Roles and Responsibilities s1

SUMMARY OF DISCUSSIONS

Health of Indigenous and Remote Northern Communities

Meeting hosted by First Nations and Inuit Health Branch (FNIHB), Health Canada in conjunction with the Northern Dimension Partnership in Public Health and Social Well-Being (NDPHS)

MUSEUM OF CIVILIZATION, GATINEAU, QUEBEC NOVEMBER 20 & 21, 2008

Prepared by Oke Health Care Consulting for the First Nations and Inuit Health Branch, Health Canada BACKGROUND

On November 19, 2008, Health Canada hosted the Fifth Partnership Annual Conference (PAC) of the Northern Dimension Partnership in Public Health and Social Well-being (NDPHS).

On November 20 & 21, as a side event to the PAC meeting in Canada, the First Nations and Inuit Health Branch (FNIHB), Health Canada, hosted a one and one-half day meeting on the Health of Indigenous and Remote Northern Communities to further explore how to increase involvement and discuss tools and approaches to advance the health of Indigenous and remote northern communities within this international partnership.

The purpose of the meeting was to further explore and develop priorities for an NDPHS shared international agenda on the health of Indigenous and remote northern communities. Expected outcomes were: 1. Identify interest of NDPHS partners to collaborate on a shared agenda on the health of Indigenous and remote northern communities. 2. Determine a common set of priority issues for promoting opportunities for collaborative action on the health of Indigenous and remote northern communities; and 3. Identify follow-up steps for the next 18 months.

Health Canada, FNIHB, led the planning, organization and preparation for this meeting. A Canadian Planning Committee worked with volunteers within the NDPHS partnership (Denmark, Greenland, Norway, Russia and a representative of the HIV/AIDS Working Group) to determine the priority topics for this meeting and associated speakers. Representatives from the Assembly of First Nations (AFN) and Inuit Tapiriit Kanatami (ITK) played an instrumental role in the planning of this meeting.

Through an iterative process of consultation it was determined that the major themes (areas of focus) for the meeting would be: . Mental Health and Addictions . Primary Healthcare Delivery . Communicable Diseases, and . Nutrition

Planning for the meeting started in June 2009. Judith Skelton-Green, President, TRANSITIONS-HOD Consultants Inc., assisted the Canadian and International Planning Committees over a five month period and through a series of meetings of the various planning groups to develop the agenda, secure the speakers, and design the supporting materials and processes that would be used during the meeting. The meeting was facilitated by an Indigenous person, Barbara Oke, who worked collaboratively with the planning teams just prior to the Meeting to ensure a smooth transition to facilitation.

COUNTRY POSTERS

To facilitate the sharing of important and comparable information regarding the target population from partner countries, a poster template (Appendix A) was developed to summarize the:  Facts regarding the Indigenous and remote populations (demographics and relevant health statistics).  Organizational structure for delivering health to these populations.  Issues and challenges (care delivery in general, and the four areas of focus for the meeting).  Key initiatives and investments (Success stories to date, and current priority initiatives).  Areas where input from others would be particularly appreciated.

It was intended that this information would be displayed as a poster during the meeting, and provided electronically to all participants afterward.

Information on the Saami in Finland (Appendix B) and the First Nations and Inuit in Canada (Appendix C) was available at the meeting. Despite willingness, other countries were unable to compile the information for the poster due to various reasons: lack of available data, lack of human resources to work on it, etc.

PARTICIPANTS

A total of sixty nine (69) people attended the meeting including members of the Committee of Senior Representatives NDPHS, thematic experts; a presenter from Alaska-United States of America, the Chairs and Technical Advisors of the four NDHS Expert Groups, Indigenous representatives from the Assembly of First Nations, Inuit Tapiriit Kanatami, the Inuit Circumpolar Council and member countries in addition to officials from Health Canada, Correctional Service Canada and the Public Health Agency of Canada (Appendix C).

AGENDA AND KEY CONTENT

Welcome and Overview

Elder Elmer Courchene, Assembly of First Nations, opened the meeting with comments on the challenges, opportunities and hopes of First Nations in Canada and a prayer to provide guidance for the discussions to follow. Anne-Marie Robinson, Assistant Deputy Minister, First Nations and Inuit Health Branch, Health Canada, provided opening remarks highlighting Canada’s role as a founding member of the Partnership and Canada’s pride in championing the inclusion of Indigenous peoples’ health as a focus in the NDPHS mandate. Robert Shearer, Counsellor, Health and Social Affairs Mission of Canada to the European Union explained the impetus for the meeting, expected outcomes and the processes used to develop the agenda. He encouraged active participation and shared his hope that the group would identify opportunities for future collaborative action.

The agenda (Appendix D) continued with three presentations intended to share general information on the health of Indigenous and remote northern communities. The purpose of these presentations was to set the stage and stimulate thought for subsequent discussions.

Setting the Stage

Eva Kruemmel, Senior Health Representative, Inuit Circumpolar Council, Canada Office, presented on the shared health concerns, gaps between Inuit and national populations and factors influencing the health for the Inuit living in Greenland, Canada, Alaska and Russia. Minna Rasmus, Researcher Ministry of Social Affairs and Health, Finland reported on a research study where the Finnish Ombudsman for Children asked Saami youth what they thought of their lives and the situation regarding their rights.

Spotlight on Canada

Debbie Reid, Director, Strategic Policy and Planning, First Nations & Inuit Health Branch, Health Canada, Jonathan Thompson, A/Senior Director, Health & Social Development Secretariat, Assembly of First Nations (AFN) and Elizabeth Ford, Director Health and Environment, Inuit Tapiriit Kanatami (ITK) co-presented on the federal, First Nations and Inuit perspectives of delivering health services to First Nations and Inuit in the north, including the jurisdictional issues, health status, challenges and opportunities.

Major Themes (areas of focus)

Each of the four major themes (Mental Health and Addictions, Primary Healthcare Delivery, Communicable Diseases and Nutrition) was introduced by three short 10-minute presentations on topics relevant to the theme. These short presentations were not intended to be a comprehensive analysis but to provoke thought and lay the foundation for group discussions that followed.

Following the presentations, the participants were asked to work at eight tables and in groups of eight or nine people to answer the questions:  What are our common interests in this area?  What might we like to accomplish together?  What is possible?

These questions enabled participants to speak broadly on the topics, share information and then start to think about areas for possible future collaboration. A short summary of each of the presentations and a synopsis of the group discussions by major themes follows.

Copies of all power point presentations are available on the NDPHS website at http://www.ndphs.org/?mtgs,health_of_indigenous_communities SUMMARY OF GROUP DISCUSSIONS AND SYNOPSIS OF OUTCOMES BY MAJOR THEMES

MENTAL HEALTH AND ADDICTIONS

Valentina Sovkina’s1 (Expert, Working Group of Indigenous Peoples of the Barents Euro-Arctic Council, Russia) presentation on the Sámi in Russia on the Kola Peninsula outlined health status information, causes of alcoholism and new kinds of emerging addictions. Viktoras Meizis (Head of the Foreign Affairs Division, Ministry of Health, Lithuania) spoke of the demographics, health status indicators, rates of suicide, main mental health problems among young people and policy changes to curb alcoholism in Lithuania. The final presentation by Kathy Langlois (Director General, Community Programs, First Nations and Inuit Health Branch, Health Canada) addressed the First Nations and Inuit Mental Wellness Action Plan, its committee structure, vision, goals, Inuit specific Task Group and future direction.

