showing Age Groups, for Canada, 1996 Census - 20% Sample Data. Retrieved May 20th, 2008 from http://www.statcan.ca/english/census96/jan13/can.htm

REFERENCES (con’t) Statistics Canada. (2003). 1996 Population 15 years and over, excluding institutional residents, by Aboriginal Identity (8), Sex (3), Age (5) by Selected Historical Occupations (SOC 1991) (51) showing Area of Residence (7), Custom Product. Statistics Canada. (2003). 2001 Population 15 years and over, excluding institutional residents, by Aboriginal Identity (8), Sex (3), Age (5) by Selected Historical Occupations (SOC 1991) (51) showing Area of Residence (7), Custom Product.

CONTACT Emily Lecompte Health Canada 613-948-8053 emily_lecompte@hc-sc.gc.ca Mireille Baril 613-954-0658 mireille_baril@hc-sc.gc.ca

Thank you… Comments or Questions?