Component Studies Socio-Economic Environment
Socio-Economic
Report 2 of 6
Community Health Study
January 2009
Environmental Impact Statement for the Lower Churchill Hydroelectric Generation Project
LOWER CHURCHILL HYDROELECTRIC GENERATION PROJECT: COMMUNITY HEALTH STUDY
ENVIRONMENTAL BASELINE REPORT LCP 535785
FINAL REPORT
DECEMBER 22, 2008
Aura Environmental Research and Consulting Ltd. for Minaskuat Inc.
Lower Churchill Hydroelectric Generation Project
ACKNOWLEDGEMENTS We wish to acknowledge Mark Shrimpton, Linda Jefferson and Colleen Leader with Minaskuat Inc. for providing study guidance and logistical support. We also acknowledge the following individuals for providing data and assistance with identifying key issues and health concerns pertinent to the communities and the region:
• Doug Abbass (Principal, Peacock Primary School, Happy Valley-Goose Bay) • Dr. Maureen Baikie (Medical Officer of Health, Labrador Grenfell Health) • Andrew Battcock (Labrador School Board) • Carol Best (Labrador Central Economic Development Board) • Teresa Bruce (Retired Teacher, Sheshatshiu) • Delia Connell (Community and Aboriginal Affairs, Labrador-Grenfell) • Genevieve Corbin (Regional Director, Child Youth and Family Services) • Deanne Costello (Regional Director, Mental Health and Addictions Services) • Dolores Dooley (Program Consultant, Health and Community Services) • Blenda Dredge (Regional Director, Rehabilitation and Intervention Services) • Jan Dymond (Regional Director, Consumers’ Health Awareness Network Newfoundland and Labrador) • Nicole Edwards (Newfoundland and Labrador Centre for Health Information) • Brian Fallow (Labrador North Chamber of Commerce) • Nelson Flynn (Regional Director Newfoundland and Labrador Housing) • Cpl. Keith MacKinnon (Labrador District Drug Awareness Coordinator RCMP) • Patti Moore (Occupational Therapist) • Sandy Penney (Addictions Service Coordinator) • Stacy Ramey (Public Health Nurse, Labrador Health Centre) • Agnes Rumbolt (Regional Director, Newfoundland and Labrador Human Resources) • Bob Simms (District Administrator, College of the North Atlantic) • Ozette Simpson (Chief Operating Officer, Captain William Jackman Memorial Hospital) • Jason St. Marie (Hyron Economic Development Board) • Dee Dee Voisey (Public Health Nurse, Labrador) • Jackie Whelan (Regional Director for Community Youth Corrections, Community Agencies and Child Care Services) • Henry Windeler (Labrador School Board)
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EXECUTIVE SUMMARY
Background In March 2007, Aura Environmental Research and Consulting Ltd., through Minaskuat Limited Partnership, was retained by Newfoundland and Labrador Hydro to conduct a Community Health Baseline Study in response to a proposed hydroelectric project in the Lower Churchill River area. The purpose of the study was to provide the community-health baseline for the Project EIS Study Area, identifying current community health issues and trends within the region. The overall objective was to generate a baseline understanding from which social and community health impacts may be identified, and appropriate mitigation and ‘issues-based’ health indicator monitoring programs developed. Within the context of this report, the definition of health is interpreted much more broadly than physical health and the absence of disease; it focuses on social and psychological well-being and the capacity to respond to changing circumstances and conditions of life in the Labrador region. The overall approach to the baselines study was guided by Health Canada’s determinants of health framework, encompassing a broad range of social, community, and physical health indicators. Development of the health baseline consisted of three phases: a literature review, compilation and analysis of secondary source health determinant data for the Study Area, and primary data collection based on interviews with local key informants.
Determinants of Health Health Services
• Only 61.4 percent of the population in the Upper Lake Melville area, aged 12 years and older, report having a regular medical doctor, in comparison to 92.1 percent in Labrador West/Churchill Falls. • There is an increasing demand for mental health services and treatment facilities in the Study Area. Mental health addictions are reported to have become more acute in the past five years. Wait times of up to 9 to 10 weeks exist for the limited mental health services that do exist. The Labrador region in general, and coastal communities in particular, lacks the necessary resources and capacity to deal with increasing mental health problems and addictions. • While there is a dedicated effort to recruit more healthcare workers and professionals to the Labrador region, and in particular to the Innu communities, what is lacking is individuals with experience in working with Innu and in understanding Innu practices, culture and traditional health systems. • Social health problems, including solvent abuse and alcoholism are addressed temporarily, and tend to resurface. What may be lacking in the Innu health care system is in-community follow- up and monitoring.
Lifestyle, Health Practices and Coping Skills
• Alcohol and solvent abuse is one of the most important social health problems in the Study Area. Such abuse is especially rooted in the social and family conditions found in the Innu communities. The consequences are often acute toxicity, neurological damage, or death of the individual.
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• Drug and alcohol awareness and education programs are in place in the local school systems; however, there is no reliable measure of effectiveness. • The smoking rate in Labrador is higher than the provincial average, with a reported 27 percent smoking rate in the Upper Lake Melville area. This is most pronounced among the female population. • Affordability and availability are amongst the major challenges to a healthy diet for those who recognize its importance. There are several school-based initiatives in the Study Area to promote healthier eating practices; low parental awareness of the benefits of nutrition initiatives is amongst the program’s most important challenges. • More than 66 percent of the population in the Upper Lake Melville and Churchill Falls area are either overweight or obese, based on BMI category. Nutrition programs have been developed in select elementary schools to target obesity and to inform healthy eating habits. • An increased risk of Type II diabetes is present in Labrador. Typically, diabetes (along with cancer, obesity, hypertension and heart disease) is rare in hunter-gatherer societies, but becomes more common following the loss of traditional ways. • Gambling activity, particularly video lottery terminal addictions, is reported to have become much more prevalent in Labrador in recent years. While the Labrador health region has amongst the lowest gambling rates in the Province, it has the highest proportion of problem gamblers. Problem gambling is associated with social relationship problems, increased levels of alcohol and drug addictions, depression and suicide. Gambling rates among the Innu are not known. • In 2001, the age-adjusted suicide rate for the Labrador region was nearly four times that of the Province, at 27 per 100,000 people. As of 2001, 42 percent in Sheshatshiu had thought actively about killing themselves and 28 percent had attempted suicide.
Diseases, Biology and Genetic Endowment
• Within the Study Area, diseases of the respiratory system the most common separation at 21.4 percent in Labrador Central/Upper Lake Melville and 26.9 percent in Labrador West/Churchill Falls. Between 2000 and 2005, as a percentage of hospital separations, diseases of the digestive system remained high in Sheshatshiu, averaging 10 percent of hospital separations. Diseases of the respiratory system averaged 10.6 percent of separations and diseases of the circulatory system 5.9 percent. • In Sheshatshiu and Natuashish, a disproportionate number of people are dying at a younger age in comparison to the Province. Deaths in Sheshatshiu and Natuashish for individuals under 20 years of age comprised 11.1 and 40 percent, respectively, in comparison to 2.7 percent at the provincial level, 7.7 percent for Labrador West and 6.8 percent for Upper Lake Melville as a whole.
Healthy Childhood Development
• Women in Labrador have children at considerably younger ages than the than the Province/Labrador as a whole. Births to young mothers are most pronounced in the communities of Sheshatshiu and Natuashish. Younger mothers are more likely to comprise single-parent families and have lower median family incomes. Teenage pregnancies can also lead to such social problems as disruptions in educational achievement.
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• Excessive alcohol consumption has been linked to higher incidences of child neglect, family dysfunction, child abuse and learning disabilities. The current state of children in care has been described as a system in crisis and the capacity within communities to provide adequate care- qualified persons is lacking. During 2000, 716 children in the Labrador region (10.9 percent of the provincial total) received protective services. • The Innu population in Sheshatshiu is growing. With growth in the community comes the need for more housing, education facilities and health service personnel. • There is limited capacity in the regional health care system, particularly in the Innu communities, to care for children with disabilities. There are a limited number of adequately trained health care professionals in the region to manage the growing numbers of children that require special care for mental illnesses, autism, or other severe disabilities. Education • Educational achievement is considerably below the provincial norm, particularly in the communities of Sheshatshiu and Natuashish. Amongst the challenges are language difficulties for Innu-speaking children in English language schools with non-Innu-speaking teachers, low school attendance, and alcohol abuse. • Educational attainment in central and western Labrador is higher than the provincial average. However, the proportion of the adult population with less than a high school education in Sheshatshiu and Natuashish is 70.1 and 70.9 percent, respectively; more than double the provincial general population statistic. • Of important concern are high teacher and support-staff turnover and the difficulty in finding teacher replacements - particularly specialized teachers. Between 2003 and 2004, there was an estimated 60 percent turn-over rate. The main reasons given for leaving Labrador included: isolation; lack of amenities; and difficulties adapting to the culture. • There is the lack of teachers trained in the Innu language or trained to teach English as a second language. Innu content has been introduced into the school setting; however, there are criticisms that it lacks meaning as the teachers are predominately non-Innu and unfamiliar with the Innu language and culture.
Social Support Networks and Environments
• There has been a marked increase in demand for senior’s care facilities and services in the past five years. The lack of senior care facilities and services in the Study Area, specifically in the non-Innu communities and urban areas, is an important concern. • The increase in the proportion of the population requiring senior care facilities is less pronounced in the Innu communities of Sheshatshiu and Natuashish, where only 4 and 3.5 percent of the population, respectively, is >65 years of age, in comparison to 6.3 percent for the Labrador region and 13.9 percent for the Province. • For those Innu who use the mainstream health care system, there is concern over the availability of traditional foods and that non-Innu health providers do not adequately understand Innu culture and health practices. • Access to affordable housing is a basic necessity for human health. There is currently an overall lack of available housing in the Study Area, and in particular subsidized or low-income housing. There is a waiting list of approximately 40 to 45 names for Newfoundland and
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Labrador Housing. The availability of housing suitable for health care workers and police staff is also limited in Labrador.
Income, Employment, and Social Status
• The employment rates for Sheshatshiu (including North West River) and Natuashish are 53.0 and 47.7 percent, respectively, compared to the provincial rate of 47.9 percent. In addition, Sheshatshiu and Natuashish have significantly higher unemployment rates than other communities within the Study Area. • The median family income for couple households for Sheshatshiu (including North West River) in 2004 was $61,500, in comparison to $57,400 in Natuashish. While this is above the Province at $51,800, it is considerably below the regional median family incomes of $85,300 for Labrador West/Churchill Falls and $72,900 for the Upper Lake Melville area. • In 2006, 970 families with children in the Labrador Central/Upper Lake Melville area received income support. Over the past 5 years, both the percentage of families on income support with children, and the total number of children on income support, has decreased. At the community level, between 2001 and 2006, the number of persons receiving income support assistance in Natuashish/Utshimassits increased from 80 to 105. Income support incidence in Sheshatshiu (including North West River) was 28.7 percent in 2001, in comparison to only 14.5 percent in 2006. This is considerably higher than other Study Area communities in 2006.
Physical Environments
• Currently, three communities within the Study Area have piped water systems: Happy Valley- Goose Bay; Sheshatshiu; and North West River. From 1997 to 2002, contractors constructed a distributed water supply system in Natuashish, including an intake from Sango Brook and chlorination treatment plant. Most homes in Sheshatshiu have septic systems, while homes in North West River and Happy Valley-Goose Bay have piped sewage systems. • Elevated levels of cadmium have been found in caribou, and low levels of PCBs. Although caribou have traditionally represented approximately 75 percent of the Innu traditional diet, concentrations of contaminants were not found at high enough levels to cause harm. Conclusion To be effective, EA practice in remote locations must be sensitive to the uniqueness of the communities (First Nations Inuit Health Branch 2001) and the understandings and beliefs of the people who live there. This is particularly true for the communities within the Study Area. This study provides a baseline from which social and community health effects may be understood and appropriate mitigation and issues-based health indicator monitoring programs developed. Further research is needed, however, to ensure the values, claims and concerns of the Innu communities within the Study Area are understood and incorporated into relevant project-based decisions.
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Lower Churchill Hydroelectric Generation Project
TABLE OF CONTENTS Page No.
EXECUTIVE SUMMARY ...... i 1.0 INTRODUCTION ...... 1-1 1.1 Study Purpose ...... 1-1 1.2 Report Structure ...... 1-2
2.0 DESCRIPTION OF STUDY TEAM ...... 2-1 3.0 HEALTH DETERMINANTS APPROACH ...... 3-1 3.1 Health Determinants in Remote Locations ...... 3-2 3.2 Study Area ...... 3-3 3.2.1 Upper Lake Melville ...... 3-4 3.2.2 Labrador West/Churchill Falls ...... 3-5 3.3 Natuashish ...... 3-5 3.4 The Innu of Labrador ...... 3-6 3.5 Study Methods ...... 3-7 3.5.1 Labrador Peoples Health Literature Search ...... 3-8 3.5.2 Health Data Collection and Analysis ...... 3-8 3.5.3 Key Informant Interviews ...... 3-10 3.6 Health Data Availability ...... 3-11
4.0 HEALTH BASELINE: CONTEXTUAL OVERVIEW ...... 4-1 4.1 Regional Population Structure and Trends ...... 4-1 4.2 Community Context ...... 4-2 4.3 Study Area Health Overview ...... 4-4
5.0 HEALTH SERVICES ...... 5-1 5.1 Labrador-Grenfell Health Programs and Services ...... 5-4 5.1.1 Community Health and Wellness ...... 5-4 5.1.2 Health Protection Services ...... 5-4 5.1.3 Mental Health and Addiction Services ...... 5-5 5.1.4 Child, Youth and Family Services and Adoptions ...... 5-6 5.1.5 Child Care ...... 5-6 5.1.6 Medical Transportation Services ...... 5-7 5.1.7 Dental Services ...... 5-7 5.1.8 Nutrition Services ...... 5-7 5.2 Health Care Services and Programs in the Study Area ...... 5-7 5.2.1 Shelters ...... 5-8
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5.2.2 Community Clinics ...... 5-8 5.3 Labrador Innu Comprehensive Healing Strategy ...... 5-10 5.4 Healthcare Use ...... 5-11 5.5 Health Care ...... 5-12
6.0 LIFESTYLE, HEALTH PRACTICES AND COPING SKILLS ...... 6-1 6.1 Alcohol and Solvent Abuse ...... 6-1 6.2 Smoking ...... 6-2 6.3 Diet and Nutrition ...... 6-3 6.4 Activity Levels ...... 6-5 6.5 Obesity ...... 6-5 6.6 Diabetes ...... 6-6 6.7 Gambling ...... 6-7 6.8 Suicide and Attempted Suicide ...... 6-9 6.9 HIV/AIDS ...... 6-12
7.0 DISEASES, BIOLOGY AND GENETIC ENDOWMENT ...... 7-1 7.1 Hospital Morbidity/Separations ...... 7-1 7.2 Mortality ...... 7-2 7.3 Life Expectancy ...... 7-3 7.4 Pneumonia ...... 7-5
8.0 HEALTHY CHILD DEVELOPMENT ...... 8-1 8.1 Birth Rates and Characteristics ...... 8-1 8.2 Infant Mortality Rate ...... 8-3 8.3 Protective Services and Intervention ...... 8-3 8.4 Children with Disabilities and Special Needs ...... 8-4 8.5 Child Maltreatment ...... 8-5 8.6 Fetal Alcohol Spectrum Disorder ...... 8-5 8.7 Child Programs and Services ...... 8-6 8.7.1 Mother Baby Nutrition Supplement ...... 8-6 8.7.2 Healthy Baby Clubs ...... 8-6 8.7.3 Pre-natal Programming ...... 8-6 8.7.4 Post-natal Programming ...... 8-7
9.0 EDUCATION ...... 9-1 9.1 Education Services and Facilities in the Study Area ...... 9-1 9.1.1 Primary and Secondary Schools ...... 9-2 9.1.2 Post-Secondary Schools ...... 9-4 9.1.3 Early Childhood Education ...... 9-6
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9.2 Education Levels ...... 9-6 9.3 Academic Achievement ...... 9-8 9.4 Attendance and Retention ...... 9-9 9.5 Teacher Turn-over and Replacement ...... 9-11 9.6 Language and Culture ...... 9-11
10.0 SOCIAL SUPPORT NETWORKS AND ENVIRONMENTS ...... 10-1 10.1 Family Composition ...... 10-1 10.2 People Requiring Home Care or Assistance ...... 10-2 10.3 Volunteerism ...... 10-3 10.4 Sense of Belonging ...... 10-3 10.5 Preservation of Innu Language and Culture ...... 10-4 10.6 Traditional Health Practices ...... 10-5 10.7 Criminal Offences ...... 10-5 10.8 Drug-Related Offences and Support Services ...... 10-7 10.9 Violence against Women ...... 10-7
11.0 INCOME, EMPLOYMENT AND SOCIAL STATUS ...... 11-1 11.1 Employment ...... 11-1 11.2 Income and Self-reliance ...... 11-2 11.3 Families Receiving Income Support ...... 11-3 11.4 Housing Support ...... 11-4 12.0 PHYSICAL ENVIRONMENTS ...... 12-1 12.1 Water Quality and Infrastructure ...... 12-1 12.2 Traditional Foods and Land Use ...... 12-2
13.0 HEALTH BASELINE SUMMARY ...... 13-1 13.1 Primary Health Determinant Issues and Indicators ...... 13-1 13.1.1 Health Services ...... 13-2 13.1.2 Lifestyle, Health Practices and Coping Skills ...... 13-2 13.1.3 Diseases, Biology and Genetic Endowment ...... 13-4 13.1.4 Healthy Childhood Development ...... 13-4 13.1.5 Education ...... 13-5 13.1.6 Social Support Networks and Environments ...... 13-6 13.1.7 Physical Environments ...... 13-7 13.2 Conclusion ...... 13-7 14.0 REFERENCES...... 14-1 14.1 Personal Communications ...... 14-1
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14.2 Literature Cited ...... 14-2 14.3 Websites ...... 14-8
15.0 LIST OF ACRONYMS ...... 15-1
LIST OF FIGURES Page No.
Figure 1-1 Human Health at the Centre of a Healthy Environment, Economy and Community ...... 1-2 Figure 3-1 Determinants of Health ...... 3-2 Figure 3-2 Core Health Component Study Area ...... 3-3 Figure 4-1 Labrador Population Structure ...... 4-1 Figure 4-2 Total Surveyed Population for Self-assessed Health Status ...... 4-5 Figure 5-1 Regional Integrated Health Authorities ...... 5-3 Figure 5-2 Hospital Admissions: Province, Labrador Central/Upper Lake Melville, Labrador West/Churchill Falls, Sheshatshiu and Natuashish, 2000 – 2004 ...... 5-13 Figure 6-1 Adult Body Mass Index, 18+ ...... 6-6 Figure 6-2 Gambling Prevalence Rates, Newfoundland and Labrador by Health Districts ...... 6-7 Figure 6-3 Problem Gambling Prevalence Rates in Newfoundland and Labrador ...... 6-8 Figure 6-4 Incidence Rate of Attempted Suicide Among 10 to 19 year-old Population, 1998-2000 . 6-12 Figure 7-1 Cause of Death by Disease Chapter, Province and Labrador-Grenfell Health, 2000 – 2004 ...... 7-2 Figure 8-1 Crude Birth Rate (per 1,000) for Study Area Sub-divisions, 2000 to 2006* ...... 8-2 Figure 9-1 Primary and Secondary School Students (K12) by Economic Zone, 2000 to 2006 ...... 9-3 Figure 9-2 Student-Teacher Ratio ...... 9-4 Figure 9-3 Average Attendance by Month, 2003 to 2004 ...... 9-10 Figure 10-1 Self-rated Sense of Belonging* ...... 10-4 Figure 11-1 Self-reliance Ratio (percent) 1999 to 2004, Study Area and Province ...... 11-3 Figure 11-2 Individuals on Income Support 2001 to 2006 ...... 11-3
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LIST OF TABLES Page No.
Table 2-1 Study Team - Community Health Study ...... 2-1 Table 3-1 Scope of Health Determinants for the Project Health Baseline Study ...... 3-9 Table 3-2 List of Baseline Study Key Informants ...... 3-11 Table 4-1 Population Characteristics and Dependency Ratios for Innu Communities, Region and Province, 2006 ...... 4-3 Table 4-2 Population Characteristics and Dependency Ratios for Non-Innu Communities, Region and Province, 2006 ...... 4-4 Table 4-3 Self-assessed Health Status by Gender* ...... 4-5 Table 4-4 Select Population and Social Health indicators for Labrador Region and Innu Communities* ...... 4-6 Table 5-1 Branches Under the Newfoundland and Labrador Department of Health and Community Services ...... 5-2 Table 5-2 Locations of Community Clinics in Labrador ...... 5-9 Table 5-3 Health Programs, Innu Healing Strategy, Sheshatshiu and Natuashish ...... 5-11 Table 5-4 Hospital Separations by Regional Integrated Health Authority ...... 5-12 Table 5-5 Hospitalization Total Stay Length ...... 5-12 Table 5-6 Population Who Report Having a Regular Medical Doctor ...... 5-13 Table 6-1 Percentage of the Population Aged 12 Years and Older who are Occasional/Daily Smokers ...... 6-3 Table 6-2 Proportion Current Daily Smokers by Gender...... 6-3 Table 6-3 Percentage of Population Aged 12 Years and Older Who are Active or Moderately Active Smokers ...... 6-3 Table 6-4 Energy and Macronutrient Intake in Utshimassits Women Aged 15 to 24 ...... 6-5 Table 6-5 Suicide Risk and Protective Factors ...... 6-10 Table 7-1 Hospital Morbidity/Separations 2000 to 2004, Percent by Diagnosis and Ratio to Province for Study Area Communities* ...... 7-2 Table 7-2 Crude Mortality Rates per 100,000 Population by Gender, Province and Health Authorities, 2000 to 2004 ...... 7-4 Table 7-3 Age Standardized Mortality Rates per 100,000, Province and Health Authorities, 2000 to 2004 ...... 7-4 Table 7-4 Deaths by Age for Province and Study Area, 1991-1996, 2005 ...... 7-5 Table 8-1 Live Births and Birth Rates, Province and Labrador-Grenfell Health Authority, 2000 to 2006 ...... 8-1 Table 8-2 Live Births for Mothers Aged 15 to 19 Years as Percentage of Total Births by Region, 2000 to 2006 ...... 8-2 Table 8-3 Infant Deaths and Infant Mortality Rate, Province and Health Regions, 2000 to 2004 ...... 8-3
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Table 9-1 Proportion of School-aged Population by Regional Economic Zone, Labrador and Province ...... 9-2 Table 9-2 Labrador Primary and Secondary Schools ...... 9-2 Table 9-3 Full-time Equivalent Teachers ...... 9-4 Table 9-4 Post-secondary Education Training Facilities and Programs in Study Area ...... 9-5 Table 9-5 Highest Level of Schooling Completed Based on Population Aged 15 Years and Older .. 9-7 Table 9-6 Innu Adults with Less than High School Education ...... 9-7 Table 9-7 High School Graduates and Academic Achievement by Zone ...... 9-8 Table 9-8 Attendance Records: Labrador School District and Provincial, 2006 to 2007 ...... 9-9 Table 9-9 High School Retention: Drop-out Rates by School District, 2002-2003 to 2003-2004 ..... 9-10 Table 10-1 Legal Marital Status of Population Aged 15 Years and Older, 2006 ...... 10-2 Table 10-2 Proportion of Individuals Requiring Help with Preparing Meals or Personal Care, Study Area and Province ...... 10-3 Table 10-3 Native Language Preservation in Innu of Labrador Communities and Canada* ...... 10-5 Table 10-4 Statistics Canada 2007 Reported Crimes by Offence, Newfoundland and Labrador ...... 10-6 Table 10-5 Criminal Offences in the Upper Lake Melville Region, Between 2001 and September, 2005 ...... 10-6 Table 10-6 Total Complaints: Break and Enter and Drug Offences, September 2005 to May 2007 . 10-7 Table 11-1 Employment Characteristics, Innu Communities, Province and Canada ...... 11-1 Table 11-2 Median Income and Self-reliance Ratios 2004, Study Area and Province ...... 11-2 Table 11-3 Income Support Assistance for Study Area Communities, 2001 and 2006 ...... 11-4 Table 11-4 Home Ownership and Condition in Study Area and Province ...... 11-5 Table 12-1 Municipal Characteristics ...... 12-1 Table 12-2 Contribution of Traditional Foods to Total Estimated Edible Food Production ...... 12-3
LIST OF APPENDICES APPENDIX A Letter of Permission from Health Canada
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1.0 INTRODUCTION
Newfoundland and Labrador Hydro (“Hydro”) is proposing to develop the hydroelectric potential of the lower Churchill River. Aura Environmental Research and Consulting Ltd. (“Aura”), through Minaskuat Limited Partnership (“Minaskuat”), was retained by Hydro in March 2007 to conduct a Community Health Baseline Study to document the current social, physical, and mental health baseline of the Study Area, which includes those communities located adjacent to the proposed project, namely the Upper Lake Melville and the Labrador West/Churchill Falls area, including the two Labrador Innu communities of Sheshatshiu and Natuashish.
1.1 Study Purpose
The purpose of this report is to provide the community-health baseline for the Project Environmental Impact Statement (EIS) Study Area, identifying current community health issues and trends within the region. The overall objective is to gather information on key socioeconomic characteristics in order to generate a baseline understanding from which social and community health impacts may be identified, and appropriate mitigation and ‘issues-based’ health indicator monitoring programs developed, as required. Within the context of this baseline, human health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization (WHO) 1947: 29). As such, health is inextricably linked to the health of the environment, the economy and local communities (Figure 1-1). The quality of the environment, economic self-sufficiency, and social practices and support mechanisms are therefore key concerns for assessing human health. As a tool used to ensure that decisions concerning development are made in the full knowledge of their environmental consequences (Noble 2005), environmental assessment (EA) is a logical medium to consider the potential impacts of development and change on human health (Laws and Sagar 1994). Addressing health impacts as part of project EA is receiving increased attention from environmental assessment and health practitioners alike (e.g., Arquiaga et al. 1994; Banken 1999; Steinemann 2000), and the need for and benefits of addressing health in EA have been recognized by many health authorities, including the World Health Organization ((WHO) 1987) and Health Canada (1999). That being said, explicit efforts to integrate human and community health in EA are few in practice (Noble and Bronson 2006).
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Figure 1-1 Human Health at the Centre of a Healthy Environment, Economy and Community
Source: Sadler and Jacobs (1990).
1.2 Report Structure
The Community Health Baseline Study consists of 12 major sections. In the sections that follow, an overview of the ‘health determinants’ approach adopted for this study is presented, along with a description of the baseline study methods. This is followed by a contextual overview of population, regional, and community health within the Study Area. The current regional and community health baseline is then presented in eight sections, organized according to the determinants of health. The final section provides a summary of the primary health issues and concerns that are likely to be most sensitive to development and socio-economic change within the region, either positively or negatively.