Synopsis of Group Work (8 Tables) – Mental Health and Addictions

What are our common interests in this area?  Common histories in many countries impacting on mental health and addiction in the population.  Alcoholism – including issues such as the underlying causes, treatment approaches, family and gender-based violence.  Mental health – particularly high suicide rates in some countries and an interest in suicide prevention activities.  A focus on youth and their concerns regarding self-esteem, addiction, suicide, & marginalization.  Interest to deal with inclusion and exclusion as precursors to these problems.

What might we like to accomplish together?  Knowledge management activities so that international data & statistics are available in one place, in multiple languages, accessible to all.  Meetings and conferences that integrate stories of resilience.  It was noted that local solutions that are community based and community driven are needed.  Need culturally sensitive policies & processes  Many groups stressed the importance of Indigenous involvement.

What is possible?  Information exchange through forums, meetings & conferences and E-portals as a way of exchanging information. o A focus on what works and what doesn’t  Alcohol related activities such as policies that restrict access and prevention activities and education for youth  Use of technology to bring services to the community. Development of databases – financing, infrastructure, etc.

1 Vitaly Chzhao, Chief Physician of the Republican AIDS Centre, Republic of Komi, Russia, presented on behalf of Valentina Sovkina as she was unable to attend the meeting.

Oke Health Care Consulting 6 PRIMARY HEALTHCARE DELIVERY

Dorothy LaPlante (Nurse Practitioner, Office of Nursing Services, First Nations and Inuit Health Branch, Health Canada) shared her northern nursing experience by describing the interdisciplinary care team, the nursing role, challenges and successes in primary health care delivery. Ernie Dal Grande’s (National Program Manager for eHealth, Primary Health Care, Nations and Inuit Health Branch, Health Canada) presentation focused on First Nations and Inuit eHealth as a strategic business issue outlining why eHealth is important, its main components and the lessons learned in Canada. Ole Mathis Hetta (Senior Advisor Sámi Public Health, Norway) spoke generally about the Sámi in four countries, their shared experiences and health status, and then more specifically about primary health care delivery in Norway.

Synopsis of Group Work (8 Tables) – Primary Healthcare Delivery

What are our common interests in this area?  Care Delivery Approaches such as: o E-health strategies o Access to specialized care as well as health promotion activities o Adapting services to cultural context and needs.  Recruitment & retention of health professional with further discussion on: o Recruitment incentives o Credentials – across borders, creep o Ethical guidelines o Best practices

What might we like to accomplish together?  Knowledge exchange through strategies such as: o On-going forums o Continued dialogue regarding Recruitment and retention o E-health as a methodology to support care  Survey of what is currently being done relative to e-health.  Transferring of responsibility to the community.  Common shared view of primary health.  Collaborative activities, multilateral projects.

What is Possible?  Sharing of best practices in recruitment and retention of health professionals including; o Developing guidelines for ethical recruitment o Incentives and initiatives o Training models  Increased use of e-health.  Adapt WHO paper on primary healthcare to local community situations.  Further explore the role of NDPHS – PHC Expert Group.

Oke Health Care Consulting 7 COMMUNICABLE DISEASES

Vitaly Chzhao (Chief Physician of the Republican AIDS Centre, Republic of Komi, Russia) presented on the incidence of AIDS–related diseases including the characteristics, distribution by gender, HIV infection-related morbidity and infection control measures. Alan J. Parkinson, (Deputy Director Arctic Investigations Program, Centers for Disease Control & Prevention, Alaska, USA) spoke on the Arctic Investigations Program, challenges to the health and wellness of Alaska Natives, health disparities, rates of HIV, AIDS and TB as well as the challenges and opportunities in Alaska. The final presentation by Kim Barker (Public Health Advisor, Assembly of First Nations, Canada) described the Global Indigenous STOP TB Initiative aimed at including Indigenous groups globally in National TB Programs, encouraged the collection of disaggregated data and promoted the implementation of culturally appropriate best practices.

Synopsis of Group Work (8 Tables) – Communicable Diseases

What are our common interests in this area?  TB  HIV (Prisons, link with alcohol, Drug use)  Prevention Strategies that are culturally appropriate, at literacy levels and in a language the community can understand.  Surveillance & data collection methodologies.  Further discussion on the social determinants of health including housing, employment & education.  Research – more or too much already?  The importance of education for health professionals.

What might we like to accomplish together?  Knowledge exchange.  Linking surveillance activities & technology.  A working group to look at research/surveillance, then educational tools.  Community based research.  Pilot programs in communities then change policies.  NDPHS encourage more action.

What is possible?  Link NDPHS working group on HIV/AIDS with Prison Health group & tie in an Indigenous component.  Establish a forum for information sharing of best practices and successes.  Develop evaluation tools and international standards for diagnosis. o Include Indigenous people

Oke Health Care Consulting 8 NUTRITION

Mikko Vienonen (Chairperson SIHLWA Working Group) outlined the work of the Social Inclusion Healthy Lifestyles Work Ability (SIHLWA) Expert Group of NDPHS, the public health challenges in nutrition and possible future roles for SIHLWA. Birgit Niclasen (MD & PhD student, Institute for Health Research, Greenland) presented on nutrition in Greenland, the aims, status and challenges. And the final presentation of the day was by John Cheechoo (Policy Analyst, Health and Environment, Inuit Tapiriit Kanatami, Canada) who spoke on Inuit food security and nutrition in arctic Canada.

Synopsis of Group Work (8 Tables) - Nutrition

What are our common interests in this area?  Issues of accessibility/availability including the challenges of: o Geography, food safety, lack of country foods and climate change  The barriers of affordability such as: o High costs and inconsistent government policies  Issues of choice. o Traditional or store bought or both? o Quantity and obesity o Lack of variety o Need for education  Data o Common indicators across jurisdictions for comparison purposes.

What might we like to accomplish together?  Lifestyle reorientation – less TV and videogames, increased physical activity, parents as role models.  Knowledge exchange and sharing of things such as food guides and best practices.  Develop common indicators.  Targeted government initiatives such as: o Food subsidies o Regulation/de-regulation o Monitoring programs

What is possible?  Forum to make a plan of action for proper outcomes. Many felt they did not have enough time to fully explore all the complexities of the issues.  Create a sub-group of SIHLWA.  Pursue activities such as regulating prices or subsidizing means of hunting and food transportation.  Undertake more research.  Focus on education.

Oke Health Care Consulting 9 CONSENSUS BUILDING AND POSSIBLE NEXT STEPS

The summary of outputs from the group discussions of the first day formed the basis of the consensus building exercise of Day 2. This exercise was designed to determine what Partners might undertake together and possible next steps.

Meeting participants selected one of the four major themes to work with others interested in that topic to answer the following questions:  What will we undertake together over the next 18 months?  Who will take responsibility to initiate the required action?  Next Steps?

The largest number of participants chose the discussion on Mental Health and Addictions, with the rest of the group split amongst the remaining themes. All groups felt the need to have a general discussion on the topic before identifying follow-up steps.

A summary of the general discussion for each of the major themes follows.

