Manitoba First Nations Centre for Aboriginal Health Research

1. Manitoba First NationsCentre for Aboriginal Health Research Rm. 715 Buhler Research Centre Department of Community Health Sciences Faculty of Medicine The University of Manitoba

2. AMC / CAHR Partnership AMC HEALTH INFORMATION RESEARCH COMMITTEE MANITOBA FIRST NATIONS COMMUNITIES & TRIBAL COUNCILS

3. CAHR Mission • The CAHR will initiate, coordinate and support research activities designed to assist First Nations and Aboriginal communities and organizations in their efforts to promote healing, wellness and improved health services in their communities. • The research program will integrate scientific and traditional Aboriginal approaches to producing new knowledge about health and health care in First Nations and Aboriginal communities.

4. CAHR Objectives • To conduct studies of the determinants of health in First Nations and Aboriginal communities. • To support culturally-appropriate studies of traditional healing in First Nations and Aboriginal communities. • To support and coordinate basic medical research into disease processes currently prevalent in First Nation and Aboriginal communities.

5. CAHR Objectives, cont’d • To conduct community-based studies into innovative culture-based approaches to healing and wellness in First Nations and Aboriginal communities. • To conduct studies of factors that influence the development of health service systems to meet the needs of First Nations and Aboriginal communities. • To promote research that addresses the gender and age related needs of First Nations and Aboriginal communities.

6. CAHR Objectives, cont’d • To provide community and university-based education and training in health research to First Nations and Aboriginal communities and students. • To facilitate capacity-building in First Nations and Aboriginal communities and organizations in the use of health information for policy and program development. • To assist with the development of quality health information systems describing changing health conditions in First Nations and Aboriginal communities.

7. CAHR Objectives, cont’d • To advise First Nations and Aboriginal governments and organizations on health policy issues based on the best available research evidence. • To facilitate communication and knowledge sharing concerning Aboriginal health development nationally and internationally.

8. CAHR Governance

9. CAHR Advisory Board The purposes of the Advisory Board are: • To develop a broad perspective on health research issues of importance to First Nations and Aboriginal communities and organizations; • To advise and assist the CAHR to determine an appropriate set of activities to meet its goals and objectives; • To assure the long-term viability of the CAHR.

10. Advisory BoardPowers, Duties and Responsibilities • Promote the CAHR and its objectives. • Assist with securing operational funding for the CAHR. • Provide general guidance for research priorities for the CAHR. • Ensure that First Nations and other Aboriginal leaderships are kept informed of the CAHR’s operations. • Ensure that appropriate academic and scientific standards are maintained in accord with University policy. • Ensure that appropriate ethical and dissemination protocols are developed and maintained. • Assist with developing and maintaining linkages and partnerships with relevant Aboriginal organizations and communities, government, and private sector. • The Board will meet twice per year or as required at the discretion of the Director, subject to the availability of funding.

11. AMC - HIRC Committee Composition • One Health Coordinator or designate from each of the seven Tribal Councils • Representative from the Assembly of Manitoba Chiefs • Representative from Manitoba Keewatinowi Okimakanak • Representative from northern independent First Nation • Representative from a southern independent First Nation • Elder to participate as an advisor • CAHR/University provides technical support and guidance

12. CAHR Research Program

13. Aboriginal Health Survey Support Program • Develop national expert working groups for existing surveys & developing new surveys that address emerging health issues • Work in full partnership with Aboriginal advisory groups or organizations in such areas as: • First Nation and Inuit Regional Longitudinal Health Survey (FNIRLHS) • FNIRLHS Off-cycle surveys • New Surveys • Ethical/Data Management Protocols • Data linkage studies • Offer Summer Institutes in Survey Research through the CAHR Applied Aboriginal Population Health Research Institute Program

14. Manitoba First Nations Regional Longitudinal Health Survey (Elias) • Partners: • National: • Assembly of First Nations • National Aboriginal Health Organizations • Assembly of Manitoba Chiefs • Regional • Assembly of Manitoba Chiefs • Centre for Aboriginal Health Research • First Wave 1997 – National and regional development, implementation and roll-up • Second Wave 2002 - Child, Youth and Adult Survey • Community Level Survey to link to RHS data to facilitate multilevel studies

