Pathways to Health and Healing

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According to “Pathways to Health and Healing,” a British Columbia update on Aboriginal health - there have been significant improvements.

“While I’m pleased there have been some improvements to the health and well-being of aboriginal people in B.C. since my first report, it’s evident a lot more work still needs to be done,” said B.C. provincial health officer Dr. Perry Kendall.

Out of 57 indicators of health, 18 have improved, 10 have worsened, and eight have recorded increasing rates of chronic disease.

Life expectancy has improved significantly, mostly in males and due to declining mortality from external causes, including deaths from motor-vehicle accidents, overdoses, accidental poisonings and suicide.

Aboriginal infant mortality is still higher than the rest of the province, but has dropped.

Youth suicides have declined.

HOWEVER, the provincial report says in some areas things are worse for Aboriginal people in BC. - Deaths from medically treatable conditions have increased over the last couple of years.

There is an increase in incidents of pre-term births, off-reserve tuberculosis, and HIV/AIDS deaths.
“Despite living in a province that has some of the best HIV care available, it is noteworthy that aboriginal people with HIV are not being reached by this care,” said Dr. Kendall.

Aboriginal women are also less likely to use preventative screening methods such as PAP tests or mammography.
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Pathways to Health and Healing
2nd Report on the Health and Well-being of Aboriginal People in British Columbia.
Provincial Health Officer’s Annual Report
http://www.hls.gov.bc.ca/pho/pdf/abohlth11-var7.pdf

Recommendations from Current Report

Determinants of Health

Individuals and families can:
• Actively oppose racism.
• Find out more about self-governance and other selfdetermination
issues.
Aboriginal communities and organizations can:
• Work together to overcome disadvantages of small
community size, for example, they can form institutional
cooperatives to achieve economies of scale.
Employers can:
• Examine hiring practices to ensure equality of
opportunity.
Schools can:
• Provide strategies that will incorporate the factors that
are linked to success in school. These factors fit into six
categories: Leadership, school climate, staff, funding and
resources, community, and programs.
Governments and communities can:
• Continue to honour and support principles in the First
Nations Health Plan.
• Facilitate the removal of structural impediments to
economic development in First Nations communities.
• Set clear, measurable goals for employment, income,
and education levels of Aboriginal people equal to those
within the general population, along with methods for
public reporting of results.
• Support efforts by Aboriginal people to achieve selfdetermination
and a collective sense of control over their
futures, in both on- and off-reserve communities.
• Invest in adult education opportunities, skills upgrading,
training, job preparation, financial assistance for finding
work and work clothing, child care, and stable, affordable
housing.

• Ensure that effective, culturally appropriate programs are
in place to support those who have suffered abuse.
• Encourage participatory research to gain a more clear
understanding of the relationship between socioeconomic
conditions and the health of Aboriginal
communities.
Healthy Beginnings: Pregnancy, Infants, and
Children
The health system can:
• Work with Aboriginal communities to develop culturally
appropriate reproductive care programs, including better
prenatal access, outreach, and nutrition programs for
mothers and infants.
• Continue to monitor the birth weights of Status Indian
infants, to better understand the factors that affect it.
• Develop better methods for preventing, diagnosing,
and tracking the occurrence of fetal alcohol spectrum
disorder.
• Support Aboriginal communities in motivating community
members to reduce tobacco misuse.
• Develop culturally sensitive and supportive programs to
address the root cause of alcohol and substance use and
to help achieve better health outcomes for mothers and
their infants.
• Continue to promote awareness of how to prevent
sudden infant death syndrome.
• Continue to improve immunization coverage.
• Promote car safety including appropriate child seats.
Government and community organizations can:
• Tackle the larger issues that affect children’s health
and development: Poverty, food security, and social
conditions.
• Implement community programs (such as the Four Pillars
Approach in Vancouver) to prevent, treat, and reduce
harms from substance abuse, with a focus on culturally
based services specific to the Aboriginal population.

Disease and Injuries
The health and social services systems can:
• Work on Aboriginal control, planning, governance, and
delivery of services (especially primary care services) and
enhance these services in ways that meet the needs of
Aboriginal people, in order to reduce the gap in medically
treatable and other diseases.
• Develop services to assist Aboriginal people with chronic
illnesses and disability-related activity limitations.
• Work with communities to develop prevention programs
for diabetes in order to improve treatment outcomes.
• Continue to improve data collection systems, in order to
get comparative regional data about the occurrence of
diabetes, arthritis, and other chronic conditions in the
Aboriginal population.
• Expand arthritis services to include all health professionals
important in arthritis care (e.g., physiotherapists,
occupational therapists) and provide these services to the
areas of the province where care is needed.
• Develop a priority system for surgical intervention for
Aboriginal people with severe arthritis to reduce surgical
wait times.
• In consultation with Aboriginal communities, develop
and deliver education programs to heighten awareness of
arthritis, osteoporosis, exercise, weight control, and injury
prevention. Expand prevention and treatment for alcohol
and substance misuse.
• Focus on underlying factors that lead to illness, such as
poverty, family distress, child abuse, inadequate housing,
and untreated mental illness.
• Increase awareness and promotion of HIV disease
prevention and develop more treatment options and
increase uptake of HAART among Aboriginal patients.
• Collaborate with Aboriginal groups to review external
causes of death data (e.g., motor vehicle accidental deaths
and other injury deaths) and develop local strategies to
reduce these causes of death in each community.