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2.0 DESCRIPTION OF STUDY TEAM
The Community Health Environmental Baseline Study was conducted by Aura Environmental Research and Consulting Ltd. under the direction of Minaskuat. The Study Team included a scientific authority, researchers, field leads and assistants and data management and reporting personnel (Table 2-1). All Study Team members possessed in-depth knowledge and experience in their fields of expertise and a broad general knowledge of the work conducted by other experts in related fields. Brief biographical statements, highlighting project roles and responsibilities and relevant education and employment experience, are provided below. Table 2-1 Study Team - Community Health Study
Role Personnel Component Manager Mark Shrimpton Study Lead Jackie Bronson Alternate Study Lead Bram Noble Scientific Authority Bram Noble, Paul Hackett Scientific Associate Diana Gustafson Field Leads Jackie Bronson Field Assistant Scott MacNeil Data Management and Reporting Bram Noble, Jackie Bronson Mark Shrimpton M.A., has over 25 years experience in socio-economic consultant research, assessing, planning and managing the impacts of resource industry activities. This has included work for the hydroelectric-power, mining, petroleum and industries, and for governments, international agencies and communities. In Canada, Mr. Shrimpton has played a lead role in preparing: socio- economic impact assessments of the Lower Churchill hydroelectric generation project, Voisey’s Bay mine/mill and processing plant, LabMag iron ore mine, and the Hibernia, Terra Nova, White Rose, Hebron, Newfoundland Transshipment Terminal and Newfoundland LNG petroleum projects; industrial benefits, human resources and diversity plans for the White Rose project; infrastructure and labour requirements studies for various hydro, mining and petroleum projects; and, studies monitoring the socio-economic effects of resource development activity. He has also worked in the US, Iceland, the Faroe Islands, France, Switzerland, the Falkland Islands and Australia, including managing the preparation of socio-economic impact assessments of the hydro and smelter projects in Iceland. Jackie Bronson, M.A., is president of Aura Environmental Research and Consulting Ltd. Ms. Bronson specializes in social health impact assessment and was the Study Lead and Field Lead for the Community Health Baseline Study. At the University of Saskatchewan, she conducted research specifically on improving environmental assessment practice to include human health in Canada’s remote regions, including a review of health inclusion in the Voisey’s Bay Nickel Mine and Mill project impact statement. She has published several peer reviewed papers which contribute directly to the ongoing efforts to strengthen the role of EA as a tool to identify, evaluate and manage the potential implications of development on human health. In addition, her revised Health Determinants Framework is an important contribution to northern EA practice in that it provides EA practitioners and administrators the necessary characteristics and design principles of contextually relevant EA practice with regard to human health inclusion. Bram Noble, Ph.D., is an Associate Professor of Environmental Assessment at the University of Saskatchewan. Dr. Noble was the Alternate Study Lead and Scientific Authority for the Community Health Baseline Study. Dr. Noble holds a Ph.D. from Memorial University of Newfoundland, specializing
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in environmental assessment. Since 2000 he has published more than 50 scientific papers and research reports in the broad area of environmental assessment, including works on health integration in environmental assessment practice. In 2003, Dr. Noble was recipient of a national SSHRC grant investigating the state of health in environmental assessment in Canada’s North, and currently holds a Northern SSHRC RDI focused on community-based monitoring programs in the Athabasca region of Saskatchewan. He is currently lead consultant for the Canadian Council of Ministers of Environment, Environmental Assessment Task Group, to develop a national system of regional and strategic impact assessment for Canada, and a former advisor to the Auditor General of Canada on sustainability auditing. From 2005 to 2007 Dr. Noble was environmental assessment lead for a comprehensive land use strategy in the Great Sand Hills of Saskatchewan, and co-lead for the project’s Aboriginal baseline impact assessment study. He is also an expert advisor to the Mikisew Cree First Nation in northern Alberta concerning oil sands development and land claims agreements. Dr. Noble is a member of the International Association for Impact Assessment, and a member of the international advisory boards for Environmental Impact Assessment Review and Impact Assessment and Project Appraisal. Paul Hackett, Ph.D., is an Assistant Professor of Health Geography at the University of Saskatchewan. Dr. Hackett specializes in First Nations health and served as a Scientific Authority to the Community Health Baseline Study. His graduate research examined the past diffusion of directly-transmitted, acute infectious diseases, leading to the publication in 2002 of his book, A Very Remarkable Sickness. This book was subsequently awarded the Jason A. Hannah medal by the Royal Society of Canada. Dr. Hackett is interested in the historical and geographical patterns of the health of western Canada’s First Nations and his current work is focused on the impact of cultural change on community health. After graduating with a PhD in geography from the University of Manitoba, he held a CIHR postdoc and Senior Research Fellowship in the Department of Community Health Sciences at that University. He has held grants from the Canadian Institutes of Health Research in support of projects examining the health history of the Island Lake (Manitoba) First Nations and the history of tuberculosis among the First Nations people. Diana Gustafson, Ph.D., is an Assistant Professor of Social Science and Health at Memorial University, Faculty of Medicine. Dr. Gustafson is author of the Aboriginal and Labradorian Peoples Health Database and was Scientific Associate responsible for compilation of secondary source health determinant data for the Community Health Baseline Study. She holds a dual PhD from the University of Toronto in sociology and equity studies, and in women and gender studies, and a master's degree in adult education from Brock University. Dr. Gustafson has many years experience working and teaching in health care. She has worked as a college professor, a clinical educator, and an education consultant for a hospital corporation. Scott MacNeil, B.A., is a former resident of Happy Valley-Goose Bay. He received his B.A. in history from the University of Manitoba and specialized in the area of Canadian public policy. Mr. MacNeil has experience working in the area of First Nations health and Medicare policy and was a Field Assistant for the Community Health Baseline Study. He has also worked extensively on Dr. Hackett’s tuberculosis and diabetes research. He is experienced in both field and archival research.
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3.0 HEALTH DETERMINANTS APPROACH
Understandings of the interconnected factors that contribute to human health have evolved considerably over time. It began in 1947 with the WHO’s definition of health. The Lalonde Report, one of the earliest health documents to identify factors that contribute to health, broadened the definition further by contending that health determinants are related to lifestyles and environment, not merely human biology and healthcare (Government of Canada 1974). Later, in 1986, the WHO’s Ottawa Charter for Health Promotion entrenched a systems approach to health promotion, wherein public participation, supportive environments, strengthened community action, enhanced personal skills, and reoriented health services are all seen as integral. The Charter led to the refined definition of health promotion, as “the process of enabling people to increase control over and to improve their health” (WHO 1986).
Health Canada, through the Federal, Provincial and Territorial Advisory Committee on Population Health (1994), released Strategies for Population Health: Investing in the Health of Canadians, introducing a series of health determinants associated with EA (Figure 3-1). There is a complexity of pathways that link project development, and environmental and social change with human health and well-being. Recent literature suggests focusing not on the direct causal relationships of health by way of predicting uncertain health impacts and outcomes, but on identifying the linkages between project actions and the various driving forces or determinants of health and well-being (e.g., Banken 1999; Birley 2002; Bronson and Noble 2006).
Determinants of health are not themselves ‘health impacts’; rather, they are the factors that influence or provide an indication of health and well-being and can be affected, either positively or negatively, by project development (Kahan and Goodstadt 1999). Consistent with the Federal/Provincial/Territorial Committee on Environmental and Occupational Health (1999), it may not be necessary for a detailed assessment based on each determinant; however, it is important to:
• identify, for each determinant, those health factors of most importance for potential mitigation and management; • establish whether projects will have an effect on the various aspects of health and well-being; and • determine how the current state of health may affect project development and operation.
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Figure 3-1 Determinants of Health
Source: Modified from Health Canada 1999.
3.1 Health Determinants in Remote Locations
Aboriginal cultures view the land, Mother Earth, as the giver of life (Wilson and Rosenberg 2002). Meredith (1995), for example, notes that northern residents are often more aware of their environment and its relationship to health and well-being than are those in the South. Aboriginal cultures typically believe an interconnection to exist between all elements of nature (for example plants, animals and the land), often referred to as spiritual relationships. Illness is seen as a change in these relationships and not only attributable to direct environmental change (such as pollutants). Thus, Aboriginal interpretations of health typically go far beyond the accepted WHO definition to include also an understanding that the state of health forms a balance between humans and their environment (O’Neil and Solway 1990; Indian and Northern Affairs Canada (INAC) 2003) and places a strong emphasis on community health, rather than individual or physical health (Davies 1992). The role of health in EA is more critical in remote locations and northern Aboriginal communities within Canada. The second Canadian Arctic Contaminants Assessment Report on Human Health (INAC 2003), for example, purport that additional determinants of health, such as lifestyle (alcohol consumption, smoking, and substance abuse), diet, as well as socio-economic status and genetic predisposition, should be considered when assessing the health status of northern residents. Aboriginal communities in northern Canada, in general, experience higher risks to their health and well-being for a variety of reasons, including limited access to health and education services and programs or to services and programs that are culturally appropriate; limited employment opportunities; increased sedentary lifestyles; constraints on traditional land use and hunting activities; and increased environmental pollutants (see Moffitt 2004 and Gibson et al. 2007). The result is often higher rates of personal and family injury, youth suicide, drug and alcohol addictions, and various other socioeconomic
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3.2 Study Area
This Project Community Health Baseline Study focuses on the current state of community health, as indicated by a cross-section of social and community health determinants, within the Study Area (Figure 3-2). The Study focused primarily on those communities located adjacent to the proposed project, namely the Upper Lake Melville Region, and therefore the most likely to be affected by the project and associated activities. Figure 3-2 Core Health Component Study Area
Source: Adapted from www.stats.gov.nl.ca/Maps.Sheshatshiu
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However, due to the limited availability of community health data and information, and also due to the variability in such data and the scale at which data are often aggregated and reported, it was necessary to approach the Study Area at multiple spatial scales. For example, where community health data and information were not available at the community level it was necessary to “scale up” to the sub-region (Labrador Central/Labrador West), and in some cases to the regional (Labrador) or provincial scale. Where data and information are available at the community level, emphasis is placed on the current health baseline and key health issues of the individual communities, including the Innu communities of Sheshatshiu (the only Innu community in the Study Area) and, to a lesser extent, Natuashish, as a background or reference condition where data permit.
3.2.1 Upper Lake Melville
The Upper Lake Melville region, also known as the Central Labrador Regional Economic Zone 3, includes the communities of Happy Valley-Goose Bay, Mud Lake, North West River and Sheshatshiu. Happy Valley-Goose Bay’s population was recorded as 7,572 during the 2006 Census1, a 5 percent decrease from 2001. Happy Valley-Goose Bay is one of the major centers in Labrador, offering access to health services and programs to surrounding communities. Mud Lake is a small community located on the Churchill River. Services in Mud Lake are limited, but include a church, elementary school and community hall2. Residents of Mud Lake must travel to Happy Valley-Goose Bay to access health services. North West River is located on the Lake Melville. The population of North West River was reported as less than 500 people in the 2006 census, down more than 10 percent since 2001. Sheshatshiu, “narrow place in the river”, is the largest Innu community in Labrador, located approximately 43 km northeast of Happy Valley-Goose Bay (Newfoundland and Labrador Statistics Agency 2008) and adjacent to the settlement of North West River. Sheshatshiu was originally a summer gathering place for Innu who resided inland most of the year, following the cyclical pattern of nomadic caribou hunting. Sheshatshiu did not become a year-round settlement until 1957 (Jacques Whitford 2003). The community is described as a closely-knit web of relations: cousins, intermarriages and distant relatives (Degnen 1996). Sheshatshiu was for many years considered part of North West River but separated in 1979 to form its own municipality. Although there is considerable interaction between the communities (e.g., Sheshatshiu residents accessing convenience services in North West River), there has been little fraternizing between the two populations (Degnen 1996). The two communities have often been described as “two solitudes”. Sheshatshiu is a current reserve with an elected Chief and Council. Similar to many Aboriginal populations across Canada, the Innu population in Sheshatshiu is growing. With growth in the community comes the need for more housing, education facilities, and health service personnel (Hanrahan 2003).
1 http://www12.statcan.ca/english/census06/data/profiles/community/Index.cfm?Lang=E 2 http://www.ourlabrador.ca/member.php?id=38
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3.2.2 Labrador West/Churchill Falls
Labrador West/Churchill Falls, also known as the Hyron Regional Economic Zone 2, includes the communities of Labrador City, Wabush and Churchill Falls. Labrador City is the largest settlement in Labrador West with 7,240 people in 2006, a 6.5% decline from the 2002 census. The town is also home to the region’s main healthcare center, the Captain William Jackman Memorial Hospital. Wabush, the “twin community” of Labrador City, had a population of 1,739 in 2006, down 8.2 percent from the 2001 census. The town is served by a local health clinic, as well as a women’s shelter, but depends primarily on Labrador City for its health services. Churchill Falls is a “company town”, located approximately 245 kilometers east of Labrador City, with its residents providing the workforce for the Churchill Falls Hydroelectric plants. The population of Churchill Falls (Census division 10, Subdivision D) was 681 persons in 2006, an increase of 5.6 percent above 2001.
3.3 Natuashish
Natuashish is a new community, developed in 2002, and is located approximately 300 km north of Happy Valley-Goose Bay on the northern coast of Labrador. The community is a current reserve with an elected Chief and Council. Though not located directly in the Study Area, the current health status of the community is a useful background or comparative reference for the community health conditions of Sheshatshiu. The population is predominately Mushuau Innu. The community is accessible only by water or air. Natuashish was created in order to relocate residents of Utshimassits (Davis Inlet) to the mainland area. The relocation was one of the first steps in the Labrador Innu Comprehensive Healing Strategy, a comprehensive plan that was initiated by Health Canada, INAC, and Solicitor General to stabilize health and create safe communities and help the Innu build a better future. The Mushuau Innu chose the Natuashish site, which is within their traditional territory, with the agreement of Canada and the Province of Newfoundland and Labrador in 1996. On December 11, 2003, the new community of Natuashish, comprising approximately 4,265.49 ha of land, was set apart as reserve land for the Mushuau Innu First Nations3. The community was constructed from previously undeveloped land as a part of the Mushuau Innu Relocation Agreement (MIRA). Reserve creation, along with relocation, was part of a long-term strategy, to address the social challenges of the community. Certain lands within Natuashish are to be set aside by the Minister of Indian Affairs and Northern Development, with the consent of the Mushuau Innu First Nation Band Council, for specific, non-commercial purposes that improve the general welfare of the First Nation. For example, land may be set aside for a school and health services.
3 http://www.ainc-inac.gc.ca/irp/irp-Pb_e.html
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3.4 The Innu of Labrador
The Sheshatshiu Innu First Nation and the Mushuau Innu First Nation are registered under the federal Indian Act and part of a larger, Algonquian-speaking, Innu cultural group whose territory, Nitassinan, stretches from the Labrador Peninsula into the eastern part of the province of Quebec4. Traditionally, the Innu were nomadic hunters, whose varied economy focused on caribou, bear, and other terrestrial, avian, and marine species, as well as on gathering berries and other plant foods (Samson and Pretty 2005). In the pre-contact period they lived mainly inland, engaged in caribou hunting, and occasionally visited the coast (Burnaby 2004: 33). Patterns of travel and hunting grounds varied from year to year, with no territories owned by either individuals or families. Following initial contact during the 1600s, Innu culture began to change as the people pursued new economic opportunities. Exposure to the fur trade and the establishment of trading posts gradually transformed the Innu from hunters to trappers, whose primary goal was to obtain furs in order to trade for goods supplied by French and English traders. As a result of increasing involvement in the fur trade, family winter bands became smaller, as (unlike traditional forms of hunting) trapping did not require cooperation on the part of two or more families. However, the fur trade also led to the emergence of larger, composite, trading post bands that summered together around particular posts or, in some cases, mission stations. Kinship ties linked members of these bands, and geographically peripheral families occasionally passed from one trading-post band to another (Rogers and Leacock 1981: 172, 183). However, the Innu population of today lives a much more sedentary lifestyle than the pre-contact Innu: a lifestyle defined by established communities and economic opportunity. By the middle part of the 20th century, the trading-post bands had begun to evolve into permanent settlements, including at Happy Valley-Goose Bay, although the Mushuau Innu at Utshimassits retained a more fluid band composition and greater mobility into the 1960s. In the late 1950s, the provincial government reinforced this trend by pursuing a policy of aggressive assimilation with respect to the Innu, and created larger, permanent communities at Sheshatshiu, in Central Labrador along the shore of the North West River, and later (1967) in Utshimassits, on Iluikoyak Island along the north Labrador coast (Samson and Pretty 2006: 529). According to the Report of the Royal Commission of Aboriginal Peoples (1996) after the Innu were relocated to Utshimassits, they were afflicted with a series of health problems, chronic alcoholism, gas sniffing, domestic violence, terrible living conditions and high suicide rates. In 2003, they were moved to a new mainland site, Natuashish, chosen by them, after charges by the Innu that the initial relocation to Utshimassits had placed them in a community with inadequate housing and services, under circumstances which had led to community-level social dysfunction (Backhouse and McRae 2002). Other reasons cited by the Mushuau Innu included: a rapidly growing population and lack of expansion room; the deterioration of their water supply; a need for greatly improved living conditions; and poor access to traditional hunting grounds (Innu Nation and Mushuau Inn Band Council 1995). These movements were part of an overall policy of sedentarisation, in which the Innu were removed from the land, and their mobility curtailed (Royal Commission of Aboriginal Peoples 1996).
4 In the past the Innu of Labrador were referred to by westerners as the Montagnais and the Naskapi. The term Innu translates to “The People” and is now the preferred term.
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It has been suggested that this loss of traditional culture has resulted among some Innu in a ‘nutrition transition’, a shift from a healthy diet based on traditional foods to a far less healthy western diet based on processed foods, and a ‘physical activity transition’, a shift from active to sedentary lifestyles on the part of many of the Innu of Labrador (Samson and Pretty 2006: 531). By the 1970s, the Innu way of life had changed substantially and, as Rogers and Leacock (1981: 185) note, they had become sedentary villagers with a westernized culture. Modern health services and a more secure food supply, both recent introductions, have led to a period of rapid population increase, which has remained into the present. Despite overall population growth, this period of rapid cultural change caused by external forces has had an adverse effect on the Innu of Labrador. Researchers (and the Innu themselves) have linked the loss of self-esteem among the Innu, the complete dependency on government programs, and the almost non-existent employment opportunities at Sheshatshiu and Natuashish, to widespread social pathologies, including solvent and alcohol abuse, suicide and sexual abuse (Andrew and Sarsfield 1985; Backhouse and McRae 2002; Samson and Pretty 2006). Andrew and Sarsfield (1985: 429) have argued, “The Innu are sick and dying because of a well documented syndrome of collective ill-health brought on by the enforced dependency and attempted acculturated of an entire people.” In addition, the Innu of Labrador are facing epidemic levels of obesity and Type 2 Diabetes Mellitus, and other chronic diseases unknown among the Innu prior to the 1960s (Samson 2005). The Innu believe that improvements to the existing poor health of their communities must be achieved through progress in the areas of socio-economic and cultural systems (Backhouse and McRae 2002).
In response to the worsening crisis of substance abuse and the underlying social and health crises, the Innu of Labrador, the Sheshatshiu Innu and Mushuau Innu, approached the federal government and the Province of Newfoundland and Labrador to provide help to the two Innu communities. As a result, the Labrador Innu Comprehensive Healing Strategy (LICHS) was developed by three federal government departments (Indian and Northern Affairs Canada, Health Canada and the Solicitor General of Canada) and initiated in 2000 (INAC 2006). A detailed examination of the LICHS is presented in Section 5.3 and provides information related to the programs and services offered in the Innu communities.
3.5 Study Methods
The Project Community Health Baseline Study is multi-scaled, focusing on key social and community health issues and trends at both the community and regional level, and drawing also upon broader provincial and Aboriginal health determinants and indicators where relevant. The overall approach to the baseline study is guided by Health Canada’s determinants of health framework, encompassing a broad range of social, community, and physical health indicators. Development of the health baseline consisted of three phases: a literature search to determine the scope of the health determinants and key health indicators, compilation and analysis of secondary source health determinant data for the Study Area, and primary data collection based on interviews with local key informants.
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3.5.1 Labrador Peoples Health Literature Search
The initial phase of the study involved a review of relevant health literature for the Study Area, the Innu of Labrador, and for the broader Labrador regional population health environment. The purpose of this review was twofold: i) to establish the context against which change and current health conditions can be assessed; and ii) to assist in identifying the key social and community health issues and indicators that would form the basis of a community health assessment, guide health data collection, and which would ultimately be carried forward to impact assessment, mitigation, and monitoring. Dr. Diana Gustafson from Memorial University’s Division of Community Health, and author of the Aboriginal and Labradorean Peoples Health Database: Research, People, Programs and Services 2000-2005, assisted with this phase of the study. The Aboriginal and Labradorean Peoples Health Database “offers an overview of the health-related programs, services, research, reports and publications created for, with, and about Aboriginal and Labradorean peoples and communities since 2000” (Gustafson 2006: 1). Prior to this work, there existed no consolidated health-related resource for Aboriginal and Labradorean peoples. Dr. Gustafson’s role in the baseline study was to compile relevant literature from the database categorized by health determinant, and to focus specifically on an extended literature search pertaining to the Innu of Labrador. The final scope of health determinants considered for the Lower Churchill community health baseline study is summarized in Table 3-1. Although a number of indicators focus on individual health, emphasis is placed on the broader determinants of health extending beyond individual and physical factors to include issues that affect community health and well-being - including socio-economic and socio- cultural stress, social diseases, support networks, self-esteem, mental health, and social and family assistance. There are a number of determinants common to most health baseline studies, such as child morbidity and mortality statistics and hospital admissions; however, ultimately, the appropriate choice of indicators is determined by the regional context of the cultural and social environments in which the development is taking place. For the Labrador region in particular, determinants of social and community health are of primary concern.
3.5.2 Health Data Collection and Analysis
In phase two of the baseline development, health indicator data were collected and interpreted for each of the health determinants where available. At the time of this baseline study no protocol had been successfully established to gain access to the Innu communities themselves or to relevant Innu health records. While certain population and community health data are collected from the Innu communities of Natuashish and Sheshatshiu, and housed by the Newfoundland and Labrador Centre for Health Information, much of this data is available only at the aggregate level due to the small population size of the communities, low data cell counts, and issues of confidentiality. There are considerable data gaps concerning Innu health. However, several categories of health information are available for the Innu communities based on previous research conducted in the area - the majority of which was conducted by non-Innu researchers.
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Table 3-1 Scope of Health Determinants for the Project Health Baseline Study
Health Determinant Scope 1. Health Services Health system structure and administration; Health care services and programs; Innu healing strategy; Hospital separations; Health care use 2. Lifestyle, Health Practices and Alcohol and solvent abuse; Smoking and physical activity levels; Gambling and Coping Skills problem gambling; Suicide and attempted suicide; Diet and nutrition; Diabetes; Obesity; HIV/AIDS 3. Biological and Genetic Hospital morbidity and separations; Mortality; Life expectancy; Pneumonia Endowment 4. Healthy Child Development Birth rates and characteristics; Infant mortality; Children in care; Protective services; Disabilities and special needs; Violence against children; Fetal alcohol spectrum disorder; Sudden infant death syndrome; Gasoline sniffing; Children’s programs and services 5. Education Primary, secondary, and early-childhood education facilities and services; Educational attainment; Academic achievement; Attendance and retention; Teacher turn-over and replacement; Language and culture 6. Social Support Networks and Family composition; People requiring care or assistance; Volunteerism; Sense of Environments belonging; Preservation of language and culture; Traditional health practices; Criminal offences; Drug-related offences and support services; Violence against women 7. Income, Employment and Employment; Income and self-reliance; Families receiving income support; Housing Social Status support 8. Physical Environments Water quality; Traditional foods and lands Data collection was aimed at various scales from the community to the regional level and, where possible, drawing comparisons between particular communities, regions, and health authorities. The approach was to first construct a Labrador regional health profile for each of the Upper Lake Melville and Labrador West/Churchill Falls areas based on data reported for the Regional Integrated Health Authority (RIHA) or regional economic zone, and to focus in on the community level where data permitted, or up to the regional and/or provincial level where comparative community-level data were not available. Included amongst the health indicator data sources reviewed were the following:
• Canadian Community Health Survey (CCHS) results for the Labrador regional economic zones, health regions, and, when available, Innu communities for 2001 and 2005; • Data runs, facts sheets, and research reports from the Newfoundland and Labrador Centre for Health Information (NLCHI); • Canadian census data for 2006 (Statistics Canada 2006a) and subsequent 2001 census data (Statistics Canada 2001), where more current data were not available; • Census Canada Aboriginal Population profiles; • Community Accounts provincial, regional, and local profiles; • Various academic research and government reports on health determinants and personal health practices for the Province, Labrador region, and for the Innu population; • Newfoundland and Labrador Statistics Agency; • Archived media reports; • Newfoundland and Labrador Department of Health and Community Services data sources; • Newfoundland and Labrador Department of Education, School Statistics; • Canadian Institute for Health Information health profiles;
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• Health Council of Canada’s health status reports of Canada’s First Nations; • Public Health Agency of Canada data releases; • Royal Commission on Aboriginal people; and • Relevant sections of the First Nations Regional Longitudinal Health Survey. In addition, a request was made to Health Canada, and granted, to use data and various findings reported in the community health component of the Innu Healing Strategy (see Appendix A for ‘permission to use’ letter).
3.5.3 Key Informant Interviews
In the third phase of the baseline study, which unfolded simultaneously with phase two, key informant interviews were used to update health information, fill gaps in the health records, and, more importantly, to place the health data in its proper regional and local context by identifying current and enduring health issues and concerns in the region. Local key informants from various social, health, and public service departments and agencies in the Study Area were interviewed to collect information relative to regional health issues, but in particular for local social and health concerns and challenges of the Innu people.
A number of key informants were first identified, and then asked to identify others whom they felt were important to contact and interview given the nature and scope of the baseline study. The intent in sampling design was neither statistical representation nor saturation. Rather, the objective was to identify a cross-section of local experts that was broad enough to capture the full range of social and community health determinants in the research framework. As such, not all health officials and practitioners in the Study Area were contacted for an interview.
Access to the Innu communities and to relevant Innu agencies and organizations was not possible at the time of this study; face-to-face interviews were conducted with other nurses and social and health care providers; current educators at the primary, secondary and post-secondary level, including a retired teacher from the Innu community and school system; and various individuals from the Labrador School Board, Labrador North Chamber of Commerce, Economic Development Boards, Royal Canadian Mounted Police (RCMP), Newfoundland and Labrador Human Resources, and Newfoundland and Labrador Housing. Multiple conversations and information sharing outside of formal interview settings occurred also over the telephone and via email correspondence with various other key informants from the Study Area. In addition to key informant interviews, a focus group was held with representatives of health, child, youth and community services in the Labrador region (Table 3-2). The focus group coincided with an annual meeting of health directors and administrators for the Labrador health region.
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Table 3-2 List of Baseline Study Key Informants
Participant Agency Interview Participants Stacy Ramey Public Health Nurse Dee Dee Voisey Public Health Nurse Cpl. Keith MacKinnon Labrador District Drug Awareness Coordinator RCMP Nelson Flynn Regional Director Newfoundland and Labrador Housing Jan Dymond Regional Director, Consumers’ Health Awareness Network Doug Abbass Principal (Happy Valley-Goose Bay) Teresa Bruce Retired Teacher (Sheshatshiu) Bob Simms District Administrator, College of the North Atlantic Henry Windeler Labrador School Board Andrew Battcock Labrador School Board Brian Fallow Labrador North Chamber of Commerce Carol Best Labrador Central Economic Development Board Jason St. Marie Hyron Economic Development Board Agnes Rumbolt Regional Director, Newfoundland and Labrador Human Resources Dr. Maureen Baikie Medical Officer of Health, Labrador-Grenfell Health, Happy Valley-Goose Bay Focus Group Participants Labrador Child Youth and Family Services Delia Connell Community and Aboriginal Affairs, Labrador-Grenfell Genevieve Corbin Regional Director, Child Youth and Family Services Sandy Penney Addictions Service Coordinator Deanne Costello Regional Director, Mental Health and Addictions Services Blenda Dredge Regional Director, Rehabilitation and Intervention Services Patti Moore Occupational Therapist Ozette Simpson Chief Operating Officer, Captain William Jackman Memorial Hospital Jackie Whelan Regional Director for Community Youth Corrections, Community Agencies and Child Care Services
3.6 Health Data Availability
Some issues related to health data in general, and community-level data for the Labrador region and Innu population in particular, should be noted prior to reporting on the baseline study results. First, gaps found in the data present a challenge to assessing the health of any Aboriginal group in Canada (Health Council of Canada 2005: 31). Data are commonly not collected for all health or demographic issues and what is collected is available for some communities but not for others. As well, Aboriginal participation in the Census and related population health studies varies considerably between communities and is often incomplete. Furthermore, language and literacy limitations impact Census data availability and reliability for Innu communities. Overall, there is a lack of publically available or representative data concerning the determinants of Aboriginal health.
Second, these challenges are exacerbated in the case of the Innu of Labrador, where the availability of public, reliable and representative community-level health data is more limited. Vital statistics and health data have generally been aggregated into regional or even provincial trends and totals that do not always capture key health issues and patterns at the community level. The aggregation is in part due to confidentially restrictions on physical health and health diagnosis data as a result of the small population and sample size of the region. For Census-based data, there are also limitations in that most indicators are derived from a 20 percent sample of a small community population size, limiting the ability to generalize the results to the community and to the Innu as a whole. In addition, the report presents data obtained through the Canadian Community Health Survey (CCHS). The CCHS is a
Community Health Study y Final Report • December 22, 2008 Page 3-11 © Aura Environmental Research and Consulting Ltd. 2008 Lower Churchill Hydroelectric Generation Project cross-sectional survey that collects information for the Canadian population related to health status, health care utilization and health determinants5. More specifically, the 2005 Canadian Community Health Survey set out to answer to fundamental questions: 1) How healthy is the health care system?; and 2) How healthy are Canadians? (Government of Newfoundland and Labrador 2007a). The target population of the CCHS includes household residents; with the principal exclusion of populations on Indian Reserves, Canadian Forces Bases, and some remote areas. These constraints often present challenges when drawing conclusions about specific aspects of community health or making comparisons to the health of other groups. Third, the population and trends of the Innu community of Sheshatshiu are more difficult to discern, as the community is an unorganized census sub-division and aggregated with the settlement of Mud Lake for census reporting. In many instances the health data for Sheshatshiu are also aggregated with North West River and with no indication as to whether this also includes statistics for Mud Lake. In addition, only 34 Sheshatshiu residents participated in the most recent iteration of the CCHS, making the results highly variable and not necessarily representative of the community self-assessed health status and do not fully represent the Innu. Fourth, there is considerable variability in health data at the aggregate level and data are not available for all health indicators for the Study Area. For example, the coefficient of variation for the proportion of individuals reporting having used mental health services in the Study Area in 2005 is greater than 33 percent, indicating extreme sampling variability. Because of this, these data were not used in this study. Finally, not all data are available at all spatial scales relevant to the Study Area (i.e., Upper Lake Melville, Sheshatshiu and Labrador West). Due to variability in health data collection and level of aggregation and reporting, it is not possible to consistently report baseline results by geographic region or sub-region. As such, baseline results are organized in this report by health determinant with regional and sub-regional patterns and variations described where data permit. Notwithstanding these limitations and shortcomings, the available primary and secondary data are considered sufficient to provide an appropriate understanding of health status and issues in the Study Area, and an adequate baseline for undertaking an assessment of the effects of the Project.
