The past few months at our Centre has seen a significant focus on the health of First Nations, Inuit and M�tis children. One way to address child health is to support stronger awareness among the next generation of medical paediatric residents in universities across the country.  The NCCAH with other leading national organizations has worked closely with the Canadian Paediatric Society to create curriculum that does just that.  In the meantime, as the H1N1 flu virus pandemic unfolds this season, our Centre is contributing to regular national consultations and the broad sharing of information, while also addressing our ongoing priorities. We invite you to read more about our projects in this autumn edition of our Closing the Circle e-bulletin. Join us as we share knowledge and work in partnership to help make a difference in the health and well-being of Aboriginal peoples.     

Meegwetch,
Margo Greenwood,
Academic Leader,
National Collaborating Centre for Aboriginal Health

 

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On the frontlines  
During her residency at hospitals and clinics in northern B.C., family physician Dr. Catherine Elliott found that optimal health for many of her Aboriginal patients meant more than addressing immediate symptoms.
 
"It is important for improved care that we  understand the historical complexities and social context that Aboriginal patients bring with them to encounters with family doctors," said Elliott, who shared her perspectives in the Journal of Family Medicine recently. 
 
In isolating an elderly First Nations woman for tuberculosis testing, for instance, Elliott learned that a routine procedure from her perspective could be a frightening experience for her patient.  That's in part because TB treatment in many Aboriginal communities has been linked to residential schools, sanatoriums, and "lonely deaths far from families and home communities."
 
Education module for paediatric residents across Canada  
Now, guidelines and curriculum that can better support paediatric residents in the care of Aboriginal patients are about to be introduced in sixteen universities across Canada.   
 
Developed by the Canadian Paediatric Society with the support of the National Collaborating Centre for Aboriginal Health and nearly a dozen national organizations in the Many Hands, One Dream partnership, the curriculum will provide not only medical information but also historical context in the care of Aboriginal children and youth.

The curriculum was piloted in a day-and-a-half workshop at Queen's University in June and is expected to be delivered in all Canadian paediatric residency programs in 2010. 
 
"Most of the students in the pilot felt there was a very strong need for this information," said Dr. Kent Saylor, of the Montreal Children's Hospital, McGill University Health Centre.  " Many were not familiar with the data presented to them, and even basic information was new, such as the difference between First Nations, Inuit and M�tis  peoples; who is considered an Aboriginal person; who the Indian Act applies to; how housing works in different jurisdictions; and who supplies basic medications in which jurisdictions. A lot of this is eye-opening."

Saylor, who has played acentral role in developing the curriculum,  said most paediatric residents will serve in teritiary centres and teaching hospitals, and are therefore likely to be involved in the care of Aboriginal children and youth from surrounding regions.
 
"It's hard to see how this program will not help improve outcomes," he said.

 

The project is expected to be a significant step in addressing questions raised by doctors like Elliott in support of meaningful and therapeutic relationships between physicians and their aboriginal patients. 

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The perception that FAS and FASD are more common among Canadian Aboriginal children than among non-Aboriginal children may not reflect reality, a newly released report by the National Collaborating Centre for Aboriginal Health cautions. 

 

Report author Mike Pacey notes there is a need to better understand gaps in knowledge about the prevalence of Fetal Aclohol Spectrum Disorder and Fetal Alcohol Syndrome in Aboriginal peoples. He found published estimates vary too widely in their methodologies to provide a basis for Aboriginal-specific rates.  Further, some Canadian Aboriginal-specific published studies focus on higher-risk communities, and may promote a perception of higher prevalence or incidence of FASD in the Aboriginal population.  

 

The report notes discrepancies between research estimates in the epidemiological lierature and the lived experiences of many Aboriginal communities, where the issue is clearly of  concern.  Pacey suggests more research is needed before there can be reconciliation between these two forms of knowledge and suggests guidelines for future studies, including the need to examine socio-economic status.  

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Can health programs in schools across Canada be redesigned to better meet the needs of Aboriginal children?  