General Discussion

Mental Health  There was great interest in pursuing activities pertinent to youth mental health and and addictions, for example: Addictions o Sharing experience/knowledge: . Looking at the factors in communities where there are either no suicides or low suicide rates. . Sharing tools, issues, visits, data base development and best practices. . Comparison of culturally specific experiences in various countries, Lithuania, FN, Sami etc. . Sharing parenting programs and models, with a focus on youth and parenting and principles of aboriginal parenting. o The SIHLWA expert group might pursue future actions relative to adolescent health and alcohol. o There is a plan next year to develop risk profiles (youth health) – this could be used as forum for information exchange.

Important principles were identified: o Need to bring a community focus on what works. o Need input from experts living in the north. o Need to involve people who know the cultural realities. o Ask communities what they know/need.

Oke Health Care Consulting 10 General Discussion

Primary  NDPHS and member expert groups need to advocate – horizontal within the Healthcare Northern Dimension, member countries, and specialized groups. Delivery  There needs to be inclusion of the people (empowerment).  Need to draw on models of best practice and evidence.  Integration of PHC into health system approach: o Integration Indigenous /remote into health services – PHC approaches  There is a need to look at the membership of the Primary Health Care Expert Group and implement a model that is respectful of all – Nurse Practitioners, Nurses, etc to avoid it being too Physician heavy.  Governments should support economic development to enhance primary health care.  Intersectoral membership on the high level Working Groups and all Experts Groups of NDPHS is needed.

Communicable  It was noted that an HIV meeting would be held in Canada in March 2009 (this Diseases will be a meeting of the NDPHS and Health Canada’s International Affairs Department).  Ways to address Indigenous populations, as it relates to communicable diseases could be discussed further at an NDPHS HIV/AIDS Expert Group Meeting. o Discussions could focus on TB/HIV/Hepatitis C. o There could be country overviews looking at current practices relative to HIV/TB and co-infections. . Note: The Public Health Agency of Canada has a co-infection working group looking at risk factors and co-morbidities o Discussions on how HIV affects public health aspects of TB (case detection, treatment, etc).

 There will be a NDPHS Prison Health Expert Group meeting in February 2009. o It might be possible to invite HIV/AIDS NDPHS member to this meeting. o A Canadian representative should be invited as well. o Canadian prison system could share their public health strategies with other countries (dealing specifically with communicable diseases). o A review of current policies regarding HIV infected prisoners could be undertaken.

 It was suggested that there could be further discussion on this theme at the next PAC meeting in Norway.

General Discussion

Oke Health Care Consulting 11 Nutrition  Are foods we are recommending available?  Food prices are increasing affecting affordability.  Pollution decreasing: o Need to continue pressure on reducing environmental contaminants o PCBs have been banned but other contaminants are increasing  Have recommendations and programs targeting different age groups – need to make them work.  Need to encourage demand for healthy food (role for NDPHS more broadly).  Demonstrate cost saving to health systems and to politicians.  Subsidize country food access.  Family influences on children’s eating habits – links with costs of oral health, primary healthcare.  Balance benefits and risks of traditional foods.  Focus on schools – school children, role models of teachers, parents.  NGO sector involvement to promote local activities  Link with food borne illness – NDPHS infectious diseases (importing store bought foods, handling)  Possibility that there could be a sub group on Nutrition (SIHLWA) to pursue this as an add-on with country partners who want to participate rather than creating something new. o Invite Indigenous groups to the SIHLWA meeting in March 2009  Work with journalists to develop outreach with mass media – the NDPHS Secretariat can support these efforts by, inter alia, offering its database of mass- media e-mail addresses.  Access support dollars for locally driven solutions, e.g. hunting and hunter support.  Address Indigenous peoples component at Partnership Annual Conference.  Link information sharing & research to reduce the discrepancy between theory and practice.

Once the groups had completed the general discussion and information sharing they went on to identify possible next steps.

Oke Health Care Consulting 12 Possible Next Steps

Mental Health and Addictions  Seminars to share knowledge  Some countries may wish to pursue research directed by Indigenous peoples for knowledge development.  The SIHLWA working group might be able to provide an avenue for future discussions, perhaps through a sub-group on Indigenous peoples’ mental health. o This could be explored further prior to the March 2009 Expert Group meeting in Sweden o It may also be appropriate to link with the Alcohol Working Group

Primary Health Care Delivery  Appoint a Canadian representative to the Primary Health Care Expert Group.  Empowerment and inclusion of Indigenous people is needed.  NDPHS and member expert groups need to advocate – horizontal within the Northern Dimension, member countries, and specialized groups for primary health care.  There needs to be further discussion on models of best practice which integrate primary health care into the strengthening of health system approaches in areas such as policies, health information systems, health human resource planning and training and development.

Communicable Diseases  Common meetings and collaboration

 Review of current policies relative to all issues documented

 HIV/AIDS and Prison Health Expert Groups could invite a member to attend each other’s meetings, as well as a Canadian representative for information exchange.

Nutrition  SIHLWA – could invite Indigenous representatives to their next meeting in March 2009.

 Opportunity for NDPHS to link with International Circumpolar Conference on Health in June 2009 in Yellowknife, North West Territories, Canada to pursue a focus on food security.

 Development of Indigenous peoples food profile within NDPHS.

Oke Health Care Consulting 13 CONCLUDING REMARKS

In her closing remarks Ms. Toril Roscher-Neilsen, Chairperson of the NDPHS Committee of Senior Representatives, indicated that the one and a half day of interesting presentations and lively discussions provided solid evidence that the health of Indigenous and remote northern communities requires and deserves proper attention. She went on to propose that the NDPHS ad hoc Strategy Working Group, established at the Partnership Annual Conference on November 19, 2008, take the findings and conclusions of this event into account when developing the recommendations on the follow-up of the NDPHS evaluation. She urged Canada to play an important role in this regard.

The summary of the proceedings for the Meeting is available to all member countries and organizations as they engage in future actions and strategic planning related to the health of Indigenous and remote northern communities.

Oke Health Care Consulting 14 APPENDICES

APPENDIX A - Country Posters - Template

APPENDIX B – Saami (Finland) - Poster

APPENDIX C - First Nations and Inuit (Canada) – Poster

APPENDIX D – Participants

APPENDIX E – Meeting Agenda

Oke Health Care Consulting 15 APPENDIX A - COUNTRY POSTERS - TEMPLATE

Health of Indigenous and Remote Northern Communities Country (name) Overview

FACTS CHALLENGES KEY INITIATIVES AND INVESTMENTS IN DELIVERING CARE TO TARGET POPULATIONS

Demographics Care Delivery Challenges - General Success Stories to Date  Population of the country  List major challenges in care delivery for the  List and briefly describe initiatives you  Population in these target group target population(s) (e.g. percent of target have mounted to meet the health and (s) population in fly-in communities; lacking IT healthcare needs of target population in  Specific characteristics of these connections for timely consultations, insufficient the past decade, which you believe target population (s), as training for primary caregivers who work in have been particularly successful compared to overall population these communities) of the country (e.g. age distribution, income, education Mental Health and Addiction levels)  Indicate whether this is a major challenge for Current Priority Initiatives the target population(s) in your country, and if  List and briefly describe current yes, describe what needs to be undertaken to priority initiatives underway to meet Health Statistics address the situation. the health and healthcare needs of  Key morbidity and mortality target population. statistics of target population , as Communicable Diseases (TB and HIV/AIDS) compared to overall population of  Indicate whether this is a major challenge for the country (e.g. life expectancy, target population in your country, and if yes, causes of death at various ages, describe what needs to be undertaken to address incidence of particular diseases) the situation. PREPARED BY: Nutrition  Person or department who prepared the  Indicate whether this is a major challenge for poster the target population(s) in your country, and if  Name of person from whom further yes, describe what needs to be undertaken to information can be obtained STRUCTURES FOR address the situation. HEALTHCARE DELIVERY Primary Health Care Access  Healthcare delivery structure for  Indicate whether this is a major challenge for overall population (e.g. the target population(s) in your country, and if public/private; federal/provincial- yes, describe what needs to be undertaken to state) address the situation.

