National Aboriginal Health Organization NAHO

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National Aboriginal Health Organization (NAHO)

• Information and Communication Technology in the
  ArcticIcelandic Chairmanship of the Arctic
  CouncilOctober 20-21, 2003

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Overview

• Canadas Aboriginal Peoples
• Aboriginal Health Research
• Knowledge as a Community Resource and
  Knowledge-Based Strategies
• National Aboriginal Health Organization (NAHO)
• Origins and History
• Interests and Initiatives
• Aboriginal Health Infostructure
• Opportunities for Innovation/Success Factors
• Thanks to assistance of NAHO Policy Research, Dr.
  Valerie Gideon, Director of the First Nations
  Centre, and Ajunnginiq Centre _at_ NAHO

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Canadas Aboriginal Peoples

• Three distinct groups Approximately 1 million
  people or 3.3 of Canadas population
• Inuit 5
• First Nations 62
• - Over fifty distinct cultural groups
• Métis 30
• Living in many types of communities
• Reserve, Urban or Rural/isolated northern
  communities
• (Statistics Canada 2003)

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Inuit Regions Communities

• Four Land Claims Regions
• Nunavut
• Nunavik
• Inuvialuit
• Labrador
• 53 Inuit Communities, ranging from 120 to 6,000
• Approximately 50,000 Inuit
• 5 of Aboriginal population

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Métis Identity Population in Canada

• 31 Metis Identity
• 68 live in urban areas
• 40 urban Aboriginal Population

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Responsibility for Health Services

• Federal government accepts responsibility for
  public and environmental health services for
  First Nations living on reserves and for Inuit
  Communities
• First Nation, Métis and Inuit also use provincial
  and territorial government health services
• Although Métis are recognized as an Aboriginal
  People in the Constitution, the federal
  government has not accepted jurisdiction for
  Métis and very few Métis-specific health
  initiatives exist at the provincial/territorial
  level

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Canadas Aboriginal Peoples

• Compared to the population as a whole, Canadas
  Aboriginal population is
• Young with 50 less than 25 years of age
• Mobile
• Growing rapidly in size
• Increasingly concentrated in large urban and
  inner city areas
• Poverty and marginalization remain major concerns
• Education, income and economic development
  opportunities are improving
• Health status is lower than general population on
  virtually every measure

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Aboriginal Health Research in Canada

• Key findings (Young K. 2003)
• Over 60 of papers referred to First Nations
• Only 2 dealt with those living off-reserve, and
  2 provided data on Métis
• Only 3 of articles dealt with smoking, although
  the prevalence of smoking in the population is
  62
• Injuries account for over a third of all deaths,
  yet occupy 3 of publications

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Aboriginal Controlled or Directed Research

• Institute of Aboriginal Peoples Health
• ACADRE program (Aboriginal Capacity and
  Development Research Environments)
• National Aboriginal Health Organization (NAHO)
• First Nations Regional Longitudinal Health Survey
  (RHS)
• Aboriginal Healing Foundation

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Federal Government Support of Aboriginal Research

• 1998 Government of Canada response to 1996 Royal
  Commission on Aboriginal Peoples, called
  Gathering Strength Canadas Aboriginal Action
  Plan, includes
• Northern Contaminants Program (NCP)
• Aboriginal Diabetes Initiative
• Aboriginal HIV/AIDS Research Capacity Building
• Research by Federal departments
• Additional Health Research Initiatives affecting
  Aboriginal Peoples

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Keynote Factors in Aboriginal Health

• Inequitable health services
• Poor health status than general Canadian
  population
• Difficulty accessing certain health care
  providers (pediatricians, mental health
  professionals, obstetricians/ gynecologists,
  midwives), in particular, in remote communities
• Quality of health care in isolated/remote
  communities

• Residential school experience and loss of land
  and culture have contributed to health and
  wellness status of Aboriginal peoples
• Use of traditional healer/ medicines reported
  more likely to use traditional care if accessible
  at local health centre and covered by health care
  system

Sources Regional Health Survey 1997, NAHO
Opinion Poll 2002
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Overview of Canadian Indigenous Research Capacity

• Strengths
• Aboriginal controlled or directed organizations
• Increased funding and involvement
• Indigenous Research capacity is high priority
• Emerging opportunities for national surveillance
• Challenges
• Sustaining the (funding) gains e.g. RHS, AHF
• Ensuring meaningful involvement in research
• Community Capacity to direct/use research
• Improving access to health data
• Systemic issues research funding mechanisms
  access to academic positions

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National Aboriginal Health Organization (NAHO)

• Vision Statement
• The National Aboriginal Health Organization, an
  Aboriginal designed and controlled body, will
  influence and advance the health and well-being
  of Aboriginal Peoples by carrying out
  knowledge-based strategies.

