First Nations Population Health and Wellness Agenda brings together both First Nations and Western ways of knowing

Hey Doug Ford! I’ve got a copy of this report with your name on it. Time to do some reading. And, pay close attention to the section on expanding both safe consumption sites and recovery services.

L to R: Dr. Danièle Behn Smith, Dr. Nel Wieman and Dr. Bonnie Henry Photo credit: THE CANADIAN PRESS/Darryl Dyck)

On August 21, 2024, the First Nations Health Authority (FNHA) and British Columbia’s Office of the Provincial Health Officer (OPHO) released their groundbreaking report, First Nations Population Health and Wellness Agenda (PHWA) providing an update to the indicators of population health and wellness of First Nations Peoples in British Columbia (BC).

The report states, “Using a strengths-based approach to focus on wellness and resilience, the report formulates two-eyed seeing to bring together both First Nations and Western ways of knowing. At its core, the PHWA recognizes that self-determination, culture, language, and connection to land are deeply interconnected and form the roots of First Nations health and wellness.”

The report indicates that some progress has been made in education and infant mortality while life expectancy and all-cause mortality have worsened.

“Although the report indicates some modest improvements to the health and wellness of First Nations Peoples in BC, it underscores persistent gaps in BC’s health and supportive systems which continue to fall short of their responsibilities to First Nations Peoples in BC, their families, communities and Nations,” said Dr. Nel Wieman, Chief Medical Officer with the FNHA.

“Moving forward, we must uphold First Nations self-determination, advance Truth and Reconciliation between First Nations Peoples and other BC residents and continue to develop our working partnerships and coordination between the provincial and federal governments and First Nations in BC,” Dr. Wieman stated.

The update. a follow up to the 2021 report of the same name, contains updates on 14 of 22 PHWA indicators of health and wellness being monitored from 2020 to 2030.

Update highlights include:

● Improvements in education and infant mortality

● No or minimal change in avoidable hospitalizations, physicians identifying as First Nations, serious injuries and youth or young adult suicide

● Worsening healthy birth weight, diabetes, life expectancy and all-cause mortality

“The findings in this report are not just data, they represent our loved ones -- our children, parents, grandparents, siblings and cousins. While some improvements have been made since the baseline report, overall progress has been limited and we must continue to work together to do more to achieve optimal health and wellness for First Nations Peoples,” said Dr. Danièle Behn Smith, Deputy Provincial Health Officer for Indigenous Health in BC.

“We must work collectively to eradicate Indigenous-specific racism and discrimination and take courageous actions that uphold inherent First Nations rights to address persistent health disparities and inequities. We hope this report can help to light the way forward as we work to transform our systems so they are culturally safe and free from racism and discrimination,” Dr. Behn Smith added.

Key findings from the report include:

● Connection to land has an important role in First Nations culture, Ceremony, language, and identity, which are key to the wellness of First Nations Peoples

● Only 0.39 per cent of registered physicians in BC self-identified as First Nations in 2023, compared to 0.32 per cent in 2019

● For the first time, the FNHA and OPHO are reporting on the proportion of First Nations nurses and midwives in BC. In 2023, only 1.5 per cent of nurses and 1.7 per cent of midwives registered with the BC College of Nurses and Midwives self-identified as First Nations

● The proportion of students who complete high school within eight years of starting Grade 8 has improved by 4.3% among Indigenous students

● Among First Nations people in BC, infant mortality is down 0.7 per 1,000 live births from 5.3 per 1,000 live births in 2013-17 to 4.6 per 1,000 in 2015-2019. And, it’s well established that infant mortality is linked to the social determinants of health – especially that of the mother.

● Life expectancy at birth for Status First Nations Peoples in BC decreased from the baseline of 73.3 years in 2017 to 67.2 years in 2021

● The mortality rate among Status First Nations Peoples in BC increased from the baseline of 117.3 per 10,000 population in 2017 to 156.0 per 10,000 in 2021

● First Nations Peoples in BC have been disproportionately impacted by the dual public health emergencies of the toxic drug crisis and the COVID-19 pandemic

The PHWA is a 10-year partnership initiative and reporting series of the FNHA’s Office of the Chief Medical Officer and the OPHO in BC. Through this work, the partners monitor, report on and honour the health and wellness journeys of those Nations whose ancestral Territories collectively form what is now known as the province of BC and all First Nations Peoples in the province, including those whose ancestral Territories are outside of BC.

