An apple a day may keep the doctor away, but what if you can’t afford to buy apples or other fresh fruits and vegetables? What if your home is overcrowded or has mould? What if you don’t even have a home?
Studies show that factors such as the availability of affordable healthy food, housing and employment have a direct impact on an individual’s health. The United Nations recently declared that the right to health extends beyond health care to include the underlying social determinants of health, such as potable water, adequate sanitation and access to health-related information.
“The health care ‘system’ is really just a small portion of health care,” says Canadian Medical Association president Dr. John Haggie. “We need to look beyond doctors and hospitals, and address the social inequities that are contributing to poor health.”
These inequities are particularly evident in remote and poorer communities. Consider the challenge of providing nutritious meals to a family when Coke is far cheaper than milk and the single local grocery store’s shelves are bare of fresh produce, meat and fish. That is the reality YMCA Canada president Scott Haldane witnessed recently when he visited several First Nation communities as chair of a national panel on native education.
“If you are living in an isolated community and are on a low income, the apple-a-day approach to health is not relevant,”
Scott Haldane, President, YMCA Canada
In addition to struggling with a lagging food security, First Nation families also contend with high unemployment, substandard housing and high dropout rates. The latter is particularly concerning, says Mr. Haldane, as youth who don’t graduate high school are more likely to fall into substance abuse, be unemployed and live in poverty – all factors that contribute to poor health.
Lack of education also affects the ability to access, understand and act on health information. “How can you educate yourself about wellness and develop the skills you need to care for yourself if you can’t read?” asks Dr. Haggie.
The disparities in health status between First Nations populations and the rest of Canada are striking and disturbing. Compared to the national average, First Nations communities have double the infant mortality rate, three to five times the prevalence of type 2 diabetes, 30 times the rate of tuberculosis infection and a life expectancy that is five to seven years lower.
Closing these gaps in health outcomes will require the development of innovative, culturally relevant community-based programs that address a wide range of social issues. “We cannot talk about health in isolation,” says Shawn Atleo, Assembly of First Nations (AFN) National Chief.
Towards that end, AFN recently held a national health forum that highlighted the need for First Nation control of First Nation health to achieve fair and sustainable health service delivery to their communities. Experts discussed the need for programs that tackle inequities in education, overcome barriers to economic development and improve infrastructure so that communities have access to clean water and safe housing.
Funding is critical to implementing these plans. In 2010, First Nation communities received less than half the funding given to non-First Nation communities to provide basic services for their citizens ($8,754 compared to $18,724). If services and programs do not receive sustained, equitable funding, health care and judicial costs in First Nation communities will reach close to $1 billion over the next 10 years.
“Collective action at this juncture in history is critical. If we don’t act now, we risk the loss of an entire generation,” says National Chief Atleo.