 Healthcare delivery structure for target population, if it differs

Note: For the purpose of this poster, target group (s) refers to the Indigenous population and/or remote northern communities

APPENDIX B – SAAMI (FINLAND) - POSTER

Oke Health Care Consulting 16 Health of Indigenous and Remote Northern Communities Finland Overview

Facts & Demographics Sources:  Saami Parliament,  State Provincial Office of Lapland (Sotkanet),  National Public Health Institute/FINRISK,  National Social Insurance Institution,  Lapland Health Review,  Finnish School Health Survey,  Finnish Statistical Bureau/FinnStat

Population: All Finland (2007) 5.3 million Indigenous2 (Saami)* 9,850 * Inari Saami have lived only in Finland, whereas the North Saami live in all Nordic countries (Finland, Sweden and Norway). The Skolt Saami migrated after the Second World War from the municipality of Petsamo, which now belongs to Russia. The Saami living in Saami Homeland (the northernmost part of Finland): 38.3 % The Saami living outside Saami Homeland: 61.7 %

Health and Mortality Statistics3 of Saami in Finland

Outcome of cohort study of 2091 Saami and 4161 non-Saami people. For the Saami:  The total mortality rate does not differ from that of the general population, but there are rather big differences in the details of the mortality patterns (e.g. cancer mortality is low, especially in men, and accidents and suicides are more common.  The mortality rate from ischemic heart disease of the Saami women was lower than that of the general population, but the mortality rate from other heart diseases was instead statistically significantly higher that that of the general population.  Cancer mortality of the Saami men was significantly lower than that of the general population. (may be related to their diet that is rich in reindeer meat and fish)  The mortality from accidents and violence was high.  The mortality from the breast cancer among Saami women was low.  Mortality from suicides among the Saami men was 70 % more common than in the general population.

For the Skolt Saami  The mortality statistics indicate that the overall health of the Skolt Saami is worse than other Saami groups and reflects the negative effects that acculturation has had on them.  The Skolt Saami had the highest SMR of suicides.  The Skolt Saami had high cancer mortality (Stomach cancer among Skolt is almost 4 times as common as among the Finnish average population and 7 times higher than among the other Saami).

Health and Mortality Statistics of Saami in Finland (continued)4

 Incidence of mental health problems is 3 times higher for youth of northernmost remote communities than for the total Province of Lapland.

2 The Indigenous Population Saami in Finland (North Saami, Inari Saami, Skolt Saami)

3Leena Soininen & Eero Pukkala, Int. J. Circumpolar Health 67:1:2008. 4 Sources: Health is everyone’s business/ Terveysasiat kuuluvat kaikille 2006; Health Review of Lapland/ Lapin terveyskatsaus 2005

Oke Health Care Consulting 17  Risk of accidents and injuries is 1.5 times higher for residents of northernmost remote communities than for the total Province of Lapland.  Use of medication among youth for most common chronic diseases (asthma, diabetes, and depression) and their compensation through national sickness insurance is 1,2 times higher for residents of Northernmost remote communities than for the total Province of Lapland.  Smoking is more prevalent in Lapland (men 35% women 24 %) than in Finland on average (men 28 % women 20 %). Among the Saami smoking is even more prevalent than among the average Lapland population.  Obesity is as prevalent in Lapland (BMI>25 men 58% women 38 %) as in Finland on average (BMI>25 men 56 % women 20 %).

Structures for Healthcare Delivery of Saami in Finland

 Publicly funded healthcare system (primary, secondary and tertiary care services) through municipal and state tax (”Beverage model national healthcare system). PHC provided through municipal PHC-centers.  User fees exist also in publicly funded health care and out of pocket fees in Finland comprise about 25 – 30 % of total healthcare expenditure (higher than average in EU).

Healthcare for Saami in Finland

The Saami population in the Finnish Province of Lapland lives totally integrated together with the rest of the population. There are no reserves and the Saami are not separately distinguished by their social security identification number or any other means. They enjoy all privileges and benefits that are stipulated by law to all residents and citizens of Finland. These benefits are mainly delivered to them through their residence municipality (three northern most municipalities are Enontekiö, Inari, Muonio, Savukoski; Pello, Sodankylä).

Healthcare system in Finland is of high standard and access is good for all. For the Saami as for other people living in northern most parts of Finland the problem is long distances difficulties in recruitment of PHC professionals (doctors, dentists and nurses).

Since 2002 a special additional state subsidy has been provided for northern Saami regions to improve availability of health and social services in Saami-language. The subsidy is allocated through the Saami parliament to Saami home municipalities. The Northern Finland Know-How Centre has a specific task to focus and develop Saami language in health- and social services (welfare-services in general, research, training, and evaluation).

Health and Healthcare Challenges of Saami in Finland

 General Healthcare Delivery Challenges o Shortage of adequate level of reliable surveillance data on indigenous Saami population. o Recruitment problems of health care professionals (doctors, nurses, dentists) with adequate knowledge of Saami language and culture. o Municipal budgets and economy under growing pressure for providing sufficient PHC and 2ry level (specialized) healthcare services for Saami- and other population in northern municipalities.

 Mental Health and Addiction o High rates of substance abuse, suicides and other mental health concerns. o Emerging complex issues such as youth illicit drug use, sexual harassment, family violence and concurrent mental health problems. As an indication of growing problems there are remarkably high rates of child protection interventions in some regions.

 Communicable Diseases (TB and HIV/AIDS)

Oke Health Care Consulting 18 o Tuberculosis amongst Saami in Finland is as low as among the rest of the population (prevalence under 10/ 100,000). o HIV/AIDS prevalence amongst Saami in Finland is practically zero.  Nutrition o Saami diet after fresh vegetables and fruit became universally accessible in 1960s has apparently been healthier than the diet of general Finnish population. Reindeer meat, fish and berries have been abundant in their diet. Positive changes (reduction) in (saturated) fat and sugar consumption since 970s have followed a positive trend inspired by the North-Karelia project. o Present day challenges and risks are the same as for general population: excessive energy intake through fat, sugar, chunk-food etc., sedentary lifestyle, excess consumption of beer and other high-calorie alcoholic beverages are causal factors for growing obesity and Type-2 Diabetes epidemic.  Primary Health Care Access o Need to improve access of culturally sensitive basic first contact services in Saami language (e.g. maternity and well-baby PHC-clinics/ counseling services and home- visiting). o Need to develop culturally sensitive special services (e.g. speech therapy) in Saami language. o Need to develop health promotion, health education and counseling services in Saami language and from Saami perspective.