15. First Nations Regional Health Survey AFN Chief’s Committee on Health National Aboriginal Health Organization AFN First Nations Information Governance Committee REGIONAL HEALTH SURVEY PARTNERSHIPS Dene National Office (NWT) Council of Yukon First Nations First Nations Adult and Higher Education Consortium (Alberta) Federation of Saskatchewan Indians Assembly of Manitoba Chiefs/Centre for Aboriginal Health Research Chiefs of Ontario First Nations of Quebec & Labrador Union of New Brunswick Indians Union of Nova Scotia Indians

16. Manitoba First Nations Regional Longitudinal Health Survey (Elias & O’Neil) AMC RESEARCH & POLICY UNIT AMC HEALTH INFORMATION RESEARCH COMMITTEE MANITOBA FIRST NATIONS & TRIBAL COUNCILS

17. Manitoba First Nations Regional Longitudinal Health Survey 62 First Nation Communities 7 Tribal Councils 2 Independent Community Strata (North/South) 26 Participating First Nation Communities Child Youth Adult

18. Childs Internal Assets Children’s Resiliency Survey (Mb) Outcomes Stressors Childs External Assets Community Unsafe community Positive environment Disparity Household Poor housing conditions Household violence Economic security Smoke free Stress vs. Not stressed Child Lifetime exposure to stressful events or situations Experience of food insecurity Community Caring adult relationships High expectations Meaningful participation Engagement in spiritual, traditional, & cultural activities Cooperation & Communication School Head start program High expectations Meaningful participation Home Caring adult relationships High expectations Meaningful participation Child care arrangements Care giver social support Peers Caring & positive relationships Cooperation Communication Empathy Problem solving Creativity Self-efficacy Self-awareness Goals & aspirations Health risk factors Health status (physical, emotional, spiritual, mental) Health service utilization Social wellbeing Academic performance Primary Care Giver Relationship to child Age and sex Education & Social-Economic Spirituality

19. Youth Resiliency Survey (Mb) Youth Internal Assets Disparity/Stress Youth External Assets Outcomes Community Unsafe Not positive Disparity Household Poor housing conditions Household social problems Economic insecurity Personal Lifetime exposure to stressful events or situations Experience food insecurity Cooperation Communication Empathy Problem solving Self-efficacy Self-awareness Goals & aspirations Spirituality Health risk factors Health status (physical, emotional, spiritual, mental) Health service utilization Social wellbeing Academic performance Community Caring adult relationships High expectations Meaningful participation Engagement in spiritual, traditional, & cultural activities Cooperation & Communication School Caring adult relationships High expectations Meaningful participation Home Caring adult relationships High expectations Meaningful participation Peers Caring relationships High expectations

20. Adult Survey (Mb) Health Risk/Status General health Signs/Symptoms Health conditions Physical injuries BMI Mental health Suicide attempts Physical, Emotional, Sexual Abuse Disability Activity Limitation Social Determinants Individual income Economic insecurity Education Residential school (intergenerational) Spirituality Cultural practices Healing practices Self-efficacy Social support Social Capital Racism Household income Household crowding Housing condition & safe drinking water Smoke free home Household social conditions Lifestyle Diet Dietary Changes Physical activity Smoking Smoking Cessation Alcohol consumption Drug use Sexual behavior Gambling Diabetes Complications Treatment Lifestyle Health services Women’s Reproductive health Residential School Survivors Health Services (Traditional / Western) Health care use, access & barriers Vaccination (e.g. flu) Dental care, access, barriers & treatment Home care Substance abuse treatment Preventative health services Medical evacuation Addictions Mental Health Traditional Healing

21. Why are Some First Nations Communities Healthy and Others Are Not? • Develop better measures of health and determinants of health in Aboriginal communities? • Conduct qualitative studies of meaning of health • Conduct qualitative studies of meaning of determinants such as poverty, education, resilience, social capital, cultural resources, etc. • Develop new epidemiological measures for health surveys based on qualitative studies.