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NAHO Mandate

• How can knowledge-based strategies be used to
  improve Aboriginal health?

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Knowledge as a Community Resource

• Knowledge is a community resource. It defines
  and drives the community. Its
  interconnectedness, its multifaceted and
  multidimensional, its revered, its language,
  communication and history.
• Its collective memory. Its captured and
  maintained for future generations. Its a
  reflection of life experience. Its acquired
  through listening and being empathetic. Its
  wisdom, strength and leadership. Its a
  strategic resource. Its the power of a good
  mind. Its imperfect.
• Its a gift bestowed by the Creator.
• Quote from Tom Maracle

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Knowledge Catalyst for Change

• The key to Aboriginal Health Partnerships is
  that theyreflect the needs and circumstances of
  the communities and people they serve.
• Romanow Commission

• Creating change starts with creating a vision
  for change and then empowering individuals to act
  as change agents to attain that vision.
• Lorenzi Riley

policy initiatives are adopted precisely because
of their power to convince decision makers that
they are the most appropriate course of action
Thus, any attempt to re-frame or replace an
existing policy is only likely to be successful
if extremely compelling evidence to justify a
change of course can be gathered. -Dion Stout
and Kipling
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Model for Change
Policy Makers
Health Professions
Health Administrators
Health System Based on Peoples Needs
Communities
Academic Institutions
Borrowed from Towards Unity for Health
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Using Knowledge-Based Strategies to Achieve the
Model
Leadership Strategy
Outcomes
Resources
Best Practices
Knowledge Based Strategies
Capacity
Knowledge-Sharing Culture
Tools Technologies
Communities of Practice
Incentives Partnerships
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How to Create and Support Knowledge
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Origins

• Royal Commission on Aboriginal Peoples (RCAP)
  consultations identify need for national health
  institute in 1996
• Aboriginal Health Institute recommended by
  National Forum on Health in 1997
• Speech from the Throne commits Canadian
  Government to establish the Institute 1998
• Consultations with five of Canadas National
  Aboriginal Organizations (1998)

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Brief History

• Cabinet approved design framework allowing for
  implementation (June 1999)
• Organization for the Advancement of Aboriginal
  Peoples Health incorporated (March 10, 2000)
• 10 Board members appointed/5 elected Staff
  recruitment Board orientation to mandate and
  establishing initial structures New corporate
  logo selected Change name to National Aboriginal
  Health Organization (NAHO) (2000)
• Establishment of 3 Centres - Inuit, First Nations
  and Métis (2001)

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Member Organizations

• Five National Aboriginal Organizations
• Assembly of First Nations (AFN)
• Congress of Aboriginal Peoples (CAP)
• Inuit Tapiriit Kanatami (ITK)
• Collaboration with Pauktuutit Inuit Womens
  Association of Canada
• Métis National Council (MNC)
• Native Womens Association of Canada (NWAC)

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Principles of Uniqueness

• Commit to unity and respect diversity
• Consider knowledge of Aboriginal traditional and
  western contemporary healing and wellness
  approaches
• View community as primary focus, including
  community-based research
• Reflect values and principles contained in
  traditional knowledge and practices

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Main Interests

• Knowledge transfer
• Provide a support network for Aboriginal health
  workers and communities
• Share information on best practices and health
  issues
• Advocate health research in the area of
  evidence-based decision making to ensure the
  unique needs of Aboriginal Peoples are met

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NAHOs Goals

• To improve and promote the health of Aboriginal
  Peoples, through knowledge-based activities
• To promote health issues pertaining to Aboriginal
  Peoples by means that include communications and
  public education activities
• To facilitate and promote research and develop
  research partnerships
• To foster the recruitment, retention, training
  and utilization of Aboriginal People in the
  delivery of health care
• To affirm Aboriginal traditional healing
  practices and medicines and to ensure such
  practices receive recognition

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Object 1 Specific Initiatives

• Collecting data
• The First Nations Regional Longitudinal Health
  Survey (RHS)
• NAHO Opinion Poll on Health Care
• Sharing information
• NAHO Annual Conference (November 2004) and three
  regional gatherings
• Five Inuit regional workshops
• Métis Health Policy Forum
• A series of workshops on Health and Community
  Control, Aboriginal health information, etc.
• Information Clearinghouse on Aboriginal Health
• Creating and supporting knowledge
• Best Practices Program

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Key Findings

• First Nations Regional Longitudinal
• Health Survey (RHS)
• Over 28,000 on-reserve First Nations (2nd
  iteration)
• 250 trained community interviewers using laptops
  with daily remote uploads of data
• NAHO Opinion Poll on Health Care
• First national poll on Aboriginal health issues
  in 2002
• 400 Métis individuals surveyed in three provinces
• 1209 First Nations adults living on or near
  reserves