Key Initiatives & Investments in Delivering Care to Saami People

Success-stories to date:

1. “Veahkki”: NGO-project for support and domiciliary services for Saami elderly. New models and patterns have now been incorporated into regular municipal social care services. 2. ”Bearašbargu”: NGO-project for support of Saami families. New models and patterns have now been incorporated into regular municipal family support services and into ”Women´s Safe Home” NGO work. 3. “ Virkkus Gilli”: NGO-project for support of Saami remote villages’ social cohesion. The project developed a multisectorial model for better collaboration between municipalities and NGOs. 4. ” Culture-interpreter”: NGO-project in Lapland’s Hospital District for language and culture interpreter action. The project has developed counseling material in Saami language and a native Saami-speaking social worker was established. 5. The right of provision of health & social services in own native language for Saami population has received recognition and acceptance at highest political level (Law on Saami language 812/2000).

Current Priority Initiatives

1. Dictionary of health sector terminology in Saami language has been developed. Work continues. Material for alcohol prevention program and health education will soon be available. 2. Remote (tele-) interpreter service is being developed for the health sector. 3. NGO-project in development for Saami families with children, for youth, for working aged population and for the elderly. They focus on improving specialist (2ry-level) services, strengthening social inclusion and cohesion, solving acute problems linked with special life circumstances, hazardous and harmful use of alcohol, etc. NGO-project to develop culturally sensitive health promotion and counseling material in Saami language

Oke Health Care Consulting 19 APPENDIX C – FIRST NATIONS and INUIT IN CANADA – Poster

CANADA OVERVIEW

Facts Demographics

SOURCE : 2006 Census CANADA INDIGENOUS (FIRST NATIONS, METIS, INUIT Population 31,612,897 1,172,785 Median Age 39.5 26.5 Median Income $25,615 $16,572 Population over 15 yrs with 76.2 % 56.3 % High School Certificate Population over 15 yrs with 18.1 % 5.8 % University Degree

Health Statistics  In 2001, life expectancy at birth for the Registered Indian population was 6.6 years lower than the overall Canadian population.  First Nations youth suicide (10-19 yrs) was 4.3 times greater than for Canadian youth in 2000. The suicide rate for Inuit regions (1989-2003) was 8.3 times higher than for Canada.  Impact of alcohol and drugs on First Nations communities is great. Alcohol- related deaths were 6 times higher, and drug-induced deaths were more than 3 times higher than that of the general population.  The prevalence of diabetes is 3.8 times higher for First Nations than for the general Canadian population.  In 2006, the incidence of TB was 5.8 times higher for Registered Indians and 22.9 times higher for Inuit than for the general Canadian population.  Indigenous peoples accounted for an estimated 7.5% of all existing HIV infections in Canada, in 2005.  In 2006, Indigenous populations accounted for 3.8% of the total population of Canada.

STRUCTURES FOR HEALTH CARE DELIVERY  Publically funded system with 100% coverage for physician, hospital, other medically necessary health services, public health and home care nursing for the whole Canadian population.  Indigenous health system a shared responsibility between federal and provincial governments.

CHALLENGES Care Delivery Challenges – General  30% of population in remote and isolated communities, remainder in rural, average population size 600.  Shortage of health cares professionals and certified Indigenous staff.  Little integration with provincial health services.  Increasing complexity of care needs.

Oke Health Care Consulting 20  Increasing funding pressures.

Mental Health and Addiction

 High rates of substance abuse, youth suicide and other mental health concerns.  Emerging complex issues such as youth illicit drug use and concurrent mental health, and addictions problems.

Communicable Diseases (TB and HIV/AIDS)

 Lack of adequate level of services and reliable surveillance data, HIV population faces issues of stigma and discrimination.  To develop a First Nations TB strategy, including TB-specific infection strategies in Indigenous communities, enhanced HIV surveillance, support on-reserve community-led prevention program and care and support networks.

Nutrition

 Food security is a major issue, particularly in the North and in remote areas.

Primary Health Care Access

 Components present but not integrated; local access to primary health care limited; health system navigation difficult due to culture and other barriers.  Need to develop comprehensive framework, strategy and plan to achieve holistic Public Health Care System.

KEY INIATIVES AND INVESTMENTS IN DELIVERING CARE TO TARGET POPULATIONS Success Stories to Date  Mental Wellness Strategic Action Plan Developed.  First-ever Food Guide tailored for First Nations, Inuit and Métis developed.  Telehealth in 200 communities has improved access to primary and specialist physician services.  Home and Community Care Program has improved access for acute and chronically ill and facilitates “Aging in Place”.

Current Priority Initiatives  Development and Implementation of Tripartite Health Agreements (federal/provincial/First Nations).  Provide support for up to 80,000 residential school students.  Double number of Aboriginal health professionals.  Integrate and adapt existing provincial & federal health systems.  Enhance and modernize addictions programs.  Implementation of Mental Wellness Teams.  To increase accessibility and affordability of healthy food.  Expansion of E-Health Initiatives.

Oke Health Care Consulting 21 APPENDIX D - PARTICIPANTS

Meeting on Health of Indigenous and Remote Northern Communities Gatineau, Quebec, Canada 20-21 November 2008

PARTNERS

Canada

Mr. Robert Shearer Ms Andrea Coady Health and Social Affairs Counsellor National Tuberculosis Nurse Advisor Mission of Canada to the European Union Communicable Disease Control Division Avenue de Tervuren, 2 First Nations and Inuit Health Branch 1040 Brussels 200 Eglantine Drive, Tunney’s Pasture BELGIUM Ottawa, Ontario K1A 0K9 Phone: +32 2 741 07 80 CANADA Fax: +32 2 741 06 97 Phone: +1-613-952-6923 E-mail: [email protected] Fax: +1-613-948-9254 E-mail: [email protected] Dr.Kim Barker Public Health Advisor Mr. Christopher Cornish Assembly of first Nations Director, Northern Region Trebla Building Policy, Planning and Evaluation 473 Albert Street, Suite 810 Regions and Programs Branch Ottawa, Ontario K1R 5B4 60 Queen Street CANADA Ottawa, Ontario K1A 0K9 Phone: +1-613-241-6789 CANADA Fax: + 1-613-241-5808 Phone: +1-613-948-6754 E-mail: K [email protected] Fax: +1-613-948-2428 E-mail: [email protected] Ms Andrea Botto Policy Officer Mr. Elmer Courchene Health Systems Development Assembly of First Nations Resident Elder First Nations and Inuit Health Branch 473 Albert Street, 8th Floor 200 Eglantine Drive, Tunney’s Pasture Ottawa, Ontario K1R 5B4 Ottawa, Ontario K1A 0K9 Phone: +1-613-292-5435 CANADA Fax: +1-613-241-5808 Phone: + 1-613-946-6659 E-mail: [email protected] Fax: + 1-613-954-0765 E-mail: [email protected] Mr. Ernie Dal Grande Mr. John Cheechoo National Telehealth Program Manager Policy Analyst Primary Health Care Inuit Tapiriit Kanatami First Nation and Inuit Health Branch 170 Laurier Avenue West, Suite 510 150 Tunney’s Pasture Driveway Ottawa, Ontario K1P 5V5 Tunney’s Pasture CANADA Ottawa, Ontario K1A 0K9 Phone: +1-613-238-8181 ext 285 CANADA Fax: +1-613-234-1991 Phone: +1-613-954-1736 E-mail: [email protected] Fax: +1-613-946-4571 E-mail: [email protected] Dr. Thomas Dignan

