Malcolm King

Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

BACKGROUNDnInternational studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries.nnnMETHODSnCollaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated.nnnFINDINGSnOur data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations.nnnINTERPRETATIONnWe systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems.nnnFUNDINGnThe Lowitja Institute.

Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis.

BackgroundIn addition to increasing the risk of adverse birth outcomes, diabetes in pregnancy is thought to be an important driver of the epidemic of type 2 diabetes affecting Canada’s First Nations population. The relative contributions of gestational diabetes mellitus (GDM) and pre-existing diabetes are not well understood. We generated a comprehensive epidemiological profile of diabetes in pregnancy over a 10-year period among the First Nations population of Alberta, Canada.MethodsDe-identified administrative data for 427,058 delivery records were obtained for the years 2000–2009. Pregnancy risk factors and delivery outcomes were described and compared by ethnicity (First Nations vs. non-First Nations) and diabetes status. Age-adjusted prevalence values for GDM and pre-existing diabetes were calculated and were compared by ethnicity. Longitudinal changes over time were also examined. Predictors were explored using logistic regression analysis.ResultsFirst Nations women had more antenatal risk factors and adverse infant outcomes that were compounded by diabetes. First Nations descent was an independent predictor of diabetes in pregnancy (pu2009<u20090.001). GDM prevalence was significantly higher among First Nations (6.1%) compared to non-First Nations women (3.8%; pu2009<u20090.001), but prevalence values increased significantly over time only in non-First Nations women (4.5 average annual percent change; pu2009<u20090.05). The prevalence of pre-existing diabetes was stable over time in both groups, but First Nations women experienced a 2.5-fold higher overall prevalence compared with non-First Nations women (1.5% vs. 0.6%, respectively; pu2009<u20090.001).ConclusionsAlthough First Nations women experience a higher overall prevalence of diabetes in pregnancy, the lack of increase in the prevalence over time is encouraging. However, because high-risk pregnancies and poor outcomes are more common among First Nations women, particularly those with diabetes, strategies to improve perinatal care must be implemented.

A community-based participatory research methodology to address, redress, and reassess disparities in respiratory health among First Nations

BackgroundTo date, determinants of respiratory health in First Nations people living on reserves and means of addressing and redressing those determinants have not been well established. Hence the Saskatchewan First Nations Lung Health Project (FNLHP) is a new prospective cohort study of aboriginal people being conducted in two First Nations reserves to evaluate potential health determinants associated with respiratory outcomes. Using the population health framework (PHF) of Health Canada, instruments designed with the communities, joint ownership of data, and based on the 4-phase concept of the First Nations Regional Longitudinal Health Survey, the project aims to evaluate individual factors, contextual factors, and principal covariates on respiratory outcomes. The objective of this report is to clearly describe the methodology of (i) the baseline survey that consists of two components, an interviewer-administered questionnaire and clinical assessment; and (ii) potential intervention programs; and present descriptive results of the baseline data of longitudinal FNLHP.MethodsThe study is being conducted over 5 years (2012–2017) in two phases, baseline and longitudinal. Baseline survey has been completed and consisted of (i) an interviewer-administered questionnaire-based evaluation of individual and contextual factors of importance to respiratory health (with special focus on chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea), and (ii) clinical lung function and allergy tests with the consent of study participants. The address-redress phase consists of potential intervention programs and is currently being rolled out to address-at community level (via green light program and environmental study), and redress-at policy level (via obesity reduction and improved diagnosis and treatment of obstructive sleep apnea) the issues that have been identified by the baseline data.ResultsInterviewer-administered surveys were conducted in 2012–2013 and collected data on 874 individuals living in 406 households from two reserve communities located in Saskatchewan, Canada. Four hundred and forty six (51%) females and 428 (49%) males participated in the FNLHP.ConclusionsThe information from this project will assist in addressing and redressing many of the issues involved including the provision of adequate housing, health lifestyle practices, and in planning for health service delivery.