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Key Findings

• Inuit Regional Workshops
• Inuvik Regional Workshop, Feb. 25-28
• Nunavik, Mar. 25-29
• Nain in Labrador, April 8-11
• Iqaluit, May 8-12
• Rankin Inlet, Nov. 25-29

• Loss of language
• Water quality
• Active living
• Teenage pregnancy
• Tobacco use
• Land activities
• Improving primary caregiving
• Inuit family values
• Resources for community health representatives

• Culture shock
• Nutrition
• Strong language and cultural festivities
• Active youth
• Eager to learn about traditional healing
  practices
• Cancer
• Addictions and suicide rates
• Elders traveling for care

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Our Collected Works to Date Highlights

• Analysis of Aboriginal Health Careers
• Aboriginal Health A Constitutional Rights
  Analysis
• Effective Governance Strategic Consideration for
  NAHO
• Ethics of Aboriginal Research
• Midwifery and Aboriginal Midwifery in Canada
• Traditional Medicine in Contemporary Contexts
• Winds of Change A Strategy for Health Policy
  Research and Analysis
• Capacity Building for the Health of Aboriginal
  Communities
• Aboriginal Integrated Health Organizations

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Our Collected Works to Date Highlights

• NGOs and a Management Strategy Framework for NAHO
  
• A Framework for Aboriginal Health Systems
• Improving Population Health, Health Promotion,
  Disease Prevention and Health Protection Services
  and Programs for Aboriginal People
• Establishing a Leading Knowledge-Based
  Organization
• A Path to a Better Future-A Preliminary Framework
  for a Best Practices Program for Aboriginal
  Health and Health Care
• Strategic Directions for an Evidence-Based
  Decision Making Framework Framework at NAHO
• Submission to the Commission on the Future of
  Health Care in Canada

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Information Clearinghouse on Aboriginal Health

• Features

• News and Current Events
• Research Register
• Conference Register
• Professional Exchange
• Keep Me Posted
• Community Profiles and Geography
• Funding and Budgets
• Legislation
• Feedback and Surveys

• The Library
• Reading Room
• Featured Papers
• Highlight Capsules
• References
• The Store
• Select and order
• Facilities and Programs
• People and Organizations
• Career and Education Centre

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Object 2 Promoting Health Issues

• Aboriginal evidence-based framework for decision
  making
• Based on community-identified priorities
• Integrates qualitative and quantitative data
• Builds on Aboriginal languages, cultures and
  indigenous knowledge, practices and values
• Continually assesses/reassesses information from
  the community, interpretations of the evidence,
  and evaluation of outcomes
• Integrates an Aboriginal peer-review process
• Takes into account patients rights

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Object 3 Facilitate Aboriginal Health Research
Search for discovery (basic curiosity)
NAHO focus
1) Basic Biomedical Research
3) Research into culture, pop. health
Individual (even cellular) level
Communities, social systems, populations
4) Health services systems investigations
2)Applied Clinical Research
Directed translation/synthesis of knowledge gained
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Working Through Partnerships

• Launch of the NAHO Journal
• Framework Agreement with the Institute of
  Aboriginal Peoples Health
• Development of models for Aboriginal Health
  Research Ethics
• NAHO Research Associates
• Participation in the Canadian Population Health
  Initiative
• ACADRE Centers
• Facilitate identification of Inuit-specific
  mental health research priorities

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Object 4 Advance and support Aboriginal health
professions

• Initiate and engage partnership arrangements
• Member Affiliations
• Object Specific Agreements
• Friends of NAHO agreements
• Contractual Agreements
• Letter of Intent with Canadian Medical
  Association, Canadian Public Health Association
• Draft Framework Agreement with IAPH
• Memorandum of Understanding with AFN

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Object 4

• Workshops
• How to Effectively Use Health Information and
  Youth Workshops on How to Conduct Research -
  First Nations Centre
• Proposal Writing Workshops - Metis Centre
• Building capacity of Aboriginal health
  researchers through ACADRE centers
• Work to address broader capacity-building
  requirements to enhance recruitment and retention
  of Inuit students and health care workers
• Develop resource books for health interpreters
• Creation of new health professions, e.g.
  traditional midwives

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Object 5 Affirm Traditional Healing Practices

• Bulletins with the Native Law Centre
• Traditional Medicine and Legal Issues
• Intellectual Property Rights and their Impact on
  Indigenous Knowledge and Medicines
• Support and gatherings for Aboriginal midwives
  from across Canada
• Environmental Scan by Dr. Dawn Martin-Hill
• Discussion Paper on International Models
• Gatherings with Communities, Elders and Healers
• Métis Elders Gatherings
• Strategies to preserve and protect traditional
  medicines
• Awareness seminars and workshops aimed at health
  professionals and students
• Work with cultural institutes

