DIABETES. What is Diabetes? How do you know if you have it? To know for sure if you have it, you need to get tested.

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1 DIABETES The history of colonization can be directly linked to poorer health outcomes for Indigenous women, girls and gender-diverse people. Events like the residential school system, the 60 s scoop, and forced starvation disrupted Indigenous kinship systems, beliefs, and cultures, which resulted in trauma that has been passed down through generations. Inequalities in healthcare have resulted in Indigenous populations experiencing high rates and risk of type 2 diabetes (Crowshoe et al, 2018). Larger issues like poverty and food insecurity play a role in high rates of diabetes experienced by Indigenous populations. Recent data indicates that Indigenous women are more likely to develop gestational diabetes than non-indigenous women. A 2011 report by the Public Health Agency of Canada shows diagnoses of 4.8% in First Nations, 4.0% in Inuit, 2.2% in Métis populations, compared to 0.5% in the non-indigenous population. What is Diabetes? Diabetes is a chronic disease where your body either does not make enough insulin or cannot use the insulin it makes. Insulin is the hormone made by the pancreas that allows the body to change glucose (sugar) from food into energy. Without enough insulin, the sugar stays in your blood and causes high blood sugar. Type 1 Diabetes: occurs when the body s immune system destroys the insulin producing cells in your pancreas, preventing the body from producing enough insulin. Type 2 Diabetes: is the most common type of diabetes, and occurs when the body does not produce enough insulin, or cannot use the insulin properly. Gestational Diabetes (GD): GD is a temporary form of diabetes that develops during pregnancy where the mother s body cannot produce enough insulin, which can result in high blood sugar levels. After the baby is born, blood sugar levels often return to normal, however the mother is at a greater risk of developing type 2 diabetes later in life. To know for sure if you have it, you need to get tested. How do you know if you have it? Some of the signs of diabetes include: having to pee often, weight gain, increased fatigue, being thirsty often, getting more frequent infections, cuts and bruises that won t heal, etc. (NADA, 2011). If you are experiencing these signs, you can get tested for diabetes by your healthcare provider. There are three kinds of diabetes tests: 1. A blood test that allows your doctor to determine the levels of blood sugar in your body; 2. A fasting blood sugar test which involves testing your blood levels after you haven t eaten for a period of time; and 3. An oral glucose tolerance test. This test involves testing your blood sugar levels after you ve been given a sugary drink (Healthline, 2018).

2 Prevention While there is no cure for diabetes, there are steps you can take to prevent diabetes and reduce the risk of diabetes related complications. Treatment While there is no cure for diabetes, people with diabetes can live long healthy lives if they are committed to daily diabetes management. Diabetes can be managed through: Regular physical activity Watching what you eat Weight management Medication: Type 1 diabetes is treated through insulin, while Type 2 diabetes is managed through physical activity and meal planning, and may also require medications and/or insulin. Stress management Trying to maintain a healthy blood pressure level (Diabetes Canada, 2018) These include: eating a healthy balanced diet, exercising regularly, aiming for a healthy body weight, watching your blood sugar level, avoiding smoking and alcohol, taking medications as prescribed, visiting your dentist regularly, getting your eyes checked regularly, etc. It is also important to get screened for diabetes on a regular basis, especially if you have had GD. These preventative steps are not always accessible for some people due to things like high costs of and difficulty accessing healthy foods. Do the best you can, and if you feel comfortable, talk to your healthcare provider about creating an approach that works for you. Protective factors: Prior to colonization, diabetes was less of an issue for Indigenous populations. Traditional lifestyles often included lots of physical activity, and it was easier to access healthy, traditional foods (NADA, 2011). This was part of a wholistic approach to health that included physical, mental, emotional and spiritual well-being. Many people argue that this shift from traditional lifestyles and diets, to one that is less active with a diet of over-processed foods high in sugar, salt and saturated fat has led to increased rates of diabetes (NADA, 2011, p. 53). Diabetes affects all aspects of our lives, and it is important to take care of not only our physical health, but our emotional, mental, and spiritual well-being as well. For some people, connection to culture, ceremony, time spent on the land, and learning about traditional food sources can be a pathway to a healthier more balanced lifestyle. For others, this might mean finding an activity that you enjoy and gets you active such as playing sports, walking, jogging, fishing, canoeing, or gardening (NADA, 2011). Self-care looks different for everyone, but it is important to remember that you deserve to take time for yourself and prioritize your health. This document was created by NWAC Pathways PEKE and funded by the Canadian Institutes of Health Research