In addition to presenting data on the health and wellness of First Nations Peoples in BC, the 2021 PHWA report called on system partners and institutions to work with First Nations organizations and collectives to nourish First Nations roots of wellness by advancing seven areas:

1. Affirm, uphold, support and advance First Nations rights and self-determination.

2. Advance First Nations data governance and uphold principles of OCAP ensuring First Nations’ ownership, control, access to and possession of data.

3. Catalyze intersectoral actions to build supportive, anti-racist, trauma-informed, culturally safe systems, with particular attention given to connection to Land.

4. Advance the roots of health and wellness for the next generations, including priority populations such as First Nations babies, children and youth.

5. Embed First Nations wellness approaches in policies, programs and services.

6. Commit to cultural safety and humility and eradicating Indigenous-specific racism across all systems.

7. Increase access, good relations, and attachment to anti-racist, trauma-informed and culturally safe primary health care.

This report also provides updates on the We Walk Together project which explores how to measure, monitor and advance the Connection to Land indicator.

The project holds stories and teachings shared by Knowledge Keepers and youth exploring what connection to land, water and territory means to the health and wellness of First Nations Peoples.

We Walk Together project participants represent 23 distinct Nations across three FNHA health regions: Vancouver Coastal, Fraser Salish and Northern.

Three key themes guide the continuing work on this indicator -- Ancestral Knowledge, Land, and water wellness and accountability.

“Substantial gaps still remain between the health and wellness outcomes of First Nations Peoples in BC and those of other BC residents,” said Dr. Bonnie Henry, BC’s Provincial Health Officer.

“It is my hope that this report can draw attention to the work that is still needed to help curb the disproportionate impact on First Nations Peoples of emergencies including the toxic drug crisis and the COVID-19 pandemic that we see in indicators like worsening life expectancy and all-cause mortality. The We Walk Together project, also in this report, highlights the ways we can work together to make a difference in the lives of First Nations children, families and communities through connection to Land, water and culture,” Dr. Henry added.

Over the past nine years the toxic drug crisis and COVID have been the main drivers of death. During COVID, First Nations Peoples waited longer before seeking treatment due to the well-founded fear of receiving racist, discriminatory care.

While First Nations Peoples make up 5.9 per cent of BCs population (2021 Statistics Canada), they account for a full 20 per cent of toxic drug deaths.

BCs coroner’s office has reported 1,158 toxic drug overdose deaths to date which is down about nine per cent from the same time last year (2023) when 1,279 deaths were reported.

That small decline is attributable to creating space for users while also connecting them with services. That means ensuring safe consumption sites are used in tandem with recovery. The two programs need to co-exist because in BC, as in most provinces, recovery spaces are limited and it can take over a year to get to the top of the list. That’s why safe consumption sites and recovery programs both need increased funding for expansion.

Another piece to that lifeline is increasing funding to ensure folks have housing so they have an address, can get a good night’s sleep and develop a routine before embarking on re-entering school, work or volunteering opportunities.

That also means challenging the stigma and stereotypes associated with folks who use drugs which keeps them disconnected from their communities and contributes to the misconception that these folks, whether First Nation Peoples or settlers, are throw away people.

Hey Doug Ford! I’ve got a copy of this report with your name on it. In fact, I can send it to Sylvia Jones and the rest of your cabinet as well! I’d highlight the important sections that are relevant reading for you and your crew, but that would be practically the entire report.

Time for the Conservatives to do some reading that’s based on sound research, solid knowledge and lived experience. And, pay close attention to the section on expanding both safe consumption sites and recovery services. Because it’s time to stop following Alberta’s handbook to “privatize everything healthcare” including control of recovery patients’ health information which allows the Alberta Conservatives to block access to data creating a system that raises concerns around privacy, consent and transparency.

Read more in Euan Thomson’s article: Private org has control of Alberta recovery patients' health info.

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Thanks to everyone who read today’s article. With your continued support, a little Nicoll can make a lot of change.