Health consequences of environmental exposures: changing global patterns of exposure and disease

Environmental pollution is a major cause of disease and death. Exposures in early life are especially dangerous. Patterns of exposure vary greatly across countries. In low-income and lower middle income countries (LMICs), infectious, maternal, neonatal, and nutritional diseases are still major contributors to disease burden. By contrast, in upper middle income and high-income countries noncommunicable diseases predominate. To examine patterns of environmental exposure and disease and to relate these patterns to levels of income and development, we obtained publically available data in 12 countries at different levels of development through a global network of World Health Organization Collaborating Centres in Childrens Environmental Health. Pollution exposures in early life contribute to both patterns. Chemical and pesticide pollution are increasing, especially in LMICs. Hazardous wastes, including electronic waste, are accumulating. Pollution-related chronic diseases are becoming epidemic. Future Global Burden of Disease estimates must pay increased attention to the short- and long-term consequences of environmental pollution.

Health effects of exposure to e-waste

www.thelancet.com/lancetgh Vol 1 August 2013 e70 2 Robinson BH. E-waste: an assessment of global production and environmental impacts. Sci Total Environ 2009; 408: 183–91. 3 UN Environment Programme. E-waste, volume 1: inventory assessment manual. Nairobi: UN Environment Programme, 2007. 4 Suk WA, Ruchirawat KM, Balakrishnan K, et al. Environmental threats to children’s health in Southeast Asia and the Western Pacifi c. Environ Health Perspect 2003; 111: 1340–47. 5 Gavidia T, Brune MN, McCarty KM, et al. Children’s environmental health—from knowledge to action. Lancet 2011; 377: 1134–36. Health eff ects of exposure to e-waste

Incidence and Prevalence of Chronic Obstructive Pulmonary Disease among Aboriginal Peoples in Alberta, Canada

BACKGROUNDnChronic obstructive pulmonary disease (COPD) is a major respiratory disorder, largely caused by smoking that has been linked with large health inequalities worldwide. There are important gaps in our knowledge about how COPD affects Aboriginal peoples. This retrospective cohort study assessed the epidemiology of COPD in a cohort of Aboriginal peoples relative to a non-Aboriginal cohort.nnnMETHODSnWe used linkage of administrative health databases in Alberta (Canada) from April 1, 2002 to March 31, 2010 to compare the annual prevalence, and the incidence rates of COPD between Aboriginal and non-Aboriginal cohorts aged 35 years and older. Poisson regression models adjusted the analysis for important sociodemographic factors.nnnRESULTSnCompared to a non-Aboriginal cohort, prevalence estimates of COPD from 2002 to 2010 were 2.3 to 2.4 times greater among Registered First Nations peoples, followed by the Inuit (1.86 to 2.10 times higher) and the Métis (1.59 to 1.67 times higher). All Aboriginal peoples had significantly higher COPD incidence rates than the non-Aboriginal group (incidence rate ratio [IRR]: 2.1; 95% confidence interval [CI]: 1.97, 2.27). COPD incidence rates were higher in First Nation peoples (IRR: 2.37; 95% CI: 2.19, 2.56) followed by Inuit (IRR: 1.92; 95% CI: 1.64, 2.25) and Métis (IRR: 1.49; 95% CI: 1.32, 1.69) groups.nnnCONCLUSIONSnWe found a high burden of COPD among Aboriginal peoples living in Alberta; a province with the third largest Aboriginal population in Canada. Altogether, the three Aboriginal peoples groups have higher prevalence and incidence of COPD compared to a non-Aboriginal cohort. The condition affects the three Aboriginal groups differently; Registered First Nations and Inuit have the highest burden of COPD. Reasons for these differences should be further explored within a framework of social determinants of health to help designing interventions that effectively influence modifiable COPD risk factors in each of the Aboriginal groups.

Approaching a collaborative research agenda for health systems performance in circumpolar regions

Health care in Canadas north and circumpolar regions faces considerable challenges with the remote and widely dispersed population, harsh environmental conditions, and human resource challenges. Despite per capita expenditures that are among the highest in the world, health outcomes continue to lag behind the rest of Canada, and health disparities between the Indigenous and non-Indigenous populations within the north persist. While improving the health of northerners requires addressing underlying social determinants, transforming the health care system holds promise for health improvements in the short- and medium-term . The evidence required to inform a northern-focused and relevant transformation of health care systems remains to be generated and applied. This seminar set out to identify priority areas for a research initiative that will address systems challenges and engage decision-makers in these jurisdictions. The overarching objectives of the seminar were to explore the priority areas for health systems research in circumpolar regions, and to propose how we might best maximize our current resources, and facilitate partnerships for the advancement of a common agenda. Keywords: health systems; circumpolar; indigenous; research; partnerships (Published: 14 August 2013) Citation: Int J Circumpolar Health 2013, 72 : 21474 - http://dx.doi.org/10.3402/ijch.v72i0.21474