5 http://www.statcan.ca/cgi- bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&dbg=f&adm=8&dis=2
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4.0 HEALTH BASELINE: CONTEXTUAL OVERVIEW
4.1 Regional Population Structure and Trends
The Labrador region comprises approximately three-quarters or 294,330 km² of the total area of the Province of Newfoundland and Labrador6. As a whole, this large territory is sparsely populated with a population in 2006 of 26,364 (Census Divisions No. 10 and 11) (Statistics Canada 2006a). Approximately 41 percent of the region is considered ‘rural’, with approximately 80 percent of the population concentrated in and around two urban areas, namely: Labrador City (Economic Zone 2) and Happy Valley-Goose Bay (Economic Zone 3). For the purposes of providing health and other services to the residents of Labrador, much of the regional population is located within close proximity to these major communities. Labrador differs from the Province in terms of its population structure. The most recent population data reports 20.5 percent of the region’s population in the 0 to 14 age group and only 6.3 percent in the 65+ age group (Statistics Canada 2006a). The population of Labrador tends to be younger than the Province, which has only 15.5 percent of its population under the age of 15. That being said, the population age cohort distribution for the Labrador region suggests a relatively stable population growth structure. Figure 4-1 Labrador Population Structure
Source: Community Accounts 2008 The trend for Newfoundland and Labrador in recent decades has been one of declining population; between 1991 and 2006 the provincial population declined by 69,841, or 12.1 percent (Government of Newfoundland and Labrador 2006a). This has been attributed to a combination of a longstanding trend of out-migration to other provinces by persons in search of employment opportunities, combined with a
6 www.gov.nl.ca/aboutnl/area.htm.
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more recent pronounced decline in natural population growth, which now lies below the replacement level due to declining fertility and an aging population (Government of Newfoundland and Labrador 2006a; 2002). The same trend has been true of Labrador: between 1991 and 2002 its population decreased from 26,463 to 23,840 (-10 percent)7. However, the reasons for this downturn differed slightly, as the same decline in birth rate was not seen in the region, while out-migration was more substantial. Internal to the region, the population declines experienced during 1991 to 2006 varied somewhat by geography: Labrador West/Churchill Falls suffered a loss of almost 22 percent of its population while the Upper Lake Melville area lost only approximately 10 percent, and the north coast (alone in the region) experienced a gain of just over 10 percent (Government of Newfoundland and Labrador 2006a).
4.2 Community Context
Most of the Innu of Labrador live either in Sheshatshiu (Sheshatshiu Innu First Nation), located in the Upper Lake Melville area, or Natuashish (Mushuau Innu First Nation), located on the north coast of Labrador. Sheshatshiu and Natuashish are both reserves, registered under the federal Indian Act; the latter community having reserve status since its inception in 2003 and the former since 2006 (Jong 2007: 25). The population structures and trends for the two Innu communities differ considerably from those of the non-Innu population of Labrador. Both are young and both are growing. As of 2001, there were approximately 1,600 Innu in the region (Government of Newfoundland and Labrador 2002: 23). By 2005, the number had risen to about 2,1008. After a 50 percent growth in the population between 1996 and 2001, the 2001 census counted 580 people in Utshimassits (later settled at Natuashish), evenly split between males and females9. By 2006, the population at the new site was 706 (Statistics Canada 2006a). The population and trends of the Innu community of Sheshatshiu are difficult to delineate, as its members do not participate in the Canadian census as an organized census sub-division and other sources of data are similarly incomplete. The 2006 Census data for Sheshatshiu are consolidated with Mud Lake and reported as an unorganized area. Thus, all figures must be treated with some caution. The reader should be aware that unless otherwise indicated, all census-based data reported for Sheshatshiu also include the population of Mud Lake. As of 2001, Sheshatshiu was estimated to be slightly larger than Utshimassits, at approximately 1,134, after growing 11.4 percent from 199610. The
7 On the whole, the region experienced higher rates of out-migration than the rest of Province, with most occurring in the 15 to 29 and 50 to 64 age groups (Government of Newfoundland and Labrador October 2002: 3, 14). 8 www.ainc-inac.gc.ca/irp/irp-Pf_e.html. 9Statistics Canada. 2002. 2001 Community Profiles. Released June 27, 2002. Last modified: 2005-11-30. Statistics Canada Catalogue no. 93F0053XIE. http://www12.statcan.ca/english/Profil01/CP01/Index.cfm?Lang=E (accessed June 21, 2007). www.communityaccounts.ca/CommunityAccounts/OnlineData/table_d7r.asp?comval=com162&whichacct=demog raphic. In 1927 there had been 92 people resident at Utshimassits, and 145 in 1968 (Henrikson 1981: 666). 10 Statistics Canada. 2002. 2001 Census Aboriginal Population Profiles. Released June 17, 2003. Last modified: 2005-11-30. Statistics Canada Catalogue no. 93F0043XIE. http://www12.statcan.ca/english/Profil01/AP01/Index.cfm?Lang=E (accessed June 21, 2007).
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sex ratio in 2001 was near equal, at 0.97 and the DR was 88.211. In 2006, the population of Sheshatshiu (including Mud Lake, as part of Census Division 10, sub-division C) was reported to be 1,112. Approximately 60 persons in the sub-division reside in Mud Lake. This too is a young community, with 37 percent under the age of 15 years. The age distribution of the Mushuau Innu is heavily skewed towards the youngest, with the largest cohorts between 0 and 14; approximately 38 percent of the total population. This produces an expansive population structure. The median age for the Mushuau Innu as of 2006 was only 20.3, younger than that of Canadian Aboriginal people in general (Waldram et al. 2006: 20) and younger than the 2006 median age for the Province (41.7). This youthful population is reflected in the value of the dependency ratio (DR) for the community, the ratio of people in non-working ages (0 to 14 and 65+) to those who are in what are considered the productive ages (15 to 64). Based on the 2006 Census, the DR for the Mushuau Innu is 71; in other words, approximately 71 dependent persons per 100 people of working age. By comparison, Canada’s DR in 2006 was 45.69 and Newfoundland and Labrador’s was 41.6 (Table 4-1). Befitting the large proportion of young people, the census figures for the Mushuau Innu suggest a population that is growing rapidly, with a 12.6 percent growth rate between 1996 and 2001 (male 13.7 percent; female 11.5 percent)12 and approximately 21 percent between 2001 and 2006. Such a concentration in the less than 15-year age cohort suggests a growing demand for child health and social services and primary school education and childcare facilities. Table 4-1 Population Characteristics and Dependency Ratios for Innu Communities, Region and Province, 2006
Region Population Median Age % <15 years % >65 years DRA Province 505,469 41.7 15.5 13.9 41.6 Labrador B 26,360 36 20.5 6.3 36.6 Sheshatshiu 1,112 20.4 37 4 69.5 Natuashish 706 20.3 38 3.5 70.9 A DR = dependency ratio. B Census Divisions No. 10 and 11. The non-Innu population of Labrador is slightly younger than the Province, with an average median age of 35.1 years. This number is slightly skewed however, as the 2006 Census data for Mud Lake are consolidated with Sheshatshiu and reported as an unorganized area. The age distribution of the non- Innu population within the Study Area is skewed towards the youngest, consistent with the Province. The community of North West River, however, is relatively evenly split between the youngest and the oldest cohorts, meaning the majority of the population is between 15 and 64 years of age. The dependency ratios for the non-Innu population are consistent with the region, except Wabush and Churchill Falls, which have significantly lower DR values.
11 Calculated from data at: Statistics Canada. 2002. 2001 Census Aboriginal Population Profiles. Released June 17, 2003. Last modified: 2005-11-30. Statistics Canada Catalogue no. 93F0043XIE. http://www12.statcan.ca/english/Profil01/AP01/Index.cfm?Lang=E (accessed June 21, 2007). 12www.communityaccounts.ca/CommunityAccounts/OnlineData/table_d7r.asp?comval=com162&whichacct=dem ographic.
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4.3 Study Area Health Overview
Self-rated health status is a reliable predictor of health problems, health-care use and longevity (Adams 1988). Based on the Canadian Community Health Survey (2005), 69.3 percent of residents surveyed in the In Labrador West/Churchill Falls area indicated no change in their health, 24.9 percent suggested that their health had improved, and 5.8 percent indicated decline. In the Upper Lake Melville area/Labrador Central, 73.8 percent indicated no change in their health in comparison to the previous year; 18.4 percent suggested that their health had improved, and only 7.8 percent indicated a decline in health, similar to the provincial and regional findings (Figure 4-2). Significantly more males in Labrador Central/Upper Lake Melville self-reported their current health as ‘fair’ or ‘poor’ in comparison to Labrador West/Churchill Falls. Only 10 percent of females in the Labrador Central/Upper Lake Melville area assessed their health status as ‘excellent’ in comparison to 21.8 percent of males (Table 4-3). Table 4-2 Population Characteristics and Dependency Ratios for Non-Innu Communities, Region and Province, 2006 Region Population Median Age % <15 years % >65 years DRA Province 505,469 41.7 15.5 13.9 41.6 Labrador B 26,360 36 20.5 6.3 36.6 Happy Valley- 7,572 35.7 20 7 36.9 Goose Bay Mud Lake13 1,112 20.4 37 4 69.5 North West River 492 43.4 15 14 41.8 Labrador City 7,240 36.9 18 4 28.6 Wabush 1,739 38.9 17 4 20.4 Churchill Falls - - - - - A DR = dependency ratio. B Census Division No. 10 and 11.
13 As noted above, the 2006 Census data for Mud Lake are consolidated with Sheshatshiu and reported as an unorganized area. Thus, all figures must be treated with some caution.
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Figure 4-2 Total Surveyed Population for Self-assessed Health Status
Source: Canadian Community Health Survey 2005: Health Status of Individuals,
accessed from Community Accounts. Table 4-3 Self-assessed Health Status by Gender*
Labrador West / Labrador Central / Province Labrador Churchill Falls A Upper Lake Melville A Males Females Males Females Males Females Males Females Excellent 19.5% 18.2% 17.9% 12.5% 21.8% 10% 20.1% 13.9% Very Good 43.3% 47.9% 45.2% 48.8% 44.7% 50.8% 42.5% 53.8% Good 25.1% 22.1% 25.6% 27.6% 19.7% 30.1% 31.7% 23.7% Fair 8.2% 8.7% 10.1% 8.5% 13.8% 6.3% 4.6% 7.0% Poor 3.9% 3.0% 1.1% 2.7% 0% 2.7% 1.0% 1.6% A No data available for the north coast region, including the community of Natuashish Source: Community Accounts 2008 * Caution should be taken in scaling these results due to relatively low participation rates and possible under-representation of the Innu population. Selected regional and community population and social health indicators for the Study Area region and communities are summarized in Table 4-4 and examined in greater detail throughout the report. Caution should be taken, however, in scaling these results to the Innu population, due to relatively low participation rates and under-representation (see Section 3.6).
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Table 4-4 Select Population and Social Health indicators for Labrador Region and Innu Communities* Sheshatshiu Upper Lake Churchill Falls North Coast and North Natuashish Indicator Melville A West River Value (Rank) Value B (Rank C) Value (Rank) Value (Rank) Value (Rank) Life expectancy 74 (L) 71 (L) 76 (L) 72.2 (L) --- High school or above 76.4% (H) 56.3% (M) 66.6% (H) 49.4% (M) 36.4% (M) Economic self-reliance 93.3% (H) 77.8% (H) 87.6% (H) 77.8% (H) 81.6% (H) ratio Social assistance 6.3% (H) 21.8% (L) 10.8% (M) 21.0% (L) 10.6% (M) incidence Median couple family $85,300 (H) $56,500 (M) $72,900 (H) $61,500 (H) $57,400 (M) income % self-rated health ‘very 66.2 64.3 good’ to ‘excellent’ D Change in employment -4.3% (L) 12.8 (H) 3.0 (M) 11.3 (H) 4.5 (M) Employment insurance 19.9 (H) 38.4 (M) 26.4 (H) 34.4 (H) 44.8 (H) incidence % births to mothers <20yrs 11.26 (M) 33 (L) 13.2 (M) 38.7 (L) 40 (L) % death <20 yrs 7.6 (M) 25 (L) 6.8 (M) 11.1 (M) 40 (L) % self rated sense of 90.8 --- 85 ------belonging strong to very % Aboriginal as mother ------88 95.4 tongue Owned: rented dwellings 3.13 : 1 --- 1.64 : 1 6 : 1 5.25 : 1 % need help with personal 3.5 --- 3.6 ------care Disease of circulatory 0.41 0.56 0.60 0/93 --- system ratio to Province Disease of digestive 0.84 1.36 1.03 1.37 1.10 system ratio to Province Source: Community Accounts 2008 * Caution should be taken in scaling these results due to relatively low participation rates and possible under-representation of the Innu population. A Data include North West River, therefore, caution should be taken in drawing conclusions about Sheshatshiu. B All values based on 2001 Census data and 2001 Community Health Survey, unless otherwise indicated. C Based on participating areas: high (H) = top 25%; middle (M) = mid 50%; Low (L) = bottom 25%. D Based on 2005 Community Health Survey.
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5.0 HEALTH SERVICES
The Newfoundland and Labrador Department of Health and Community Services (NLDHCS) provides support services to six Regional Institutional Boards, four Regional Health and Community Services Boards, two Regional Integrated Boards and one Regional Nursing Home Board located in St. John's14. Community health boards undertake the delivery of programs and services. The health and community service system in Newfoundland and Labrador includes:
• 14 hospitals; • 19 health centres; • 22 nursing homes; • 14 nursing stations; • 106 community/clinical offices; • 1,678 hospital beds; • 2,737 nursing home beds; • 2,750 personal care home beds; and • 254 community care beds. The total NLDHCS budget (approximately $1.2 billion) represents approximately 33 percent of all government spending. Approximately $800 million is spent in support of the 13,000 full time equivalent jobs in the service industry sector with about 640 physicians receiving fee for service and about 300 receiving fixed salaries15. NLDHCS underwent reorganization in 2005 to provide more efficient input into policy and program development and supports to boards and agencies. The organizational structure is comprised of five branches with 15 divisions (Table 5-1). In addition, the provincial government announced in September 2004, the transition of the 14 health boards to four RIHAs. It is anticipated that the new structures will achieve greater collaboration in creating comprehensive and integrated programs and services on a regional basis. The four new authorities are: 1) Eastern; 2) Central; 3) Western; and 4) Labrador-Grenfell (Figure 5-1). The four health authorities support the full continuum of care, from health promotion and community services to acute and long-term care. The Labrador-Grenfell Regional Health Authority (Labrador- Grenfell Health) was formed April 1, 2005, with the merging of the two health boards in Labrador, namely: Health Labrador Corporation and Grenfell Regional Health Services. The newly formed health authority provides health and community services to more than 40,000 people in Labrador, employs approximately 1,150 staff, and operates 23 facilities, including: three hospitals; three community health centres; 14 community clinics; and three long-term care homes16. The Labrador-Grenfell Health’s headquarters is located in Happy Valley-Goose Bay.
14 http://www.health.gov.nl.ca/health/department/default.htm 15 http://www.health.gov.nl.ca/health/department/default.htm 16 http://www.lghealth.ca/
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Table 5-1 Branches Under the Newfoundland and Labrador Department of Health and Community Services Branch Description The Board Services branch provides overall relations with the government- funded regional boards, the coordination of their service, the identification of Board Services Branch service quality improvements, and has program responsibility for road and air ambulance and other emergency services in the Province. The Policy and Program Services branch provides the overall policy and program development functions of NLDHCS, strategic planning for the Policy and Program Services Branch health and community services system, and applied research and evaluation activities. Government and Agency Relations has extensive involvement with intergovernmental activity at the federal-provincial levels, legislative and Government and Agency Relations regulation review responsibility as well as interaction with the many professional associations, voluntary and consumer advocacy groups active in the health and community services sector in the Province. The Support Services branch is responsible for the overall administrative, financial, human resource, claims management and information Support Services Branch management services of NLDHCS, including all financial arrangements with, and financial monitoring of, government-funded regional health boards. The Medical Services branch is responsible for NLDHCS's mandate related Medical Services Branch to the provision of medical services, disease control, epidemiology, environmental health and pharmaceutical services. 17 Source: NLDHCS 2007
17 http://www.health.gov.nl.ca/health/department/default.htm
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Figure 5-1 Regional Integrated Health Authorities
Source: NLDHCS: Annual Report 2004-2005 (2005).
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5.1 Labrador-Grenfell Health Programs and Services
Health care services provided by Labrador-Grenfell Health include both primary and secondary health services to the region: acute care, diagnostic services, continuing and long term care, health promotion, mental health and addictions, family and rehabilitation services, child protection and intervention services, youth services, adoptions, child care services, residential services and community health nursing. Labrador-Grenfell Health works with Nunatsiavut Department of Health and Social Services, two Innu Band Councils, the Labrador Métis Nation, Health Canada and private practitioners to deliver community health programs in Aboriginal communities (Labrador-Grenfell Health 2007).
5.1.1 Community Health and Wellness
Programs are put in place by Labrador-Grenfell Health to assist people in making healthy choices and to develop healthy and supportive environments. Community health nursing can be divided into two groups: public health and continuing care. Public health nurse services include: • pre-natal program; • post-natal program; • B.U.R.P.S. (a parenting and breastfeeding support program); • Health Checks Program which promotes the health, growth, and development of infants and preschool children; a school health program; and • Community Health Education, Promotion and Screening Program. Continuing care includes various programs such as:
• home care nursing; • assessments for the institutional placement program; • a home support program; • palliative care; and • a special assistance program, available to people of all ages, which provides health care supplies, various equipment and other health related services to financially eligible persons who have chronic health conditions. Health promotion is carried out through a variety of community-based activities that are designed to promote the health and well being of people and communities in the Labrador-Grenfell region. Labrador-Grenfell Health staff work with community partners, schools and Aboriginal groups, using a variety of strategies to address needs and develop programs in all areas of health. Programs to promote health and well being include cervical screening, diabetes education, health education, heart health and reproductive health (Labrador-Grenfell Health 2007).
5.1.2 Health Protection Services
Labrador-Grenfell Health, under the direction of the Medical Officer of Health (MOH), offers a variety of programs which are designed to protect the health of the public with legislative authority coming from the Health and Community Services Act, the Communicable Disease Act, the Food and Drug Act, the
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Tobacco Control Act and related regulations. Programs include Environmental Health, Communicable Disease Control, and Health Emergency Management (Labrador-Grenfell Health 2007).
5.1.3 Mental Health and Addiction Services
Mental health services are provided at two hospitals: the Captain William Jackman Memorial (CWJ) Hospital in Labrador City and Labrador Health Centre in Happy Valley-Goose Bay, as well as at the community clinic located in Churchill Falls. Mental health professionals include nurses, social workers and a psychologist. Outpatient counseling services include: individual counseling; family counselling; couple counselling; youth work; case management for chronic and persistent mental illness. Other services offered include:
• group sessions - topics may include anxiety, gambling, healthy living, parenting, relationship and marriage, and self-esteem; • workshops and educational presentations for staff and community members; • critical incident stress debriefings; • consultations are available for other professionals and concerned family/community members; • in-patient work; • referrals to outside agencies as needed; and • impaired driving assessment. Mental health addictions are reported to have become much more acute in Labrador in the past five years. In Sheshatshiu, for example, 2004/2005 IDC chapter diagnosis ‘mental disorder’ constituted 9.1 percent of all hospital separations; up from 6.2 percent in 2000/200118. Working with clients with mental illnesses, for example, has been identified as one of the most significant challenges facing Human Resources and Employment in Labrador (A. Rumbolt, pers. comm.). The Province employs 45 addiction councellors, 56 mental health councellors (which includes case managers, social workers, psychologists and registered nurses) and 8 mental health and addiction councellors (S. Barnes, pers. comm.). The Labrador region in general and coastal communities in particular lack needed resources to deal with increasing mental health problems and addictions (J. Dymond, pers. comm.). Many mental illnesses are presented to Community Health workers; only a single psychologist serves the entire Labrador-Grenfell region, with no dedicated facility for mental health patients. Happy Valley- Goose Bay has only one room available for proper psychiatric treatment; most patients must be transported to St. John’s. Wait times up to 9 to 10 weeks exist for mental health services (Health Directors Focus Group, pers. comm.). The Health Labrador Corporation Addiction and Mental Health Services in Happy Valley-Goose Bay is a public health and community-based mental health and addictions service provided to coastal
18 Data supplied by NLCHI, based on Clinical Health Database Management System.
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communities by the Labrador Inuit Health Commission and the Innu Health Commission, in partnership with Health Labrador Corporation19. As of 2007, Lake Melville (Happy Valley-Goose Bay) is served by two addiction councellors, one addictions coordinator/officer, five mental health councellors and one mental health case manager. Wait times in Happy Valley-Goose Bay are reported to be short with most referrals being seen within one month of being referred. Labrador West is served by two addictions councellors, one addictions coordinator/officer, 4.5 mental health councellors as well as the regional mental health and addictions clinical manager. Churchill Falls employs one part time mental health nurse. Wait times in Labrador City are up to 4 to 6 weeks, as position vacancies are a challenge to the department. At both the Happy Valley-Goose Bay and Labrador City locations emergency cases are priority20.
5.1.4 Child, Youth and Family Services and Adoptions
The Child, Youth and Family Services Program is responsible for the assessment of children alleged to be in need of protection or intervention and for provision of services and permanency planning for these children and their families and alternate caregivers. The program is mandated to provide early intervention and services to children under 16 years and youth 17 and 18 years of age and is legislated by the Child, Youth and Family Services Act (2000) and the Adoption Act (2003) (Labrador-Grenfell Health 2007). In the Study Area, Labrador-Grenfell health has Child, Youth and Family Services offices located in Happy Valley-Goose Bay, Labrador City/Wabush, and Sheshatshiu/ North West River. The offices provide protective intervention services, youth services, adoption services, family and rehabilitative services, child care services, and community corrections services.
5.1.5 Child Care
As of July 2007, there are 10 licensed child care centres in the Labrador-Grenfell region, four of which are located within the Study Area, including Happy Valley-Goose Bay, Sheshatshiu, Labrador City and Natuashish. In January 2007 there were 346 children enrolled in child care. The centres are operating at capacity with over 50 children on a waiting list21. These centres are run by non-profit boards and organizations and families may apply for a subsidy for their child(ren) to attend licensed centres. In May 2006, the Province announced a plan to enhance child care services in Newfoundland and Labrador. Included amongst the 2007 Northern Strategic Plan for Labrador is a commitment to $8.3 million over the next five years to enhance social work staffing and a family resource coordinator position to improve family resource planning in the region. In addition, three strategies have been implemented to help establish and maintain inclusive quality child care, including training in inclusion, grants to support inclusion and human resources (Labrador-Grenfell Health 2007).
19 http://nl.snis.ca/search/view/?organization_id=940 20 Based on personal communication with Deanne Costello, Regional Director, Mental Health Services 21 Based on personal communication with Dolores Dooley, Program Consultant, Child Care Services, Health and Community Services.
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5.1.6 Medical Transportation Services
Based out of St. Anthony, Labrador-Grenfell Health operates a provincial air ambulance service, one of two provincial air ambulances operated in the Province. In addition, Labrador-Grenfell Health operates road ambulances, has specialized equipment to facilitate medical evacuation by snowmobile and provides physician/nursing escorts and paramedic services (Labrador-Grenfell Health 2007). The 2007 Northern Strategic Plan for Labrador includes a provincial government commitment of $1.2 million to medical transportation over the next five years to assist with reimbursement of expenses under the Medical Transportation Assistance Program for residence that incur travel expenses to receive medical treatment.
5.1.7 Dental Services
In parts of the region, Labrador-Grenfell Health is responsible for the provision of dental services. At selected locations, regular preventive/corrective dental care is provided. Dentists and community health professionals throughout the region carry out promotion of dental health. Payment for dental services varies across the region. For example, fee-for-service dentists in Labrador West provide dental services; however, on the North Coast of Labrador services are provided by the Nunatsiavut Department of Health and Social Development (Labrador-Grenfell Health 2007).
5.1.8 Nutrition Services
The Nutrition Services Department consists of Registered Dietitians working in various capacities throughout the region to provide nutrition expertise to improve the nutritional status of the population served. In addition, Clinical Dietitians on staff at the three hospitals within the region, working as members of the health care team. Nutrition services are provided directly to inpatients, outpatients and long term care residents. A Regional Nutritionist and a Community Dietitian are also available to provide nutrition expertise to assist people of all ages and their communities adopt healthy eating practices and policies that will promote health and prevent disease (Labrador-Grenfell Health 2007).
5.2 Health Care Services and Programs in the Study Area
Labrador Central/Upper Lake Melville Of the three hospitals operated by Labrador-Grenfell Health, two are located within the Study Area. The Labrador Health Centre, opened in 2000, is located in Happy Valley-Goose Bay and is equipped with 26 beds and has a 24-hour Emergency Department, as well as out-patient clinics. The Labrador Health Centre is the referral centre for the community clinics in Sheshatshiu, North West River and Mud Lake. The hospital is staffed with family physicians, as well as specialists including: a general surgeon, an anesthetist and an obstetrician/gynecologist. A maternity care team is comprised of an obstetrician, physician residents, midwives and registered nurses and provides routine obstetric and high-risk obstetric care. The hospital offers full diagnostic and rehabilitative services and a number of specialists visit the hospital on a regular basis (Labrador-Grenfell Health 2007). The Harry L. Paddon Memorial Home, the only long-term care facility in the Study Area, is located Happy Valley-Goose Bay and offers Levels 2, 3 and 4 nursing care to residents. The facility has been in operation since 1979 and has 29 rooms, including seven single-occupancy, 20 double-occupancy, one respite and one special care. Registered nurses, licensed practical nurses and personal care
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attendants on a 24-hour basis staff the facility. Doctors visit the facility on a weekly basis. Other services provided at the facility include occupational therapy and physiotherapy (Labrador-Grenfell Health 2007). Labrador West/Churchill Falls The Captain William Jackman Memorial Hospital opened in 1965 and serves Labrador West. The CWJ hospital has 20 beds, six of which are designated long-term care beds for Levels 3 and 4 nursing care. Six family physicians, a general surgeon, an anesthesiologist and three dentists provide health services at CWJ (Labrador-Grenfell Health 2007).
5.2.1 Shelters
There are three shelters and one safe house in the Study Area.
Labrador Central/Upper Lake Melville In Sheshatshiu, the Nukum Munik Shelter provides 24-hour service and is funded by INAC, the Canadian Mortgage and Housing Corporation, and sponsored by the Sheshatshiu Innu Band Council. The Rose Gregoire Safe House, also in Sheshatshiu, opened in 2007 and provides a safe place for youth. The Safe House can accommodate three youths at a time. In Happy Valley-Goose Bay, Libra House is used by women and children from all coastal areas of Labrador. Libra House currently has 10 beds, which is generally sufficient to meet current demand. Labrador West/Churchill Falls In Labrador City, the Labrador West Family Crisis Shelter provides a 24-hour crisis line. The shelter currently has nine beds and is reported to be generally sufficient to meet current demand, although occupancy fluctuates throughout the year. The service is available to people of Labrador West area, including the communities of Churchill Falls, Wabush and Labrador City. The service is also available to women and children from other parts of Labrador. The shelter is in the process of rebuilding in order to increase its capacity and level of service.
5.2.2 Community Clinics
The vision of Labrador-Grenfell Health is of healthy people living in healthy communities. To that end, Labrador-Grenfell Health operates 14 community clinics throughout Labrador and the Northern Peninsula (Table 5-2). The focus of these clinics is on health promotion, disease prevention and overall community wellness. The clinics are staffed by regional nurses who provide management of acute and chronic health problems and are specialized emergency treatment. Family physicians from the Labrador-Grenfell Health Centre visit the clinics every six to eight weeks and dental services are provided by independent dentists. Clinics are open Monday to Friday, 9 a.m. to 5 p.m. (Minaskuat 2007). Three of the 14 community clinics are located within the Study Area or in Natuashish.
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Table 5-2 Locations of Community Clinics in Labrador
Black Tickle Makkovik St. Lewis Cartwright Mary’s Harbour Nain Charlottetown Port Hope Simpson Natuashish Churchill Falls Postville Sheshatshiu/North West River Hopedale Rigolet Source: Labrador-Grenfell Health 2007. Bold: indicates community clinic located within Study Area and Natuashish Labrador Central/Upper Lake Melville Labrador-Grenfell Health partners with the Sheshatshiu Innu Band Council in the provision of primary health care. The health team includes two part-time public health nurses, a public health aide (employed by the Sheshatshiu Innu Band Council), diabetes initiative workers, home care workers, a community diabetic worker and a part-time diabetes educator, who provide a range of services (Labrador-Grenfell Health 2007).
The Mani Ashini Health Centre, located in Sheshatshiu, serves the residents of the Sheshatshiu and North West River and is staffed by a regional nurse, a part-time public health nurse, a home care nurse, two personal care attendants, a part-time personal care attendant/clerk and two ambulance attendants. Emergencies are transported by ambulance to Happy Valley-Goose Bay. A medevac service is provided by helicopter (Minaskuat 2007). In 2005-06 there were 428 emergency and non-emergency patients medevaced from Labrador, the majority of which originate from Coastal Labrador. In a 29 April 2008 Health and Community Services news release, the Province committed to invest approximately $8 million in the purchase of a new air ambulance to increase service capacity to those regions and patients who cannot be transported by commercial airline or by road ambulance.
Labrador North (Natuashish)
The community clinic located in Natuashish provides primary health care to the community. The clinic staff includes one Regional Nurse II, two Regional Nurse I, one personal care attendant, two maintenance repairers, two child, youth and family services social workers and two community service workers. A physician visits every four to six weeks from Happy Valley-Goose Bay and a dentist visits periodically.
Labrador-Grenfell Health is joined by the Nunatsiavut Department of Health and Social Development, two Innu Band Councils, the Labrador Métis Nation, Health Canada and private practitioners in delivering community health programs that meet the health needs of residents within the Aboriginal communities in the region (Labrador-Grenfell Health 2007). For example, on the north coast, Labrador- Grenfell Health partners with the Mushuau Innu Health Commission (MIHC) in the provision of health care. Community health services are provided by a community health nurse, a community health aide, commission community service workers, a diabetic worker and a home care coordinator (Labrador- Grenfell Health 2007).
