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Tuesday, August 9, 2011

What makes a difference to Aboriginal health?

  For the launch of our report on Aboriginal maternal and child health, our CEO, John G. Abbott, wrote an editorial piece called What makes a difference to Aboriginal health? The following is the editorial in full, which we have also distributed to news outlets across the country.
Read the full report

Many Canadians are aware that First Nations, Inuit, and Métis people have significantly worse health and more challenging living conditions than the larger Canadian population. In 2010, the Health Council of Canada began a multi-year project to learn about programs and strategies that have the potential to reduce these unacceptable health disparities between Aboriginal and non-Aboriginal Canadians.

In January and February 2011, the Health Council of Canada held seven cross-Canada sessions that brought together front-line workers, government representatives, researchers, and others to identify programs and services that are helping to improve the health care of expectant Aboriginal mothers and young children. Each region had its own specific topics and programs to bring forward, but there were some common threads of discussion across the country.

Today we released a report about what we heard for Canadians and governments, titled Understanding and Improving Aboriginal Maternal and Child Health in Canada.  I’d like to highlight three important themes from this document.

First, embedded in many success stories we heard was the importance of rebuilding what was stripped from Aboriginal Peoples, such as knowledge of their language and traditions, pride in their culture, and self-determination. Participants expressed concern that many non-Aboriginal Canadians – including those who work in health care, child welfare services, and government offices – simply don’t understand or value the Aboriginal world view, and don’t understand how the multi-generational impact of colonialism and the residential school experiences have effected the entire culture. We heard about the importance of offering health care services that integrate mainstream Western medicine with traditional and culturally relevant Aboriginal practices. Front-line workers told us that a history of paternalistic treatment and racism, coupled with a continued lack of understanding, has created a sense of wariness among Aboriginal mothers they serve. Women can be afraid to seek out care because they’re afraid of racism, or of being judged for their lack of knowledge or behaviour. If they are treated insensitively, they may be reluctant to return.

Second, a number of successful programs have had to move beyond typical health care services to help Aboriginal women and families with other aspects of their lives, such as housing, social/emotional support, and education. The importance of education came up repeatedly at every regional session—specifically prenatal education, support for new parents, and preschool programs for young children. These early interventions help to lay a foundation for better lifelong physical and emotional health. Participants talked about the underlying issues of Aboriginal health at every regional session—factors such as poverty, addictions, family violence, self-esteem, and the intergenerational legacy of colonization and residential schools. They believed improving Aboriginal health required broader thinking and a more holistic approach. There are positive changes happening to address these factors in some communities and jurisdictions, but successful efforts are both tantalizing and frustrating to people in regions where change is moving more slowly.

Third, participants told us that politics, bureaucracy, and insufficient funding get in the way of their efforts to make things better. They told us that there are many programs and strategies that work to improve the health of expectant mothers and young children, but these good programs often lack stable, multi-year funding, or don't have enough funding to meet the needs of the population they serve. They said that governments start many great programs that are responsive to the needs of Aboriginal people, but then funding ends and many of the benefits are lost. They said they are frustrated that priorities and funding can shift with political agendas and changes in government; sometimes a good program will be dropped, retooled, and brought back a few years later. Several participants said they would like governments to recognize that new programs need time to develop, and perhaps even a generation to see evidence of success. In addition, funding applications and arrangements are often complicated and inflexible. Front-line workers are burning out in the process of trying to make programs work within these complexities.

Despite these issues, participants spoke positively about the many promising programs and strategies that they see making a difference in the lives of pregnant Aboriginal women and young children. While governments are looking at the bigger picture of Aboriginal relations, we encourage them to build on existing successes in maternal and child health by expanding programs that are clearly working and ensuring long-term, simplified funding arrangements.

As a country envied throughout the world, we owe it to our Aboriginal mothers and children to do better – for their sakes as well as ours.

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