Oke Health Care Consulting 22 A/Regional Community Medicine Specialist Ms Louise Garrow Ontario Region, Regions and Programs Program Officer Branch Health Systems Development 28 Cumberland Street North First Nations and Inuit Health Branch Thunder Bay, Ontario P7A 4K9 200 Eglantine Drive, Tunney’s Pasture CANADA Ottawa, Ontario K1A 0K9 Phone: +1-807-343-5359 CANADA Fax: +1-807-344-6184 Phone: +1-613-946-0679 E-mail: [email protected] Fax: +1-613-954-0765 E-mail: [email protected] Ms Nubiya Enuaraq Youth Suicide Prevention Coordinator Ms. Ann Marie Hume Inuit Tapiriit Kanatami Director General, 170 Laurier Avenue West, Suite 510Ottawa, Public Health, Ontario, Canada K1P 5V5 Correctional Service Canada CANADA 427 Laurier ave. W Phone: +1-613-238-8181 Ottawa, Ontario, Canada Fax: +1-613-234-1991 K1A 0P9 E-mail: [email protected] Phone: +1-613- 992-8792 E-mail: [email protected] Ms. Melissa Follen Senior Policy Analyst Mr. Bob Imrie Health Systems Development Senior Policy Advisor First Nations and Inuit Health Branch Office of Inuit Health 200 Eglantine Drive, Tunney’s Pasture First Nations and Inuit Health Branch Ottawa, Ontario K1A 0K9 200 Eglantine Drive, Tunney’s Pasture CANADA Ottawa, Ontario K1A 0K9 Phone: +1-613-948-2420 CANADA Fax: +1-613-954-0765 Phone: +1-613-941-4429 E-mail: [email protected] Fax: +1-613-952-5770 E-mail: [email protected] Ms Elizabeth Ford Director of Health and Environment Ms. Marita Killen Inuit Tapiriit Kanatami Program Officer 170 Laurier Avenue West, Suite 510 International Affairs Directorate Ottawa, Ontario K1P 5V5 Strategic Policy Branch CANADA 200 Eglantine Drive, Tunney’s Pasture Phone: +1-613-238-8181 Ottawa, Ontario K1A 0K9 Fax: +1-613-234-1991 Phone: +1-613-941-4765 E-mail: [email protected] Fax: +1-613-957-4195 E-mail: [email protected] Ms Anna Fowler Senior Policy Advisor Ms. Michelle Kovacevic Office of Inuit Health Director General First Nations and Inuit Health Branch Strategic Policy, Planning and Analysis 200 Eglantine Drive, Tunney’s Pasture First Nations and Inuit Health Branch Ottawa, Ontario K1A 0K9 200 Eglantine Drive, Tunney’s Pasture CANADA Ottawa, Ontario K1A 0K9 Phone: +1-613-948-6759 Phone: +1-613- 957-3402 Fax: +1-613-952-5770 Fax: +1-613-952-5770 E-mail: [email protected] E-mail: [email protected]

Oke Health Care Consulting 23 Ms. Eva Kruemmel Ms. Onalee Randell Senior Health Researcher Director Inuit Circumpolar Council Office of Inuit Health 170 Laurier Avenue West, Suite 504 First Nations and Inuit Health Branch Ottawa, Ontario K1P 5V5 200 Eglantine Drive, Tunney’s Pasture CANADA Ottawa, Ontario K1A 0K9 Phone: +1-613-563-2642 CANADA Fax: +1-613-565-3089 Phone: + 1-613-941-1606 E-mail : [email protected] Fax: +1-613- 952-5770 E-mail: [email protected] Ms. Kathy Langlois Director General Ms. Debbie L. Reid Community Programs Directorate Director First Nations and Inuit Health Branch Strategic Policy and Planning 200 Eglantine Drive, Tunney’s Pasture First Nations and Inuit Health Branch Ottawa, Ontario K1A 0K9 200 Eglantine Drive, Tunney’s Pasture CANADA Ottawa, Ontario K1A 0K9 Phone: + 1-613-952-9616 CANADA Fax: +1-613-941-3170 Phone: + 1-613-941-4359 E-mail: [email protected] Fax: +1-613- 948-2179 E-mail: [email protected] Ms Dorothy Laplante A/Executive Director Ms Irene Roberts Office of Nursing Services Special Advisor, Public Health Branch First Nations and Inuit Health Branch Health Services 200 Eglantine Drive, Tunney’s Pasture Correctional Service Canada Ottawa, Ontario K1A 0K9 340 Laurier Street CANADA Ottawa, Ontario K1A 0P9 Phone: +1-613-946-0442 CANADA Fax: +1-613-957-9986 Phone: +1-613-995-9901 E-mail: [email protected] Fax: +1-613-995-5064 E-mail: [email protected] Ms. Valerie Leinan Manager, Northern Strategic Issues Ms. Janet Hatcher Roberts Strategic Policy Directorate Executive Director Public Health Agency of Canada Canadian Society for International Health 130 Colonnade Road 1 Nicholas St, Suite 1105 Ottawa, Ontario K1A0K9 Ottawa, Ontario K1N 7B7 CANADA CANADA Phone: +1-613-941-5415 Phone: +1-613-241-5785 Fax: +1-613-946-2062 Fax: +1-613-241-3845 E-mail: [email protected] E-mail: [email protected]

Ms Fiona Miller Ms. Anne-Marie Robinson Senior Policy Advisor Assistant Deputy Minister International Affairs Directorate First Nations and Inuit Health Branch Strategic Policy Branch 200 Eglantine Drive, Tunney’s Pasture 200 Eglantine Drive, Tunney’s Pasture Ottawa, Ontario K1A 0K9 Ottawa, Ontario K1A 0K9 CANADA CANADA Phone: +1-613-957-7701 Phone: +1-613-957-7293 Fax: +1-613-957-1118 Fax: +1-613-952-7417 E-mail: [email protected] E-mail: [email protected]

Oke Health Care Consulting 24 Ms Hannah Rogers Ms Mary Trifonopoulos Assistant Executive Director Senior Nutritionist Health Systems Development Chronic Disease and Injury Prevention First Nations and Inuit Health Branch First Nations and Inuit Health Branch 200 Eglantine Drive, Tunney’s Pasture 200 Eglantine Drive, Tunney’s Pasture Ottawa, Ontario K1A 0K9 Ottawa, Ontario K1A 0K9 CANADA CANADA Phone: +1-613-957-7712 Phone: +1-613-946-1937 Fax: +1-613-954-0765 Fax: +1-613-954-8107 E-mail: [email protected] E-mail: [email protected]