Scaling up the Knowledge to Achieve Aboriginal Wellness

Mental health is, in some ways, the most important health issue for Aboriginal Peoples in Canada, partly because it contributes both directly and indirectly to so much of the gap in health status, and perhaps even more importantly, because mental health issues are so neglected in our society, especially so for Aboriginal Peoples, where the gap in mental health research and services is particularly accentuated. Recognizing and understanding the social determinants of health is key to understanding the problems, and in my view, key to achieving success in addressing and correcting those problems. It is important to realize that there are unique social determinants for Aboriginal Peoples associated with their cultures, histories, and colonization, and the current social, economic, political, and geographic context.2 In the first In Review article, Dr Colleen Anne Dell and colleagues3 describe their experiences with helping addicted First Nations youth at an Ontario native-run solvent-abuse treatment centre. Their experience and their study is an exercise in knowledge translation. They draw on a residential school treatment modality that is grounded in a culture-based model of resiliency. The youth they are trying to help are too young to have experienced residential schools, and, although they may be suffering from intergenerational trauma, the means of helping them lies in appealing to and reviving their cultural roots and evoking their resilience through that culture. Youth who come to the treatment centre for solvent abuse are introduced to the spirituality that is the lost part of their culture and their identity. Their identity as First Nations youth, and their inner spirit, has lain dormant, and needs to be revitalized. The whole family can benefit from this program, which is particularly important where the parents and even the grandparents have lost those connections and that identity. A consultation with an Elder and a sweat lodge ceremony are integral parts of the treatment program. The offering of blueberries as a traditional medicine, as an example, helps to make that connection with their cultural roots. Through the examples brought forward, these addicted youth have benefited from this culture-based approach to healing. So how do we translate the knowledge? How do we apply it to a different community, a different pathology, a different sociocultural context within our diverse community? How do we scale up the knowledge about what works? This is the critical point. If we improve the health of a small community, that is important, but, for every group such as the clients of the Nimkee Healing Centre, there are hundreds or even thousands more like them, but different. Blueberries are a particular thing, common in our country, but certainly not universal. Are strawberries the same as blueberries? The concept of blueberries, as a form of therapy - an adjunct or an amplifier - may be much closer to universal if we can just find the translation key. What is it about the blueberry treatment that worked? Knowledge translation is a vital part of our scientific arsenal that still needs refinement. In the second In Review article, Dr Laurence J Kirmayer and colleagues4 present 4 case studies in 4 different Aboriginal communities in Canada: 1 Inuit, 1 Metis, and 2 First Nations (Mikmaq and Mohawk). Their choices reflect only a small part of the diversity of Aboriginal Peoples in Canada. Again, there is no universal story, no universal solution, no magic pill that works for everyone. And yet there is a commonality in these 4 compelling stories. The commonality is in the incorporation of indigenous constructs in achieving wellness through resilience. …

Determinants of excessive daytime sleepiness in two First Nation communities

BackgroundExcessive daytime sleepiness may be determined by a number of factors including personal characteristics, co-morbidities and socio-economic conditions. In this study we identified factors associated with excessive daytime sleepiness in 2 First Nation communities in rural Saskatchewan.MethodsData for this study were from a 2012–13 baseline assessment of the First Nations Lung Health Project, in collaboration between two Cree First Nation reserve communities in Saskatchewan and researchers at the University of Saskatchewan. Community research assistants conducted the assessments in two stages. In the first stage, brochures describing the purpose and nature of the project were distributed on a house by house basis. In the second stage, all individuals age 17xa0years and older not attending school in the participating communities were invited to the local health care center to participate in interviewer-administered questionnaires and clinical assessments. Excessive daytime sleepiness was defined as Epworth Sleepiness Scale scoreu2009>u200910.ResultsOf 874 persons studied, 829 had valid Epworth Sleepiness Scale scores. Of these, 91(11.0%) had excessive daytime sleepiness; 12.4% in women and 9.6% in men. Multivariate logistic regression analysis indicated that respiratory comorbidities, environmental exposures and loud snoring were significantly associated with excessive daytime sleepiness.ConclusionsExcessive daytime sleepiness in First Nations peoples living on reserves in rural Saskatchewan is associated with factors related to respiratory co-morbidities, conditions of poverty, and loud snoring.