3 MENTAL WELLNESS From an Indigenous perspective, mental wellness is something that can be understood holistically. Factors like physical, spiritual, and emotional well-being, as well as connection to culture, and the land all play a role in mental wellness (FNIGC, 2018). This differs from western biomedical understandings of mental health, which have mostly defined mental health as the absence of mental illness (FNIGC, 2018). Comparing mental health between Indigenous and non-indigenous populations is challenging because of these cultural differences in understanding (FNIGC, 2018). Due to the history of and ongoing processes of colonization in Canada, Indigenous women and gender-diverse people often experience high rates of adverse mental health outcomes such as, depression and anxiety. The traumatic effects of things like the residential school system, and the 60 s scoop are passed down through generations and continue to be felt today. Lived realities such as poverty, food insecurity, and unemployment also contribute to adverse mental health outcomes. What is depression? How do you know if you or someone you know has it? Clinical depression is a, complex mood disorder caused by various factors, including genetic predisposition, personality, stress, and brain chemistry (CAMH). Some signs of depression include: changes in appetite and weight, difficulty sleeping, loss of interest in activities you normally enjoy, withdrawal from friends or family members, feeling short-tempered, tiredness, trouble concentrating, suicidal thoughts, and increased anxiety (CAMH). What is anxiety? How do you know if you or someone you know has it? Everyone experiences anxiety to some degree, but it is often infrequent and does not cause interference with your day-to-day activities. Anxiety can also be more severe, and cause distress, disruption, and harmfully affect multiple aspects of an individual s life. Some signs of anxiety include: anxious thoughts, irrational or extreme fear, difficulty managing daily tasks, avoidance of situations one fears, safety behaviours, etc. (CAMH).

4 Treatment: There are numerous ways to treat depression and anxiety. Western approaches to treating depression include antidepressants, cognitive behaviour therapy (CBT), and psychosocial support (NCCAH, p. 17). CBT has also been shown to be effective in treating anxiety (NCCAH[2], p. 21). Western approaches to treating depression and anxiety are not always effective for Indigenous peoples, and some researchers advocate for culturally appropriate programming that address healing on an individual and community level. Programming that incorporates both traditional Indigenous knowledge and Western approaches have also been found to be effective (NCCAH). Protective factors: Despite these realities, recent data indicates that mental wellness among Indigenous populations is steadily improving. Phase 3 of the First Nations Information Governance Centre (FNIGC) Regional Survey indicated that, nearly two-thirds (66.1%) of Indigenous adults reported they were likely to be well, while one-fifth (17.4% reported moderate to severe mental distress (FNIGC, 2018, p. 74). Overall, the majority of Indigenous adults rated their mental health as being good, very good, or excellent in this survey (FNIGC, 2018, p. 72). Indigenous people face multiple barriers to mental wellness, but research shows that despite these additional stressors, Indigenous people are resilient (NCCAH[2], 2015) A number of factors that protect against adverse mental health outcomes and promote resiliency within Indigenous populations have been identified. Protective factors include high quality social supports, spending time on the land, cultural continuity, having positive role models, and learning about culture and tradition (NCCAH[2], 2015). While these may be protective factors for some people, it is important to remember that everyone s mental wellness journey is unique and valid. What works for one person may not be appropriate for another, and it might take multiple approaches before you find something that works for you. If you or someone you care about is struggling, talk to someone you trust or reach out for help: Kid s Help Phone: Provides anonymous and nonjudgemental support to youth and teens Talk 4 Healing: Free and culturally safe telephone help line for Indigenous women living in Northern Ontario HEAL Native Youth Crisis Hotline: First Nations and Inuit Hope for Wellness Help Line: Provides culturally grounded assessment, referrals, and support in times of crisis, and suicide intervention Kamatisiaqtut Help Line: Provides culturally-specific assessments and support in English or Inuktitut for those living in Nunavut or Nunavik This document was created by NWAC Pathways PEKE and funded by the Canadian Institutes of Health Research

