Manitoba First Nations:Manitoba First Nations:Health & Health Care in an Health & Health Care in an

Aboriginal PopulationAboriginal Population

Patricia J. Martens & Ruth-Ann Soodeen

MANITOBA CENTRE FOR HEALTH POLICY

Winnipeg, Manitoba, Canada

This lecture is based on the report, The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study by:

Patricia J. Martens, Ruth Bond, Laurel Jebamani, Charles Burchill, Noralou Roos, Shelley Derksen, Marcella Beaulieu, Carmen Steinbach, Leonard MacWilliam, Randy Walld, Natalia Dik, Doreen

Sanderson & the Health Information and Research Committee of AMC, Marilyn Tanner-Spence, Audrey

Leader, Brenda Elias, & John O’Neil

MANITOBA CENTRE FOR HEALTH POLICY

Winnipeg, Manitoba, Canada

Collaborators

• Assembly of Manitoba Chiefs – Collaborative working group– Chief’s Health Committee

• Health Information and Research Committee

• Centre for Aboriginal Health Research (CAHR)• Manitoba Health• First Nations and Inuit Health Branch of Health Canad

a• Indian and Northern Affairs Canada (INAC)• Work done at the Manitoba Centre for Health Policy

Key Terms

• Registered First Nations

• First Nations Community

• Tribal Council (TC)

• Regional Health Authorities (RHAs)

DOTCILTCIRTCKTCSCTCSERDCWRTC

DOTCILTCIRTCKTCSCTCSERDC

I N-NI N-S

WRTC

KTC

SCTC

DOTC

SERDC

IRTC

WRTC

ILTC

80 0 80 160 Kilometers

Burntwood

Norman

InterlakeParkland

North Eastman

Central

Marquette

Churchill

SouthWestman

South Eastman

80 0 80 160 Kilometers

WinnipegBrandon

Data Sources

• Health care administrative data (Fiscal years April 1 1994 - March 31, 1999)

• Vital Statistics - (1995-1999)

• Census Data (1996)

• Publicly-available reports from Indian & Northern Affairs Canada (INAC)

• Status Verification System (SVS) Files (1994/95-1998/99)

Key Measures

1. Health status

2. Burden of disease

3. Preventive care

4. Use of physician & hospital services

1. Health Status Indicators

1. Life expectancy at birth • Most common measure

2. Premature mortality rate (PMR) • Death before age 75

3. Potential years of life lost (PYLL) • Similar to premature mortality but gives greater weight

to death of a younger person

Key findings

1. Life Expectancy at Birth• RFN = 8 years less than for all other Manitobans

– males 68 yrs vs. 76 yrs; females 73 yrs vs. 81 yrs

2. Premature Mortality Rate• Twice as high for RFN vs. all other Manitobans

– 6.6 deaths per 1000 RFN versus 3.3 for all other MB

3. Potential Years of Life Lost• Higher risk for RFN

– male RFN = 2.5 X higher (158 vs. 63 yrs/1000)

– female RFN = 3 X higher (103 vs. 36 yrs/1000)

2. Burden of Disease

Two measures of illness & injury:

1. Diabetes - occurs when pancreas doesn’t produce enough insulin, when cells stop responding to the insulin, or temporarily during pregnancy; glucose in the blood cannot be absorbed into the body’s cells

2. Injuries - physical damage usually inflicted on the body by external force

Key findings

1. Diabetes Treatment Prevalence • 4.2 times higher for RFN vs. all other Manitobans

(18.9% vs 4.5%)• Amputation rates - population prevalence is 16 times

higher for RFN

2. Injury hospitalizations• 3.7 times higher for RFN compared with all other

Manitobans• RFN 32% due to violence by others and to self (vs.

10% for all other Manitobans)

3. Preventive Care

1. Childhood immunization - at ages one and two years of age

2. Mammography - for women between 50 and 69 years of age

3. Breastfeeding - at hospital discharge for newborns

Key findings

RFN vs. all other Manitobans:

• Lower immunization rates

• Lower mammography rates

• Lower newborn breastfeeding rates

4. Physician & Hospital Services

Physician Services• Ambulatory visits• Consults• Physician type:

– General

– Specialist

• Visit location

Hospital Services• Hospital separations• Length of stay• Hospital Location

We examined use (in terms of rates) of several physician and hospital services.

Key findings

Physician visit rates• 6.1 visits per person per year for RFN (probably

understated) versus 4.9 for all other Manitobans

Consult rates• only slightly higher for RFN compared to all other

Manitobans

Specialist visit rates• urban areas have very high rates, but slightly lower for

RFN in Winnipeg

• In some RHAs, RFN rates are comparatively higher than other RHA residents

Key findings

Hospital use• Double the hospitalization rates

• 1.7 times the total days of hospital care

• Location of hospitalizations varies considerably

Procedure rates• RFN have higher or similar heart-related

surgery rates compared to all other MB

Summary of Key Findings

• Health status of Registered First Nations people (RFN) is much poorer

• Big differences in health across Tribal Council areas

• Higher overall use of physicians and hospitals reflect poorer health status of RFN

• Preventive care rates are lower for RFN

Health of RFN people - not a good story:

• lower life expectancy

• more injury-related hospitalizations

• higher prevalence of diabetes

How do we improve their health status?

• Are more hospitals needed? More doctors?

• Is there any “right” answer?

Final Thoughts

Where do we go from here?

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