Labrador West/Churchill Falls
The Churchill Falls Community Clinic is staffed by one Regional Nurse, one Registered Nurse who provides public health services on a quarter-time basis and mental health on a half-time basis, one physician, and two support staff. A dentist visits the clinic regularly (Labrador-Grenfell Health 2007).
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5.3 Labrador Innu Comprehensive Healing Strategy
In June 2001, the Government of Canada, represented by INAC, Health Canada and the Solicitor General, initiated the Labrador Innu Comprehensive Healing Strategy (LICHS) to address the health and social conditions of the two Innu communities, including the commitments made to the Innu in response to the gas-sniffing crisis in their communities (INAC 2006). The LICHS encompasses the population health approach by addressing a wide variety of community issues such as housing, governance, justice and social and health services. According to Health Canada (2003), the following community health programs were offered through the Innu Healing Strategy as of February 2003.
• Addictions: The community health centre in Sheshatshiu offers in-country family treatment and day program and aftercare for these programs. Similarly, in-country mobile treatment is operating in Natuashish; however, there is no day program and aftercare for the in-country treatment was not available in February 2003. In addition, parent support staff are available in both communities and an addictions therapist with the Labrador Health Secretariat has been hired in Happy Valley-Goose Bay. • Mental Health: A mental health therapist and psychologist (Manager of the Mental Health Team) are on staff with the Labrador Health Secretariat. At the time of the Heath Canada (2003) study, there were provisions for two mental health nurses in the mental health/ addictions team and another psychologist. Mental health counselling is available in Natuashish. • Public Health: Public health positions include a maternal/child health team manager, an early childhood development nurse, and nutritionist and there are plans to hire a public health team to serve both communities; however, these positions were not filled as of February 2003. • Community Health Planning: A Community Development Officer is located in Happy Valley- Goose Bay and agreements were in place in 2003 to hire community health planners in both communities. • Labrador Health Secretariat: Positions with the Labrador Health Secretariat included a mental health therapist, addictions therapist, case management coordinator, maternal/child health team manager, early childhood development specialist, community development officer, Program Evaluation Office, manger of the mental health team, Director, Associate Director, Finance Officer and administrative assistant as of 2003 (Health Canada 2003: 16). More specifically, the programs offered in the communities of Sheshatshiu and Natuashish are summarized in Table 5-3. An evaluation process is in place to help ensure the LICHS meets its objectives. INAC is therefore responsible for regular reporting on the progress being made on the implementation of the Healing Strategy. The Institute of Environmental Research (IER) Planning, Research and Management Services and the Aboriginal Research Institute (ARI) were contracted to evaluate the LICHS in October 2002. The purpose of the evaluation was to assess progress against plan for each of the five main components of the Strategy, and provide an overall assessment of ongoing relevance and needs, early success and cost-effectiveness (INAC 2006).
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Table 5-3 Health Programs, Innu Healing Strategy, Sheshatshiu and Natuashish Strategy area Sheshatshiu Natuashish Funded By Mental health and Family treatment support Mobile treatment program Strategy addictions Day program Mobile treatment youth Aftercare for family Aftercare for mobile treatment and day treatment program Healing services Innu Uauitshitun Mental health crisis Mental health management Brighter futures Solvent abuse Solvent abuse Maternal and child Parenting support Parenting support program Strategy health program Next generation guardians Health Canada Pre-natal nutrition Pre-natal nutrition program PPHB, HRDC, program Province Day care and Aboriginal head start Community health Community health planner Community health nursing Strategy Planning Community health nursing Health promotion and Health Canada injury/illness prevention Communicable disease control Diabetes initiative HIV/AIDS strategy Source: Health Canada 2003: 18, 32. The first evaluation was completed 18 months into implementation. Generally speaking, the LICHS has made many positive steps towards improving health within the two communities. For example, the Innu-run healing programs have been successful, including the family treatment program (run by the Sheshatshiu Innu) and the country treatment program (run by the Mushuau Innu). However, many challenges exist and include lack of involvement and communication and collaboration between the government and the Innu. In addition, health and social problems in the two communities date back many years. The evaluation report (2006) suggests that while the Healing Strategy involves multiple initiatives to address these problems, additional efforts beyond the Healing Strategy (e.g., self- government negotiations) will be required by the communities and the federal/provincial governments to solve the Labrador Innu’s problems effectively (INAC 2006: 22).
5.4 Healthcare Use
Separations from hospitals refer to discharges, transfers and deaths. Separations are based on the diagnosis which caused a patient to stay in hospital and do not reflect individual cases, as one person with multiple stays for the same condition is counted multiple times. At the same time, hospital separations are not based on the reason for the hospitalization, only the type of care required (for example: acute care, long-term care, etc.). Separations by Health Authority for 2004-2005 are depicted in Table 5-4. There were just over 8,100 hospital separations for the Labrador-Grenfell region in 2004- 2005, of which 65 percent were classified as acute care, followed by surgical day care at 35 percent. This is in comparison to the provincial statistics of 49 and 51 percent, respectively. The total hospitalization stay length for the region was 29,140 days; of which over 85 percent was attributed to acute care hospitalizations (Table 5-5).
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Table 5-4 Hospital Separations by Regional Integrated Health Authority
Health Total Acute Surgical Day Care Authority Separations Care Eastern 58,092 27,418 30,674 Central 21,304 11,559 9,745 Western 20,774 9,321 11,453 Labrador-Grenfell 8,169 5,289 2,880 Total 108,339 53,587 54,752 Note: Data current as of February 2003. Source: Government of Newfoundland and Labrador 2007c.
Table 5-5 Hospitalization Total Stay Length
Health Total stay Acute Authority (days) Care Eastern 241,208 200,477 Central 88,924 76,289 Western 94,073 80,918 Labrador-Grenfell 29,140 27,708 Total 453,345 385,392 Source: Government of Newfoundland and Labrador 2007c. The majority of hospitalizations in the Labrador-Grenfell region are diagnosed disorders and diseases of the circulatory and digestive system. This is consistent with patterns that exist at the provincial level. However, at the community level of Sheshatshiu (including North West River) and Natuashish (Utshimassits), there is a prevalence of hospital admissions/separations related to diseases/illness of the respiratory system: 210 or 26.8 percent for Sheshatshiu/North West River and 70 or 28.5 percent for Natuashish in comparison to 27,970 or only 16 percent for the Province (Figure 5-2). Hospital admissions due to injury or poisoning are also proportionately higher in Sheshatshiu/North West River and Natuashish at 24.5 percent each, in comparison to a provincial statistic of only 11.3 percent.
5.5 Health Care
In 2005, 87.1 percent of the Province’s residents aged 12 years and older reported having a regular medical doctor; however, compared to the other health authorities, only 59 percent of residents in the Labrador-Grenfell Health Authority report having a regular medical doctor (Government of Newfoundland and Labrador 2007a). This percentage has increased since 2003; however, it remains statistically significantly lower than the provincial or national figures (Table 5-6). In 2005, only 61.4 percent of the population in the Upper Lake Melville area aged 12 years and older report having a regular medical doctor, in comparison to 92.1 percent in Labrador West/Churchill Falls (NLCHI 2007)22.
22 Data based on Statistics Canada, Canadian Community Health Survey, Share File, 2005. Data are statistically weighted to represent the population.
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Figure 5-2 Hospital Admissions: Province, Labrador Central/Upper Lake Melville, Labrador West/Churchill Falls, Sheshatshiu and Natuashish, 2000 – 2004
Source: Health Canada 20
Source: Community Accounts 2008 Table 5-6 Population Who Report Having a Regular Medical Doctor
2003 2005 Location/Jurisdiction (%) (%) Canada 85.9 85.8 Newfoundland and Labrador 85.9 87.1 Eastern Health Authority 90.1 92.4 Central Health Authority 83.8 82.6 Western Health Authority 87.4 85.8 Labrador-Grenfell Health Authority 55.6 59.0 Upper Lake Melville -- 61.4 Labrador West/Churchill Falls -- 92.1 Source: Statistics Canada 2006a, Canadian Community Health Survey, 2003 and 2005. As previously noted, caution should be taken in scaling these results to the Innu population, due to relatively low participation rates and under-representation (see Section 3.6).
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6.0 LIFESTYLE, HEALTH PRACTICES AND COPING SKILLS
Lifestyle includes not only self-reliant individual choices, but also the influence of social, economic and environmental factors on the choices that people make concerning their health. These influences affect personal health through stress, social relationships, sense of control and personal life skills and contribute to patterns of alcohol abuse, smoking, poor dietary patterns, suicide and various social illnesses. Personal health practices and coping skills are those actions by which individuals can prevent such problems, and make choices that enhance health and well-being.
6.1 Alcohol and Solvent Abuse
Alcohol is reported as the biggest social health problem in the Study Area and remote communities in Labrador (Cpl. K. MacKinnon per. comm.), and is the root of many social ailments. According to a 2001 survey, 16.7 percent of respondents in Labrador West/Churchill Falls and 18.9 percent in the Upper Lake Melville area/Labrador Central (Province: 11.5 percent) had in the previous year been drunk or ‘hung-over’ while at work or at school, or while taking care of children23. Regarding the frequency of binge drinking, 20.9 percent of the participants from Labrador West/Churchill Falls reported drinking five or more drinks greater than once a month. Respondents engaged in binge drinking more frequently in the Upper Lake Melville area/Labrador Central, as 31.1 percent admitted drinking five or more drinks greater than once a month. For the Province as a whole, the total was 20.2 percent. In 2005, the percentage of survey participants who reported having five or more drinks on one occasion more than once a month, in the past 12 months, had increased to 38 and 32.8 percent in Labrador West/Churchill Falls and in the Upper Lake Melville area, respectively. Innu Community Alcohol and solvent abuse have been significant threats to the health of the Innu of Labrador since the implementation of a sedentary lifestyle. Peter Penashue, president of the Innu Nation, expressed the Innu understanding of why these social pathologies had emerged since the 1950s. He observed that: I was taught to believe that the Innu people were inferior and that I would have to change if I wanted to fit into this new world. If children are taught this constantly, they will start believing it; and this is what has been happening and continues to happen. So, in the end, what you have is a boy or girl, a man or a woman, who is absolutely confused as to who he or she is. These people do not fit into the Canadian environment and they do not fit into their own. They are somewhere in between. Most of us believe this is why we have children who sniff gas. That is why we have a high rate of sexual abuse. That is why our society is falling apart on a large scale (Penashue 2001: 23). Degnen (2001) argued that the social pathologies that now affect the Innu of Sheshatshiu are tied to the loss of culture and identity associated with the non-voluntary shift to a sedentary lifestyle, and suggested that a solution to these persistent social pathologies might lie in a return to the land. Backhouse and McRae (2002) noted that the ability of the two communities to cope with these ongoing problems has changed over time, as have the jurisdictions involved in treatment. They contrasted the
23 www.communityaccounts.ca/CommunityAccounts/OnlineData.
Community Health Study y Final Report • December 22, 2008 Page 6-1 © Aura Environmental Research and Consulting Ltd. 2008 Lower Churchill Hydroelectric Generation Project responses to the sniffing crises in 1993, at Utshimassits, and in 2000, at Sheshatshui. In both cases children were removed from the community for treatment, and in both cases children resumed sniffing once returned to their homes. However, whereas in 1993 the children were dealt with by the federal Health Canada under voluntary care arrangements, in 2000, the Innu approached the provincial government, requesting that the children be apprehended under provincial child welfare laws. As of 1977, approximately 53 percent of the people of Utshimassits had alcohol problems (Neuwelt et al. 1992: 153). Years later, high rates of alcoholism and solvent abuse still exist in the community (Royal Commission of Aboriginal Peoples 1996). The development of the Voisey’s Bay mining project in the mid-1990s was blamed in Utshimassits for defeating anti-alcohol programs due to feelings of powerlessness over mineral development on Innu land (Fouillard 1997). There have been 93 drug offence complaints (including possession or possession for trafficking) in the Upper Lake Melville area between September 2005 and May 2007; 14 in Sheshatshiu (Cpl. K. MacKinnon, pers. comm.). Drug use is a problem in the region, and media reports indicate an increasing presence of ‘hard drugs’ in the Innu community of Sheshatshiu (see, for example, Paul Pigott’s news report at http://www.cbc.ca/nl/features). No quantitative data are available on the increase in the usage or availability of ‘hard drugs’; however current school-based drug education and awareness programs do include information about the dangers of Ecstasy and cocaine. Some funding for problematic substance use treatment is provided in both Sheshatshiu and Natuashish through the National Native Alcohol and Drug Treatment Program, administered by the First Nations and Inuit health Branch of Health Canada. Included amongst the funded programs are:
• a family treatment centre in Sheshatshiu; • the Healing Lodge in Natuashish; • the Charles J. Andrew solvent abuse inpatient treatment centre for youth ages 12 to 18 in Sheshatshiu; and • and community health workers and addictions counselors in Sheshatshiu and Natuashish.
6.2 Smoking
Smoking is generally more common in the Province of Newfoundland and Labrador than in Canada, although it has decreased considerably in both jurisdictions over the past 20 years. As of 1996-1997, 31 percent of the provincial population (aged 12 and over) admitted smoking, compared to 28 percent of Canadians (Government of Newfoundland and Labrador 2002: 11). Between 2000 and 2004, the percentage of smokers in the Province (aged 15 and older) decreased from 27.7 to 21.8 percent (Government of Newfoundland and Labrador 2006b: 1). The population of Labrador tends to smoke more than the provincial population (Table 6-1), although here again the trend has been towards decreased rates in recent years.
Within the region, the residents of Labrador Central/Upper Lake Melville are more likely to smoke than those of Labrador West/Churchill Falls (27.3 to 18.6 percent), and this is most pronounced among females (32.4 to 17.7 percent) (Table 6-2). The smoking rates for the Innu are not known; however, 60 percent of on-reserve Aboriginal people between the ages of 18 and 34 currently smoke, and 52
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Between 2000 and 2005, smoking activity levels increased substantially in the Province, but declined by a similar amount in Labrador (Table 6-3). During that period, Labrador (as represented by the Labrador-Grenfell Health Authority) fell from being one of the most active regions in the Province to amongst the least active.
Table 6-1 Percentage of the Population Aged 12 Years and Older who are Occasional/Daily Smokers
Jurisdiction 2000/01 2003 2005 Canada 25.9% 22.9% 21.7% Province 29.3% 23.8% 23.4% Labrador-Grenfell Health Region 34.6% 30.1% 26.7% Sources: Statistics Canada 2001 and Canadian Community Health Surveys 2003, 2005.
Table 6-2 Proportion Current Daily Smokers by Gender
Jurisdiction Male Female Total Province 19.8% 18.8% 19.9% Labrador-Grenfell Health Region 21.8% 20.9% 21.4% Labrador Central/Upper Lake Melville 22.0% 32.4% 27.3% Labrador West/ Churchill Falls 19.5% 17.7% 18.6% Source: Government of Newfoundland and Labrador 2007a, based on Statistics Canada, Canadian Community Health Survey. Data compiled by NLCHI 2007. Data should be interpreted with caution due to high sampling variability associated with estimate.
Table 6-3 Percentage of Population Aged 12 Years and Older Who are Active or Moderately Active Smokers Jurisdiction 2000/01 2003 2005 Canada 46.6% 52.1% 52.3% Province 40.4% 45.4% 45.6% Labrador-Grenfell Health Region 47.1% 42.0% 42.7% Source: Government of Newfoundland and Labrador 2007a. Data Sources: Statistics Canada 2001 and Canadian Community Health Surveys 2003, 2005.
6.3 Diet and Nutrition
Based on data from the Canadian Community Health Survey (2005), only about 40 percent of all Canadians aged 12 and older consume 5 to 10 servings of fruits and vegetables a day, and those in Newfoundland and Labrador are substantially worse, with only 22.2 percent eating the recommended quantity (Government of Newfoundland and Labrador 2007a). However, only 3.1 percent of people in Labrador West/Churchill Falls report not being able to eat their desired quality or variety of foods, in comparison to 14.7 percent provincially. The proportion in Upper Lake Melville/Labrador Central was
24 www.hc-sc.gc.ca/fnih-spni/substan/tobac-tabac/index_e.html#facts.
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14.4 percent. In 2005, 57.9 percent of people in Labrador aged 12 years and older made changes to their diet in the previous year in order to improve their health, up from 52 percent two years previous (Government of Newfoundland and Labrador 2007a: 14). Pop machines were removed from all schools under the Labrador School Board in 2006 (A. Battcock, pers. comm.). Further, a number of schools in the area have nutritional education programs, including Peacock Primary School’s very successful ‘Fruit of the Month’ program (D. Abbass, pers. comm.). Amongst the most important barriers to nutritional change in Labrador are the cost of shipping fresh fruits and other perishable foods to coastal communities, particularly during the winter months, and low parental awareness of the benefits of nutrition initiatives (A. Battcock, pers. comm.). Innu Community The traditional diet of subarctic hunters such as the Innu was rich in nutrients and provided high levels of protein, fat, vitamins and minerals, but was low in carbohydrates (Samson and Pretty 2006). However, over the past few decades, the Innu have switched to a ‘fast food’ diet that is generally high in carbohydrates and saturated fats, but is lacking in essential nutrients. By the 1980s, country foods had declined considerably, such that only 30 to 65 percent still departed for hunting and other activities on the land; this percentage has fallen even further in recent years. Nevertheless, unlike many other Aboriginal populations in Canada, the Innu continue to hunt, though at a reduced level, and are able to mix healthier country foods with unhealthy processed foods obtained in their communities (Samson and Pretty 2006: 532, 537). That being said, people of Aboriginal descent are typically at increased risk for poorer nutritional status, obesity, and diabetes (NLDHCS 2005). In Aboriginal cultures, food is inextricably linked with health and the availability and access to traditional food remains an important factor Innu cultures. A study completed by Hanrahan (2002), in which 143 Innu and Inuit were interviewed, revealed the importance for culturally appropriate foods in urban health care settings. Access to culturally appropriate foods is often limited in Labrador hospitals and meals are restricted to three times a day at regular times. Quality and quantity of culturally appropriate food is a problem for elders and youth alike (Hanrahan 2002: 151). In 2002, Lawn (2002) conducted an analysis of nutritional surveys previously completed in isolated places, one of which was conducted in Utshimassits (1992-1993). The typical diet in these surveys was very low in the consumption of fruits, vegetables and dairy products, as well as being deficient in calcium, magnesium, folate, vitamin C and vitamin A. Conversely, it was rich in sugar, fat and saturated fat, and, as such, overweight was a growing health risk. However, because country foods were still harvested, protein, iron, zinc, phosphorus, thiamin, riboflavin, niacin and vitamin B12 were consumed at adequate levels. Lawn’s (2002) survey found that the Innu diet was exceptionally high in energy intake, at 178 percent of the ‘recommended nutrient Intake’ (Table 6-5). The mean fat intake among women at Utshimassits, for example, was found to be 153 grams; far in excess of recommended levels, while fibre, at 11.8 grams, was deficient. Approximately 44 percent of their energy was derived from fats, 12.5 percent of it from saturated fats, again exceeding recommended levels (Lawn 2002).
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Table 6-4 Energy and Macronutrient Intake in Utshimassits Women Aged 15 to 24
Carbohydrates Protein Fat Saturated Fat PUFAA Fibre 1992 No. Calories (g) (g) (g) (g) (g) (g) 57 3,375 301 192 153 46.8 19.6 11.8 %RNIB 178 377 Source: Based on Lawn 2002, Table 1. A Polyunsaturated fatty acids. B Recommended Nutrient Intake.
6.4 Activity Levels
Activity levels in the Province tend to be low. In 1996-1997, 60 percent of the provincial population was inactive, and approximately 66 percent were not active enough to receive any health benefits (Government of Newfoundland and Labrador 2002: 12).
Innu Community
People of Aboriginal or indigenous ancestry are considered to be at higher risk for inactivity, particularly in communities that have experienced a transition from traditional high-activity lifestyles to a more sedentary, westernized, lifestyle (Waldram et al. 2006: 119). According to Samson and Pretty (2006), the Innu have undergone a recent and rapid transition in physical activity as part of the move to permanent villages. The traditional Innu hunting lifestyle required a high level of energy expenditure integral to day-to-day activities that was far in excess of normal recommended levels in western society. Even with the high-calorie country diet that was typical of life away from the village, the amount of food calories taken in would rarely have been greater than the calories being consumed in day-to- day energy expenditures (Samson and Pretty 2006). This situation prevailed until recently, as the people of Utshimassits maintained a demanding life centred on hunting and trapping well into the 1960s. In contrast, for most Innu of Labrador adults, village life now requires very little activity beyond limited walking, though activity levels may be higher for some children. The decline of hunting and replacement with village life has meant that the Innu now engage in minimal physical exercise, and that energy input from food frequently exceeds energy expenditure (Samson and Pretty 2006).
6.5 Obesity
As of 1996-1997, 39 percent of people from Newfoundland and Labrador were overweight, the second highest provincial/territorial rate in Canada (Government of Newfoundland and Labrador 2002: 12). Four years later, 49 percent of respondents to the 2001 Adult Health Survey self-identified as being overweight. This general trend of increasing numbers of overweight people in the Province has continued, and from 2000 to 2005, the proportion of the provincial population that was obese (Body Mass Index (BMI) >30) increased from 21.7 to 26.7 percent (Figure 6-1).
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Figure 6-1 Adult Body Mass Index, 18+
Source: Data compiled from Canadian Community Health Survey, 2005: Health Practices. Study Area: Zone 3 – Labrador Central/Upper Lake Melville; Zone 2 – Labrador West/Churchill Falls.
In the Upper Lake Melville area, approximately 43.5 and 22.8 percent are identified as ‘overweight’ and ‘obese’, respectively, based on BMI category25. Data are similar for the Labrador West/Churchill Falls area, at 44.1 and 23.1 percent. At the same time, Labrador, which typically has a higher than average proportion of obesity compared to the Province, remained relatively steady. Although data are lacking for the Innu of Labrador in general, Lawn’s (2002) study of nutrition in the north did include data for women from Utshimassits aged 15 to 44. Lawn found that 89 percent were overweight (BMI >24.9) and, of those, 50 percent were obese (BMI >30) (Lawn 2002: Table 23).
6.6 Diabetes
At 6.8 percent (as of 2005), the Province of Newfoundland and Labrador has the highest rate of diabetes among people aged 12 and over of any province or territory in Canada (Statistics Canada 2006b). This is considerably higher than the Canadian rate of 4.9 percent. There is some variation in diabetes rates within the Province, and Labrador (Labrador and Grenfell RIHA) at 6.0 percent has the lowest rate of the four RIHAs. I In the Labrador Central/Upper Lake Melville area, diabetes was diagnosed in only 3.7 percent of the population, and was more common in males (4.7 percent) than females (2.8 percent). In Labrador West/Churchill Falls, diabetes was more common in females (8.2 percent) than males (3.5 percent) in 2001. The overall percentage was 5.8 percent26.
25 Data supplied by NLCHI 2007, compiled from Statistics Canada, Canadian Community Health Survey. Results for category ‘obese’ should be interpreted with caution due to high sampling variability associated with estimate. 26 www.communityaccounts.ca/
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Innu Community
Typically, diabetes (along with cancer, obesity, hypertension and heart disease) is rare in hunter- gatherer societies, but becomes more common following the loss of traditional ways (Samson and Pretty 2006). Diabetes figures for either prevalence or mortality are not available for the Innu, however, diabetes is three times more prevalent in Aboriginal communities than in the general population, and most Aboriginal diabetics are women, by a factor of 2:1 (Boyer 2006). Males have higher rates of diabetes than females in the general population. A difference also exists between the prevalence of diabetes amoung Aboriginal peoples living on and off reserves. For example, Collins et. al. (2007) found that one in four individuals in First Nations communities on-reserve over the age of forty-five were found to have diabetes.
6.7 Gambling
Gambling levels in Newfoundland and Labrador are comparable to those of other provinces, but on the rise. A study completed in 2005 on behalf of NLDHCS revealed that provincially, 84 percent of respondents had bet or spent money on gambling activities over the 12-month reporting period. A 1996 Newfoundland and Labrador Student Drug Use Survey reports that youth as young as a Grade 7-age are already looking for help for their gambling behavior27.
Regionally, the prevalence rates of gambling ranged from 78 percent in central to 87 percent in the eastern region, with the Labrador-Grenfell region reporting the second lowest gambling prevalence rates in the Province (Figure 6-2). However, increased gambling, in particular video lottery terminal additions, is reported to have become much more prevalent in Labrador in recent years (Health Directors Focus Group, pers. comm.). Figure 6-2 Gambling Prevalence Rates, Newfoundland and Labrador by Health Districts
Source: Based on Market Quest Research Group Inc. report submitted to the Government of Newfoundland and Labrador 2005b.
27 http://www.health.gov.nl.ca/health/commhlth_old/factlist/GAMBLING.HTM
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According to a report submitted to the Government of Newfoundland and Labrador (Government of Newfoundland and Labrador, November 2005b) on gambling patterns and rates in Newfoundland and Labrador, gamblers were: equally likely to be male and female; between the ages of 35 to 54 (46 percent); married (62 percent); had completed at least some post-secondary education (61 percent); employed full-time (42 percent); and in the $20,001 to $60,000 range (41 percent). Lottery tickets were reported as the most preferred gambling activity both provincially and regionally, with 46 percent playing on a weekly basis. On average, gamblers spent a total of seven hours participating in gambling activities in a typical month (ranging from 1 to 250 hours) and spent an average of $249.64 on gambling activities over a 12-month period (approximately $21.00 per month), with spending ranging from $1.00 to $55,740.00. Gamblers in the Labrador-Grenfell region spent more money on average than any other region. Only 1.2 percent of gamblers were identified as: ‘problem’ gamblers; 2.2 percent ‘moderate risk’ gamblers; 6.1 percent ‘low-risk’ gamblers; and 74.9 percent non-problem gamblers (Government of Newfoundland and Labrador 2005b). ‘Problem’ gambling is more pronounced in the Labrador-Grenfell region (2.4 percent) than any other health region (Figure 6-3). Problem gambling is defined as “gambling behavior that creates negative consequences for the gambler, others in his or her social network, or for the community” (Ferris and Wynne 2001), and is often associated with negative consequences such as financial difficulty, social/ relationship problems, alcohol/drug problems, stress/ anxiety, and depression or suicide (Statistics Canada 2003). Figure 6-3 Problem Gambling Prevalence Rates in Newfoundland and Labrador
Source: Based on Government of Newfoundland and Labrador 2005b. Within the Labrador-Grenfell region, moderate-risk gamblers were mostly male (61 percent) and between the ages of 19 to 24 (39 percent). Most were common-law or single (33 percent each) and evenly distributed in terms of education. The majority of moderate-risk gamblers were employed full- time (39 percent) and most had incomes in the $20,001 to $40,000 range (28 percent). Problem gamblers were mostly female (53 percent), with most between the ages of 35 to 44 (40 percent) and single (40 percent). Over half (53 percent) had high school or less than high school education. Problem gamblers were equally likely to be employed and unemployed (40 percent each). Similar to the other regions, lottery tickets, scratch tickets and video lottery terminals were reported to be the most common activities among problem gamblers (Government of Newfoundland and Labrador 2005b: 52). Among problem gamblers, the most common reasons for gambling were that it decreases boredom (36
Community Health Study y Final Report • December 22, 2008 Page 6-8 © Aura Environmental Research and Consulting Ltd. 2008 Lower Churchill Hydroelectric Generation Project percent), it is exciting/fun (33 percent) and they can win money (32 percent). Eighty-eight percent of low-risk gamblers in the Labrador-Grenfell region reported experiencing no adverse consequences from gambling; however, this percentage fell to 7 percent for problem gamblers. For problem gamblers, income loss/debt was cited as the most common consequence of gambling (67 percent), followed closely by relationship problems and loneliness/increased isolation (53 percent each) (Government of Newfoundland and Labrador 2005b: 70).
Overall, 30 percent of respondents said that they were aware of gambling counselling services available in their community. Those living in the Labrador-Grenfell region displayed a greater awareness of counselling services in their communities (38 percent), compared to those living in the western, central and eastern region (29, 18 and 34 percent, respectively). Knowledge of local gambling counselling services was similar for males and females (31 and 30 percent, respectively); however, awareness of local counselling services generally decreased with age.
The gambling rates for the Innu are not known; however, there is some evidence that problem gambling is higher amoung Aboriginal peoples that the rest of Canada (Wynne and McCready 2005).
6.8 Suicide and Attempted Suicide
Suicide is a public health concern for the Province, and in particular, the region of Labrador (Alaghehbadan et. al. 2005). Suicide currently accounts for only 0.7 percent of all deaths in Newfoundland and Labrador, but 16 percent of deaths among people aged 15 to 24. It is the second leading cause of death for this age group (Government of Newfoundland and Labrador 2004a). In 2001, the age-adjusted suicide rate for the Health Labrador Corporation region was estimated to be 27.0 per 100,000 population (41.9 males; 13.3 females), compared to only 6.7 per 100,000 (11.9 males; 1.7 females) for Newfoundland and Labrador as a whole28. Numerous risk factors for suicide have been identified; factors that tend to promote the possibility of an individual making an attempt on his or her life. Other factors tend to make a suicide attempt less likely among individuals (Table 6-6). An individual’s level of education is not a predictor of suicide, but education does play an important role in understanding and preventing suicide attempts. For males and females the incident rate of suicide attempts amongst people at least 15 years of age with less than 12 years of education (37.2 per 100,000) is considerably greater than those with 12 or more years of education (15.0 per 100,000)29. On average, 33 percent of the population in Labrador West and the Upper Lake Melville area have less than a high-school diploma. In addition, research conducted on the epidemiology of suicide attempts in Newfoundland and Labrador (Government of Newfoundland and Labrador 2004) found the mean age of those who attempted suicide in Labrador (26.6 years) was significantly lower than for the island portion of the Province (34.3 years).