22. To define extent & magnitude of problem To enhance understanding of causes, mechanisms & cultural concepts To develop strategies to control & arrest progression of the epidemic Diabetes ProjectDrs. K. Young and S. Bruce

23. Diabetes Sub-Projects Regional Diabetes Registry Community-Based Screening Administrative Database Surveillance Identification of Genetic Markers Prenatal / Early Infancy Risk Factors Prenatal Nutrition Knowledge Evaluation of Community-Based Prevention Projects Stress and Diabetes Prevention of Gestational DMs

24. First Nation Bone Health StudyDr. B. Leslie et al • Mb First Nations peoples have more than twice the rate of hip fractures compared to other Manitobans • Lifestyle, nutrition & genetic factors determine the chance of developing osteoporosis • Study evaluates bone health in 300 Mb First Nations women age 25-75 years • Assess how frequently osteoporosis occurs, how likely women are to develop bone fractures over time, and how diet, exercise, & medications might affect the development of osteoporosis & fractures

25. First Nations Health Services ProjectO’Neil, Lavoie, et al • To determine what factors enhance or constrain the development of a First Nations controlled health care system. • To understand within the context of health transfer the self-government aspirations of First Nations, as well as the devolution and regionalization policy objectives of federal and provincial governments. • To address several theoretical questions related to the history and development of First Nations controlled health care system.

26. Study describes: First Nations Tribal Council and RHA Areas and populations Health status Measures of disease and injury Preventive care Use of physician services Use of hospital services Procedure rates Social determinants of health Data Sources: Population-based data using Mb Health administrative (physician claims, hospital claims etc.) data sources Involved Linkage of Manitoba Health data with SVS files for years 1994/95 to 1998/99 PROPOSED STUDY: Produce Health Report Cards (next slides illustrate partnerships and database linkages required to produce report cards) Health Disparities and Registered First Nations People Living in Manitoba: A Population-based Study(Dr. P. Martens, MCHP et al and Elias MFN-CAHR et al)

27. Health Service Research Opportunities (Manitoba) Surveys Indian Registry Status Verification System MFN-HIS (ehealth) First Nation Databases MOU Linkage Opportunities Manitoba Health Population-based Registry Manitoba Health Databases Physician Claims Hospital Drug Nursing Home Home Care Community Services Vital Statistics Census

28. First Nations population health registry partnership to facilitate health disparity research (Elias) Department of Community Health Sciences AMC EXECUTIVE COUNCIL OF CHIEFS / ALL CHIEFS AMC HEALTH INFORMATION RESEARCH COMMITTEE INDIAN AND NORTHERN AFFAIRS CANADA HEALTH CANADA FIRST NATIONS AND INUIT HEALTH BRANCH MANITOBA FIRST NATIONS & TRIBAL COUNCILS

29. Two level linkage Memorandum of Understanding required for health services research MB Population Health Registry INAC SVS INDIAN AND NORTHERN AFFAIRS CANADA MFN Population Health Registry HEALTH CANADA FIRST NATIONS AND INUIT HEALTH BRANCH AMC-HIRC + MFN Anonymized Health Data REB HIPC + Joint Partnership Joint Partnership Linkage Study Researchers (University/Government)

30. International Health Research • International Comparative Studies of Indigenous Health Care Systems in Central and South America(Mignone, O’Neil, Bartlett) • Australia, New Zealand, and Canada Collaboration on Resiliency Research: • Resilience of Health Worker Networks(Bartlett)

31. New Projects • Early detection of Rheumatoid Arthritis • Suicide Prevention (Youth) (Proposed) • Gatekeeper • Mental health services • School services • Dialectical Behavioral Therapy • Population health research (Manitoba regional health survey and S. Mason (Colorado) collaboration) • Cultural continuity • Hydro electric development and other environmental health • Costing, health services and telehealth

32. ACADRE Program Linda Diffey Program Coordinator

33. ACADRE Program Objectives • Develop research based on collaboration and partnership between the University and Aboriginal communities; • Create an environment that encourages Aboriginal students to pursue careers in health research; • Develop a research environment that fosters participation for scientists from all disciplines to engage in collaborative research with Aboriginal communities; • Ensure that research training is available for students and faculty and that training emphasizes appropriate communication and dissemination activities that are consistent with Aboriginal values and goals for healthy, self-governing communities.

34. Primary Research Training Areas • Population Health Research into complex health interactions • Health Services Research to address the need for health systems • Child Health and Development Research to ensure children benefit from the medical knowledge and technology and to determine how communities can best support children and youth • Ethical Issues in Aboriginal Health Research • Other themes as determined by partnerships

35. Student Funding Opportunities & Activities Summer Internship BSc Medical and Dentistry M.Sc and PhD Fellowships Career Development Awards -------------------------------------------------------------- Health Science Career Camps Seminars in Health and Health Services Aboriginal Health Research Colloquium