Mr. Edmond Roy Ms Sarah Trottier Senior Policy Advisor Policy Analyst, Northern Region Health System Development Regions and Programs Branch First Nations and Inuit Health Branch 60 Queen Street 200 Eglantine Drive, Tunney’s Pasture Ottawa, Ontario K1A 0K9 Ottawa, Ontario K1A 0K9 CANADA CANADA Phone: +1-613-954-7119 Phone:+1-613-948-5441 Fax: +1-613-948-2428 Fax: +1-613-954-0765 E-mail: [email protected] E-mail: [email protected] Ms. Jacqueline Arthur Mr. Mark Schindel A./Manager, Population Section Senior Policy Analyst Public Health Agency Canada Mental Health/Addictions 100 Eglantine Driveway, Tunney's Pasture First Nations and Inuit Health Branch Ottawa, Ontario, K1A 0K9 200 Eglantine Drive, Tunney’s Pasture CANADA Ottawa, Ontario K1A 0K9 Phone: + 1-613-957-7477 CANADA Fax: +1-613-952-3556 Phone:+613-954-2295 E-mail: [email protected] Fax: + 1-6136-946-0649 E-mail: [email protected] Ms. Kelly Folz Head, Sexual Health Promotion and STI Mr. Jonathan Thompson Prevention A/Senior Director Public Health Agency of Canada Assembly of First Nations 200 Eglantine Driveway, Tuney’s Pasture Trebla Building Ottawa, Ontario, K1AoK9 473 Albert Street, Suite 810 Phone: +1-613-954-5318 Ottawa, Ontario K1R 5B4 Fax: +1-613-957-0381 CANADA Phone: +1-613-241-6789Fax: + 1-613-241- Ms. Kelly Stone 5808 Director, Childhood and Adolescence E-mail: [email protected] Public Health Agency of Canada 200 Eglantine Driveway, Tuney’s Pasture Ms Jackie Thorne Ottawa, Ontario, K1AoK9 Senior Policy Analyst Phone: +1-613-286-4688 Health Systems Development Fax: +1-613-946-2324 First Nations and Inuit Health Branch 200 Eglantine Drive, Tunney’s Pasture Ottawa, Ontario K1A 0K9 CANADA Phone:+1-613-952-3106 Fax: +1-613-954-0765 E-mail: [email protected]

Oke Health Care Consulting 25 Denmark Finland

Mr. Mogens Jörgensen Mrs. Maria Waltari Head of Division for International Affairs Senior Officer Ministry of Health and Prevention Ministry of Social Affairs and Health Slotsholmsgade 10-12 P.O.BOX 33 1216 Copenhagen K 00023 Helsinki, Government DENMARK FINLAND Phone: +45 7226 9600 Phone: +358 9 16074193 Fax: +45 7226 9607 Fax: +358 9 16073296 E-mail: [email protected] E-mail: [email protected]

Mrs. Lis Witsø-Lund Mr. Kalle Kankaanpää Senior Adviser Counsellor Ministry of Social Welfare Ministry for Foreign Affairs Holmens Kanal 22 Laivastokatu 22, P.O. Box 428 DK-1060 Copenhagen K Copenhagen 00023 Government, Helsinki Denmark FINLAND Phone: +45 33929310 Phone: +358 9 160 55432 Fax: +45 33924278 Fax: +358 9 160 56120 E-mail: [email protected] E-mail: [email protected]

Dr. Birgit Niclasen Mrs. MA Paula Karppinen-Lehtonen Gp, PhD student Consul National Institute of Public Health Consulate General of Finland in St. Avallia 13, P.O. Box 7011 Petersburg 3905 Nuussuaq Preobrazhenskaya pl. 4 GREENLAND 191028 St. Petersburg Phone: +299 523832 Russian Federation Fax: + 299 342481 Phone: +359 9 75162 406 E-mail: [email protected]; Fax: +7 812 331 7612 [email protected] E-mail: [email protected]

Estonia Ms. Minna Rasmus Researcher Ms. Triin Uusberg Ministry of Social Affairs and Health Head of EU coordination Merikoskenkatu 10 as 17 Ministry of Social Affairs of Estonia Oulu 90500 Gonsiori 29 FINLAND 15027 Tallinn Phone: +358404190570 ESTONIA Fax: +35885533451 Phone: +372 6269 242 E-mail: [email protected] Fax: +372 699 2209 E-mail: [email protected] Dr. Lydia Heikkila Project coordinator Sámi Soster Organization Ounastie 2060 99410 Vuontisjarvi FINLAND Phone: +358 40 5940559 Fax: +358 16 546 201 E-mail: [email protected]

France

Oke Health Care Consulting 26 Norway (NDPHS Chair Country) No registrants Ms. Toril Roscher-Nielsen Director General Germany Ministry of Health and Care Services P.O. Box 8011 Dep Mr. Thomas Ifland 0030 Oslo Officer NORWAY Federal Ministry of Health Phone: + 47 22 24 8420 Rochustrasse 1 Fax: + 47 22 24 9577 53121 Bonn E-mail: [email protected] GERMANY Phone: +49 228 941 3311 Dr. Ole Mathis Hetta Fax: +49 228 941 4945 Senior Advicor Sami Public Health, MD E-mail: [email protected] Directorate of Health, Godalsv 4 N-4015 Stavanger Iceland NORWAY Phone: +47 51568750 No registrants Fax: + 47 51530079 E-mail: [email protected]

Latvia Ms. Vibeke Gundersen Senior Adviser Mr. Rinalds Muciņš Ministry of Health and Care Services Deputy State Secretary Einar Gerhardsens plass 3 Ministry of Health of the Republic of Latvia 0030 Oslo 1011 Riga NORWAY LATVIA Phone: + 47 22 24 87 73 Phone: 00371 67876001 Fax: + 47 22 24 95 77 Fax: 00371 67876002 E-mail: [email protected] E-mail: [email protected]

Lithuania Poland

Mr. Viktoras Meižis No registrants Head of Foreign Affairs Division Lithuanian Ministry of Health Vilniaus 33 01506 Vilnius LITHUANIA Phone: +370 526 61420 Fax: +370 526 6 1402 E-mail: [email protected]

Oke Health Care Consulting 27 Russian Federation (Co-Chair Country) Council of the Baltic Sea States (CBSS)

Dr. Mikhail Murashko Represented by Denmark (CBSS Minister of Health Presidency) Ministry of Health Lenina Street 73 167981 Syktyvkar Nordic Council of Ministers RUSSIAN FEDERATION Phone: +7-8212-440777 Ms. Maria-Pia de Palo Fax: +7-8212-441325 Senior Advisor E-mail: [email protected] Nordic Council of Ministers Storestrandstræde 18 Mr. Andrey Avetisyan 1255 Copenhagen Deputy Director DENMARK Department of European Cooperation Phone: +45 29692990 Ministry of Foreign Affairs Fax: + 4533960216 Smolenskaya-Sennaya Pl. 32-34 E-mail: [email protected] 119200 Moscow RUSSIAN FEDERATION Phone: + 7 495 2444534 NDPHS EXPERT GROUPS Fax: + +74952444338 E-mail: [email protected] HIV/AIDS EG

