question

[Guest nonce]

if in an interview, you were asked about the major health issues facing the aboriginal population today, what would you say?

I know that the major issue right now is that of diabetes. But im sure they would like some sort of a hypothetical solution to the problem...so would you attack it as a genetic problem, or from a socio-economic (basically, the type of lifestyle) stand point?

Or both?

 

Thanks

[Guest lots of thinking]

Thats a good question, and an issue that comes up (particularly at interviews at the University of Manitoba, in my experience).

I think you have to look at it from a lot of different view points (including genetics, lifestyle, and history)

 

Presently, even if the problem is a genetic one, that does not present a solution to the problem.

Lifestyle is the main factor that needs to be worked on, and I think the most important aspects are

1)education and prevention

2)teaching in a way that encompasses the beliefs and practises of the aboriginal people. Throwing solutions at them that have worked for other populations isn't neccesarily going to work for them.

3) I think its also really important to train aboriginal health care workers who can disseminate knowledge and resources.

thats it for now.

Hope that helps.

M

[Guest MayFlower1]

nonce,

 

I think the alarming rate of diabetes is only one of the signs of the primary aboriginal problems. You should definitely read the Romanow report...a great section on Aboriginal issues. Diabetes is actually only one of the plethera of problems faced by Aboriginals in this country. General health is a huge issue...there is a large disconnect, as Romanow says, between the health of the "average Canadian" and Canadian Aboriginals. The average life expectancy of Aboriginals is significantly...(I believe it's 6 years or so, collapsing across gender as a factor) lower than non-aboriginals in this country. Although, as lots of thinking correctly points out, education and teaching are some of the things required...there are social, psychosocial, cultural and environmental issues at play as well which could actually be more important in the long run than the medical issues themselves...one of Romanow's recommendations was that these environmental and other issues mentioned also need to be addressed as they are more likely the root cause of many of the "symptomatic" health issues.

 

Then there's the question of access to services...(1) whether or not aboriginals are covered by government funding seems to hinge on whether they are living on-reserve or off reserve...whether they identify as being inuit, metis, etc. I believe off-reserve (i.e., aboriginals living in urban areas...a significant number...I believe it's one in two?) aren't even eligible for aboriginal healthcare benefits. And where does the money actually reside for aboriginals...all over the place...it's fragmented across various bands, governments, provinces, communities...a logistical nightmare and diluted overall fund...Romanow recommends amalgamating all sources of aboriginal funding into one pool for more leverage...the pool could be managed in a number of ways...you'll have to read the report to get this info...it's incredibly long and convoluted. Then there's travel to medical facilities...I believe it's an average of about 100km, on average, for many aboriginal peoples. I conducted the pilot study for a national survey on Maternity Experiences of Canadian women this year for Health Canada...aboriginal women...and women living in remote areas...are often flown out of their home towns to the nearest urban centre to have their babies due to lack of appropriate resources in their areas...imagine, at this important time...and sometimes scary time...in your life not having your familiar environment, friends, family, or even a doctor who speaks your native language at your side? It's very sad, really. Not to mention the fact that the average cost of flying someone to an urban centre from the Northwest Territories, for example, is about 10K Canadian, return.

 

So, in addition to the very valid points lots of thinking has mentioned...here are a few others to consider. I hope this helps. Again, I can't stress enough how much great info is contained in the report...being in Manitoba, if I were you, I'd at least read the executive summary as well as the sections on aboriginals and people living in remote and rural areas sections of the Romanow report.

 

Cheers,

 

Peter

[Guest tirisa]

Great points Peter. I agree that Romanow did a great job making the case for increased funding for aboriginal health.

 

Just to add some personal experiences, I think another point to consider when discussing diabetes among the aboriginal population is that of diet and access to healthy foods. In many communities, fresh vegtables and dairy products arrive by air once a week, and only those who stand in long lines actually can buy these products the day they arrive, all of which are sold out by days end. So most food that is consumed is canned or boxed. Furthermore, thanks to the marketing power of coca-cola :\ and other big food companies, coke in the north costs about the same as in the south, while a 4 litre bag of milk can cost up to $14.00. (This is specifially the case in the James Bay and Hudson bay cree communities in Ontario). If you're on a limited budget, which one would you buy for your kids. I was appalled when I walked through the one grocery store in Peawanuk a couple of years ago (cree community with pop. 150 on Hudson Bay) and saw mostly shelves filled with chip bags, cookies, and pop, with the fruit loop cereal costing $4 and same size box of bran flakes at $13. Healthy foods were either non-existant or costly.

