Aboriginal Child Health

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Aboriginal Child Health

• What role can pediatric health care institutions
  play?

M Moffatt Winnipeg Regional Health Authority
University of Montreal
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Outline

• Identify aboriginal children
• Health indicators
• Current system(s) of delivery
• Likely future trends
• Quality health care for Aboriginal children
• Where do CAPHC institutions fit in?

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Who and where are aboriginal children?

• 1 million Aboriginal people (gt 40 children)
• First Nation (62)
• On reserve
• Off reserve
• gt50 now live in urban areas
• Status vs. non status
• Inuit (5)
• Métis (32)

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(No Transcript)
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Urban Aboriginal children
2 groups
Educated, employed parents
Poorly educated, Often unemployed parents
Inner city, Ghetto, Poverty, ? morbidity
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Profile of urban Aboriginal people
Source Statistics Canada. Aboriginal Peoples
Survey 2001
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Health status
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Regions with gt19 Aboriginal population

• PYLL 50 greater

Source Allard et al. Health Reports 20041551-60
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PYLL by cause
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Diabetes Mellitus Type II new cases in Manitoba
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Canadian BMI data

• Young 1990 Mb and NW Ont.. - adults
• BMIgt30 - 27.3
• Young, Dean et al 1999 (unpublished)- Mb children
• BMI gt 95 - girls 40
• boys 34
• BMI predictive of diabetes
• Hanley 2000 NW Ont BMI gt 85 girls 34, boys 28

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Child Hunger

• 16 Aboriginal off-reserve families vs. 3.9
  others

Source McIntyre L et al. CMAJ 2000163961
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Social Determinants or health care?

• Poverty, lack of power and control, low education
• There seems no excuse for complacency we ought
  to speak out.
• But
• The high levels of morbidity make it unethical
  not to provide the best possible care.
• Health care has a small (but measurable)effect

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Usual existing delivery system

• ON-reserve/remote
• Federal (except Quebec and territories)
• Nurse clinician model
• GP support
• Some areas tied into systems of specialist
  support
• On-reserve not remote
• PH services in community
• Use adjacent communities for acute and primary
  care
• Urban
• Use existing services

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Gaps in current system

• Assumption if services are close, access occurs.
  Not valid
• Remote/rural
• Staff turnover/human resources shortage
• limited or no access to allied health
• Federal-provincial wrangling
• Handicapped children
• Lack of community control

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Falling between the cracks
Case 1 An 11 month old girl with a birth
defect of her heart, corrected surgically,
remains on a respirator has a tracheotomy and is
fed through GT tube. Brain is normal no
cognitive impairment expected. In hospital all
her life, now ready for discharge. Needs a
medical foster home and parents, who remain
involved, agree.Although a good home is found,
placement has been denied by the First Nations
Child and Family Services Agency, on the strength
of a directive indicating that INAC and FNIHB
will not fund the costs. Parents faced with the
option of giving up rights to the child so she
becomes a ward of the province. Ultimately this
child stays in hospital for 14 months before the
issues are resolved.
Case 2 A child with a complex genetic disorder
who is also severely developmentally delayed .
Languished in hospital for 18 months after ready
for discharge. VPA held up because no one would
agree to pay the costs.
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Issues

• Federal? Provincial downloading
• Piece-meal approach to funding
• Uninsured services (often require individual item
  approval)
• Lack of a patient-centred approach
• First Nations agencies caught in between

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Characteristics of a good health system

• Access 24/7
• Continuity
• Seamless integration
• Full range of services
• Patient-centred
• Evidence-based
• anticipatory

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Evolving Aboriginal health system

• Nunavut and NT
• Quebec
• Individual Community examples of excellence
• Eskasoni
• Kahnawake
• Urban Aboriginal systems

Lemchuk-Favel and Jock J Aboriginal Health Vol. 1
Jan 2004
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Community-controlled aboriginal health services
characteristics

• Self-empowerment
• Holistic approach
• Synergy of traditional and western
• Primary care
• Collaboration with provincial services
• Integrated
• Administrative reform

Lemchuk-Favel and Jock J Aboriginal Health Vol. 1
Jan 2004
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Community control and health
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Effectiveness of Specialist outreach visits

• Cochrane review (Gruen et al)
• Some evidence that outreach improves access and
  quality, particularly if done in a multi-faceted
  manner
• Main evidence from urban non-disadvantaged
  populations

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Highest premature mortality
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CAPHC and Aboriginal health

• Most of tertiary resources for children
• Unique knowledge base
• Telehealth technology
• Networks
• RHAs
• formal
• Multiply handicapped children remain in our
  institutions

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What can we do?

• Support Aboriginal control of services
• Develop partnerships with aboriginal groups
• Provide new, or link with existing outreach
  programs
• Insist that these be multi-faceted
• Think outside the box!
• Make services client-centred
• Connect with evolving primary care
• Provide interpreter services

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What can we do?

• Foster cultural awareness
• Aboriginal employment
• zero tolerance for prejudice
• Take a stand on repatriation of multiply
  handicapped children
• Offer services by telehealth
• But must link with existing care system
• Think outside the box
• Lobby for social and political change