 

That question has been at the heart of Shirley Tagalik's work in Canada and internationally. Tagalik,  an education consultant, recently helped redesign Nunavut's education system based on Inuit traditional knowledge - or Inuit Qaujimajatuqangit. She is now working with the NCCAH and partners to help rebuild school programs in Canada and more broadly.

 

Doug McCall, executive director at the Canadian Association for School Health (CASH), observed that among educators, researchers, and professionals,  "there is a great deal of interest and a level of concern about the health of Aboriginal children."   As a result, CASH has established an active national community of practice network on Aboriginal health.   

 

 

Two new publications highlight major issues in Aboriginal and child health in Canada by emphasizing the "life course" approach and the critical role of childhood in improving health outcomes.   

From tuberculosis to mental illness and diabetes, chronic disease among Aboriginal peoples is on the rise and will require both urgent action and social change to end an intergenerational cycle.
 
In his new book on the crisis, Dr. Jeff Reading, of the Centre for Aboriginal Health Research at the University of Victoria,  finds the traditional emphasis on treating adult risk factors for chronic disease falls short when "subsequent generations grow up in the same conditions that fostered the onset of chronic disease in their parents."

 

Reading draws on multiple sources of research to make links between issues such as poverty and chronic disease, and to help guide policy and intervention. He cites troubling evidence that the number of Aboriginal people with diabetes could triple by the year 2016, that 77 per cent of all Aboriginal children between the ages of zero and nine are living in poverty, and that diseases such as tuberculosis continue to be an issue, particularly for HIV-AIDS-infected people and for children and youth.  

 
Although the focus in public and population health on disparities tends to minimize attention to healthy Aboriginal communities and individuals, Reading notes that, particularly in relation to child poverty: "No matter how you look at the numbers...one can conclude that the current and future health of Aboriginal children is at serious risk." 

 

He states "a new approach to studying disease trends and facilitating positive interventions is urgently needed."

 

In taking a social determinants approach to the chronic disease crisis, Reading targets poverty rooted in colonial history as a major factor in chronic disease in Aboriginal populations.  He also emphasizes the lifecourse model, which recognizes the health impacts for individuals and populations of physical and social exposures at various stages in life, from prenatal to adulthood.
 
Together, these approaches can help guide policies and prevention methods to improve outcomes.  Reading notes, for example, evidence that obesity in children can stem from obesity issues in mothers, suggesting that pre-pregnancy and pregnancy could be seen as an "extremely effective point in the life course to target obesity and thus reduce the burden of type 2 diabetes."

However, he argues "no amount of risk assessment or health recommendations will reduce the burden of disease without a parallel understanding of the importance of social change."

 

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Although children in Canada are among the world's healthiest, there are "worrying trends"  that require concerted action, particularly for sub-populations such as low-income families, Aboriginal peoples, and children with disabilities, Canada's Chief Public Health Officer finds in his newly released report on the state of public health in Canada. 
 
Dr. David Butler-Jones,  Canada's first Chief Public Health Officer, released his second report on the state of public health in Canada, focusing on childhood as a "critical stage that most strongly impact[s] the rest of our lives, and where the greatest opportunity for positive influence lies."  
 
His report, "Growing Up Well - Priorities for a Healthy Future," highlights six issues of persistent or worsening concern:  socio-economic status, abuse and neglect, prenatal risk, mental health and disorders, obesity, and unintentional injuries.
 
Although the report targets all children in Canada, Butler-Jones consistently draws attention to indicators where Aboriginal children fare worse than the general population, and finds that "inequalities are evident even at the earliest stages of life, particularly among children who are Aboriginal, who have disabilities or who are part of families with low income."
 
The health officer said Canada "may fail these children" without concerted action.
 
Butler-Jones sought advice and guidance in the writing of his 2009 report from leading experts in Aboriginal health and half a dozen Aboriginal organizations, including the Centre for Aboriginal Health Research at the University of Victoria, Assembly of First Nations,  First Nations Child and Family Caring Society,  National Aboriginal Health Organization and the Native Women's Association of Canada.  
 
The Chief Public Health Officer's first report, in 2008, highlighted  social and economic inequalities as contributors to health inequalities.  
 
 

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