28 www.statcan.ca/english/freepub/82-221-XIE/2006001/tables/14193_01.htm 29 Based on NLCHI 2006. Epidemiology of Suicide Attempts in Newfoundland and Labrador, 1998 to 2000
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Table 6-5 Suicide Risk and Protective Factors
Risk Factors for Suicide Protective Factors Mental health issues (depression, low self esteem or Family and community support feelings of hopelessness) Sence of belonging; positive self-esteem Previous suicide attempts Skills in problem solving, conflict resolution, and non-violent Alcohol and substance abuse handling of disputes
Family or caretaker history of mental health problems Cultural and religious beliefs that discourage suicide and (alcoholism, drug abuse or depression) support self-preservation instincts
Impulsive or aggressive tendencies Good school performance; positive attitude towards school
Barriers to accessing mental health treatment Good physical and mental health
Recent severe stressor; loss (relational, social, work or Early identification and appropriate treatment of psychiatric financial) illness
Physical illness Easy access to a variety of clinical interventions
Easy access to lethal methods Effective clinical care for mental, physical and substance abuse disorders Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or suicidal Support from ongoing medical and mental health care thoughts relationships.
Cultural and religious beliefs
Isolation – a feeling of being cut off from other people
Local epidemic of suicide
Sexual orientation (homosexuality)
Community instability or lack of prosperity; poverty; limited opportunities for employment
Lack of proper housing and inadequate sanitation and water quality
Isolated geographic location, loss of control over land and living conditions Source: Government of Newfoundland and Labrador, November (2004: 4); NAHO 2001 Innu Community The breakdown of Innu society under the strain of colonialism and the decline of living conditions in both Sheshatshiu and Utshimassits have been identified as key factors in the emergence of the ongoing problems of substance-abuse and suicide (Samson et al. 1999). On the occasion of a visit by Queen Elizabeth II to Sheshatshiu in 1997, community leaders commented in a speech upon the issue of suicide in that community:
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The history of colonization here has been lamentable and has severely demoralized our People. They turn now to drink and self-destruction. We have the highest rate of suicide in North America. Children as young as 12 have recently taken their own life30. Many of the risk factors previously discussed (Table 6-6) have become relatively common in the Innu communities in recent decades, in particular mental health issues, alcohol related factors and feelings of isolation, and many of the Innu youth lack the protective factors that would make them less likely to attempt suicide. High rates of suicide appear to be a recent phenomenon for the Innu. Wotton (1985) noted that there had been no known incidents of suicide among the Labrador Aboriginal people (including the Innu of Utshimassits) prior to 1979, but in the five years between 1979 and 1983, the rate was 65.6 per 100,000 - five times the Canadian rate31. Samson et al. (1999) calculated that the Utshimassits suicide rate between 1990 and 1998 was 178 per 100,000, or 13 times the Canadian rate of 14 per 100,000. They were informed by the Utshimassits Innu that almost 33 percent of the adults had attempted suicide (parasuicide) in 1993, often in alcohol-fuelled incidents. Conditions in Sheshatshiu, though perhaps not as dire as at the former Utshimassits site, still seem to be far worse than for the non-Aboriginal Labrador population. In 1988, 21 of the community’s young people attempted suicide (Armitage 1991). As of 2001, 42 percent in Sheshatshiu had thought actively about killing themselves and 28 percent had attempted suicide (Rogan 2001). In the summer of 1999, the community experienced an especially severe suicide epidemic, as several teenagers committed suicide in succession. Between 1991 and 1994, 109 of the 500 people of Utshimassits attempted to commit suicide, with only two being successful (Demont and Sibbald 1994). Over the period 1998 to 2000, the rate of attempted suicide among Innu of Labrador aged 10 to 19 was approximately 1,750 per 100,000 - 17 times the provincial rate, and far greater than that for the Labrador Inuit and Labrador non-Aboriginal communities (Newfoundland and Labrador November 2004: 1; Figure 6-4).
Attempted suicide was more common among Innu males, and was most frequent among the 14 to 19 year age group (Newfoundland and Labrador 2004). This finding is not consistent with trends in general population in which suicide attempts within the female population are higher than in the male population (Fremouw et al. 1990). Several programs have since been implemented to combat suicide. Band Councils at Sheshatshiu and Utshimassits started programs to encourage families to talk about suicide prevention in 2000. In February 2007, the provincial government announced funding approval for a family suicide prevention program, to be delivered by the Sheshatshiu Innu First Nation32. More recently a Youth Achievement Awards program was implemented to raise self-esteem in an attempt to combat youth suicide33.
30 www.cbc.ca/news/background/aboriginals/sheshatshiu.html. 31 These findings combine the Inuit with the Mushuau Innu. 32 www.releases.gov.nl.ca/releases/2007/laa/0227n01.htm. 33 www.thelabradorian.ca/index.cfm?iid=2601&sid=22507.
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Figure 6-4 Incidence Rate of Attempted Suicide Among 10 to 19 year-old Population, 1998- 2000
Source: Government of Newfoundland and Labrador 2004a.
6.9 HIV/AIDS
Between 1984 and 2002, there were 205 registered cases of HIV infection (158 male; 47 female) in Newfoundland and Labrador. Of these, 82 had progressed to AIDS (64 male; 18 female). Of those 82 cases, 60 had resulted in death (51 male; 9 female). The general trend in the Province was of a high number of cases in the early 1990s, followed by a decline towards the end of that period (Government of Newfoundland and Labrador 2002). Overall, the Province has had a relatively low mortality rate due to HIV/AIDS. Whereas the Canadian rate is approximately 4 per 100,000, the mortality rate in the Province is only approxiamtely 1.4 per 100,00034. In recent years in Canada, a steady rise has been seen in the proportion of reported AIDS cases and positive HIV test reports among Aboriginal persons (PHAC 2007). By 2006, Aboriginal persons accounted for 24.4 percent of the total reported AIDS cases for which ethnicity was known. In addition, the proportion of Aboriginal cases attributed to injecting drug use (IDU) has increased overtime, from 18 percent prior to 1995 to 47.2 percent during 1995-2000 and 503. Percent during 2001-2006 (PHAC 2007). Reliable data for HIV/AIDS rates among the Aboriginal population of Newfoundland and Labrador are not available; however, recent attention given to HIV/AIDS training and awareness programs suggests there is a growing concern. In 2006, the Labrador Friendship Centre in Happy Valley-Goose Bay received support from The Non- Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund (The Non-Reserve Fund) to deliver HIV/AIDS training. The Friendship Centre formed an advisory committee, which included representatives of Innu communities, to developed training programs to educate health care
34www.phac-aspc.gc.ca/canada/regions/atlantic/Publications/Tool_kit/14_e.html.
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7.0 DISEASES, BIOLOGY AND GENETIC ENDOWMENT
The basic biology and make-up of the human body are a fundamental determinant of health. Although socio-economic and environmental factors are important determinants of overall health, in some circumstances genetic endowment may predispose certain individuals to particular diseases or health problems (Health Canada 1999).
7.1 Hospital Morbidity/Separations
In the past, infectious diseases, including polio, tuberculosis and measles, constituted the most important threat to the health of Aboriginal people in Canada. Since the 1950s, innovations in vaccinations and treatments have seen a precipitous decline in many of the key infections, particularly with respect to mortality (Waldram et al. 2006: 85). Nevertheless, Aboriginal populations continue to experience higher rates of morbidity from some of these infections when compared to the broader Canadian population (Young 1988). Tuberculosis morbidity rates are from 8 to 10 times higher than the general Canadian rate35, with an average of 37 per 100,000 over the period 1997 to 2001 (Waldram et al. 2006: 86), while acute respiratory infections have also been found to be far more common among Aboriginals (Fraser-Lee and Hessel 1994; Alaghehbandan et al. 2007). As of 2000, other infectious diseases were similarly higher among Aboriginals, including pertussis (2.2 time), rubella (7 times), and shigellosis (2.1 times)36. Provincially, between 2000 and 2004, a ‘disease of the circulatory system’ is the most common single diagnosis at 14.3 percent, followed by ‘diseases of the digestive system’ at 11.0 percent (Table 7-1). Within the Study Area, ‘diseases of the respiratory system’ is the most common diagnosis in Labrador Central/Upper Lake Melville, at 9.3 percent, and ‘diseases of the digestive system’ is the most common diagnosis in Labrador West/Churchill Falls at 13.5 percent. Expressed as a ratio to the Province, ‘diseases of the digestive system’ and ‘injury and poisoning’ are relatively high in Labrador Central/Upper Lake Melville at 1.02:1 and 1.20:1, respectively. In Labrador West/Churchill Falls, ‘injury and poising’ separations are also high at a ratio of 1.30:1 to the Province, followed by ‘diseases of the digestive system’ (1.23:1) and ‘diseases of the genitourinary system’ (1.07:1). Separations by ‘cancers’ are well below the provincial level in the Study Area At the community level, separations by ‘injury and poisoning’, expressed as a ratio to the Province, are greater than 1:1 in all communities, particularly Natuashish and Sheshatshiu at 1.55:1 and 1.41:1, respectively (Table 7-2). ‘Diseases of the digestive system,’ ‘diseases of the genitourinary system,’ and ‘cancers’, are highest in Churchill Falls with ratios to the Province of 1.39:1, 1.26:1, and 1.18:1, respectively.
35 www.hc-sc.gc.ca/fnih-spni/diseases-maladies/index_e.html. 36 www.hc-sc.gc.ca/fnih-spni/pubs/gen/stats_profil_e.html.
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Table 7-1 Hospital Morbidity/Separations 2000 to 2004, Percent by Diagnosis and Ratio to Province for Study Area Communities*
Sheshatshiu Happy Valley – (includes North Natuashish Labrador City Wabush Churchill Falls Goose Bay West River) Ratio to Ratio to Ratio to Ratio to Ratio to Ratio to % % % % % % Province Province Province Province Province Province Diseases of the 6.5 0.46 3.3 0.23 9.7 0.67 9.5 0.66 12.4 0.86 7.7 0.53 circulatory system Diseases of the 7.4 0.67 9.8 0.89 9.8 0.90 13.3 1.21 13.9 1.27 15.4 1.39 digestive system Diseases of the respiratory 11.4 1.25 11.5 1.25 8.6 0.94 7.1 0.78 9.8 1.07 5.1 0.56 system Diseases of the genitourinary 3.3 0.54 1.6 0.27 5.8 0.96 6.2 1.03 7.2 1.20 7.7 1.26 system Injury and 9.0 1.42 9.8 1.55 7.1 1.12 8.3 1.31 8.2 1.30 7.7 1.20 poisoning Cancers 2.2 0.34 1.6 0.25 3.7 0.57 4.3 0.67 4.1 0.64 7.7 1.18 Infectious and 0.5 0.47 0.8 0.70 0.8 0.72 1.1 0.91 1.0 0.89 - - parasitic diseases Endocrine, 2.5 0.91 1.6 0.61 2.5 0.94 2.4 0.88 2.60 0.96 - - nutritional - Indicates suppressed data to low cell count * Does not reflect individual cases; does not include all diseases; diagnoses based on ICD-10 Codes Source: Statistics Canada 2006 Census; Community Accounts 2008
7.2 Mortality
Similar to the Province, the leading causes of death by disease chapter in Labrador are diseases of the circulatory system and cancers; however, the relative proportions of deaths by these two disease chapters are lower for the Labrador region than for the Province as a whole. In 2003, the leading causes of death in the Province were circulatory system diseases (36.1 percent), cancer (27.5 percent) and diseases of the respiratory system (7.7 percent) (Government of Newfoundland and Labrador 2006c: 1). Endocrine, nutritional and metabolic diseases (6.8 percent) and nervous system disease (5.4 percent) were responsible for lesser amounts of mortality, while other causes collectively amounted to 16.5 percent of the total (Figure 7-1). Figure 7-1 Cause of Death by Disease Chapter, Province and Labrador-Grenfell Health, 2000 – 2004
Source: Government of Newfoundland and Labrador, 2006c.
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Innu Community Total deaths by disease chapter for the Innu communities of Sheshatshiu and Natuashish are not reported in the health data due to low cell counts (i.e., there are less than five deaths per year per disease chapter in each of the two communities). Historically, the age adjusted mortality rate, though comparable, has been higher in both sexes for Labrador than for the country as a whole (see Hunter 1988). This has been most pronounced in the infant (sub-1 year) population. For both men and women, between 1974 and 1985 for example, coronary heart disease (262 per 100,000 men; 138 per 100,000 women) and cerebrovascular disease (93 per 100,000 men; 55 per 100,000 women) were the most common causes of death during the study period, with chronic obstructive pulmonary disease (COPD) and various cancers occupying much of the remaining top 10. Hunter (1988) also found that during 1974 to 1985, death due to violence was more pronounced for Labrador men than women, and included motor vehicle accidents (21 per 100,000), suicide (18), and drowning (17). For women, suicide (7 per 100,000) was the only cause of death related to violence to appear among the top 10. For both men and women, diabetes appeared near the end (male: 14 per 100,000; female: 7/100,000).
7.3 Life Expectancy
The crude mortality rate for Labrador (Labrador and Grenfell Integrated Health Boards) during the period 2000 to 2004 was consistently lower than elsewhere in the Province (Table 7-2). However, this may be attributed to the young population in the region. Age-adjusted mortality rates for the RIHAs indicate that the region actually has the highest mortality rates in the Province (Table 7-3). During the period 2000 to 2004, the age-adjusted rate trended downwards for the Province, though that pattern was not evident in the Labrador and Grenfell RIHA37.
37 Age-standardized mortality rates were calculated by direct standardization methods using the 1991 Census Population as the standard population. Source: NLCHI 2007.
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Table 7-2 Crude Mortality Rates per 100,000 Population by Gender, Province and Health Authorities, 2000 to 2004 Labrador- Year Gender Province Eastern Central Western Grenfell male 885 877 919 933 748 2000 female 744 775 812 669 485 total 813 825 865 800 618 male 870 824 997 1,012 569 2001 female 710 737 790 659 373 total 789 779 894 833 472 male 867 864 901 926 648 2002 female 745 748 795 797 451 total 805 804 848 860 551 male 881 882 922 927 673 2003 female 763 782 856 709 481 total 821 831 889 816 577 male 897 850 1,070 955 685 2004 female 755 766 782 800 497 total 825 807 926 876 592 Source: Government of Newfoundland and Labrador 2006c.
Table 7-3 Age Standardized Mortality Rates per 100,000, Province and Health Authorities, 2000 to 2004 Year Province Eastern Central Western Labrador-Grenfell 2000 744 752 704 716 934 2001 700 690 707 719 716 2002 693 699 634 704 741 2003 691 712 646 650 778 2004 676 675 651 686 744 Source: Government of Newfoundland and Labrador 2006c Age-adjusted mortality rates in the Upper Lake Melville and Labrador West/Churchill Falls have been similar between the two regions since 2000, notwithstanding variations from year to year. However, rates in Sheshatshiu have been, on average, four times higher than the remainder of the region. In 2002, for example, the age standardized mortality rate in Sheshatshiu was 39.3 per 1,000, in comparison to 7.0 in Upper Lake Melville and 11.6 in Labrador West/Churchill Falls.
In 2005, there were 4,475 deaths in the Province, of which people less than 65 years of age comprised 23 percent and those under 20 years of age comprised just less than 1.5 percent (Table 7-4)38. In Labrador West/Churchill Falls, approximately 42 percent of all deaths in 2005 were to people under 65 years of age; however, there were no deaths recorded for the less than 20 year category. In the Upper Lake Melville Region the distribution is quite different, with over 12 percent of all deaths in 2005 occurring in the less than 20-year age category.
Recent age-specific death statistics for Sheshatshiu and Natuashish are not available due to low cell counts (i.e., there are less than five deaths per year per age category in each of the two communities). Between 1991 and 1996, however, deaths of people less than 65 years of age in Sheshatshiu and
38 Comparable data not available for the community-level post 1996. Based on the 2006 census the trend has continued at the regional scale.
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Natuashish comprised 55 and 80 percent, respectively, of total deaths in the communities. This suggests that the population is dying at a younger age in these two communities in comparison to the Province. The proportion of deaths for individuals less than 65 years of age during this same period was similarly high in the Study Area, at 69 (Labrador West) and 45.4 (Upper Lake Melville) percent, respectively. At all scales, the majority of deaths occurring under the age of 65 are amongst the male population. Between 1991 and 1996, deaths in Sheshatshiu and Natuashish for individuals under 20 years of age comprised 11.1 and 40 percent, respectively, in comparison to 2.7 percent at the Province level, 7.7 percent for Labrador West/Churchill Falls and 6.8 percent for the Upper Lake Melville area/Labrador Central as a whole during that same period.
Table 7-4 Deaths by Age for Province and Study Area, 1991-1996, 2005
Province Labrador West Upper Lake Melville Sheshatshiu Natuashish Age 91-96 / 05 91-96 / 05 91-96 / 05 91-96 / 05 91-96 / 05 Deaths 2.7% 1.4% 7.7% 0% 6.8% 12.5% 11.1% n/a 40% n/a <20 years Deaths 23% 23% 69% 42% 45.4% 37.5% 55.5% n/a 80% n/a <65 years Sources: Statistics Canada Annual Mortality Data Files (2000-2005); Population Estimates for Census Subdivisions, Statistics Canada, 2000-2005 (based on 2001 Census of Population).
7.4 Pneumonia
Alaghehbandan et al. (2007) reported that Innu/Inuit (undifferentiated) communities in Labrador had 3.9 times the rate of hospitalization due to pneumonia than that of non-Aboriginal communities in the region over the period 1995 to 2001. These Aboriginal patients also tended to be younger than those in the general population. This relationship is generally consistent with Aboriginal populations elsewhere in Canada (Alaghehbandan et al. 2007: 26). Further, the authors also found that the Innu rate of hospitalization due to pneumonia (16.9 per 1000 population) was much higher than that of the Inuit (8.4 per 1,000), and that this was true across all age groups. However, for the Study Area, pneumonia has generally amounted to only a small percentage of total admissions to hospital in the past. Risk factors for pneumonia include, amoung others, chronic illness (diabetes, heart or lung disease); weakened immune system (cased by AIDS); malnutrition; alcohol and drug abuse and smoking. Historically, pneumonia seems to have been a greater concern among the Innu than the general population. Neuwelt et al. (1992: 155) found that in 1986, the rate of visits to medical facilities for pneumonia among the Innu of Sheshatshiu was 107 per 1,000, compared to less than 36 per 1,000 for North West River.
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8.0 HEALTHY CHILD DEVELOPMENT
Pre-natal and early childhood experiences influence subsequent health, well-being, coping skills and competence (Health Canada 1999). The quality of care early in life has lasting effects and influences a child’s coping skills and health. Healthy child development is recognized as a powerful determinant of health, but at the same time, is influenced by other determinants of health, including income, housing, education and diet and can affect the physical, social, mental, emotional and spiritual development of children and youth (Public Health Agency of Canada 2003).
The time between conception and age six, particularly for the first three years, set the base for competence and coping skills that will affect learning, behaviour and health throughout life (Federal/ Provincial/Territorial Committee on Environmental and Occupational Health 1999). A report entitled Strategies for Population Health: Investing in the Health of Canadians purport that babies born with low birth weights are linked to problems not only in childhood but also in adulthood. In addition, low birth weights are linked to income and social level. However, factors such as coping skills also play an important role (Federal, Provincial and Territorial Advisory Committee on Population Health 1994).
In addition, the built environment plays an important role in healthy child development - particularly the home environment. On reserve, Aboriginal homes, for example, have been found to have twice the density of residents of the Canadian average; a situation that is conducive to the spread of contagious diseases such as tuberculosis and acute respiratory disease (Clark et al. 2002: 941).
8.1 Birth Rates and Characteristics
In 2006, approximately 20.5 percent of the Labrador population was under 15 years of age (Statistics Canada 2006a). In 2004, there were 384 babies born in the Labrador-Grenfell Region, and 4,506 in the Province as a whole (NLCHI 2007). The Labrador-Grenfell Health Authority has had the highest crude birth rate (the number of live births per 1,000 total population) among the RIHAs and also experienced the largest percent decrease in the number of live births (17.0 percent) between the years 2000 and 2004 (Table 8-1; Figure 8-1) (Government of Newfoundland and Labrador 2006a: 19, 20). Table 8-1 Live Births and Birth Rates, Province and Labrador-Grenfell Health Authority, 2000 to 2006
Utshimassits/ Province Labrador-Grenfell Sheshatshiu* Year Natuashish* Live Births Rate Live Births Rate Live Births Rate Live Births Rate 2000 4,887 9.1 460 11.0 36 32.5 20 59.7 2001 4,721 9.0 415 10.1 31 26.8 18 30.5 2002 4,685 9.0 411 10.2 35 29.8 29 45.5 2003 4,628 8.9 383 9.6 33 27.6 31 45.1 2004 4,506 8.7 384 9.8 17 14.0 21 28.2 2005 4,527 8.8 392 10.1 28 22.5 26 32.3 2006 4,579 9.1 412 11.1 35 31.5 23 32.6 Source: Data supplied by NLCHI 2007. Based on Live Birth System, Centre for Health Information, 2000 to 2006; Population Estimates for Census Subdivisions, Statistics Canada, 2000 to 2005 (based on 2001 Census); Statistics Canada, 2006 Census of Population. Live births and population estimates for Sheshatshiu include communities coded in census subdivision 1010020; for Utshimassits/Natuashish 1010042. *Caution should be taken in scaling these results due to relatively low participation rates and possible under- representation of the Innu population.
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Figure 8-1 Crude Birth Rate (per 1,000) for Study Area Sub-divisions, 2000 to 2006*
Source: Based on data supplied by NLCHI 2007. Based on Live Birth System, Centre for Health Information, 2000 to 2006; Population Estimates for Census Subdivisions, Statistics Canada, 2000 to 2005 (based on 2001 Census); Statistics Canada, 2006 Census of Population. Live births and population estimates for Sheshatshiu include communities coded in census subdivision 1010020; for Utshimassits/Natuashish 1010042. *Caution should be taken in scaling these results due to relatively low participation rates and possible under- representation of the Innu population.
Women in Labrador also have children at a younger age than the than the Province/Labrador as a whole. This is most pronounced is along the north coast, where 23 percent of children are born to mothers less than 20 years of age, compared to 14 percent in Labrador and 7 percent in the Province (Jong 2007) (Table 8-2). In Sheshatshiu between 1991 and 1996, 26 percent (60/230) births were to mothers less than 20 years of age; 34.7 percent in Natuashish39. Table 8-2 Live Births for Mothers Aged 15 to 19 Years as Percentage of Total Births by Region, 2000 to 2006
Province Labrador - Grenfell Sheshatshiu* Natuashish* Year # 15-19 yrs % total # 15-19 yrs % total # 15-19 yrs % total # 15-19 yrs % total 2000 387 7.92 70 15.22 20 55.56 -- -- 2001 344 7.29 51 12.29 12 38.71 7 38.89 2002 302 6.45 59 14.35 11 31.43 11 37.93 2003 302 6.52 39 10.24 9 27.28 9 29.03 2004 291 6.46 35 9.11 10 58.82 -- -- 2005 258 5.70 40 10.20 12 42.86 -- -- 2006 279 3.09 50 6.78 9 25.71 6 26.09 Source: Data supplied by NLCHI 2007, Live Birth System. – indicates data suppressed due to cell counts <5. Live births for Sheshatshiu include communities coded in census subdivision 1010020; for Utshimassits/ Natuashish 1010042. *Caution should be taken in scaling these results to the Innu due to relatively low participation rates and possible under representation of the Innu population. Teenage pregnancies can lead to such social problems as disruptions in educational achievement, poverty and other forms of social exclusion (Government of Newfoundland and Labrador 2002). However, regional health centres and family centres are available to guide teens through their
39 Source: Community Accounts. A request has been filed with NLCHI for 2000 to 2005 birth rates for the Innu communities. Data will be integrated in this report once they become available.
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8.2 Infant Mortality Rate
According to Zakir and Wunnava (1997), infant mortality rate (IMR) can be associated with the well- being of a population and is therefore an important indicator of population health. IMR is defined as the number of infants who die in the first year of life per 1,000 live births (Government of Newfoundland and Labrador 2006c). Risk factors for IMR include: smoking; alcohol and drug use; poor nutrition; delay of prenatal care; domestic violence; poverty; stress; and inadequate funding and capacity in perinatal health care. The IMR for the Province as a whole was 4.6 per 1,000 live births in 2003 and 4.5 in 2004 (Government of Newfoundland and Labrador 2006c: 4). Overall, the IMR remained steady over the five-year period between 2000 and 2004, although there was considerable variation regionally (Table 8-3). Table 8-3 Infant Deaths and Infant Mortality Rate, Province and Health Regions, 2000 to 2004
Jurisdiction 2000 2001 2002 2003 2004 # rate # rate # rate # rate # rate Province 17 3.5 22 4.7 21 4.5 21 4.6 20 4.5 Eastern 11 3.9 9 3.2 14 5.2 10 3.6 11 4.1 Central -- 1.1 7 8.8 -- 3.5 6 7.4 -- 3.8 Western -- 4.4 -- 4.7 -- 3.0 -- 6.2 -- 3.1 Labrador-Grenfell -- 4.3 -- 7.2 -- 4.9 0 0.0 -- 10.4 Source: Government of Newfoundland and Labrador 2006c. Notably, the IMR for Labrador (Labrador-Grenfell RIHA) tended to be the highest in the Province, and was highly variable during this period, possibly due to low population numbers. Life expectancy at birth has been improving in the Province since the 1950s40, and although it is one of the lowest in Canada, it is comparable to the other provinces. IMR and life expectancy for the Innu are not known. Specific life expectancy and IMR for the Labrador Innu are not known.
8.3 Protective Services and Intervention
The number of children in care in the Labrador-Grenfell health region is reportedly comparable to the southern and island regional health authorities, which have 10-times the total population (Health Directors Focus Group, pers. comm.). Identifying the needs of a child who may be in crisis and finding them appropriate care is the responsibility of local social workers. Frequently, the children end up being cared for by their grandmothers (T. Bruce, pers. comm.). The current state of children in care is what participants of the Health Directors Focus Group (pers. comm.) described as a “system in crisis”. The capacity within communities to provide adequate care-qualified persons is lacking.
40www.communityaccounts.ca/CommunityAccounts/OnlineData/charts_health.asp?whichacct=health&getcontent =charts&comval=zone2.
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Due in part to the limited capacity of foster-care services in the region, and the increasing demands for such services, there is a large dependency on protective intervention - the most intrusive form of state action (Health Directors Focus Group, pers. comm.). The Child Youth and Family Services Act, proclaimed in January 2000, reflects a cultural shift in service delivery practices. Although the safety of the child remains paramount, new ways of intervening promote early intervention and greater emphasis on prevention activities.
During 2000, there were 6,549 children under the age of 16 who received some form of protective intervention service because they were vulnerable to abuse and violence. Just fewer than 49 percent were female. In addition, residential placements were provided for approximately 900 children and youth. This includes 228 children in continuous custody (i.e., permanent care), 302 youth over the age of 15 (who signed voluntary care agreements) and the remainder, 370, who were temporarily placed for short periods but are now back with family. For the same period in the Labrador region, 716 children (50.3 percent female and 49.7 percent male) received protective services, 10.9 percent of the provincial total. As well, for those receiving residential services, 21 children were in continuous custody and eight were youth with voluntary agreements.
8.4 Children with Disabilities and Special Needs
According to Statistics Canada (2007) an individual is considered to have a disability if the parent reports a chronic condition, either a physical disability or a cognitive/emotional disability. Within the context of the Participation and Activity Limitation Survey (PALS) conducted by Statistics Canada in 2001, a chronic condition limits the amount or kind of activity that a person can perform, the condition is expected to last at least six months and has been diagnosed by a health professional. A physical disability may be a difficulty in hearing, seeing, speaking or being understood, walking or dexterity. Chronic conditions classified as physical disabilities include, among others, asthma, heart conditions, cancer, epilepsy, spina bifida and muscular dystrophy. Cognitive/emotional disabilities include, among others, learning disabilities (attention problems, dyslexia); cognitive limitations due to a disorder such as Down syndrome or autism; and emotional, psychological or behavioural conditions (Statistics Canada 2007).
The survey found that the disability rate amoung children under 14 years of age in the Province of Newfoundland and Labrador as a whole was 3.9 percent compared to 3.8 percent in Canada (Table 8.5).
Table 8-5 Disability Rates Amoung Children 0 to 14 Years of Age, 2000 to 2004
Persons with Persons without Total Population Disability Rate (%) Disability Disability Canada 5,471,350 202,350 5,269,000 3.7 Newfoundland and Labrador 77,730 3,010 74,720 3.9 Source: Statistics Canada 2007
Children with mild to moderate disabilities include those whose health condition causes some activity limitations—for example, children who experience some or a lot of difficulty walking or moving their hands. Children with severe to very severe disabilities include those with multiple significant disabilities as well as those who suffer from the total loss of a function—for example, children who cannot walk or
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who have a total loss of sight (Statistics Canada 2007). The highest proportion of children with disabilities in Newfoundland and Labrador are classified as mild disabilities (Table 8-6).