5 ORAL HEALTH Oral health refers to the health of a person s teeth, gums, and related dental structures (PHAC, 2018). Oral health is an integral aspect of a persons overall health and well-being throughout the duration of their life (FNIGC, 2018). Healthy teeth and gums influence the physical, mental, and social well-being of a person (PHAC, 2018). Oral health is also linked to other health conditions such as diabetes, dementia, cardiovascular disease, and can affect how often these diseases occur (PHAC, 2018). Phase 3 of the Regional Health Survey conducted by the First Nations Information Governance Centre (FNIGC) found that two-thirds (66.0%) of First Nations adults rated the health of their teeth and mouth as good, very good or excellent, while more than one- third (34%) rated their oral health as fair or poor (FNIGC, 2018, p. 99). For Indigenous communities, poor oral health outcomes, such as periodontal disease, are linked to larger factors like poverty, lack of access to healthy foods, and barriers in accessing culturally appropriate dental care. For many remote communities, there is no dentist located close by and getting to one can be challenging. To improve oral health outcomes, culturally appropriate care must be made accessible for all Indigenous women, girls, and genderdiverse people. What is periodontal disease? How do you know if you or someone you know has it? Without daily care of teeth and gums, and regular cleanings by a dental professional, individuals may develop periodontal disease (NCCAH, 2013). The two most common forms of periodontal disease are gingivitis and periodontitis. The most common type is gingivitis, which is caused by an accumulation of plaque and tartar and may present as redness, swelling, and bleeding (NCCAH, 2013). Periodontitis is more severe, and can develop if gingivitis is not treated properly. The inflammation begins to spread beyond the gum tissue, causing loss of bone and connective tissue that support the tooth (NCCAH, 2013, p. 1). Periodontitis can be diagnosed by a dental professional using x-rays and through a clinical examination (NCCAH, 2013, p. 1).

6 Prevention: There are a number of things that you can do to practice good oral health to prevent disease which includes: Brushing your teeth twice a day Flossing (cleaning between your teeth and above and below your gums daily) Visiting a dental professional regularly Cutting back on sugary drinks and foods Using mouth rinses that contain fluoride Cutting back on smoking and drinking alcohol Dental Health Benefits for First Nations and Inuit in Canada Many dental and orthodontic services are covered by Health Canada s Non-Insured Health Benefits (NIHB) program for status First Nations and Inuit land claim beneficiaries. In British Columbia, the First Nations Health Authority (FNHA) provides health benefits to help meet the dental needs for BC First Nations peoples not covered by provincial, territorial, or other third party health insurance. Your dental provider will be able to tell you what services are covered by NIHB or the FNHA Health Benefits program. Services covered include cleanings, fillings, braces, and general examinations, if they are not covered by provincial or territorial insurance. Calls to Action There is currently a large gap in who is able to receive dental health benefits in Canada. Non-status First Nations and Métis people are not eligible for coverage under any of the existing programs. Organizations like NWAC have called on the federal government to fix these gaps, and ensure health equity for all Indigenous women, girls, and gender-diverse people. For information on NIHB, visit the First Nations and Inuit Health Branch at the Health Canada webpage, or call the Dental Predetermination Center toll free at For FNHA Health Benefits information, visit the FNHA website: or call toll-free: This document was created by NWAC Pathways PEKE and funded by the Canadian Institutes of Health Research

