Community-based Intervention Research as a Pathway to Health Equity for First Nations, Inuit and Métis

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1 Community-based Intervention Research as a Pathway to Health Equity for First Nations, Inuit and Métis Malcolm King, PhD, Scientific Director CIHR Institute of Aboriginal Peoples' Health

2 Aboriginal / Indigenous Peoples in Canada Section 35 of the Constitution Act, 1982 recognizes three groups of Aboriginal people: Indians (First Nations), Métis & Inuit. The size of the Aboriginal population was 1,172,790 in (3.8%) Non-status Indian (133,155) 11,4% Registered Indian (623,780) 53,2% Other Aboriginal * (11,235) 0,9% Inuit (49,115) 4,2% Métis (355,505) 30,3%

3 Aboriginal Health Research: Addressing the Challenges to First Nations, Inuit, and Métis Wellness Infectious diseases Chronic diseases Mental diseases, emotional trauma, addictions e.g. effects of colonization, Indian Residential Schools, etc. Injuries and violence Barriers to access to health care Primary care (physical& mental health) Reconciliation & healing

4 Population Pyramid, <5 Male Non First Nations Female Non First Nations Male First Nations Female First Nations Percentage of Population Courtesy Larry Svenson, Alberta Health & Wellness

5 CIHR s 13 Institutes Population and Public Health Gender and Health Nutrition, Metabolism and Diabetes Musculoskeletal Health and Arthritis Cancer Research Health Services and Policy Research Genetics Infection and Immunity Aboriginal Peoples Health Neurosciences, Mental Health and Addiction Aging Circulatory and Respiratory Health Human Development, Child and Youth Health

6 CIHR Institute of Aboriginal Peoples Health Overview Values: Ensure inclusion and recognition of First Nations, Inuit and Métis values and cultures in health research Vision: Resolve critical First Nations, Inuit and Métis health issues ACADRE-NEAHR program 9 centres across Canada AHRNet Secretariat national coordination CIHR Guidelines for Health Research Involving Aboriginal People (2007) / Tri-Council Policy Statement (2010)

7 CIHR Health Research Roadmap: Strategic Directions for Health Research Promote patient-oriented research and target science and technology innovations to improve health outcomes and health systems. Support a high quality, accessible and sustainable health care system. Decrease health inequities in Aboriginal Peoplesand other vulnerable populations. Prepare and respond to existing and emerging global threats to health. Promote health and reduce the burden of chronic disease and mental illness.

8 Community-based Intervention Research as Best Practice towards Health Equity for Indigenous Peoples Can we really talk about best practice? Can we ever achieve it? Do we really mean good practice? Good practice is never perfect; it can always be improved. But we can learn from it. Good practice in Indigenous research can be defined as research done in a good way.

9 Good Practices in Indigenous Health Research Good practice in training/capacity building Good practice in community engagement Good practice in research team development Good practice in intervention research: opportunistic interventions designed interventions Good practice in knowledge translation

10 Good Practice in Indigenous Research Methodology Bartlett J, Robertson P, et al. INIHKD 2010 Indigenous control and leadership located within Indigenous worldviews knowledge translation is a critical element evolve Indigenous research approaches and build our capacity critical approaches preferred examine nature of power relationships researchers as boundary walkers/bridgers maintenance of research team wellbeing

11 Good Practices in Indigenous Health Research Good practice in training/capacity building Good practice in community engagement Good practice in research team development

12 CIHR IAPH National Virtual Network: NEAHR UofA UBC UofR UofM Laval McGill UofO UofT Dal

13 Good Practice in Indigenous Research: Training

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15 Good Practices in Indigenous Research: Interventions Culture and language Ceremony, spirituality Education of ourselves of others Nutrition,food security Economic development Housing / water / environment

16 Good Practice in Indigenous Research: Designed Interventions Kovesi T, et al. Heat recovery ventilators prevent respiratory disorders in Inuit children. Indoor Air 2009; 19: Illustration of the connection of a heat recovery ventilator to a furnace in a house with forced-air heating

17 Good Practice in Indigenous Research: Designed Interventions Kovesi T, et al. Nunavut heat recovery ventilator study. Indoor Air 2009 Wheezing during the study period in each groups. (a) Proportion of subjects over time reporting wheeze in the placebo and active heat recovery ventilator (HRV) groups (solid line and filled squares placebo, dashed line and open triangles active group). (b) Odds ratio between the two groups for reporting wheeze along with 95%CIs. Odds ratios less than 1 favor the active HRV group.

18 Good Practice in Indigenous Research: Bringing back to the community CIHR Café Scientifique Sunday, May 9, 2010, 8:00 PM, The Visitor s Center, Iqaluit RSV and The Ulu: The Cutting Edge of Research into Home Ventilation and Wheezing in Young Inuit Children Inuit babies in communities in Nunavut have very high rates of RSV infection needing admission to hospital. There are many reasons for this. This talk will discuss new research looking at the possible connection between indoor air quality and home ventilation and the risks of wheezing and RSV in young Inuit children in Nunavut. The talk will feature Dr. Tom Kovesi, who has studied indoor air quality in the houses of young Inuit children in Qikiqtaaluk Region and recently finished a study looking at the effects of adding heat recovery ventilators to furnaces, to prevent wheezing in young Inuit children, and Dr. Malcolm King, Scientific Director of the Canadian Institutes of Health Research Institute of Aboriginal Peoples Research.

19 Good Practice in Indigenous Research: Interventions Dr. Jay Wortman, Health Canada, Métis physician.

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21 Addressing Pathways to Health Equity for Aboriginal Peoples: The Way Forward Through capacity building with First Nations, Inuit and Métis communities Through fostering broad coalitions of researchers and knowledge users Through intervention research: designing, testing, refining interventions to improve Aboriginal health Through knowledge translation: applying the research knowledge to define best practice to improve health

22 Aboriginal / Indigenous Health: Addressing the Health Gap Progress in reducing the health inequities faced by Indigenous peoples will only be made if Indigenous communities are engaged in the process of healing and revitalization. Mainstream individuals and organizations researchers, health professionals, decision-makers have important roles to play, but Indigenous communities need to lead the process. Interventions tied to social determinants, such as economic development or improving the built environment, should benefit not only the social development of Indigenous peoples, but also their health.

23 Who s Who in the IAPH Edmonton: Malcolm King, PhD, Scientific Director Angeline Letendre, PhD, Associate Director Janice Mathewsie, Admin. Coord.; Atsinak Bishop, Admin. Support; Isaac Bell, Tech. Support; Gayle Spencer, Accounting Ottawa: Laura Commanda, MSW, Assistant Director Jacques Dalton, Project Officer IAB Chair: Dr. Frederic Wien, Dalhousie University AHRNet Chair: Dr. Charlotte Loppie Reading, UVictoria Summits Core Committee: John Crier, Alice Reid, Willie Ermine, Janet Smylie, Gail Turner Summits Planning Team: Dawn Marsden, Phyllis Steeves (Writers); Sharon Shirt, Martha Morin (Audiovisuals); Lisa Bourque-Bearskin, Claudine Louis (Facilitators)

24 Institute of Aboriginal Peoples Health Edmonton, Alberta Thank you Miigwech