Table 8-6 Severity of Disability Amoung Children 0 to 14 Years of Age, 2000 to 2004
Very Total Mild Moderate Severe Severe Canada 202,350 58,530 42,080 41,090 33,110 (28.9%) (20.8%) (20.3%) (16.4%) Newfoundland and Labrador 3,010 1,090 620 470 390 (36.2%) (20.6%) (15.6%) (13.0%) Source: Statistics Canada 2007
There is currently limited capacity in the Labrador regional health care system, particularly in the communities, to care for children with disabilities. In particular, the capacity to address early therapeutic care is missing (Health Directors Focus Group, pers. comm.). There are only a limited number of adequately trained health care professionals in the region to manage the growing numbers children that require special care for mental illnesses, autism, or other severe disabilities.
An additional challenge is successfully caring for such children, who may have disabilities or special needs, through the current education system. A number of focus group participants noted that often when a child with “persuasive and significant” needs has been cared for from the ages of one to five years, their needs are not always met by the education system in terms of special service provision and follow-up (Health Directors Focus Group, pers. comm.). The principal of the Peacock K-3 school in Happy Valley-Goose Bay echoed these concerns, noting the difficulty, long wait lists and red tape involved in applying for and securing special needs positions and support in the schools - even when such needs have been identified by both education and health professionals (D. Abbass, pers. comm.).
8.5 Child Maltreatment
There were approximately 6,000 children in Newfoundland and Labrador found to be in need of protective intervention as defined in Section 14 of the Child, Youth and Family Services Act during the period April 2000 to March 2001 (Government of Newfoundland and Labrador 2002). In 2003, children and youth under the age of 18 accounted for 21 percent of victims of physical assault and 61 percent of victims of sexual assault, while representing 21 percent of the population (Statistics Canada 2005). Of the 15,000 sexual assaults reported by 122 police services, 61 percent of victims were aged 17 and under. Approximately 20 percent of the victims were girls, and more than 66 percent of these females were between 11 and 17 years old (Statistics Canada 2005). Up to 75 percent of survivors of sexual assaults in Aboriginal communities are young women under 18 years old. Fifty percent of those are under 14 years old, and almost 25 percent are younger than seven years old (METRAC 2001). Specific data for the Study Area were not available; however, the demand for shelters in the Study Area for women and children is an indicator of the magnitude of the problem. Refer to Section 10.9 which provides further information on child maltreatment and the use of shelters.
8.6 Fetal Alcohol Spectrum Disorder
A report by the Federal, Provincial and Territorial Advisory Committee on Population Health (1999) purport that risk factors for FASD include personal behavior, biology and socio-economic factors. In 2004, Philpott et al conducted a study on Innu school children and learning patterns. They suggest that
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approximately 35 percent of Innu youth display learning difficulties consistent with FASD. However, this study was not based on specific diagnoses of FASD but rather on an examination of learning difficulties and behaviours amongst school-aged children. Detailed information on the prevalence of FASD within the Innu population is not known.
8.7 Child Programs and Services
The quality of early childhood services is critical; poor quality services may even have a negative effect on child development (Friendly 2002). The Province and the Labrador-Grenfell region have a number of programs and services in place to address this.
8.7.1 Mother Baby Nutrition Supplement
The Mother Baby Nutrition Supplement (MBNS), initiated by the Province in 2001, is a $60 monthly benefit payable to all eligible low-income pregnant women and families with children under the age of one residing in the Province. The benefit provides financial support to assist with the additional nutritional costs of eating healthy during pregnancy and throughout a child’s first year of life. Through referrals to community health nurses and family resource programs, the MBNS also enhances access to information and community support for pre- and post-natal care. Eligibility for the benefit is based on two criteria: 1) income in the previous year was below the maximum income threshold for the Newfoundland and Labrador Child Benefit (NLCB) (currently at $22,397); or 2) the individual/family is presently in receipt of Income Support. The program supported approximately 1,775 families per month (1,325 post-natal and 400 pre-natal) in 2003-2004 (Government of Newfoundland and Labrador 2004b: 5).
8.7.2 Healthy Baby Clubs
Healthy Baby Clubs is a pre and post-natal support program offered through community-based family resource programs. The program is designed to actively promote and support healthy lifestyles for women during and after pregnancy through a mix of peer and professional supports. The program objective is to have a positive effect on the development of the baby and to increase support and knowledge for the mother. Healthy Baby Clubs provide:
• peer support; • information and skills training relating to healthy pregnancy and lifestyle, birth, and parenting; • breastfeeding support; • food supplements; and • supportive environments for pregnant women and families with newborns.
8.7.3 Pre-natal Programming
The pre-natal classes follow the Pre-natal Program “Growing Babies Growing Parents” and are generally taught in a series of four, through which topics such as Caring for the Newborn, Labor and Delivery, Breathing and Relaxation, and Breastfeeding are covered. One-on-one pre-natal teaching is also offered to clients at any time based on their needs (D. Voisey, pers. comm.). However, it is estimated only approximately 25 percent of all expecting mothers take part in the pre-natal classes offered by the public health system (S. Ramey, pers. comm.).
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8.7.4 Post-natal Programming
Post-natal programs are offered based on provincial standards under a program called “Healthy Beginnings” and requires follow-up with the mother after discharge from the hospital. Additional assistance and referrals are available based on the client’s needs (for example, information on immunizations, baby care, self-care of parents, siblings, feeding, breast feeding assistance and referral to a lactation consultant, safety) (D. Voisey, pers. comm.). Challenges emerge when some parents miss appointments on a repeated basis during the 2-, 6-, 12- and 18-month immunization check-up. The B.U.R.P.S program started in 2004 and is based on a similar program that ran successfully for several years in Newfoundland. The program has grown in size from approximately three to five mothers and babies in the beginning, to approximately 20 mothers and babies today. The program is a voluntary drop-in program offered one afternoon a week, where parents and children up to one year of age can come to socialize, get information and have the baby weighed and measured, if desired (D. Voisey, pers. comm.). The Health Checks program is offered twice a week. Babies aged 2, 4, 6, 12 and 18 months attend for overall health assessment, weight, height, head circumference and required immunizations. Pre-school health checks are done at age four years two months and are similar to the Health Check program. The child’s hearing, vision, speech, comprehension, dental, health, safety practices, nutrition and behavioural issues are assessed and referrals are made as necessary. The child receives any required immunizations at this time and any identified concerns relevant to the school system are passed on to the school officials with parent’s consent (D. Voisey, pers. comm.). The Denver (motor skill) development screening tool test is performed on all 12-month old children seen by a public health nurse and again at the pre-school health check. Public health nurses make general health presentations through the primary and elementary schools. Rapid health assessments, vision and hearing screenings are conducted at the teacher’s request. Presentations to high schools include topics such as birth control, sexually-transmitted diseases and parenting issues. The Hepatitis B immunization program is offered to Grade 4 students and requires three visits during the school year, with additional visits for absent students (D. Voisey, pers. comm.). A diphtheria tentanu cecellular pertussis (DTaP) immunization program for Pertussis, or whooping cough, is offered to Grade 9 students, aged 14 to 16. Introduced in 1999 in Canada, Newfoundland and Labrador was the first Province to implement the program. Since then, approximately 28,000 adolescents have been immunized41 (Public Health Agency of Canada 2005). Immunization compliance rates are relatively high, particularly in Happy Valley-Goose Bay, approaching an estimated 95 percent (S. Ramey, pers. comm.). A major challenge to child health care is that there currently is no mechanism to capture new children arriving in the area, namely Happy Valley-Goose Bay. From the ages of 0 to 5 years, there is no guarantee that a public health nurse will see a child prior to pre-Kindergarten initiation. Given Happy Valley-Goose Bay’s transient nature, this is an issue of considerable concern. S. Ramey (pers. comm.) indicates that it could be as long as four years before a public health nurse sees a child new to the town. A more consistent and comprehensive reporting system, streamlined between Child Youth and Family Services, doctors, and public health nurses, is needed (S. Ramey, pers. comm.).
41 http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/05vol31/dr3122eb.html
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The Innu communities of Natuashish and Sheshatshiu have their own public health nurses, who are employed by the Mushuau Innu Health Commission and the Sheshatshiu Innu Band Council, respectively (D. Voisey, pers. comm.).
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9.0 EDUCATION
Educational attainment is a key component of socio-economic status and positively associated with good health and health practices (Millar and Stephens 1992). In the 1996-1997 National Population Health Survey, only 19 percent of respondents with less than a high school education rated their health as ‘excellent’, in comparison with 30 percent of university graduates (Federal, Provincial and Territorial Advisory Committee on Population Health 1999). In comparison with other Canadian provinces and territories, Newfoundland and Labrador has the highest proportion of its population with less than a high school education and the least proportion with a university degree (Millar and Stephens 1992). Moreover, Aboriginal people in general are less likely to have high levels of formal education (Federal, Provincial and Territorial Advisory Committee on Population Health 1999). People with low levels of education tend to experience overall poorer health and well-being. Compared to non-graduates, for example, high school graduates (Federal, Provincial and Territorial Advisory Committee on Population Health 1999) tend to:
• use preventative medical services more frequently; • make fewer multiple visits to doctors; • have better knowledge of health behaviours; • have better general health status; • have lower stress levels or tend to cope better with stress; and • have better family functioning. Further, non-graduates also are more likely to be jailed than graduates; non-graduates comprise 34 percent of the population but make up 74 percent of the prison population (Ungerleider and Burns 2002). In turn, a number of social health factors influence educational attainment, including nurturing, stimulation, diet, family income, parental depression and relative disadvantage in terms of levels of crime and substance abuse (Ryan and Adams 1999).
9.1 Education Services and Facilities in the Study Area
In 2006, approximately 21 percent of the Labrador population was considered of primary and secondary school age (5 to 19 years), 6.3 percent of normal post-secondary school age (20 to 24 years), and 5.2 percent of pre-school or day care age (<5 years). In terms of the regional population, the proportion of primary and secondary school age population is highest on the Labrador Central/Upper Lake Melville (24.2 percent) and lowest in Labrador West/Churchill Falls (19.6 percent), whereas the proportion of the population of post-secondary age is highest in Labrador Central and lowest in Labrador West (Table 9-1).
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Table 9-1 Proportion of School-aged Population by Regional Economic Zone, Labrador and Province Labrador Central / Labrador West / Labrador Province Upper Lake Melville Churchill Falls 2006 pop 9,175 9,660 36,755 505,470 % <5 years 6.3 5.0 5.2 4.5 % 5 to 19 years 24.2 19.8 21.2 17.7 % 20 to 24 years 6.7 6.9 6.3 6.2 % >25 years 46.8 50.8 46.4 43.9 % seniors 15.9 17.5 20.9 27.7 Source: Based on Statistics Canada 2006 Census data. Accessed via Community Accounts.
9.1.1 Primary and Secondary Schools
The primary and secondary school system in Labrador is administered by two school boards: the Labrador School Board and the Northern Peninsula and Labrador South School Board. The two school boards responsible for 18 schools (Table 9-2), six of which are in the Upper Lake Melville area (Happy Valley-Goose Bay, North West River, Mud Lake and the Innu community of Sheshatshiu). Additional schools encompassed in this portion of the health baseline study include schools in Labrador City and Wabush and Labrador’s second Innu community, Natuashish. Enrolments at most schools are currently close to capacity, with the exception of the Lake Melville School, serving the communities of Sheshatshiu and North West River, which is currently near 50 percent enrolment capacity. Table 9-2 Labrador Primary and Secondary Schools
School Grades Community Western Labrador A.P. Low Primary K-3 Labrador City and Wabush J.R. Smallwood Middle School 4-7 Labrador City and Wabush Menihek High School 8-12 Labrador City and Wabush Central Labrador Peacock Primary School K-3 Happy Valley-Goose Bay Queen of Peace Middle School 4-7 Happy Valley-Goose Bay Mealy Mountain Collegiate 8-12 Happy Valley-Goose Bay Mud Lake Elementary K-9 Mud Lake Lake Melville School K-12 North West River Peenamin McKenzie K-12 Sheshatshiu Coastal Jens Haven Memorial 4-12 Nain Jens Haven Primary K-3 Nain Mushuau Innu Natuashish School K-12 Natuashish Amos Comenius Memorial K-12 Hopedale B.L. Morrison K-12 Postville J.C. Erhardt Memorial K-12 Mammovik Northern Lights Academy K-12 Rigolet Henry Gordon Academy K-12 Cartwright St. Peter's School K-12 Black Tickle Source: Labrador School Board 2008
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Innu schools of Sheshatshiu and Natuashish had student enrolments in 2005-2006 of approximately 370 (capacity 400) and 260 students, respectively. The Sheshatshiu School has a teaching staff of 36 and a teaching support staff of 19. The Natuashish School has a teaching staff of 17, plus eight student teachers. The school also participates in a student breakfast program. Each of the schools in Labrador West/Churchill Falls has a school counsellor. The schools in Happy Valley-Goose Bay and Sheshatshiu similarly have one counsellor each; a traveling counsellor serves the North West River School.
The facilities at a number of these schools are in need of improvement. Of particular concerns at the Peacock Primary School, for example, are exterior school grounds themselves and, in particular, the lack of appropriate facilities to provide a ‘hot lunch’ or breakfast program (D. Abbass, pers. comm.). In the 2007 Northern Strategic Plan for Labrador, the Province announced a $4 million contribution toward the construction of a new school in Sheshatshiu.
Total primary and secondary school enrolment in the Study Area was 3,630 students in the 2005-2006 academic year (Figure 9-1). Provincial primary and secondary school enrolments have been declining an average of 3.1 percent per year since 2000-2001. In the Labrador region, enrolment decline has been slightly higher, averaging -3.8 percent over the past four years (Newfoundland and Labrador Department of Education 2005). At the Peacock K-3 school in Happy Valley-Goose Bay, for example, enrollment has declined 20 to 25 percent since 2003. However, enrollment decline is most pronounced in Labrador West/Churchill Falls, where 2005-2006 enrolments are 16 percent below those of 2000- 2001. That being said, the decline in school enrolment is consistent with, although not as rapid as, the decline in the population as a whole (Jong 2007). The three schools in Happy Valley-Goose Bay currently have capacity to accommodate approximately 250 additional students from K to 12.
Figure 9-1 Primary and Secondary School Students (K12) by Economic Zone, 2000 to 2006
Source: NLDE. Accessed via Community Accounts. Study Area: Zone 2 – Labrador West/Churchill Falls; Zone 3 – Labrador Central/Upper Lake Melville
The number of full-time equivalent teachers in the Upper Lake Melville area has decreased from 166.7 in 2001-2002 to 139.5 in 2006-2007, a decline of 16 percent (Table 9-3). The number of full-time equivalent teachers in Labrador West/Churchill Falls declined by 14.6 percent over the same period.
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The combined result of declining school enrolments and declining full-time equivalent teachers means that the student-teacher ratio has remained relatively constant, with both areas near or below the provincial average (Figure 9-2). However, in 2005-2006, the student-teacher ratio in Labrador West/Churchill Falls was statistically significant above the provincial mean and the highest in the Labrador region. Table 9-3 Full-time Equivalent Teachers
Region 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 Province 6,257.4 5,931 5,861 5,640.3 5,363.3 5,460.6 Labrador 670 634 636.7 613 537.8 580.8 Labrador West / 128.8 111 119.5 114.5 88.8 110 Churchill Falls Source: NLDE. Accessed via Community Accounts.
Figure 9-2 Student-Teacher Ratio
Source: NLDE. Accessed via Community Accounts.
9.1.2 Post-Secondary Schools
Approximately 75 percent of Labrador’s post-secondary age bracket resides in the Study Area. The post-secondary population is served provincially by: Memorial University, which administers the Labrador Institute in Happy Valley-Goose Bay, the College of the North Atlantic (CNA), which has two campuses in Labrador; and one private training institution. There are CNA campuses in Happy Valley-Goose Bay and Labrador City. Each year, the Happy Valley- Goose Bay campus receives approximately 300 full-time students. Approximately 50 percent of students are said to be coming from coastal areas, with approximately 65 percent of the CNA total enrolment now Aboriginal. The majority of these students are Inuit and Metis, with less than 10 percent reported to be Innu (B. Simms, per. comm.).
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In addition to the main campuses, CNA manages six Coastal Learning Centres (Nain, Hopedale, Natuashish, Rigolet, North West River and Port Hope Simpson). The centres teach Adult Basic Education (ABE) to local residents and each centre has an instructor, with the exception of the North West River Centre, which has three. Centres with one instructor can accommodate up to 12 students. The CNA has also delivered an Early Childhood Education Program in Natuashish in conjunction with Health Canada (B. Simms, pers. comm.). The Happy Valley-Goose Bay main campus also provides a variety of support services, including a Graduate Employment Officer, Industrial Education Consultant, Inuit Education Coordinator and Guidance Counsellor, and campus housing. The CNA is currently working to expand its Happy Valley-Goose Bay campus so as to accommodate 200 more students, and to add to its overall service capacity to the Upper Lake Melville region. The CNA has no plans to expand the availability of student housing, which may not be adequate to accommodate additional students. The family residence is regularly full, and the ‘singles’ residence is currently at approximately 80 percent capacity (B. Simms, pers. comm.). The CNA offers a variety of programs, including ABE, Office Administration, Millwright and Industrial Mechanic, Construction and Industrial Electrical, Integrated Nursing Access and Early Childhood Education (Table 9-4). The CNA also offers programs that are tailored to meet the specific needs of major development projects or skill set shortages; however, in such cases, there is a need to enhance and allocate funding for such programs in a way that enhances capacity and not just provides for service delivery (B. Simms, pers. comm.). The limited availability of apprenticeship programs is a common concern throughout the Labrador region (Government of Newfoundland and Labrador 2007b).
The ABE program is overall the most subscribed post-secondary education program in Labrador. ABE training is divided into three levels in Newfoundland and Labrador: ‘Level 1’ is equivalent to a K to 6 functioning; ‘Level 2 Grades 6 to 9; and ‘Level 3’ represents a Grade 10 to 12 proficiency. In many cases, Innu students entering the ABE program at CNA require ‘Level 1’ training, making the transition into other trades and diploma programs challenging (B. Simms, pers. comm.).
Table 9-4 Post-secondary Education Training Facilities and Programs in Study Area
Region Post-Secondary Institution Types of Programs Offered Labrador Central / • CNA • ABE; Business Administration; College/ Upper Lake • Happy Valley-Goose Bay and North West University Transfer; College Transition Melville River campuses Integrated Nursing Access Program; • Memorial University Common First Year Engineering Technology; Community Studies; Construction and Industrial Electrician; Environmental Technology (Year 1); Heavy Duty Equipment Technician; Millwright; Office Administration • Teacher Education Program Labrador West / • CNA • ABE; College/University Transfer; Churchill Falls • RSM Safety and Training Private Training Comprehensive Arts and Science; First Year Institution Engineering Technology; Mining Technology; community service courses including First Aid and WHMIS • Accident Investigation; Excavation and Trenching Safety; Heavy Duty Equipment Operation Source: http://www.ed.gov.nl.ca/edu/post/mun.htm There are no private training colleges in the Upper Lake Melville area, but there is one in Labrador West. The RSM Safety Institute, Inc., in Labrador City, is a subsidiary of RSM Mining Services and
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offers health and safety training services for the mining and construction industries. In addition, the Nunatsiavut Government has initiated a number of funded programs, including nursing, which are offered only in Inuit language, with the intent to ensure student success and to meet ‘cultural needs’ in post-secondary training. Similar initiatives have not occurred for the Innu. However, there is considerable financial support available for post-secondary education to Innu (B. Simms, pers. comm.),
9.1.3 Early Childhood Education
Currently, there are 74 government-funded programs (including satellite sites) across the Province, with two of them being located in the Labrador region. Research has shown that access to regulated child care increases the likelihood of healthy child development. Ten licensed centres are located in the Labrador region, providing full-time space for 274 children. The majority of the full-time spaces in child care centres are occupied by children under the age of five. There are currently 24,603 children under the age of five in the Province, with 1,593 in the Labrador region. There are 10 early childhood education or daycare facilities in Labrador, with three in Happy Valley- Goose Bay and one in Sheshatshiu. The demand for early childhood education and day care facilities is on the increase in Labrador, following the general pattern depicted both provincially and nationally. Between 1994 and 2002, there was a 42 percent increase in the number of children aged six months to five years in care facilities in Newfoundland and Labrador42. In order to meet the demand for day care and early childhood educators, in 2006, Health Canada identified funding to deliver an early childhood education program in Natuashish. Five students enrolled in the program, three of which were hired back by the Band Council into other occupations prior to completion (B. Simms, pers. comm.). The lack of available spaces, staff and high operational costs, as well as the ability to recruit and retain professionals throughout Labrador, are identified as the main concerns facing early childhood education in the region. In 2007, the Provincial budget included an announcement of $450,000 to expand the delivery of Early Childhood Education programming, at the Corner Brook and Happy Valley- Goose Bay campuses.
9.2 Education Levels
Educational attainment varies considerably in the Study Area (Table 9-5). Provincially, in 2006, 33.5 percent of the population greater than 15 years of age did not hold a certificate, diploma or degree. This is considerably lower in Wabush, Labrador City, and Churchill Falls at 18.8 percent, 19.9 percent, and 24.8 percent respectively. Happy Valley-Goose Bay is closer to the provincial statistic, with 29.1% of the population not holding a certificate, degree or diploma in 2006. The proportion of the population with an apprenticeship or trades certificate or diploma is greater in all Study Area communities than the Province, with the exception of Natuashish. All communities in the Study Area, with the exception of Churchill Falls, have a lower proportion of its population with a university certificate, degree or diploma than the Province (Statistics Canada 2006a). In general, a larger percentage of the Aboriginal population than the non-Aboriginal population has less than a high school education. Approximately 42 percent of all Aboriginals in Canada, for example, have less than a high school education, whereas this percentage is much lower (21.4 percent) for all of
42 http://www.ccsd.ca/pccy/2006/pdf/pccy_communityresources.pdf
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Canada. These statistics are much more pronounced in the Innu communities of Sheshatshiu and Natuashish (2001 Census), where the language and culture issues, high teacher turnover and a shortage of specialist teachers combine to produce very few graduates (Jong 2007) (Table 9-6). In 2006, the proportion of the adult population with no certificate, diploma or degree in Sheshatshiu is 70.1 percent, and in Natuashish 70.9 percent; more than double the provincial general population statistic. Sheshatshiu also has the lowest proportion of its population with a university-level education, when compared to all other Study Area communities. Interestingly, 9.3 percent of the population in Natuashish have completed a university certificate, degree or diploma program – more than Wabush and only slightly lower than the provincial statistic of 11.3 percent (Statistics Canada 2006a). Table 9-5 Highest Level of Schooling Completed Based on Population Aged 15 Years and Older
Educational Happy Valley Churchill Sheshatshiu* Wabush Labrador City Natuashish Province Attainment – Goose Bay Falls** Total Population (>15 years of 685 % 5,945 % 1,460 % 5,935 % 525 % 430 % 422,385 % age) No certificate, diploma or 480 70.1 1,730 29.1 275 18.8 1,180 19.9 130 24.8 305 70.9 141,575 33.5 degree High school certificate or 65 9.5 1,095 18.4 405 27.7 1,545 26.0 110 21.0 25 5.8 93,330 22.1 equivalent Apprenticeship or trades 90 13.1 850 14.3 230 15.8 1,085 18.3 80 15.2 30 7.0 51,380 12.2 certificate or diploma College, CEGEP or other non-university 40 5.8 1,420 23.9 370 25.3 1.340 22.6 130 24.8 25 5.8 74,100 17.5 certificate or diploma University certificate or diploma below 10 1.5 200 3.4 55 3.8 175 2.9 15 2.9 10 2.3 14,310 3.4 the bachelor level University certificate, 10 1.5 650 10.9 130 8.9 595 10.0 65 12.4 40 9.3 47,690 11.3 diploma or degree * Includes North West River and Mud Lake, Division No. 10, Subdivision C. **Division 10, Subdivision D Source: Statistics Canada 2006a
Table 9-6 Innu Adults with Less than High School Education
% Adults with Less than High School Group Education Innu in Sheshatshiu (>25 years) 70.1 Innu in Natuashish (>25 years) 70.9 All Aboriginal groups, Newfoundland and Labrador (>25 years) 40 Newfoundland and Labrador general population (20 to 64 years) 31.7 Source: Statistics Canada 2006a
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9.3 Academic Achievement
Approximately 50 percent of Labrador high school students who graduate receive a general diploma, making them ineligible for admission to many post-secondary institutions (Table 9-7). Provincially, students in more urban areas of Labrador are at or above the provincial level of academic achievement, but there is consistent underachievement among students in more rural areas. This may be linked in part to the high teacher turn-over rate in rural areas in general (Labrador School Board 2003). A 2003 survey of high school students from the north coast and Labrador West/Churchill Falls found that 57 percent of students planned to attend university and 19 percent planned to attend community college upon completion43. However, there is considerable variability among regions in terms of sufficient qualifications for entry to post-secondary education, with Labrador West/Churchill Falls having the highest proportion (50 percent) of high school graduates eligible to attend Memorial University. Approximately 45 percent of Labrador Straights high school graduates are eligible for direct entry to Memorial University, followed by the south coast (42 percent), Upper Lake Melville (32 percent) and the north coast (8 percent)44. Table 9-7 High School Graduates and Academic Achievement by Zone
Category of High School Graduation Total Economic Zone Honours Academic General Graduates # % # % # % Northern Labrador 0 0 5 20 20 80 25 Labrador West / Churchill 30 28.8 38 36.5 36 34.6 104 Falls A Upper Lake Melville A 7 8.4 36 43.4 40 48.2 83 Southeastern Labrador 4 12.9 10 32.3 17 54.8 31 Labrador Straights 5 17.2 10 34.5 14 48.3 29 Labrador 46 17 99 36 127 47 272 Province 1,180 21.8 2,263 41.7 1,980 36.5 5,423 Source: NLDE, Education Statistics 2005-06, Elementary and Secondary. A Located within Study Area Aboriginal populations across Canada are characterized by exceptionally low high-school graduation rates. The most limiting factor for post-secondary education is the low level of student success in the K to 12 system. This is particularly the case for in the Innu communities of Labrador. A study by Philpot et al. (2004) found that only 51 percent of Innu students reported high school graduate as a goal, and since 1993, Natuashish (then Utshimassits) produced only three high school graduates and 12 from ABE programs. Sheshatshiu produced 14 high school graduates and eight ABE graduates during that same period (Philpot et. al. 2004). The factors contributing to the less than average performance of primary and secondary school children in Innu communities are many and varied. However, of notable importance are language difficulties for Innu-Aimun-speaking children in English language schools with non-Innu-Aimun-speaking teachers, low school attendance, and alcohol abuse. Philpott et al. (2004) report that most Innu children begin falling behind as early as the first grade, and continue to fall even further behind grade and age expectations as they move through school. Approximately 66 percent of seven-year-olds were
43 Labrador Regional Strategic Social Plan and Futures in Newfoundland and Labrador’s Youth 2003. The Future Plans of High School Students of the Labrador Regions: Survey Results. 44 Memorial University Centre for Institutional Planning and Analysis.
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estimated to be at least one to two years behind grade level. The decline continued to a point where 66 percent of 16-year-olds were at least five years behind. In reading skills assessment, Philpott et al. (2004) found that 80 percent of seven-year-olds were one to two years behind grade level; approximately 85 percent of 15-year-olds were at least five years behind. The pattern is similarly evident in mathematics, where 100 percent of 15 year-olds were found to be at least five years behind their grade level. Innu children who attend school outside of their home community are reported to perform closer to grade level. However, at the Peacock Elementary School in Happy Valley-Goose Bay, Grade 1 students in general are reported to be 20 percent below provincial literacy grade level measures (D. Abbass, pers. comm.). .
Aboriginal students who successfully complete high school go on to succeed in post-secondary education at about the same rate as everyone else (Mendelson 2006). The problem is that Aboriginal students are much less likely to complete high school. Philpott et al. (2004) conclude that the school system as it exists at present is failing Innu youth. The 2007 Northern Strategic Plan for Labrador indicated a provincial investment of $750,000 to work with partners, Aboriginal government and organizations to enhance K to 12 initiatives to prepare Aboriginal youth in Labrador for post-secondary education.
9.4 Attendance and Retention
School attendance at the primary and secondary level in Labrador is consistent with attendance for the Province as a whole (Table 9-8), with just under 90 percent attendance rate. However, within the Innu communities of Sheshatshiu and Natuashish, where approximately 50 percent of the communities are of school-age, attendance is considerably worse than the average attendance for the Labrador region (Figure 9-3). Philpott et al. (2004) report that the vast majority of those who attend school do so sporadically: approximately 33 percent of the population do not attend school; 17 percent attend less than 20 percent of the time; and for the population who do attend, attendance approximates 54 percent of total school time in Natuashish. This includes a 10 percent increase following the establishment of the new community and school. Table 9-8 Attendance Records: Labrador School District and Provincial, 2006 to 2007 School District Attendance Rate Average # Days Absent Labrador 86.9 23.3 Province 90.9 16.2 Source: NLDE, Elementary and Secondary School Statistics 2006-200745.
