1. Ecosystem Health in Northern Aboriginal Communities in Manitoba Shirley Thompson University of Manitoba S_thompson@umanitoba. ca SLESH conference 2006

2. Question  Are sustainable livelihoods and Ecosystem health approaches appropriate in Canada (for Northern Aboriginal Communities)?

3. Agenda  Introduction  Health indicators  Ecosystem health  Case study: TB and Housing  Case study: Water quality  Conclusions

4. Four key challenges for an Ecosystem Approach to Human Health  finding a shared vision;  assuring community access;  gaining credibility; and,  measuring success.

5. Traditional Knowledge reveals the complexity of traditional approaches to environmental systems. Elder Robin Greene teaches the traditional ways. Photo by: Randy Paishk

7. Medicine Wheel

8. TO BE REPLACED BY UPDATED SLIDE

9. Community Food Security “ a condition in which all residents obtain a safe, culturally appropriate, nutritionally sound diet through an economically and environmentally sustainable food system that promotes community self-reliance and social justice!” Hamm & Bellows Hamm & Bellows

10. Health Not only the absence of disease but also “the extent to which an individual or group is able to on the one hand to realize aspirations and satisfy needs and on the other to change or cope with the environment.” “State of complete physical, mental and social well- being and not merely the absence of disease or infirmity.” It is not “an objective for living, but a resource for everyday life.” WHO

11. Source: Millenium Ecosystem Assessment

14. Age-standardized Leading Causes of Death, First Nations (2000) and Canada (1999)  Used to compare rates across groups with different demographic characteristics  Reduces the effects of very old or young population age differences

15. Potential Years of Life Lost (PYLL) by Cause of Death, First Nations (2000) and Canada (1999)  Calculates the number of years of life lost assuming an average lifespan of 75 years  Expressed as a rate per 100,000 population (similar to death rates) Increased risk of suicide at all ages for First Nations up to 65 years of age; highest for young males and females. Source: Health Status of First Nations in Canada (1999)

16. Infant Mortality Rates, Manitoba, 1991 to 2001

17. Life Expectancy at Birth, by Sex, First Nations and Canada, 1980, 1990 and 2000

18. Projected Number of People with Diabetes MB First Nations, 1996-2016 Source: http:// www.gov.mb.ca/health/publichealth/ epiunit/docs/storm.pdf

19. Diabetes – Implications for Health Care Persons with diabetes account for: 91% of lower limb amputations 91% of lower limb amputations 60% of hospitalizations for heart disease 60% of hospitalizations for heart disease 50% of hospitalizations for stroke 50% of hospitalizations for stroke 41% of hospital days 41% of hospital days 30% of all hospitalization 30% of all hospitalization (Strategy Steering Committee, 1998) First Nations patients with diabetes in Manitoba have longer hospital stays with an increased intensity of care, and there is an increase in obstetrical admissions (Dow, 1999)

20. Health Facilities and Hospitals

21. NIHB Expenditures In Manitoba Region by Benefit (FY 2003/2004 $2.8M $17.3M $53.5M $5.6M $48.5M Total: $127.8 M

25. Environmental Change drivers

26. Case Study: Housing  Shelter: Only 56.9% of homes in FN communities adequate  (not needing major repair or replacement) (1999/2000)

27. Pukatawagan Remediation The houses condemned and knocked down because of the fuel spill have not been replaced, leaving only 299 residences for 2,600 people, with an average of nearly nine occupants per house.

28. Rates of Tuberculosis, 1994 to 2004* in Manitoba * 2004 Data is preliminary

29. Tuberculosis Notification Rates, by Community Housing Density, First Nations, 1997-9

30. Tuberculosis Host Environment Agent

31. Inadequate housing

32. Case study: water quality

33. Determinants of Health –Water and Sanitation  Water Quality: Only 41.4% of FN communities reported at least 90% of homes connected to water treatment plant (1999/20)  Sanitation: Only 33.6% of FN communities had at least 90% of homes connected to community sewage disposal system (1999/2000) Source: A Statistical Profile on the Health of First Nations in Canada, 2003, Statistics Canada 2001 Census

34. Difficulties with building adequate infrastructure for Safe water on Reserves  technical difficult and costly to develop infrastructure in isolated areas, often having difficult terrain (e.g., permafrost, swamp) and often having drinking water source off-reserve;  limited access to financing and recovery of costs due to poor economic conditions;  lack of qualified personnel in environmental service delivery;  high birth rates in these communities expanding infrastructure needs rapidly; and  unclear technical standards with limited support for standards and enforcement mechanisms.

35. Why the safety of First Nations drinking water is compromised?  No laws and regulations govern the provision of drinking water in First Nations communities.  INAC and Health Canada implement policies, administrative guidelines, and funding arrangements with First Nations inconsistently and piecemeal.  Action with First Nation communities is not being taken to: 1.assess the capacity and support that First Nations need to deliver safe drinking water in their communities; 2.establish the institution or institutions that could consolidate these capacity-building and support functions for all First Nations; and 3.define the information needed to demonstrate that the drinking water is safe (Gelinas 2005). http://www.oag-bvg.gc.ca/domino/reports.nsf/html/c20050905ce.html

36. Drinking water at risk in First Nations communities  In 2001, Indian and Northern Affairs (INAC) found a significant risk to the quality or safety of drinking water in three-quarters of the systems (Gelinas 2005).  In Manitoba 5 northern First Nations are on boil-water advisories one with a reported case of E. coli contamination (Water Stewardship Branch 2005)  Assembly of Manitoba Chiefs spokesman, Michael Hutchinson, reported that many as 25 Manitoba First nations have varying degrees of water quality problems (CanWest 2005).  Kashechewan First Nation’s story http://www.cbc.ca/story/canada/national/2005/10/28/ka shechewan-evacuation051028.html http://www.cbc.ca/story/canada/national/2005/10/28/ka shechewan-evacuation051028.html http://www.cbc.ca/story/canada/national/2005/10/28/ka shechewan-evacuation051028.html

37. Multiple Barrier Approach to Safe Drinking Water (1) source: the best possible raw water quality should be maintained and protected (2) treatment: effective treatment should be designed, operated and maintained (3) distribution: secure storage and distribution of treated water should be provided (4) monitoring: appropriate and effective monitoring should be performed (5) response: appropriate and effective responses to adverse monitoring or adverse circumstances are needed.

38. Thank you. Questions?  Are sustainable livelihoods and Ecosystem health approaches appropriate in Canada (for Northern Aboriginal Communities)?