Local First Nation control of health care decision-making is the "way to go" study finds
International study links aboriginal health, lifestyle, local decision-making
July 2, 2009 - THE CANADIAN PRESS
EDMONTON - Aboriginal people around the world are increasingly suffering from lifestyle-related illness such as heart disease, obesity and diabetes, according to a major new global study.
The study, published Thursday in the prestigious British journal "The Lancet," also found that living conditions make aboriginals everywhere more likely to be infected with swine flu.
And it concludes that the healthiest aboriginal communities are those with the most control over their own decision-making.
"Some of the bright spots are communities that have taken measures of self-determination - community control of health and education services, of social services," said Malcolm King, one of the report's authors and a researcher at the University of Alberta's medical school.
"These things end up translating into better health."
King and co-researchers were following up a similar study done in 2006 to measure aboriginal health progress in 193 countries around the world. They found that in Canada, the United States and New Zealand - three of the countries that kept the best statistics - the health gap between aboriginals and national averages seemed to be closing.
Life expectancies for aboriginals in all three of those countries were catching up, although the life expectancy for aboriginals in Canada is still seven years shorter than the average. In Australia, however, that gap is 17 years and widening.
"In Australia, it's far worse relative to the main Australian population," said King.
Canadian progress remains "spotty," he said.
HIV infection is spreading in aboriginals more quickly than it is in the general population. As well, the westernization of aboriginal diets is causing new problems. The increasing consumption of high-fat, high-salt food, combined with decreasing physical activity, have contributed to rising levels of heart disease, obesity and diabetes in Canada and around the world. The study found that 60 per cent of northwest Australian aboriginals over the age of 35 had diabetes.
Those underlying health problems, as well as crowded, substandard homes, have also made aboriginal people around the world more susceptible to infections such as swine flu.
More than one-quarter of all Manitoba's swine flu cases are from remote northern communities that are mostly aboriginal.
Nunavut, which is 85 per cent Inuit, has a disproportionately high rate of swine flu infection.
King attributes many of the underlying causes of poor aboriginal health to the lingering effects of cultural dislocation, such as loss of language and removal from the land.
"Language is crucial to identity, health and relations," his report states. "Language revitalization can be seen, therefore, as a health promotion strategy."
Evidence suggests that getting communities to take responsibility for their own health gets results, King said - a cause-and-effect relationship that's hard to prove definitively, but seems to be supported by statistical evidence.
"It's the way to go," he said.
That evidence forms the basis of the report's recommendation that governments around the world enter into more co-management agreements with aboriginal communities to allow decisions to be made locally. That implies a related need to increase educational levels to successfully manage such programs.
"Capacity-building and education is required to enable communities of aboriginal people to take a more active share in the activities of community life that we take for granted in regular society."
Research is ongoing to look more deeply into the link between local control and community health, King said.
"It's an opportunity for Canada to lead the world," he said. "If we can demonstrate these links, then other countries with indigenous populations would have to stand up and pay attention."