 

Although it's true that many aboriginal groups have a genetic predisposition to diabetes, diabetes only became a problem in this population when their diet and physical activity habits changed.

 

Anyway, just wanted to share another point of view.

Cheers,

Tirisa

[Guest MayFlower1]

tirisa,

 

Wow :eek ...it's a really, really sad statement that milk and other things we take for granted as staples are so grossly overpriced in these remote areas! Thanks so much for sharing your experiences. This again shows that Romanow has hit the nail on the head...biological and/or psychological illness may be, in fact, the symptom...the root causes are much more likely environmental, cultural and psychosocial. I can't imagine how it must have felt to be there...

 

Peter

[Guest shelleyrn]

Hi Tirisa and Peter,

 

From experience, I can attest to the availability (or lack there of)of fresh fruits and vegetables. When I worked in Northern Manitoba (Nursing Stations), I spoke with the infamous Northern Store manager in regards to this issue. He stated that it was not so much the availability, it was that the stock would essentially spoil on the shelves because people simply did not buy it.

 

Again this speaks to the issue of primary prevention/education...it simply is not a "field of dreams" in terms of "stock it and they will buy it"....

 

From a nursing perspective in the North, we try ad nauseum to add a health promotion component to our practice, but, it most definitely falls short with the other demands that fall upon us. A poor excuse, maybe...but when resources are limited, it becomes a "dam-plugging" system in the provision of health care. A shame....

 

If the government continues in its myopic meanderings regarding primary prevention the system will continue to be overwhelmed with people with chronic illnesses, which again, could be reduced or prevented. I believe throwing a large chunk'o'cash at prevention would be well spent....a long term investment (the "how" of that, I haven't quite figured out...changing peoples behaviours is VERY difficult...more thinking needed)....my humble thoughts.....Shelley

[Guest MayFlower1]

Hey Shelley,

 

You speak words of wisdom. It's kinda like research...the results look all official and everything...but the reality is that someone is out there talking to people...and seeing how they live...etc.

 

Pete

[Guest tirisa]

I agree. The difficulty of changing someone's behaviour has got to be one of the most frustrating aspects of being a physician, particularly a family physician. And the lack of patient accountablility and responsibility is related to it, of course. Why someone would prefer to go to the doctor and take a pill or get injections when they could simply eat better and exercise is beyond me.

 

Speaking of exercising... I gotta run.

Have a great weekend all.

Tirisa

[Guest Biochem10]

I think the old saying is "Old habits die hard", I guess it's easy to think about eating well and exercising, but the unfortunate reality is many people just don't have the willpower. Our society doesn't make it easy either, we live in a world where working long hours is the norm therefore leaving little room for exercise and healthy eating. Not only that, but we receive contradictory messages, smoking is bad for you, yet tobacco companies are present in our everyday lives in the form of sponsorships. If we want to make things better, we've got to completely reform our way of thinking about the Canadian lifestyle. I see things starting to happen in the urban centers, but now we've got to get that message out to Canadians in rural areas.

[Guest Chieka]

Great discussion. I really don't have much to contribute, but I agree that genetics is a major factor, whose influence was only seen when other things (lifestyle choices) became a factor also.

 

Anyhow, Peter, do you have a link to the Romanow report online?

 

Thanks.

 

C.

[Guest MayFlower1]

Chieka,

 

Here's the link...have fun... 8o

 

www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.asp?MediaID=1162&Filename=HCC_Final_Report.pdf

 

Peter

[Guest Chieka]

Thanks for the link, Peter. I downloaded the massive document last night, instead of writing my English paper. My computer nearly had a coronary under all the pressure, but it's doing well now.

 

C.