• Continue to develop a coordinated response to the health
and social problems faced by injection drug users.
• Create a provincial Aboriginal mental health and wellness
plan. One pillar of the plan would focus on vulnerable
communities and youth suicide prevention.
Physical Environment
Individuals and families can:
• Maintain a smoke-free home, and encourage others to do
so.
• Use newer, less polluting, wood-burning stoves.
The health system can:
• Engage with Aboriginal organizations to actively improve
on-reserve housing.
• Work with First Nations to ensure that housing conditions
on-reserve are regularly monitored and tracked so that
deficiencies may be addressed.
• Develop ways to monitor indoor air quality and study
the health effects resulting from second-hand smoke,
inadequate heating, and moisture control.
• Continue to provide training and certification for water
system operators and make this mandatory, with subsidies
to enable participation. Undertake monitoring to make
sure water systems are adequately maintained and that
they are providing health benefits.
Governments can:
• Support Aboriginal communities to identify and address
local housing needs; e.g., by supporting loan funds
operated by First Nations organizations or by offering
courses on technical or administrative subjects.
• Work with First Nations, on a priority basis, to make
continued improvements to drinking water systems onreserve.
• Encourage research and public discussion about
environmental risks and the options for managing them,
using both traditional and scientific knowledge.

• Encourage public reporting on the impact of human
activities on fish stocks, forest areas, mineral supplies, and
other natural resources.
• Conduct surveillance of contaminants in food safety.
• Support capacity building initiatives to address knowledge
gaps in home maintenance and financial management.
• Ensure easy access to housing resources and information
through expanded broadband connectivity.
Health Services
First Nations communities can:
• Participate in health governance structures and planning
processes.
• Work towards increasing the participation of Aboriginal
women in prevention and screening programs, such as
Pap tests and screening mammography.
The health system can:
• Work with the Aboriginal community to develop
performance expectations for Aboriginal health. Include
performance measures and targets in health authority
service plans.
• Make a comprehensive effort to respond to mental health
problems and trauma in Aboriginal communities.
• Work with Aboriginal communities to increase the uptake
of breast cancer screening and Pap tests by Aboriginal
women.
• Encourage Aboriginal involvement in describing and
capturing evidence about what works to promote health,
treat illness, and care for the vulnerable. Support the use
of traditional healing in conjunction with other primary
health services.

The College of Physicians and Surgeons can:
• Continue to monitor professional prescribing practices
and deal with those professionals who are inappropriately
prescribing medication.
Government can:
• Work from the principle that Aboriginal people, like all
British Columbians, have the right to receive services that
will help them achieve and maintain good health and wellbeing.
Jurisdictional issues should not negatively impact
the delivery of health services.
• Continue to work on plans for routine record linkage
to identify Status Indian records in health databases
(e.g., hospital morbidity, physician claims, mental health
database, BC Cancer Registry, BC Centre for Disease
Control).
What more needs to done?
• Commit to making self-determination for the Aboriginal
population in the province a reality.
• Examine and review systemic barriers to economic
development and make it a priority.
• Continue to improve the socio-economic status of the
Aboriginal population by creating more educational and
job opportunities.
• Focus on implementing demonstrated best practices so
that Aboriginal children can fully benefit from educational
opportunities.
• Improve housing and the physical environment for the
Aboriginal population.
• Continue to work on Aboriginal health plans for health
authorities.
• Recommit to achieving stated goals.
• Make issues underlying HIV/AIDS a priority.
• Create a provincial Aboriginal Mental Health and Wellness
Plan.

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NEWS RELEASE
For Immediate Release
June 25, 2009

Ministry of Healthy Living and Sport

VANCOUVER – British Columbia’s provincial health officer, Dr. Perry Kendall, today released his report on the health and well-being of Aboriginal people in British Columbia

The 2007 annual report, entitled “Pathways to Health and Healing: 2nd Report of Health and Well-being of Aboriginal People in British Columbia,” is an update to the 2001 provincial health officer’s report and provides detailed information on the health and well-being of Aboriginal people compared to other British Columbians. This report discusses the progress that has been made since 2001, and the next steps that may be necessary to further improve the health of Aboriginal people and to close the gap between Aboriginal people and other British Columbians.

“While I’m pleased there have been some improvements to the health and well-being of Aboriginal people in B.C. since my first report, it’s evident a lot more work still needs to be done,” said Kendall. “We know the answers lie in fully engaging Aboriginal peoples to help find the solutions, in building capacities and in removing barriers.”

The report analyzes 64 indicators, including: determinants of health; healthy beginnings (pregnancy, infants and children); diseases and injuries; and health services. The report was able to show how 57 of these indicators have progressed since 2001. Of those, 18 have shown improvements, 10 have worsened and eight show increasing rates of chronic disease. The remaining indicators have shown not much change or a fluctuation in data with no trend.

“One of the biggest steps we’ve taken since the 2001 report has been to strengthen the partnership between Aboriginal peoples, the Province and the federal government, and have all three parties commit to achieving concrete targets,” said Aboriginal health physician advisor Dr. Evan Adams.

Improvements have been seen in overall mortality, external causes of death such as motor vehicle accidents, accidental poisoning, and drug-induced and alcohol-related deaths. But data indicates the gap still needs to be closed between the Aboriginal population and other residents, especially in the areas of chronic disease, HIV/AIDS, and hospitalization rates for external causes and mental and behavioural disorders due to psychoactive substance use.

Other recommendations include making economic development a priority; improving housing and the physical environment for the Aboriginal population; and continuing to improve the socio-economic status of the Aboriginal population by creating more educational and job opportunities.

More information and copies of Pathways to Health and Healing are available electronically at www.hls.gov.bc.ca/pho or from the Office of the Provincial Health Officer, Ministry of Healthy Living and Sport, 4th Floor - 1515 Blanshard St., Victoria, B.C. V8W 3C8.