We continue to be impressed by the thoughtful questions we receive, and we encourage you to keep the questions coming.

Today’s question concerns our plans for serving and engaging with the Aboriginal communities within our health authority.

If you have questions or suggestions on this or any other topic, we welcome them; email us any day or night.

Today’s answered question

Q. I recently read a column on VCH news re: Poverty among indigenous children. It quoted that 42% of aboriginal children live in poverty in Canada. This is striking and needless to state requires strategies and initiatives to address this issue. VCH serves 14 Aboriginal communities within its boundaries and has a duty to provide health services to these outlining communities.  How do you envision your new strategy will address this example of complexity that is a part of Aboriginal people’s current state? How do you plan to engage Aboriginal communities to improve the health inequities they face?

A. Thank you for your question about how we plan on addressing this important issue. As discussed in the original article you reference, the rate of children living in poverty is strikingly high for Canada compared to other developed nations. Even more shocking and worrisome is how much higher this rate is for Aboriginal children compared to non-indigenous children. According to the 2006 census, the B.C. children’s poverty rate was 48% for status First Nation children, 28% for other Aboriginal children and 17% for non-indigenous children.  These disparities in income, along with other social determinants of health, contribute to the inequities we see in health outcomes for Aboriginal people compared to the non-indigenous population (e.g. shorter life expectancy, and higher rates of diabetes, hospitalization and infant mortality).

While poverty reduction is not part of our health authority’s mandate, our Population Health Community Investments Program provides funding to community-based organizations to support health promotion for children and youth. For the 2013/14 fiscal year, we provided more than $650,000 towards health promotion for programming targeting youth populations. Of that funding, $180,000 was for community-based programs for Aboriginal youth, funded by our Aboriginal Health Initiatives Program. Some of the program activities included parent-focused workshops on cultural and traditional practices in parenting, providing access to Early Child Development programs in First Nation communities and establishing a Family Centre for Aboriginal parents in Vancouver.

In regards to your question about engagement, input from Aboriginal communities to both set priorities and identify potential solutions is crucial to addressing the health inequities they experience. For VCH, this process is informed by our Aboriginal Health Operations Council (AHOC), which coordinates regional planning as well as implementation and delivery of services. The AHOC helps to identify service gaps, prioritize improvement efforts, recommend solutions and evaluate our progress at addressing health inequities for Aboriginal communities. Our May 2012 Partnership Accord with First Nations Health Authority (FNHA) and First Nations Health Council (FNHC) is also central to this process. This accord formalizes our commitment for stronger collaborations with the FNHA, to provide more culturally competent services, and mandates the development and implementation of an Urban Aboriginal Health Strategy.  The FNHA has a formalized engagement process to support communities’ self-determination in health through engagement “hubs”. These hubs, composed of local representatives, help to set priorities, suggest approaches, and validate our finalized plans for action. VCH has and will continue to work with the FNHA on health service planning via this process, as well as our own community engagement with Aboriginal communities aligned with this model.

As a health authority, our primary role is the delivery of health care and health promotion within our region. However, we know that it will take more to eliminate inequities in health outcomes. Some studies in the U.S. suggest that only 14-50% of health outcomes are determined by clinical care. Poverty and income are components of a larger set of determinants (e.g. education, employment, social and physical environment, etc.) that influence our health. Action to reduce inequities in the social determinants of health will be necessary in order to reduce inequities in health outcomes, and achieve our True North Goal of promoting better health for our communities. Much of the action to address root causes of health inequities will require meaningful change and participation from the whole of society.

For example, as part of Our Health Care Report Card, VCH uses the Early Development Instrument, to gauge childhood vulnerability within our region, identify areas for improvement and monitor our progress. Reducing childhood exposure to poverty has been identified as one way to reduce childhood vulnerability for our entire region, particularly for Aboriginal children. Some of the policy recommendations identified by scholars working in this area include:  1) raising welfare benefits for parents, 2) enhanced family/in work tax credits, or higher minimum wage levels and 3) making early education and care services affordable.