Mr. Yuri Proskurnikov Prof. Pauli Leinikki Secretary-referent HIV/AIDS EG Chair Departament of European Cooperarion Yölinnuntie 1 Smolenskaya-Sennaya 32/34 02660 Espoo 119200 Moscow FINLAND RUSSIAN FEDERATION Phone: +358405524314 Phone: +7(495)255 25 66 Fax: Not available Fax: +7(495)241 96 02 E-mail: [email protected] E-mail: [email protected] Mrs. Outi Karvonen Dr. Vitaly Chzao HIV AIDS EG International Technical Chief Doctor Adviser Komi AIDS Centre Lintulahdenkuja 4 Pushkina street 103 00530 Helsinki 167004 Syktyvkar Finland Russian Federation Phone: +358-939672046 Phone: +7-8212-229826 Fax: +358-97732922 Fax: +7-8212-211824 E-mail: [email protected] E-mail: [email protected]

PH EG Sweden Ms. Ingrid Lycke Ellingsen Ms. Kerstin Ödman PH EG Chair Senior Adviser Styrmoes vei 13 Ministry of Health and Social Affairs 3043 Drammen 103 33 Stockholm NORWAY SWEDEN Phone: +47 32832370 Phone: +46 8 405 22 46 E-mail: [email protected] Fax: +46 8 21 78 76 E-mail: [email protected]

Oke Health Care Consulting 28 Dr. Zaza Tsereteli INVITED GUESTS PH EG International Technical Advisor J.Vilmsi 6-3 United States 10126 Tallinn ESTONIA Dr. Alan Parkinson Phone: +372 5 26 93 15 Deputy Director Fax: +372 6 410 200 Arctic Investigations Program E-mail: [email protected] 4055 Tudor Centre Drive 99508 Anchorage, Alaska UNITED STATES PHC EG Phone: 907 729 3407 Fax: 907 729 3429 Dr. Göran Carlsson E-mail: [email protected] PHC EG Chair Erstag. 1F SE-11691 Stockholm NDPHS SECRETARIAT SWEDEN Phone: +4684413351 Mr. Marek Maciejowski Fax: +4686187660 Head of Secretariat E-mail: [email protected] P.O. Box 2010 103 11 Stockholm SWEDEN SIHLWA EG Phone: +46 8 440 1938 Fax: +46 8 440 1944 Dr. Mikko Vienonen E-mail: [email protected] SIHLWA EG Coordinating Chair Sysimiehenkuja 1 Mr. Bernd Treichel 00670 Helsinki Senior Advisor FINLAND P.O. Box 2010 Phone: +358 50 44 21 877 103 11 Stockholm E-mail: [email protected] SWEDEN Phone: +46 8 440 1946 Ms. Hanna Koppelomäki Fax: +46 8 440 1944 SIHLWA EG International Technical Adviser E-mail: [email protected] Mannerheimintie 166 00300 Helsinki FINLAND Fax: +358947448338 E-mail: [email protected] Phone: +358947448327

Oke Health Care Consulting 29 Health of Indigenous and Remote Northern Communities

NOV 20 &21, 2008

APPENDIX E

Health of Indigenous and Remote Northern Communities Meeting hosted by First Nations and Inuit Health Branch (FNIHB) for the NDPHS Museum of Civilization, Gatineau, Quebec, November 20 to 21, 2008

AGENDA

THURSDAY NOVEMBER 20 7:30 – 8:00 Morning Refreshments 8:00 – 8:30 Welcome & Overview

. Opening Prayer: Elder Elmer Courchene, Assembly of First Nations . Greetings: Anne-Marie Robinson, Assistant Deputy Minister, First Nations and Inuit Health Branch, Health Canada . Impetus for the Meeting: Robert Shearer, Canadian Representative to Committee of Special Representatives, NDPHS

8:30 – 9:00 Setting the Context Presentations 1. Eva Kruemmel, Senior Health Researcher, Inuit Circumpolar Conference 2. Minna Rasmus, Researcher for Office of Ombudsman for Children, Finland 9:00 – 10:15 Spotlight on Canada

. Presentations 1. Debbie Reid, Director, Strategic Policy and Planning, First Nations & Inuit Health Branch, Health Canada 2. Jonathan Thompson, A/Senior Director, Health & Social Development Secretariat, Assembly of First Nations (AFN) 3. Elizabeth Ford, Director Health and Environment, Inuit Tapiriit Kanatami (ITK) . Questions & Answers

10:15 – 10:30 Break 10:30 – 11:45 Mental Health and Addiction . Presentations 1. Valentina Sovkina, Expert, Working Group of Indigenous Peoples of the Barents Euro-Arctic Council, Russia 2. Viktoras Meizis, Head of the Foreign Affairs Division, Ministry of Health, Lithuania 3. Kathy Langlois, Director General, Community Programs, First Nations and Inuit Health Branch, Health Canada . Discussion: - What are our common interests in this area? - What might we like to accomplish together?

OKE HEALTH CARE CONSULTING 30 Health of Indigenous and Remote Northern Communities

NOV 20 &21, 2008

THURSDAY NOVEMBER 20 - What is possible? 11:45 – 13:00 Primary Healthcare Delivery . Presentations 1. Dorothy LaPlante, Nurse Practitioner, Office of Nursing Services, First Nations and Inuit Health Branch, Health Canada 2. Ernie dal Grande, National Program Manager for eHealth, Primary Health Care, Nations and Inuit Health Branch, Health Canada 3. Ole Mathis Hetta, Senior Advisor Sámi Public Health, Norway . Discussion: - What are our common interests in this area? - What might we like to accomplish together? - What is possible?

13:00 – 14:00 Lunch & Networking 14:00 – 15:15 Communicable Diseases . Presentations 1. Vitaly Chzhao, Chief Physician of the Republican AIDS Centre, Republic of Komi, Russia 2. Alan J. Parkinson, Deputy Director, Arctic Investigations Program, Centers for Disease Control & Prevention, Alaska, USA 3. Kim Barker, Public Health Advisor, Assembly of First Nations, Canada . Discussion: - What are our common interests in this area? - What might we like to accomplish together? - What is possible? 15:15 – 15:30 Break 15:30 – 16:45 Nutrition . Presentations 1. Mikko Vienonen, Chairperson Social Inclusion, Healthy Lifestyles and Work Ability (SIHLWA) Working Group, NDPHS 2. Birgit Niclassen, MD &PhD student, Institute for Health Research, Greenland 3. John Cheechoo, Policy Analyst, Health and Environment,Inuit Tapiriit Kanatami, Canada . Discussion: - What are our common interests in this area? - What might we like to accomplish together? - What is possible? 16:45 – 17:00 Conclusion Day 1 18:00 -> Dinner and Cultural Event

OKE HEALTH CARE CONSULTING 31 Health of Indigenous and Remote Northern Communities

NOV 20 &21, 2008

FRIDAY NOVEMBER 21 Time Focus 8:00 – 9:00 Morning Refreshments & Networking

9:00 – 9:30 Summary of Outputs from Day 1 Focus Group Sessions

9:30 – 10:45 Consensus Building . What will we undertake together over the next 18 months? . Who will take responsibility to initiate the required action? . Next Steps

10:45 – 11:00 Closure  Closing Remarks: Toril Roscher-Nielsen , Director General, Ministry of Health and Care Services, Norway, NDPHS Committee Chair  Closing Prayer: Inuit Elder 11:00 –>> Bilateral meetings with Canadian counterparts (over lunch and/or in the afternoon) 11:00 –>> For individuals not involved in bilateral meetings.  Coffee and networking discussions  Visit to Museum of Civilization (optional)

OKE HEALTH CARE CONSULTING 32