ontario public health relations with first nations an assembly ...

1. Ontario Public Health Relations with First NationsAn Assembly of First Nations Perspective Dr. Kim Barker, Assembly of First Nations February 8, 2008

2. Outline Context Challenges Successes Key Steps Forward

3. Context Limited human resources There are no multidisciplinary teams in community nursing stations comparable to provincial hospital/clinical settings Geographic distance Limited medical transportation High curative burden Few linkages in planning, program development and resource allocation with health determinants Impeded by administrative and funding agreements Jurisdictional barriers in primary and secondary/tertiary care systems Fiscal imbalance

4. Context (ctd) No regional or a national community development plan for First Nations health Fragmented program development � some improvements made under Upstream Investments No study or data indicating the impact of under-serviced First Nations populations in Canada 3% cap on federal funding envelope on April 1/06 versus 6.5% annual growth in Canada Health and Social Transfers Pilot projects by First Nations in the Health Integration Initiative have demonstrated benefits of collaboration and co-operation in delivering health services to First Nations across jurisdictions, e.g. The Vancouver Island project adapted a chronic illness model at the community level; Elsipogtog used a population health model for mental health services; and, North Peace Tribal Council developed case management tools with diabetic passports for clients to carry.

5. Challenges with Current Relationships in Ontario Public Health Agency of Canada Health Canada�s First Nations and Inuit Health Branch Disease Surveillance in Ontario Public Health Capacity in Ontario Health Human Resource Crisis Jurisdictions including the new LHINs Health Protection and Promotion Act Mandatory Public Health Programs

6. Challenges: Federal Agencies The Creation of the Public Health Agency of Canada The long term vision of First Nations and Inuit Health Branch of Health Canada The role of Indian and Northern Affairs Canada Why does this make relationship building in Ontario Challenging?

7. Challenges: Disease Surveillance in Ontario Dependency on paper based reporting by nursing stations and health centers who are understaffed Lack of inclusion early on in the development of i-phis and now Panorama in the implementation plan and lack of clear funding options at the outset Stories of duplicate vaccination on and off-reserve Why does this become a challenge for relationship building?

8. Challenges: Building Capacity Lack of opportunities for training and skill building in partnership with local public health units Lack of time by the Public Health Units to assist with building capacity Lack of Boards of Health prioritizing capacity building as an upstream investment Absence of comprehensive plan that would determine a vision of public health units and FNIHB public health employees identifying capacity needs and development of a plan

9. Challenges with Relationships defined by Jurisdictions A well known story to this audience which is complicated by personal opinions of some Medical Officers of Health in the Province translating into unclear Provincial mandate. Equal issues on both sides where some Public Health Units feel unwelcome on reserve

10. Challenges: Human Resource Crisis With no shortage of jobs it comes as no surprise that employers that can pay more will be more attractive Up until recently the role of Telehealth has not been used to the extent that it could in the areas of public health service and training

11. It often appears that money dictates public health reactions rather than legislation Ongoing debate as to whether HPPA applies on reserve Again challenges on both sides in the areas of tobacco control Water has been another example Challenges with Relationships where there is no Public Health Legislation

12. Challenges with Relationships where Mandatory Programs exist �Mandatory� Some programs lack community cultural sensitivity eg HPV Duplication in services and complexities in provincial services communicating back to health care providers on reserve to ensure continuity

13. Potential Successes: Surveillance Immunization work with Chiefs of Ontario Inclusion of Chiefs of Ontario in the Panorama role out and implementation Participation by Ontario in the Client Registry Project Supports First Nations data ownership and capacity building in public health, research and surveillance Supports concurrent pan-Canadian surveillance projects

14. FN Client Registries

15. Potential Successes: FN PH Programming

16. Potential Successes: Legislation Greater emphasis on tripartite agreements as a potential next step Greater capacity building to encourage Band Councils to pass public health laws Need for early inclusion in the development of Federal legislation which is anticipated by PHAC

17. Potential Successes: Funding and Capacity

18. PHF: Funding and Capacity (ctd) Funding to Reflect: Total population base Age and gender of population base Socio-economic composition of the population base Services communities provide to residents of other communities Remoteness factor Local cost of living Population growth Local needs, e.g. workload measurement and health status

19. Potential Successes: HHR Considerations

20. Key Steps Forward Public Health Framework pilots in three regions Joint Workplan with AFN-HC: Cross-jurisdictional agreements Sustainability Management and Accountability Data Infrastructure Legislative Base for Public Health Joint submissions to address current key programming gaps, e.g. mental health, food security, injury prevention, continuing care Fostering transfer of funding and capacity to First Nations health authorities Promoting innovation in new Upstream Investments, AHTF and AHHRI

21. Pilot Status Year one began May 2007 Four Arrows MB, Kenora ON, File Hills Qu�Appelle SK Year one is focusing on (1) governance including the agreement of the content of a tripartite agreement with Prov, Feds and FN (possible quad-partite in ON with the Public Health Unit, (2) identification of programs and services to be included in years 2-5 and (3) phase 0 of the Canada Health Infoway sponsored Client Registry project

22. Next Steps Increased collaboration between the COO public health initiatives and the Kenora Project with Provincial and Public Health Unit services may inform us the way forward Evaluation of year one activities in Kenora Proposal to be submitted for next phase of Client Registry with Canada Health Infoway