Many of us take for granted that our health will be good and if we need medical services, that everything will be in place to provide the treatment we need. That assumption makes us feel protected and safe, but not everyone faces the same situation. Historically, Aboriginal people have experienced a higher incidence of poor health than non-Aboriginal residents. This gap in health status is worrying.
In 2001, the Provincial Health Officer presented a report entitled “The Health and Well-being of Aboriginal People in British Columbia” which defined the extent of the gap in health outcomes and made recommendations for reducing the inequity. In 2005, the Transformative Change Accord (TCA) was signed between the Province of BC, the Federal Government and First Nations. Subsequently, the First Nations Health Plan (FNHP) built upon the accord and committed to improving health outcomes for First Nations peoples.
The FNHP set out seven specific health indicator targets to be achieved by 2015. Published in November 2015, “First Nations Health and Well-being: Interim update” compiles progress on the seven indicators with data up to 2013. The final report will come in 2017 and will use data to 2015.
Set out in the original agreement, the indicators are life expectancy at birth; mortality; youth suicide; infant mortality; diabetes prevalence; childhood obesity; and the number of practising, certified First Nations health care professionals.
The 2015 Interim Update identifies some improvements, and some regress. The goal of reducing the gap in the incidence of diabetes by a third between Aboriginal and non-Aboriginal looks to be on target. Also positive, the programs and initiatives aimed at reducing youth suicide appear to have had positive effects and offer an opportunity to build on the momentum.
The rate of youth (ages 15 to 24) suicide, expressed as a rate per 10,000 population, has improved from a baseline of 3.52 (2001-2005) to 2.32 in the most recent period. In comparison, the more recent rate for non-Aboriginal youth is 0.75 per 10,000.
While life expectancy for Aboriginals has improved, it is not projected to meet the FNHP target of reducing the gap by a third to within three years of the non-Aboriginal rate. That gap is presently between a life expectancy of 75.9 years for Aboriginal residents and 81.6 years for other residents.
The target improvement for the incidence of diabetes is a one-third reduction in the gap between Aboriginal and non-Aboriginal residents. Over the past 20-plus years, the incidence of diabetes has increased in both populations. Currently for Aboriginals, the rate sits at 8.1 cases per 100 population (it was 6.7). Fortunately, the increases appear to be slowing among all people and the gap is projected to narrow enough to meet the target.
That there even is a gap is the most disturbing aspect of all. Fortunately, there are significant, coordinated efforts being made to narrow this difference. Understanding a problem is the first step towards resolving it. The health gap experienced by First Nations is an embarrassment, but the First Nations Health Plan can help us to understand and work towards resolving the imbalance in health outcomes.
Written by Dr. Paul Martiquet, Medical Health Officer for Rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.