45 http://www.ed.gov.nl.ca/edu/pub/stats07_08/ATT_07_7.PDF
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Figure 9-3 Average Attendance by Month, 2003 to 2004
Source: Redrawn from Philpott et al. 2004. Since the introduction of the school breakfast program in Sheshatshiu in 2005-2006 (Peenamin Machkenzie School), attendance has improved considerably at the primary level (T. Bruce, pers. comm.). Innu children who attend school outside their community (e.g., Happy Valley-Goose Bay) have much better attendance performance, with an attendance rate of approximately 90 percent (Philpott et al. 2004). However, there is concern they will find it harder to retain their Innu language fluency (Jong 2007). There also is a seasonal pattern of school attendance in the Innu communities, with attendance rates at their lowest in the early spring. Interestingly, the pattern is similar for those Innu youth who attend school outside the Innu communities. Philpott et al. (2004) note that this pattern is in part due to continued participation in traditional lifestyle activities, but other factors such as limited daycare facilities, perceptions of the value of formal education, and the attraction of the job market are explanatory factors. Closely associated with attendance is retention - the number of graduates divided by the number of Grade 10 students in the cohort two years prior (Table 9-9). Fleet (2003) reports a retention rate of 48 percent for the Labrador region in 2002, in comparison to the provincial average of 77 percent. On the north coast, retention rates ranged from a low of 19 percent to a high of 53 percent, with the school in Natuashish producing no graduates out of the cohort of 46 Grade 10 students. In Sheshatshiu, a total of only 14 students have completed high school since 1990. Table 9-9 High School Retention: Drop-out Rates by School District, 2002-2003 to 2003-2004 School District Drop-out Rate Labrador 7.6% Province 4.3% Source: NLDE, Elementary and Secondary School Statistics 2003-2004.
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9.5 Teacher Turn-over and Replacement
Recruitment and retention of teachers is particularly difficult in Labrador. A survey conducted by the Retention and Recruitment Working Group for the Strategic Social Plan (2003) found that teachers in Labrador were more likely than other professionals to consider leaving (73 percent versus 69 percent). The main reasons given for leaving Labrador included: isolation; lack of amenities; and difficulties adapting to the culture (Retention and Recruitment Working Group, 2003). As previously noted, declining school enrolments and declining full-time equivalent teachers means that the student-teacher ratio has remained relatively constant in the Study Area - near or below the provincial average. However, recruitment and retention of teachers in Labrador is especially important as it impacts the health and well-being of the communities. When teachers leave is often difficult to find appropriate placements for their positions and positions are sometimes filled with personnel without the ideal qualification (D. Abbass, pers. comm.). Filling positions such as guidance councilors and speech language pathologists is particularly problematic (H. Windeler, pers. comm.). Innu Community Turnover of teachers in the Innu communities is a major concern and ongoing problem. Like many schools in the area, the Sheshatshiu school lacks specialized teachers and is characterized by a high turnover in both teachers and support staff (T. Bruce, pers. comm.). Between 2003 and 2004, for example, the turn-over rate was approximately 60 percent (T. Bruce, pers. comm.).
9.6 Language and Culture
Both the Sheshatshiu and Mushuau Innu Bands stress the need to improve the level of primary, elementary and secondary education available in their communities and to do so in a manner that protects and promotes their distinctive languages and cultures (Government of Newfoundland and Labrador 2007b). The Innu communities of Sheshatshiu and Natuashish are amongst the minority of Aboriginal communities in Canada that have managed to retain their traditional language as the predominate language that is spoken. However, language retention has both its positives and negatives in the education systems of Sheshatshiu and Natuashish. Innu children are almost all raised in households where Innu-aimun is spoken as the major language of communication. The 2006 census reported 1,670 people within the Province speak Montagnais- Naskapi. However, there has been limited accommodation to this linguistic reality on the part of non- Innu institutions and services. Recently, there was an attempt for more Innu control over the school system, whereby half of the school day, particularly in the lower grades, would be taught in Innu-aimun; however, there is limited support for teachers with such language skills and the schools in both Sheshatshiu and Natuashish remain predominately English schools. Moreover, non-Innu teachers normally do not have training in teaching English as a second language. Philpott et al. (2004) report that less than 2 percent of teachers in Sheshatshiu and Natuashish are certified to teach English as a second language; although all schools hire Innu interpreters, 44 percent of teachers surveyed report never using this service - 70 percent of the students identified some sort of communication concern. The lack of fluency in English has had a large impact on Innu education from primary school onward. The Innu face considerable challenges to train teachers and develop the Innu-aimun curriculum materials required to revamp the primary and secondary education system to better reflect their desire
Community Health Study y Final Report • December 22, 2008 Page 9-11 © Aura Environmental Research and Consulting Ltd. 2008 Lower Churchill Hydroelectric Generation Project to both retain their language and acquire the knowledge and skills needed to pursue post-secondary education (Jong 2007). Philpott et al. (2004) explain that Innu content has been introduced into the school setting. However, there are criticisms that it lacks meaningfulness out of the context of the natural environment and that it is presented more as something of historical interest rather than something relevant to current life. Teachers are predominately non-Innu and unfamiliar with the language and the culture of the Innu. For Innu who are strongly attached to traditional ways, the school often clashes with their language and culture. Despite this, parents, as well as students and teachers, want education to produce bicultural youth capable of achieving in their traditional language and culture as well as in contemporary mainstream society (Philpott et al. 2004). However, Backhouse and McRae (2002) report that some Innu parents in Sheshatshiu have lost faith in the capacity of the school to offer education either in the Innu language and culture or in the basic skills offered under the provincial curriculum. As a result, a number of parents have responded by sending their children to the school in North West River. A transitional facilitator was recently hired by Sheshatshiu Community to bring it closer to running its own school system (H. Windeler, pers. comm.).
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10.0 SOCIAL SUPPORT NETWORKS AND ENVIRONMENTS
The values and norms of a society influence the health and well being of its individuals, and the health of a community is reflected in its social support networks including institutions, organizations and informal giving practices. In addition, social stability, recognition of diversity and cohesive communities provide a supportive network that reduces or avoids many potential social and physical health risks. Low availability of emotional support and low social participation have been associated with all-cause mortality (Federal, Provincial and Territorial Advisory Committee on Population Health 1999).
Support from families, friends and communities is associated with better personal and community health and, as such, is important in helping solve social and health problems and in coping during stressful circumstances. The caring and respect that occurs in social relationships, and the resulting sense of satisfaction and well-being, can act as a buffer against health problems (Federal, Provincial and Territorial Advisory Committee on Population Health 1999).
Interruptions in social networks, particularly violence, have a devastating effect on social health and well being - especially for women and children. Women who are assaulted often suffer severe physical and psychological health problems. In 1996, family members were accused in 24 percent of all assaults against children (Fitzgerald 1996).
10.1 Family Composition
As of 2001, the majority of adult residents of Happy Valley-Goose Bay and Labrador City were married, with a much smaller percentage having single status (Table 10-1). Families headed by a married couple, a common-law couple, or by a lone parent, tended to be small, with those headed by two people having on average a single child. This may in part reflect the younger average age in the region. Adults in Natuashish were much more likely to be single, compared to Happy Valley-Goose Bay and Labrador City. According to the 2006 census, of those residents of Natuashish aged 15 years or older, 66.3 percent were single, 23.3 percent married, 4.7 percent separated, 2.3 percent divorced and 3.5 percent widowed. The provincial percentages were: 30.9 percent single; 54.3 percent married; 2.3 percent separated; 5.6 percent divorced; and 6.9 percent widowed. The Natuashish families tended to be somewhat larger than those of the Province for married-couple families (4.7 to 2.9), lone-parent families (3.0 to 2.8) and common-law-couple families (3.7 to 2.4). Approxiamtely 25 percent of all Natuashish families (50 of 165) were single-parent households and 73 percent had two parents. In contrast, only approximately 15.5 percent of all Newfoundland and Labrador families in 2006 were headed by a single parent46. In 1996 approximately 84 percent of Labrador families were husband-wife, while only 11.8 percent single parent families47.
46 Statistics Canada. 2002. 2001 Community Profiles. Released June 27, 2002. Last modified: 2005-11-30. Statistics Canada Catalogue no. 93F0053XIE. www12.statcan.ca/english/Profil01/CP01/Index.cfm?Lang=E (accessed June 21, 2007). 47 Government of Newfoundland and Labrador 2002: 16.
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Table 10-1 Legal Marital Status of Population Aged 15 Years and Older, 2006
Happy Valley- Labrador City North West Marital Status Province Natuashish Goose Bay River Total 427,245 6,050 5,945 415 430 132,005 2,280 1,915 150 285 Single (30.9%) (37.7%) (32.2%) (36.1%) (66.3%) 231,820 2,970 3,305 210 100 Married (54.3%) (49.0%) (55.6%) (50.6%) (23.3%) 9,745 145 150 5 20 Separated (2.3%) (2.4%) (2.5%) (1.2%) (4.8%) 24,015 425 400 20 10 Divorced (5.6%) (7.0%) (6.7%) (4.8%) (2.3%) 29,650 235 165 25 15 Widowed (6.9%) (3.8%) (2.8%) (6.0%) (3.5%) Average # persons in married- 114,630 1,470 1,645 105 45 couple families Average # persons in common- 16,935 445 350 30 75 law couple families Average # persons in lone- 24,165 360 320 25 50 parent families Source: Compiled from Statistics Canada Community profiles www12.statcan.ca. In North West River in 2006, 36.1 percent of residents aged 15 years or older were single, 50.6 percent were married, 1.2 percent were separated, 4.8 percent were divorced and approximately 6 percent were widowed. Married-couple families in North West River averaged 2.8 persons per household, lone- parent families 2.5 persons per household, and common-law-couple families 2.2 persons per household. Sixteen percent of all families in North West River were headed by a single parent (25 of 160); and 84 percent lived in two-parent families48. Family composition for Aboriginal populations in Canada varied depending on the location of the family. In 2001, the proportion of Aboriginal children aged 14 and under living in two-parent families was 65 percent on reserve or in rural, non-reserve areas. However, it was only 46 percent in urban areas. In both Innu of Labrador communities, the proportion of families headed by two parents exceeded the average for Canadian Aboriginal families, either on or off reserve49.
10.2 People Requiring Home Care or Assistance
The health system, particularly in rural areas where formal home care provision is limited, depends heavily on informal caregivers. The concern is that a large portion of volunteer caregivers are over the age of 60, the result of which is increased personal stress and health concerns (Government of Newfoundland and Labrador 2002). The proportion of the population in the Study Area requiring assistance with either preparing meals or personal care is lower than the provincial statistic (Table 10- 2), however, data should be interpreted with caution for the Study Area due high sampling variability. There is limited support currently in place for these people requiring assistance. For example, there is no ‘meals on wheels’ or equivalent service in the Study Area. There is a Continuing Homecare unit in
48 Statistics Canada. 2002. 2001 Census Aboriginal Population Profiles. Released June 17, 2003. Last modified: 2005-11-30. Statistics Canada Catalogue no. 93F0043XIE. www12.statcan.ca/english/Profil01/AP01/Index.cfm?Lang=E (accessed June 21, 2007) 49 www.statcan.ca/Daily/English/050623/d050623b.htm.
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Labrador West, with an anticipated three new care provider positions (Health Directors Focus Group, pers. comm.). Table 10-2 Proportion of Individuals Requiring Help with Preparing Meals or Personal Care, Study Area and Province
Labrador Central / Labrador West / Need help Province Upper Lake Melville Churchill Falls with: M F Total % M F Total % M F Total % Preparing 2.6% 0.4% 1.5 - 0.6% 0.3 3.1% 4.5% 3.8 Meals Personal 1.6% 0.6% 1.1 1.6% 2.9% 2.3 2.3% 2.4% 2.3 Care Source: Canadian Community Health Survey (2005), accessed through Community Accounts. Overall, there is a lack of senior care facilities and services in the Study Area and no clear and consistent database that allows community health workers to identify the elderly and where they live (Health Directors Focus Group, pers. comm.). In Labrador West, for example, there are currently only six beds available, although this number is expected to increase to 14 beds. The construction of a senior’s complex and care facility in Happy Valley-Goose Bay would be of considerable benefit to the region. Similarly, there was never a demonstrated demand or need for such care in Labrador City, but recently there has been more of a need for appropriate accommodation and care facilities (Newfoundland and Labrador Housing, pers. comm.50). Information on homecare specific to the Innu communities is not known. On June 27, 2007, Premier Williams turned the sod of a new $20M long-term care home for Happy Valley-Goose Bay51. The government news release indicated that the new 50-bed facility will be attached to the Labrador Health Centre, and will have the capacity to expand to 72 beds in the future. An additional $4.5 million was also announced to begin site work on a new 28-bed health centre in Labrador West.
10.3 Volunteerism
At the provincial scale, 31 percent of the population >15 years of age volunteered in 2002; the national average was 26.7 percent. Additionally, 8 out of 10 Canadians reported that they contributed time, on their own, to assist people outside their household with basic activities such as shopping, driving to appointments or stores, housework, baby-sitting and doing home maintenance or yard work for others (Government of Newfoundland and Labrador 2002). However, there was a notable decrease in the number of individuals volunteering in 2000, down from 33 percent in 1997, but those volunteering were giving more hours. This has considerable implications for residents in rural areas, in particular where there is a greater reliance on unpaid supports both within and outside of the family. Detailed information on volunteering for the region or Innu communities are not known.
10.4 Sense of Belonging
A high sense of belonging to the community is associated with improved mental health (Bailey and McLaren 2005). Research has clearly established a relationship between social relationships and
50 Interviewee wished to remain anonymous. 51 http://www.releases.gov.nl.ca/releases/2007/exec/0627n07.htm
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health, in that people who are socially isolated or lack a sense of belonging to their community are more likely to suffer from poor physical and mental health and are even more likely to die prematurely52. A low sense of belonging can thus be used to predict depression, a factor often leading to further health problems or even suicide. Based on the Canadian Community Health Survey (2005), provincially, there is a strong association between those people who felt connected to their community and perceived their health positively. Provincially, 79.1 percent of individuals rate their sense of belonging as somewhat to very strong. Self-ratings are considerably higher in the Study Area (90.8 and 85 percent, respectively) (Figure 10-1). Figure 10-1 Self-rated Sense of Belonging*
Source: Canadian Community Health Survey 2005, Community Accounts. Zone 3 – Labrador Central/Upper Lake Melville Zone 2 – Labrador West/Churchill Falls *Caution should be taken in scaling these results due to relatively low participation rates and possible under- representation of the Innu population.
10.5 Preservation of Innu Language and Culture
A key characteristic of Innu life is the need to preserve the integrity of their culture, including language. The extent to which traditional Aboriginal cultures and languages have been preserved varies considerably across Canada. The Innu of Labrador, in contrast to the majority of Aboriginal people in Canada, speak their traditional mother tongue - with almost complete fluency in the Innu-aimun language in the communities of Sheshatshiu and Natuashish (Statistics Canada 2001) (Table 10-3).
52 http://www.statcan.ca/english/research/82-621-XIE/82-621-XIE2005001.htm
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Table 10-3 Native Language Preservation in Innu of Labrador Communities and Canada*
All Aboriginals in Sheshatshiu Natuashish Canada Aboriginal language as mother tongue 88% 95.4% 20.1% Knowledge of Aboriginal language 90.7% 95.4% 24.1% Source: Statistics Canada 2001 Census. *Caution should be taken in scaling these results due to relatively low participation rates. The Innu have two dialects of their traditional language, Innu-Aimun, and these are commonly used in conversation and at home and work (Jong 2007: 16). Indeed, almost all of the Innu of Labrador speak Innu-aimun as their first language, and the percentages of the population speaking it, using it as their mother tongue, and having some knowledge of it, far exceed that found in other Aboriginal peoples (Burnaby 2004: 35). In order to promote education among their children and young adults, who have experienced little educational success, the Innu are attempting to develop Innu-Aimun instruction materials and to train teachers who speak their language (Jong 2007: 16). Those children who leave the community for instruction in better schools in Happy Valley-Goose Bay are generally successful, but there is some fear that they may not retain their knowledge of their traditional language as well (Philpott 2004, referenced by Jong 2007: 24). At the same time, many Innu understand that traditional lifestyles are no longer viable, and that some level of accommodation with the outside world will be necessary, suggesting that some level of linguistic duality will be necessary (Burnaby 2004: 46-47). Overall, Burnaby (2004: 38-39) suggests that: “…the Innu of Sheshatshiu and Natuashish have strong resources in community functions of their language, mainly at the least formal levels, but have not as a group accommodated strongly to the English speaking environment or majority culture which is increasing around them, nor has the majority non-Innu community acknowledged the Innu-aimun language reality…the result is economic, educational and linguistic marginalization of the Innu.”
10.6 Traditional Health Practices
There seems widespread consensus among the Innu that the programs that work best for them are the family healing programs, in which families go to the country and seek to come to terms with alcohol, gas sniffing and other problems of social dysfunction. However, many of the problems resurface on the return to the communities, and at present, there is little to provide the essential in-community follow-up. Proposals to link cultural awareness and health, like the outposts program, tend to fall through the funding gaps (Backhouse and McRae 2002).
10.7 Criminal Offences
As of 1998, the Province’s rates of violent crime (893 per 100,000) and property crime (2,666 per 100,000), were lower than the Canadian rates (975 and 4,541 per 100,000, respectively). Its homicide rate of 1.29 per 100,000 was well below the Canadian rate of 1.83 per 100,000. Its adult incarceration rate was 70 per 100,000 (Statistics Canada 1999). As of 2002, the Province had the lowest overall crime rate in Canada, and the fourth lowest rate of violent crime. It continued to have low rates of homicide, attempted murder, abduction and robbery, but the rate of assault was higher than the national average (Government of Newfoundland and Labrador 2002).
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That being said, during 2000/2001, the rate of incarcerations in Labrador was 10.5 per 100,000 and was the highest in the Province (provincial rate=3.0 per 100,000). By 2007, Newfoundland and Labrador still had a comparatively low crime rate; however, its homicide, assault, and sexual assault rates all exceeded the Canadian rates (Table 10-4). The number of criminal code offences in the Upper Lake Melville area, for example, peaked at 4,582 in 2004, occurring more frequently than any other type of crime in the region (Table 10-5). The Rural Secretariat’s 2004 report on community safety and security issues in Labrador communities identifies caseload to police officer ratios in Happy Valley- Goose Bay of 200:1, compared to the Canadian average of 40:1. Table 10-4 Statistics Canada 2007 Reported Crimes by Offence, Newfoundland and Labrador Canada Province53 Rate per 100,000 population All incidents 8,512.6 6,603.8 Criminal Code offences 7,761.1 6,088.8 Crimes of violence 942.9 868.7 o Homicide 2.0 1.7 o Attempted murder 2.4 0.6 o Assaults 727.4 728.5 o Sexual assault 72.2 84.5 o Other sexual offences 8.5 4.1 o Robbery 88.8 28.9 o Other crimes of violence 41.5 20.3 Source: Statistics Canada 2007.
Table 10-5 Criminal Offences in the Upper Lake Melville Region, Between 2001 and September, 2005
2001 2002 2003 2004 2005 Criminal Code Offences 3,620 3,585 4,393 4,582 3,826 Federal Offences 156 153 225 162 89 Provincial Offences 1,465 1,167 1,219 1,174 957 Municipal Offences 37 34 43 39 7 Collisions and Traffic Offences 182 178 185 231 133 Source: J. Taylor, pers. comm. Aboriginal people represent only a small part of the Canadian population; however, they are over- represented in corrections populations across Canada. Overall, in 1998/1999, 17 percent of provincial and territorial admissions and 17 percent of federal admissions to legal custody were Aboriginal people. (Statistics Canada 2001). Further, between January 2004 and March 2007, for example, Aboriginal Labradorean women composed 100 percent of Labradorean admissions to the Newfoundland and Labrador Correctional Center for Women. The view among society may also be one that associates the Innu with criminal activity despite low overall levels of criminal behaviour (Claxton-Oldfield and Keeke 1999). A study of media presentations found that approximately 15 percent of the news stories concerning the Innu placed them in the context of crime and deviance, fuelling stereotypes about the Innu held by the public (Claxton-Oldfield and Keefe 1999). In 1999, 35 percent of Aboriginal people surveyed as part of the General Social Survey reported being victims of crime in the previous 12 months, compared to 25 percent of non-Aboriginal respondents
53 From www40.statcan.ca/l01/cst01/Legal04a.htm.
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(Statistics Canada 2001: 6-7). This was especially the case for violent crime. At the same time, Aboriginals were more likely to come into contact with the police for a serious criminal matter, either as a victim (17 versus 13 percent), as a witness (11 versus 6 percent), or by being arrested (4 versus 1 percent) (Statistics Canada 2001: 8). Aboriginal inmates were more likely to be incarcerated for violent offences, were younger, had less education, and were more likely to be unemployed. Contact with the legal system by the Innu, and the ‘criminalization’ of Innu behaviour, began with their settlement in permanent villages (Samson et al. 1999: 26). Prior to that, disputes were settled within the community using traditional mechanisms. Initially, Innu involvement with the criminal justice system centred on hunting rights. Following the arrest of several Innu hunters and the confiscation of their meat and guns for violating game laws in 1977, the Province began to routinely apply those laws. According to Hanrahan (2003: 268), by the end of the decade, almost every adult male in Sheshatshiu had been convicted of violating provincial wildlife regulations. This continued into the 1980s.
10.8 Drug-Related Offences and Support Services
Break and enter statistics are a good barometer of the success of drug outreach and education programs in the community, as such crimes are often committed to support drug purchases and habits (Table 10-6) (Cpl. K. Mackinnon, pers. comm.). The Aboriginal Shield Program is a pilot program in Sheshatshiu designed to help build self-esteem amongst youth and to raise awareness as to the dangers of drug use including marijuana, Ecstasy, cocaine and alcohol (Cpl. K. Mackinnon, pers. comm.). This is a program targeted 100 percent toward Aboriginal youth and is part of a 10-week pilot program in eight Aboriginal communities across Canada. The program uses local Aboriginal people to facilitate the operation of Aboriginal Shield classes in the community so as to ensure the program is appropriate to the local language and culture. The program is delivered through the school system to Grades 4 through 9. In terms of reoffending, the region is no different than any other region (Cpl. K. MacKinnon, pers. comm.). Increased support services and programs are essential. However, the services provided are generally underused. As a result, more outreach is needed. Table 10-6 Total Complaints: Break and Enter and Drug Offences, September 2005 to May 2007 Total Break and Enter Complaints Total Drug Offence Complaints (businesses, residents, cottages) (possession, possession for trafficking) Happy Valley-Goose Bay 175 79 Sheshatshiu 89 14 Source: Cpl. K. MacKinnon, pers. comm.
10.9 Violence against Women
According to the Provincial Advisory Council on the Status of Women (2007), women in Newfoundland and Labrador face many challenges, including poverty, barriers to education, employment discrimination and violence. Violence against women is particularly a problem within Aboriginal communities. For example in 2004, spousal abuse percentages for women living in Newfoundland and Labrador were amongst the lowest in the country. However, it has been estimated that between 75 and 90 percent of women in some northern Aboriginal communities are abused (Dumont-Smith and Sioui Labelle 1991), and Aboriginal people are three times more likely to be victims of spousal violence than those who are non-Aboriginal (21 versus 7 percent) (Statistics Canada June 2001). Specifically, 37 percent of non-Aboriginal women reported experiencing severe and potentially life threatening violence;
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this figure increased to 54 percent for Aboriginal women. Unlike non-Aboriginal women and men, where the difference in the rate of spousal violence was found to be statistically significant, there was no statistical difference between the rate of spousal violence experienced by Aboriginal women (24 percent) and Aboriginal men (18 percent).
An issue paper prepared by the Native Women’s Association of Canada (2007) suggests that violence against Aboriginal woman and girls is grounded in colonialism and the lack of recognition of the collective human rights of Indigenous Peoples (Native Women’s Association of Canada 2007). Traditionally, Aboriginal women’s roles were central to the community and included the responsibility of transmitting values and beliefs to their families (Native Women’s Association of Canada 2007). Recent reports, however, purport that up to 75 percent of sexual assault survivors in Aboriginal communities are young women under 18 years old (METRAC 2001) and Aboriginal woman aged 25 to 44 are five times more likely than other Canadian women of the same age to die of violence (Amnesty International 2004). During 2004/2005, there were 1,084 admissions of women and dependent children to shelters in Newfoundland and Labrador. Of those admitted for abuse, 100 percent were fleeing psychological abuse, 67 percent physical abuse, 60 percent threats, 33 percent harassment, 20 percent financial abuse, and 13 percent sexual abuse (Statistics Canada 2005). The Government of Newfoundland and Labrador’s commitment to addressing the problem of violence in the Province is reflected by the Violence Against Women’s Initiative, a six year (2006 to 2012), multi- departmental, government - community partnership to find long term solutions to the problem of violence against those most at risk in our society - women, children, seniors, Aboriginal women and children, persons with disabilities and other vulnerable people who are victims of violence because of their race, ethnicity, sexual orientation or economic status (Government of Newfoundland and Labrador 2008). In addition, there are three shelters providing protective services to women and children in the Study Area. However, in Sheshatshiu, the 24-hour Nukum Munik Shelter has experienced a markedly high level of use. In its first year of operation, the shelter housed 130 women and children; all but three were first-time users. The shelter was occupied for 115 days in the first two quarters of 2001/2002.
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11.0 INCOME, EMPLOYMENT AND SOCIAL STATUS
Income and social status is ranked as one the most important determinants of health (Health Canada 1999). This is demonstrated by a large body of evidence, suggesting that there is a sharp gradient in health status associated with socio-economic position (Laws and Sagar 1994; Birley 2002). In addition, research suggests that high levels of unemployment and economic instability cause considerable mental health problems and adverse effects on the physical health of unemployed individuals, their families and their communities (Dooley et al. 1996).
11.1 Employment
Canadian Aboriginal people tend to have lower employment levels than non-Aboriginal people. Reported in the 2006 Census, the employment rate54 for Canada’s total Aboriginal population was 53.7 percent, in comparison to the total Canadian rate of 62.4 percent. The employment rates for Sheshatshiu (including North West River) and Natuashish were 53.0 and 47.7 percent, respectively, compared to the provincial rate of 47.9 percent (Table 11-1). In addition, Sheshatshiu and Natuashish have significantly higher unemployment rates than other communities within the Study Area. For example, Happy Valley-Goose Bay unemployment rate stood at 12.7 percent, while Labrador City and Wabush unemployment rates stood at 8.9 percent and 8.1 percent, respectively. Table 11-1 Employment Characteristics, Innu Communities, Province and Canada
Province Sheshatshiu Natuashish Happy Valley- Labrador Total and North Wabush (Utshimassits) Goose Bay City Population West River A Participation Rate 58.9 66.3 65.1 63.0 72.9 71.6 (%) Employment Rate 47.9 53.0 47.7 53.7 66.4 65.4 (%) Unemployment 18.6 20.0 26.8 14.8 8.9 8.1 Rate (%) Source: Statistics Canada 2006 Census. A Data include North West River. Though gender is not explicitly included within Health Canada’s framework, the health status of males and females is affected differently by income and social status (Kosteniuk and Dickinson 2003). For example, females are attributed with lower income and social status while maintaining longer lifespans and enduring the struggle of juggling work and family obligations (Health Canada 1999). With regard to the Voisey’s Bay development, Fouillard (1997) notes that the project has placed a burden on women. Few women have been employed (as of 1997) due to a lack of education appropriate for office jobs and the fact that male-dominated jobs, such as drilling, labour and construction, are not open to women. As well, the absence of men to the job sites has left women alone in the community to deal with children, often with no money.
In the general population, such gender differences have been shown to negatively affect women’s health with, for example, higher levels of depression, psychiatric disorders, distress and a variety of chronic illnesses reported by women than men (Laws and Sagar 1994; Denton et al. 2004). The
54 Defined as the number of persons employed in the week prior to Census Day, expressed as a percentage of the total population 15 years of age and over.
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11.2 Income and Self-reliance
The individual incomes of Aboriginal peoples tend to be much lower than those of non-Aboriginal Canadians. In 1995, for example, the average personal income of the non-Aboriginal population was $25,400, while that of the Aboriginal population was $14,900. On average, approximately 29 percent of all income received by Aboriginals came from government transfer payments (Statistics Canada 2001: 6). The median family income for couple households for Sheshatshiu (including North West River) in 2004 was $61,500, in comparison to $57,400 in Natuashish (Table 11-2). While this is above the Province at $51,800, it is considerably below the regional median family incomes of $85,300 for Labrador West/Churchill Falls and $72,900 for the Upper Lake Melville area. Median family incomes for lone- parent families in 2004 were considerably lower than couple families by more than 50 percent across all areas. The self-reliance ratios for 2004 were above the provincial ratio in all areas, with a self-reliance ratio in Labrador West of 0.928 - meaning that of all the income flowing into the area, 92.8 cents on every dollar was from market sources and 7.2 cents was transfers from government. However, it is only post-2003 that the self-reliance ratio for Sheshatshiu exceeded that of the Province (Figure 11-1). Table 11-2 Median Income and Self-reliance Ratios 2004, Study Area and Province
Labrador West/ Upper Lake Melville/ Sheshatshiu and Province Natuashish Churchill Falls Labrador Central North West River A Median income (couple $51,800 $85,300 $72,900 $61,500 $57,400 families) Median income (lone- $22,700 $25,900 $24,900 $24,900 $21,500 parent families) Self-reliance ratio B 78.1% 92.8% 88.2% 81.0% 78.9% Source: Community Accounts. A Data include North West River. B Self-reliance ratio – measure of the community's dependency on government transfers such as: Canada Pension, Old Age Security, Employment Insurance, social assistance, etc.
