Canadian Heart Health Strategy

1
Question Driven Approach
Canadian Heart Health Strategy
Promising Practices
Addressing and Enhancing Aboriginal/Indigenous
Cardiovascular Health
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
2

Question Driven Approach

• What is the burden of CVD in the Indigenous
  community?
• What are the most promising practices with
  respect to Indigenous heart health?
• What strategic directions must the CHHS pursue to
  best serve Indigenous Canadians?

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach
Promising Practices

• Aboriginal values and worldviews,
• cultural/personal safety
• skilled practitioners cognizant of their
  strengths and limitations
• portability or flexibility
• historical and contextual influences
• choice of traditional, western or blended
  approaches
• evidence informed intervention

Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach
1) Kahnawake Schools Diabetes Prevention Project
2) Sandy Lake Health and Diabetes Project 3)
Cape Breton Island, Nova Scotia 4) New South
Wales Aboriginal Vascular Health Program
5) United States Strong Heart Study 6) Diabetes
Risk Evaluation and Microalbuminuria 7) BRAID
(Believing We Can Reduce the Aboriginal
Incidence of Diabetes) 8) Food Security in
Canadas North 9) Heart and Stroke Foundation
Saskatchewan
Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach

• Conceptual tension
• Circulatory diseases gt 30 of all deaths in 2000
• Rapid westernization changing risk gt North
• Hospitalization rates 76 to 186 per 10,000
• Diabetes epidemic 19.7 FN adults (35 gt 55 yrs)
• Oji-Cree 40 adults 5x higher 80 (50-64 yrs)

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach
Question Driven Approach

• no or very crude health services
• tertiary care closer to home
• lifestyle modification campaigns limited success
• smoking and poor diet well-entrenched
• 46 of FNs adults smoke daily gt (5418-29 yrs)
• smoke free life is best established before
  addiction sets
• variation in risk between communities

Promising Practices
Promising Practices
Promising Practices
Problem Statement
Problem Statement
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach

• Glaring Omissions
• Acute, rehabilitative or palliative care
• Rural and remote access
• Gender
• Mental health issues,
• Systemic racism
• Pregnancy and infancy

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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• Key elements of promise
• responding to community initiative
• appreciative focus
• multiple components gt context
• capacity building
• service access generated through partnerships
• evidence for efficacy of nurse practitioners
• cultural competency of non-indigenous health
  professionals
• traditional practices
• large scale longitudinal genetically focused
  research

Question Driven Approach
Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach
Promising Practices

• Social determinants
• Relationship to the land is central
• Visibility and outcome orientation
• High degree of cultural competence
• Contemporary effects of colonial history
• Internal moral authority by responding to
  community initiative
• Appreciative model

Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach
Policy
Promising Practices

• Response to community initiative
• Collaboration between Aboriginal communities
• Cross-jurisdictional arrangements
• Remote and rural access fund
• Heart and Stroke Foundation

Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Services
Question Driven Approach

• Continuum of care
• Create synergy with other chronic disease and
  early development initiatives
• Life course approach.
• Traditional and more nutrient rich foods.
• CVD management algorithm

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach
Human Resources
Promising Practices

• Extend training and expertise
• Cultural competency
• Treatment algorithm
• Nurse practitioners
• Outreach, training and support

Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Research
Question Driven Approach

• Trans-theoretical model
• Addresses the individual in context
• Evaluate food security
• Multi-component health promotion
• Screening, surveillance and monitoring systems
  
• Database

Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Shah B, Hux JE The impact of diabetes on
cardiovascular risk factors and outcomes in a
native Canadianpopulation. Diabetes Res Clin
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B, O'Neil JD Type 2 diabetes mellitus in
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Human Development Index (HDI) is a comparative
measure of poverty, literacy, education, life
expectancy, childbirth, and other factors for
countries worldwide. It is a standard means of
measuring well-being, especially child welfare.
The index was developed in 1990 by the Pakistani
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http//en.wikipedia.org/wiki/Human_Development_Ind
ex 15Cooke, M., Beavon, D., McHardy, M.
(2004). Measuring the Well-Being of Aboriginal
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Human Development Index to Registered Indians in
Canada, 1981?2001. Strategic Research and
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Strategic Policy and Planning Unit, First Nations
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18 Commission on the Future of Health Care in
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Health Care in Canada, Final Report, 2002.
Question Driven Approach
Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations
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Question Driven Approach
Promising Practices
Problem Statement
Context
Rationale
Observations
Rationale
Strategic Recommendations
Strategic Recommendations