7 TUBERCULOSIS Indigenous populations continue to experience higher rates of active Tuberculosis (TB). Inuit communities face even higher rates than First Nations and Métis populations. In 2016, 1,737 cases of active TB were reported in Canada. Of the 333 cases reported amongst Indigenous populations, 63% were First Nations, 34% were Inuit, and 3% were Métis. In 2016, TB rates among Inuit in Inuit Nunanagat, were over 300 times the rate of Canadian-born non-indigenous people (ITK, 2018). What is Tuberculosis? TB is a disease caused by bacteria that most often affects the lungs and is spread from person to person through the air. The bacteria can also spread throughout the body, infecting areas such as the kidneys, spine, and brain (Centre for Disease Control and Prevention, 2011). Active TB Latent TB What causes it? TB bacterium TB bacterium While latent TB can develop into active TB at any point, this only happens in roughly 10% of people who are infected. Will you show signs? Yes No Can you spread it? Yes No How can you get it? TB can be spread through germs in the air when someone, with TB disease of the lungs or throat coughs, sneezes, speaks, or sings, and it is possible for the germs to remain in the air for several hours afterwards (Centre for Disease Control and Prevention, 2011). A person may become infected from breathing in TB germs in the air; although this may not turn into active TB. TB was not always a problem for Indigenous populations; it first arrived in Canada with European settlers in the 1700s. TB was spread to First Nations, Métis and Inuit communities during early colonization. Things like starvation, confinement to reservations, residential schools, and poor housing allowed the disease to spread quickly (Canadian Public Health Association, 2018). How do you know if you or someone you know has it? Many people do not show any signs of TB, sometimes for years. When you do show signs, they can include: persistent coughing, chest pains, coughing up blood or phlegm, feeling very tired, not feeling hungry, fever. Latent TB can usually be diagnosed with a skin test done by a medical professional. Active TB of the lungs requires a lab test and chest x-ray to confirm infection. If you have been in contact with someone who has or shows symptoms of TB disease, you need to get checked by your doctor or local health centre.

8 Prevention Some precautionary measures can be taken to prevent the spread of TB, which include: Washing your hands regularly Covering your mouth when you cough Although TB is preventable and curable, larger issues such as overcrowded housing, food insecurity, and poverty continue to contribute to high rates of active TB amongst Indigenous populations. Therefore we call upon the Federal government to implement calls to action listed below. Treatment Tuberculosis is preventable and curable. Antibiotics can cure TB if taken properly. Be sure to take the medication as directed by your healthcare provider. Calls to Action In 2017 the Government of Canada and Inuit leaders met and pledged to establish a task force to eliminate TB across Inuit Nunangat by 2030, with reduction of 50% of active TB by 2025 (ITK, 2018). Some specific recommendations to address TB amongst Indigenous populations include: Investments in rapid TB diagnostic technology Facilitating timely access to antibiotics used to treat TB, including Rifapentine. Culturally-appropriate education and awareness campaigns To know for sure if you have it, you need to get tested. Community mobilization initiatives Funding towards addressing inequities in the social determinants of health such as housing, poverty, and food insecurity. This document was created by NWAC Pathways PEKE and funded by the Canadian Institutes of Health Research