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Managing Change for an Aboriginal Health
Infrastructure

• Creating an Aboriginal community in practice
  for health infostructure adoption
• Draft Blueprint and Tactical Plan recommends
  flexible technology architecture to accommodate
  varying community needs
• Aboriginal Health Infostructure - an autonomous
  and distinct commitment, strategically and
  appropriately interlinked with the pan-Canadian
  Health Infostructure

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Notable Policy Developments

• 1996 Royal Commission on Aboriginal peoples
• 1997 F/P/T Advisory Committee on Population
  Health
• 1999 Ministerial Advisory Council on Health
  Infostructure
• January 2001, the Speech From The Throne
  Government of Canada commitment to strengthen its
  relationship with Aboriginal people, improve
  conditions for Aboriginal people, develop modern
  information systems, improve health care and
  support health research.

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Notable Policy Developments

• 2001 National Broadband Task Force recommended
  that government take leadership to ensure that
  affordable access to broadband services is
  available to all Canadians by 2004 as a matter of
  priority
• 2002 The Health Transition Funds Aboriginal
  Health Synthesis Report recommended additional
  resources be allocated to support Aboriginal
  communities collection, management, and use of
  local health data
• 2002 the Romanow Commission proposed that
  Aboriginal Health Partnerships be created,
  supported by up-to-date information on
  performance indicators and the capacity to make
  decisions based on the best available evidence.

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Aboriginal Health Infostructure

• Drivers
• Improved continuum and access to health
  information and health care
• Professional support for better recruitment and
  retention
• Aboriginal peoples governance over their health
  information and service delivery
• Improved health planning of Aboriginal health
  systems and F/P/T governments

• Barriers
• Connectivity and Capacity
• Relevant Content
• Inclusion in Canadian, provincial and/or
  territorial initiatives
• Sustained support for initiatives
• Policy uncertainties

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Draft Blueprintand Tactical Plan

• Key Directions
• Empower communities
• Improve access to health services
• Build human resources institutional capacity
• Improve linkages with N/P/T health systems
• Respect OCAP

• The Process
• Planning Committee created in 2001
• Environmental Scan completed
• Vision drafted
• Stakeholder feedback sessions initiated
• Draft Plan in January 2003

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Blueprint/Tactical Plan

• Common Priorities
• All validate Vision Statement
• All support one-stop web-based health information
  site
• Region-specific approach to health infostructure
  development may be preferred
• Capacity building is fundamental to user
  ownership and participation
• Improved infrastructure is required

• First Nations
• Specific applications that respond to breadth of
  programs
• Inuit and Métis
• Development of basic infrastructure for sharing
  and utilizing of services and information

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Opportunities for Innovation

• Aboriginal Health Surveillance
• Major Gap recognized by Canadian Public Health
  Association
• Invitations to participate in developing
  surveillance systems in food and nutrition,
  cancer care, maternal health from Health Canada
• Need for integrated, comprehensive Aboriginal
  public health surveillance strategy to identify
  priorities, building blocks, and implementation
  plan

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Opportunities for Innovation

• Building Models for Integrated Aboriginal Health
  Systems
• Providing key information in support of the
  Partnership model presented in Romanow Commission
  Report
• Case studies of Aboriginal community-controlled
  systems, study of funding models and
  international perspectives
• Common strands
• Paradigm shift from ill to population-based
• Local governance and Aboriginal involvement
• Interdisciplinary primary care
• Traditional medicine linked with mainstream
• system
• A focus on children and youth
• Holistic framework

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Linkages with Health Canada other Federal
Departments

• Develop effective and friendly information tools
  for Aboriginal communities
• Clearinghouse
• Tool Kits for Community Planning
• Support research for identifying health needs,
  priorities and successful models
• Develop integrated models for addressing broader
  determinants of health across/within federal
  departments

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Critical Success Factors

• Inclusion of all Aboriginal peoples
• Aboriginal peoples ownership, control, access
  and possession over their information
• Aboriginal collective and individual empowerment
  in health systems
• Holistic approach to health
• and wellness

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Challenges

• To be accountable to the Aboriginal Peoples of
  Canada, through the First Nations, Metis and
  Inuit Centres, and with other organizations
• To make a difference in the health of the
  Aboriginal Peoples of Canada

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Sharing Information and Ideas

• Contact Us!
• NAHO/ONSA
• 56 Sparks Street
• Ottawa, ON Canada
• K1P 5A9
• www.naho.ca