9 REFERENCES MENTAL WELLNESS Bellamy, S and Hardy, C. (2015). Understanding depression in Aboriginal communities and families. National Collaborating Centre for Aboriginal Health Bellamy, S and Hardy, C. (2015)[2]. Anxiety disorders and Aboriginal people in Canada: The Current State of Knowledge and Directions for Future Research. DIABETES Crowshoe, L et al. (2018). Diabetes Canada. Type 2 Diabetes and Indigenous Populations. Retrieved from ca/browse/chapter384 Diabetes Management. (2018). Treatments & Medications. Retrieved from Healthline. (2018). Diabetes Tests. Retrieved from healthline.com/health/diabetes-tests#blood-tests NADA. (2011). Pathways to Wellness: A Handbook for Aboriginal People Living with Diabetes. Retrieved from ca/wp-content/uploads/2016/pdfs/nada%20resources/pathway-to-wellness-handbook.pdf Public Health Agency of Canada. (2011). Chronic Diseases. Diabetes in Canada: Facts and figures from a public health perspective. Retrieved from Chowdhury, T et al. (2016). CMAJ. Lifetime risk of diabetes among First Nations and non-first Nations people. Retrieved from Benoit et al (2016). Experiences of chronic stress among urban Indigenous women. Archives of Women s Mental Health. 19(5), CAMH. (2018). Depression. Health Info. Retrieved from depression First Nations Information Governance Centre (2012). First Nations Regional Health Survey (RHS) 2008/10: National report on adults, youth and children living in First Nations communities. First Nations Information Governance Centre. Retrieved from ca/sites/default/files/docs/first_nations_regional_health_survey_ rhs_ _-_national_report.pdf First Nations Information Governance Centre (2018). National Report of the First Nations Regional Health Survey Phase 3: Volume I. First Nations Information Governance Centre. Retrieved from Rainbow Health Ontario. (2016). Two-Spirit and LGBTQ Indigenous Health. Rainbow Health Ontario. Retrieved from content/uploads/2016/07/2slgbtqin- DIGENOUSHEALTHFactHeet.pdf Statistics Canada. (2016). Lifetime suicidal thoughts among First Nations living off reserve, Métis and Inuit aged 26 to 59: Prevalence and associated characteristics. Statistics Canada. Retrieved from Stout, R. (2010). Kiskâyitamawin miyo-mamitonecikan: urban Aboriginal women and mental health. Winnipeg: Prairie Women s Health Centre of Excellence. ORAL HEALTH BC Ministry of Health & BC Health Authorities. (2006). Model Core program: Dental Public Health. Federal, Provincial and Territorial Dental Working Group. (2013). Reducing Dental Disease: a Federal, Provincial and Territorial Framework for Action to Improve Oral Health. FNIGC. (2018). First Nations Regional Healthy Survey: Phase 3, Volume 1. Retrieved from National Collaborating Centre for Aboriginal Health (NCCAH) Oral Health and Hygiene. NCCAH. Retrieved from PHAC. (2018). Key Health Inequalities in Canada: A National Portrait. Inequalities of Oral Health in Canada. Retrieved from publications/science-research/key-health-inequalities-canada-national-portrait-executive-summary/hir-full-report-eng.pdf Schroth, R.J. et al. (2009). Oral health of Indigenous children and the influence of early childhood caries on childhood health and well-being. Pediatric Clinics of North America, 56(6): BC Aboriginal Child Care Society. (2007). Aboriginal Children and Early Childhood Caries (ECC). Caring for our Children Newsletter, 9(1): 1-2. TUBERCULOSIS Canadian Public Health Association. (2018). History of Public Health. TB and Aboriginal People. Retrieved from cpha.ca/tb-and-aboriginal-people Centers for Disease Control and Prevention. (2011). Tuberculosis: General Information. Retrieved from Public Health Agency of Canada. (2018). Tuberculosis Retrieved from reports-publications/canada-communicable-disease-report-ccdr/ monthly-issue/ /issue-3-4-march /article-1-tuberculosis-2016.html INAC. (2017). Tuberculosis Task Force. Retrieved from canada.ca/en/indigenous-northern-affairs/news/2017/10/tuberculosis_taskforce.html ITK. (2018). Ending Tuberculosis- Backgrounder. Retrieved from Halseth, R. (2013). Aboriginal Women in Canada, Gender, Socio-Economic Determinants of Health, and Initiatives to Close the Wellness-Gap. Prince George, BC: National Collaborating Centre for Aboriginal Health. Statistics Canada. (2016). First Nations, Métis and Inuit, Women in Canada: A Gender-based Statistical Report. Canada.