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Figure 11-1 Self-reliance Ratio (percent) 1999 to 2004, Study Area and Province
Source: Community Accounts. Zone 2 – Labrador West/Churchill Falls Zone 3 – Labrador Central/Upper Lake Melveille
11.3 Families Receiving Income Support
In 2006, 970 families with children in the Labrador Central/Upper Lake Melville area received Income Support. Over the past 5 years, both the percentage of families on Income Support with children, and the total number of children on Income Support, has decreased. The change can be attributed, in part, to the overall drop in the number of children in the area and across the Province as a whole. The number of individuals receiving income support assistance in Labrador peaked during the mid-1990s and declined thereafter to 3,105 in 2006 (Figure 11-2). Figure 11-2 Individuals on Income Support 2001 to 2006
Source: Community Accounts, Newfoundland and Labrador Statistics Agency.
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A similar pattern of decline in individual social support occurred in Upper Lake Melville, where 1,300 people were receiving assistance by 2001, compared to only 970 in 2006.
Innu Community
At the community level, between 2001 and 2006, the number of persons receiving income support assistance in Natuashish/Utshimassits increased from 80 to 105. Income support incidence in Sheshatshiu (including North West River) was 28.7 percent in 2001, in comparison to only 14.5 percent in 2006. This is considerably higher than other Study Area communities in 2006 (Table 11.3). Table 11-3 Income Support Assistance for Study Area Communities, 2001 and 2006 Sheshatshiu (includes Happy Valley- Churchill Natuashish Labrador City Wabush North West Goose Bay Falls River) 2001 2006 2001 2006 2001 2006 2001 2006 2001 2006 2001 2006 Individuals* 490 250 80 105 810 720 520 415 70 15 -- -- Income support 28.7% 14.5% 12.6% 15.4% 10.0% 9.5% 6.9% 5.9% 3.8% 0.9% -- -- assistance incidence * Includes individuals who received payments through the Department of Human Resources, Labour and Employment. Excludes Child Welfare -- Data not available Source: Statistics Canada 2006 Census, Community Accounts
11.4 Housing Support
Access to affordable housing is a basic necessity for human health. The 2006 Census reports that the degree of home ownership is high in Newfoundland and Labrador and for the majority of Study Area communities (Table 11-3). There is considerable variability in dwelling condition across the Study Area, with Sheshatshiu and Wabush having a relatively higher proportion of dwellings that are in need of major repair in comparison to the provincial statistic, and Labrador City, Happy Valley-Goose Bay and Churchill Falls considerably below the provincial statistic.
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Table 11-4 Home Ownership and Condition in Study Area and Province Happy Valley- Labrador Churchill Sheshatshiu* Wabush Natuashish Province Goose Bay City Falls** Total private 746 3,226 746 2,963 436 170 235,958 dwellings Total private dwellings occupied by 319 2,725 690 2,780 240 165 197,185 usual residents*** Owned private 580 1,620 580 2,190 0 0 155,195 dwelling Rented**** 105 1,105 105 595 235 10 41,670 Requiring major 10.9% 6.6% 10.9% 5.9% 0.0% 9.1% 7.9% repair***** *Includes Northwest River and Mud Lake, Division no. 10, subdivision C **Division 10, subdivision D *** Private dwellings in which a person or group of persons are permanently residing. **** Private dwelling provided without cash rent or at a reduced rent, and dwellings that are part of a cooperative ***** As a percentage of total occupied private dwellings Source: Statistics Canada. 2007. 2006 Community Profiles. 2006 Census. Statistics Canada, Ottawa. Released 13 march 2007
The overall lack of available housing, and in particular subsidized or low-income housing, is a major issue in Labrador (A. Rumbolt, pers comm.). Newfoundland and Labrador Housing Corporation (NLHC) offers non-profit housing throughout the Province. The NHLC currently has approximately 300 units in all of Labrador, including 92 units in Happy Valley-Goose Bay and 92 units in Labrador City. There are 63 units in northern coastal communities and 35 in southern coastal communities (Dreaddy 2002). However, there are currently no available units and there is a waiting list of approximately 40 to 45 names. The problem is similar for Melville Native Housing, which has 75 units and a current waiting list of approximately 20 to 25 clients. Melville’s 10-unit senior apartment facilities also have a waiting list. Happy Valley-Goose Bay is similar and has no available houses for NLHC to add to its inventory (N. Flynn, pers. comm.).
In addition, the NLHC has developed a Victims of Family Violence Policy that gives priority to women and children who must be relocated due to a history of recurring abuse or are in danger (Dreaddy 2002). However, according to Dreaddy (2002), referrals under the policy are considered low, with two in Labrador West, three in Happy Valley-Goose Bay, five in northern Labrador and zero on the south coast.
The availability of housing suitable for health care workers and police staff is also limited in Labrador (Health Directors Focus Group, pers comm.). As a means to partially address this shortage, the 2007 Northern Strategic Plan for Labrador announced a $600,000 commitment for new housing units for police officers in Churchill Falls.
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12.0 PHYSICAL ENVIRONMENTS
The physical environment is an important determinant of health, as human health is critically dependent on the elements of the natural world (Lewis 1998; Health Canada 1999). Newfoundland and Labrador is set within a unique physical environment and is an important part of the region’s heritage55. Physical environmental factors such as water quality, air quality and access to traditional country foods, in addition to human-built environments such as housing, are important indicators of health within the Labrador region.
12.1 Water Quality and Infrastructure
Overall, the quality of drinking water in Newfoundland and Labrador is safe, though on the low end for Canadian provinces, and illnesses due to water impurities are rare56. As of the summer of 2006, Happy Valley-Goose Bay exceeded aesthetic values for water colour, total dissolved solids, iron and manganese, and exceeded contaminant values for turbidity; although at that time Labrador City did not exceed any guidelines57. Currently, five communities within the Study Area have piped water systems: Happy Valley-Goose Bay; North West River; Sheshatshiu, Labrador City and Wabush (Table 12-1). However, in Happy Valley- Goose Bay, not all residences are connected to water and sewer infrastructure. Residents of Mud Lake receive their water from ground water wells that are fed by the Churchill River. Happy Valley-Goose Bay receives 50 percent of its water from the water treatment plant and 50 percent from Spring Gulch (Minaskuat 2007: 19). System operators are required to maintain data on the quality of the drinking water, including any violations of regulatory requirements and reliability of the system. Table 12-1 Municipal Characteristics
Happy Valley - North West Labrador Wabush Goose Bay River City No. of Residences 3,150 239 3,054 761 Water Connection (% of 96.3 100 100 100 households) Sewer Connection 96.3 100 100 100 (% of households) The first homes built by the federal government for the Innu of Labrador following confederation in 1949 lacked water and sewage services, although they were equipped with tubs, toilets and sinks (Burns 2006: 67). As of 1997, there were 70 overcrowded and unpainted homes at Utshimassits, none of which had such services. For the Mushuau Innu, the move to Natuashish in 2003 addressed several of the most pressing environmental problems associated with life at Utshimassits, and a deteriorating
55 http://www.heritage.nf.ca/environment/climate.html. 56 In 2006, the Sierra Legal Defence Fund gave Newfoundland grade of C- for water quality, due to issues with treatment standards, water quality testing, public reporting and the absence of operator certification (Christenson 2006: 48). Canada received a failing grade, in part due to issues with water quality in First Nations communities. 57 www.env.gov.nl.ca/env/env/waterres/Surfacewater/Drinking/2006Summer/WEB%20- %20Source%20Water%20-%20Season%20-%20Physical%20and%20Major%20Ions.pdf; www.env.gov.nl.ca/env/env/waterres/Surfacewater/Drinking/2006Summer/WEB%20-%20Source%20Water%20- %20Season%20-%20Nutrients%20and%20Metals.pdf.
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supply of drinking water was one of the key criteria cited for agreeing to move to the new settlement (Innu Nation and Mushuau Innu Band Council 1995). From 1997 to 2002, contractors constructed a distributed water supply system in Natuashish, including an intake from Sango Brook and chlorination treatment plant (Butt 2006). The long-term storage capacity was set at 340,000 L (20-year) and 810,000 L (50-year), and domestic demand was recommended at 225 L/capita/day for consumption. Joined to this was the construction of a sewage treatment system, tied into each home. These systems were designed to accommodate predicted domestic demand and fire protection needs for several decades into the future (Butt 2006). Unlike the Mushuau Innu, the Sheshatshiu Innu have not had the benefit of completely new water infrastructure. Most homes in Sheshatshiu have septic systems, while homes in North West River and Happy Valley-Goose Bay have piped sewage systems. Sewage from Happy Valley-Goose Bay is discharged into the Churchill River; however, the community has requested funding for a sewage treatment plant (Minaskuat 2007: 19). In addition, the most recent census data (2006) indicates considerable variability in dwelling condition across the Study Area, with Sheshatshiu and Wabush having a relatively higher proportion of dwellings that are in need of major repair in comparison to the provincial statistic.
12.2 Traditional Foods and Land Use
Health indicators such as ‘sustaining Aboriginal cultural identity’ and the ‘link to the environment’ are recognized in the literature as important factors for sustaining human health, particularly in northern environments (O’Neil and Solway 1990). This includes the need to maintain the integrity of such activities as hunting on the ‘land’ and obtaining traditional native foods, as well as psychological, social, cultural and spiritual values. This is particularly important in Labrador, where the Innu of Sheshatshiu and Natuashish have traditionally relied heavily on hunting and fishing for their foods. Overall, there has been a marked decline in wild food consumption among the Innu, although this has varied between communities and individuals. As of 1987, total annual per capita consumption of wild food was estimated at between 34 and 41 kg at Sheshatshiu and 101 kg at Utshimassits58. It was reported that approximately 33 percent of adult males in Sheshatshiu hunted food in the country, while only 11 percent of those at Utshimassits did so. At Sheshatshiu, the contribution to the wild game diet came mainly from caribou (40 percent) and fish (20.1 percent), with the remainder split between other animal species (Table 12-1). At Utshimassits, 75 percent of edible food production was derived from caribou, with much smaller amounts coming from other species.
58www.inco.com/about/development/voisey/assessments/additional/chapter.asp?Chapter=chap6/ch6app6a.html.
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Table 12-2 Contribution of Traditional Foods to Total Estimated Edible Food Production
% of Total Edible Food % of Total Country-based % of Total Community- Species Category Production Production based Production Sheshatshiu Caribou 40.0 36.4 48.3 Bear and Moose 9.3 12.3 2.6 Furbearers 8.4 11.2 2.0 Migratory Waterfowl 10.1 13.2 3.0 Fish 20.1 15.5 30.6 Small Game 12.0 11.4 13.5 Seal 0.1 0.1 Nil Utshimassits Caribou 74.8 75.7 74.6 Bear and Moose 1.2 3.1 0.9 Furbearers 0.2 1.3 0.04 Migratory Waterfowl 4.8 2.9 5.1 Fish 8.2 3.9 9.0 Small Game 3.4 10.4 2.2 Seal 7.3 2.7 8.2 Source: Armitage 1990. Hunting and fishing are still important to the Innu of Labrador, but traditional foods such as caribou, salmon, rabbit and beaver are supplemented with store-bought foods. Samson and Pretty (2006: 537, 538) note that traditional forms of food procurement, including hunting, fishing, trapping and gathering, have subsequently fallen dramatically among the Innu of Labrador, particularly across generations. The reasons for this decline are varied, and include the effect of government relocation and sedentarization policies, the cost of transport to favoured locations, and the availability of cheaper, though less nutritious, processed foods (Samson and Pretty 2006: 538-539). The traditional diet provides important social, cultural, spiritual, nutritional and economic benefits to the individual and to the society, and serves as a protective mechanism against obesity, diabetes and cardiovascular disease (Van Oostdam et al. 2005). That said, there are two main sources of concern in the Study Area regarding Innu traditional food: loss of habitat, and county food contamination. Developments such as the Churchill Falls hydroelectric project and the Trans Labrador Highway connecting Labrador City and Happy Valley-Goose Bay, for example, have threatened large areas of traditional lands, or removed them from use by the Innu. For instance, the Churchill Falls hydroelectric project involved flooding 4,130 km² of key Innu hunting territory and the loss of important hunting and trapping grounds (Samson et al. 1999: 30). A related area of concern lies in the possibility of health effects due to contaminated country foods, both from local (e.g., local development or industry) and external sources. Recent research among Arctic peoples has identified levels of toxic substances in traditional foods that, while not yet exceeding thresholds for action, are potential health threats should they increase. For instance, Van Oostdam et al. (2005) identified levels of organochlorines, chlordane and toxaphene among the Inuit that exceeded provisional tolerable daily intakes, while mercury and lead were also a concern. Projects such as the Churchill Falls hydroelectric dam and the Voisey’s Bay nickel mine, for example, have raised concern among the Innu about the effects of environmental pollution and the declining quality of traditional country foods (Samson and Pretty 2006: 539). Another concern facing the Innu are low levels of Persistent Organic Pollutants (POPs) within their traditional country foods. The Voisey’s Bay EIS reported on a 1977 survey of Sheshatshiu residents, for example, which indicated elevated levels of mercury in 37 percent of those surveyed.
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The incursion of non-Aboriginal, large-scale industrial development and other activities into the traditional Innu hunting territories, such as the extension of the Trans Labrador Highway and low level flight training, is thought by the Innu to have affected the habitats of game animals, diminishing the available supply. Other projects, including the Churchill Falls hydroelectric dam and the Voisey’s Bay nickel mining operation, have raised fears among the Innu about the effects of environmental pollution and the declining quality of traditional country foods (Samson and Pretty 2006: 539). Contrary to these fears, a modelling exercise carried out in 1997 as part of the Voisey’s Bay project predicted that the caribou would not bioaccumulate the modelled metals (nickel, copper, cobalt, zinc, lead and cadmium) to an extent that they would produce an adverse effect59. Between 1999 and 2002, a study examining key game species deemed at risk (caribou, Canada Goose and porcupine) for evidence of environmental contaminants was carried out with the cooperation of elders from Sheshatshiu and Utshimassits60. The study found elevated levels of cadmium in the kidneys of caribou, and low levels of POPs, including polychlorinated biphenyls, in caribou and porcupine. Levels of some POPs were found to be elevated in the fat of Canada geese; however, in each case it was believed that these contaminants did not occur in high enough concentrations to harm the animals. Nevertheless, the fear of these contaminants may cause the Innu to refrain from hunting these species.
59 www.vbnc.ca/eis/chap16/chap16.htm. 60 www.hc-sc.gc.ca/sr-sr/finance/tsri-irst/proj/cumul-eff/tsri-210_e.html.
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13.0 HEALTH BASELINE SUMMARY
This report set out to develop an understanding of the current community health issues and trends within the Project EIS Study Area, including the two Innu communities of Sheshatshiu and Natuashish. The overall objective was to generate a baseline from which social and community health effects may be understood and appropriate mitigation and issues-based health indicator monitoring programs developed, as required. Health, within the context of this study, is interpreted much more broadly than physical health and the absence of disease; it focuses on social and psychological well-being and the capacity to respond to changing circumstances and conditions of life in the Labrador region. As such, the various indicators addressed in this report under the determinants of health framework cannot be treated in isolation. Social and psychological well-being, for example, affects a community’s capacity to respond and make healthy choices under stressful circumstances in light of changing conditions. In turn, stressful circumstances and changing conditions have significant implications for individual and community health and well-being. The Aboriginal populations of Canada experience considerably poorer health than the general population of the country, and also suffer corresponding higher rates of hospitalization and mortality. This is true also for the Innu of Labrador. That being said, while the health status of Aboriginal people lags well behind that of Canadians in general, the contribution of different health concerns, population characteristics, and regional social and economic conditions to differential health status varies considerably.
13.1 Primary Health Determinant Issues and Indicators
The Study Area has a relatively young structure, with approximately 20 percent of its population under the age of 15, in comparison to 15.5 percent for the Province as a whole. From 1996 to 2006, the region did experience an overall population decline, primarily due to out-migration. The age distribution in the Innu communities of Sheshatshiu and Natuashish is statistically significantly skewed toward the younger population cohort, providing for an expansive population base in near future; approximately 37 percent of the population in Sheshatshiu is under the age of 16. The dependency ratios of both communities are relatively high (69.5 in Sheshatshiu, 70.9 in Natuashish), suggesting increasing stress on the capacity of school and early childhood and child care facilities. Self-assessed health in the Study Area is relatively high, with an average 66 percent of residents rating their health as ‘very good’ to ‘excellent’; and more than twice as many males as females in the region rating their health as ‘excellent’. However, these ratings are not necessarily representative of the Innu communities, due in part to the small community population relative to the larger centres in the region. The following sections provide a summary of the primary health issues and concerns that are likely to be most sensitive to development and associated socio-economic change, either positively or negatively, in the Study Area. The health issues identified are indicators or sub-sets of overall health determinants, and reflect the values, claims and concerns of Innu and non-Innu peoples and emphasize a range of issues important to consider in assessing Project outcomes. The intent is to identify current health issues and opportunities such that Project assessment can focus first on enhancing health outcomes and second on mitigating potentially adverse health effects. In this way, attention is directed toward achieving the most desired, versus the most likely, health outcomes.
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13.1.1 Health Services
Health care services contribute to health status, particularly when they are designed to maintain and promote health and prevent disease through such services and programs as pre-natal care, immunization and those that serve to educate children and adults about health risks and choices. Health care services provided in the Study Area include both primary and secondary health services such as acute care, diagnostic services, continuing and long term care, health promotion, mental health and addictions, family and rehabilitation services, child protection and intervention services, youth services, adoptions, child care services, residential services and community health nursing. Immunization rates have improved considerably in recent years, and the availability of pre- and post- natal care services and programs currently exceeds their uptake. However, access to such programs is not universal in Labrador, particularly amongst the coastal and more remote communities, and certain health services and programs are either limited or lacking throughout the region. 1) Only 61.4 percent of the population in the Upper Lake Melville area, aged 12 years and older, report having a regular medical doctor, in comparison to 92.1 percent in Labrador West/Churchill Falls. 2) There is an increasing demand for mental health services and treatment facilities in the Study Area. Mental health addictions are reported to have become more acute in the past five years. Wait times of up to 9 to 10 weeks exist for the limited mental health services that do exist. The Labrador region in general, and coastal communities in particular, lacks the necessary resources and capacity to deal with increasing mental health problems and addictions. One psychologist currently serves the region, with no dedicated facility for psychiatric treatment. Dealing with mental illness and addictions has been identified as one of the most important challenges facing not only health services, but also Labrador Human Resources and Employment, and Newfoundland and Labrador Housing. 3) Resources dedicated to heath care in the Innu communities has increased considerably in recent years; however, Innu Nation President Peter Penashue in 2004 observed that the arrival of an elaborate health care system has coincided with a rapid worsening of Innu health. This is not a cause-effect relationship; this does not imply also an increase in local health - in particular Innu health. While there is a dedicated effort to recruit more healthcare workers and professionals to the Labrador region, and in particular to the Innu communities, what is lacking is individuals with experience in working with Innu and in understanding Innu practices, culture and traditional health systems. 4) Social health problems, including solvent abuse and alcoholism are addressed temporarily, and tend to resurface. What may be lacking in the Innu health care system is in-community follow-up and monitoring.
13.1.2 Lifestyle, Health Practices and Coping Skills
Social environments that promote healthy choices and lifestyles are linked to improved health. Diet and physical activity have been shown to provide substantial health benefits, while tobacco and excessive consumption of alcohol are linked to many of the most common health and social problems. While lifestyle choices, health practices and coping skills in the Study Area are similar in many respects to those of the Province, a number of important health challenges and behaviours are present amongst the population, and within the Innu communities, that are sensitive to socio-economic development and change.
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1) Alcohol and solvent abuse is one of the most important social health problems in the Study Area. Such abuse is especially rooted in the social and family conditions found in the Innu communities. The consequences are often acute toxicity, neurological damage, or death of the individual. 2) Approximately 33 percent of individuals in the Upper Lake Melville area and 38 percent in Labrador West/Churchill Falls reported binge drinking on one or more occasion per month in 2005. Drug and alcohol awareness and education programs are in place in the local school systems; however, there is no reliable measure of effectiveness. 3) The smoking rate in Labrador is higher than the provincial average, with a reported 27 percent smoking rate in the Upper Lake Melville area. This is most pronounced among the female population. 4) Diet and nutrition are poor in the Province in general and even more so in Labrador. However, only 3.1 percent of people in Labrador West/Lower Churchill report not being able to eat their desired quality or variety of foods, in comparison to 14.7 percent provincially. The proportion in Upper Lake Melville was 14.4 percent. Affordability and availability are amongst the major challenges to a healthy diet for those who recognize its importance. There are several school-based initiatives in the Study Area to promote healthier eating practices; low parental awareness of the benefits of nutrition initiatives is amongst the program’s most important challenges. 5) More than 66 percent of the population in each of Upper Lake Melville and Labrador West are either overweight or obese, based on BMI category. Nutrition programs have been developed in select elementary schools to target obesity and to inform healthy eating habits. In 2005, approximately 58 percent of people in Labrador aged 12 years and older made changes to their diet in the previous year in order to improve their health, up from 52 percent from the two years previous. 6) An increased risk of Type II diabetes is present in Labrador. Typically, diabetes (along with cancer, obesity, hypertension and heart disease) is rare in hunter-gatherer societies, but becomes more common following the loss of traditional ways. 7) Gambling activity, particularly video lottery terminal addictions, is reported to have become much more prevalent in Labrador in recent years. While the Labrador health region has amongst the lowest gambling rates in the Province, it has the highest proportion of problem gamblers. Problem gambling is associated with social relationship problems, increased levels of alcohol and drug addictions, depression and suicide. Among problem gamblers, the most common reason for gambling was that it decreases boredom. Approximately 30 percent of individuals in the Labrador region report awareness of gambling counselling services in their community. This is a higher awareness than in other health regions throughout the Province. Gambling rates amoung the Innu are not known. 8) In 2001, the age-adjusted suicide rate for the Labrador region was nearly four times that of the Province, at 27 per 100,000 people. Many of the risk factors for suicide have become more common in the Innu communities in recent decades, in particular mental health issues, alcohol related factors and feelings of isolation. As of 2001, 42 percent in Sheshatshiu had thought actively about killing themselves and 28 percent had attempted suicide. Education is a major factor, in that the incident rate of suicide attempts amongst people at least 15 years of age with less than 12 years of education is measurably less than those with 12 or more years of education. On average, 37 percent of the population in the Study Area has less than a high-school diploma; the proportion is 65 and 60 percent in Sheshatshiu and Natuashish, respectively.
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13.1.3 Diseases, Biology and Genetic Endowment
Life expectancy in the Study Area is ranked in the bottom 25th percentile for life expectancy in the Province, ranging from a low of 72.2 in Sheshatshiu to a high of 76 at the regional level in Upper Lake Melville. Although socio-economic factors are important determinants of overall health, in some circumstances, genetic endowment may predispose certain individuals to particular diseases or health problems (Health Canada 1999). However, in many cases it is a combination of social practices and biological characteristics that lead to poor health status, increased health risks, and reduced longevity. 1) Provincially, between 2000 and 2004, diseases of the circulatory system were the most common single diagnosis, accounting for 26.9 percent of all hospital admissions/separations, followed by diseases of the digestive system at 20.6 percent. Within the Study Area, diseases of the respiratory system the most common separation at 21.4 percent in Labrador Central/Upper Lake Melville and 26.9 percent in Labrador West/Churchill Falls. Between 2000 and 2005, as a percentage of hospital separations, diseases of the digestive system remained high in Sheshatshiu, averaging 10 percent of hospital separations. Diseases of the respiratory system averaged 10.6 percent of separations and diseases of the circulatory system 5.9 percent. 2) During the period 2000 to 2004, the age-adjusted mortality rate trended downwards for the Province. This pattern was not evident in the Labrador region. In Sheshatshiu and Natuashish, a disproportionate number of people are dying at a younger age in comparison to the Province. Deaths of people less than 65 years of age comprised 55 and 80 percent of total deaths in Sheshatshiu and Natuashish, respectively. The proportion of deaths for individuals less than 65 years of age is similarly high at the regional level, at 69 percent in Labrador West and 45.4 in Upper Lake Melville. Deaths in Sheshatshiu and Natuashish for individuals under 20 years of age comprised 11.1 and 40 percent, respectively, in comparison to 2.7 percent at the provincial level, 7.7 percent for Labrador West and 6.8 percent for Upper Lake Melville as a whole.
13.1.4 Healthy Childhood Development
Approximately 20.5 percent of the Labrador population was under 15 years of age in 2006. Between 2000 and 2005, the Labrador-Grenfell Health Region had the highest birth rates of all health regions in the Province. The quality of care early in a child’s life has lasting effects on the child’s coping skills and overall health and well-being. Healthy child development is an important determinant of health, but at the same time, is influenced by other determinants of health, including income, housing, education and diet, and can affect the physical, social, mental and emotional development of children and youth. 1) Women in Labrador have children at considerably younger ages than that of the Province/Labrador as a whole. In 2006, 6.8 percent of births were to mothers aged 15 to 19 years, down from 20 percent in 2000, in comparison to 3.1 percent for the Province. Births to young mothers are most pronounced in the communities of Sheshatshiu and Natuashish. Trends are similarly downward; however, rates remained high in 2006, with 25.7 percent of births in Sheshatshiu to mothers aged 15 to 19. Younger mothers are more likely to comprise single-parent families and have lower median family incomes. Teenage pregnancies can also lead to such social problems as disruptions in educational achievement. However, regional health centres and family centres are available to guide teens through their pregnancies. 2) Excessive alcohol consumption has been linked to higher incidences of child neglect, family dysfunction, child abuse and learning disabilities. The total number of children in care in the
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Labrador-Grenfell Health Region is comparable to that of the southern and island regional health authorities, which have 10 times the total Labrador population. The current state of children in care has been described as a system in crisis and the capacity within communities to provide adequate care-qualified persons is lacking. Identifying the needs of a child who may be in crisis and finding them appropriate care is the responsibility of local social workers. As a result, there is a large dependency on protective intervention - perhaps the most intrusive form of state action. During 2000, 716 children in the Labrador region (10.9 percent of the provincial total) received protective services. 3) The Innu population in Sheshatshiu is growing. With growth in the community comes the need for more housing, education facilities and health service personnel. There is limited capacity in the regional health care system, particularly in the Innu communities, to care for children with disabilities. The capacity to address early therapeutic care is missing. There are a limited number of adequately trained health care professionals in the region to manage the growing numbers of children that require special care for mental illnesses, autism, or other severe disabilities. The challenges are exacerbated once children enter the education system, in that access to resources is further constrained by bureaucratic procedure. The lack of resources and dedicated staff is identified as a major limitation to children with disabilities receiving the proper treatment and education.
13.1.5 Education
Approximately 22 percent of the Labrador population was of primary and secondary school age in 2006, with 6.3 percent considered to be of normal post-secondary school age. Enrolments at primary and secondary schools in the region are at or close to capacity, with the exception of Lake Melville School, serving the community of North West River, which is currently operating near 50 percent capacity. Educational attainment is a key component of socio-economic status and positively associated with health and health practices. Health status improves with an increasing level of education, and education improves opportunities for employment, self-sufficiency, and provides the skills necessary to make and support healthy life-style choices. Low education levels have been associated with increased crime, certain addictions, and reduced ability to cope with stressful situations. In turn, a number of social factors influence the level of education and educational achievement, including nutrition, family income, parental support, and relative disadvantage in terms of social living conditions.
1) Educational achievement is considerably below the provincial norm, particularly in the communities of Sheshatshiu and Natuashish. Amongst the challenges are language difficulties for Innu-speaking children in English language schools with non-Innu-speaking teachers, low school attendance, and alcohol abuse. 2) Approximately 50 percent of Labrador high school students who graduate receive a general diploma, making them ineligible for admission to many post-secondary institutions. Labrador West/Churchill Falls has the highest proportion (50 percent) of high school graduates eligible to attend Memorial University. 3) Educational attainment in central and western Labrador is higher than the provincial average. However, the proportion of the adult population with less than a high school education in Sheshatshiu and Natuashish is 70.1 and 70.9 percent, respectively; more than double the provincial general population statistic.
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4) ABE is the most subscribed ‘post-secondary’ training program in the Study Area, and expected to continue to increase. However, between 1993 and 2004, Natuashish and Sheshatshiu produced in total only 20 ABE graduates. 5) Approximately 33 percent of the Innu population do not attend school and 17 percent attend less than 20 percent of the time. Attendance follows a seasonal pattern, consistent with hunting and traditional activities, but is also explained in part by a lack of needed child care and perceptions of the value of formal education. Since the introduction of the school breakfast program in Sheshatshiu in 2005/2006, attendance has measurably improved at the primary level. Innu children who attend school outside their community (e.g., Happy Valley-Goose Bay) have much better attendance performance, approximately 90 percent, but there is concern they will find it harder to retain their Innu language fluency. 6) Notwithstanding a decline in the number of teachers in the Study Area, particularly in the Innu communities, teacher-student ratios have remained relatively stable and are comparable to the provincial average. However, of important concern are high teacher and support-staff turnover and the difficulty in finding teacher replacements - particularly specialized teachers. Between 2003 and 2004, there was an estimated 60 percent turn-over rate. The main reasons given for leaving Labrador included: isolation; lack of amenities; and difficulties adapting to the culture. 7) There is the lack of teachers trained in the Innu language or trained to teach English as a second language. For Innu who are strongly attached to traditional ways, the school often clashes with their language and culture. Innu content has been introduced into the school setting; however, there are criticisms that it lacks meaning as the teachers are predominately non-Innu and unfamiliar with the Innu language and culture.
13.1.6 Social Support Networks and Environments
A high sense of belonging to the community is associated with improved mental health. Self-rated sense of belonging in the Study Area is 90.8 percent in Labrador West and 85 percent in Upper Lake Melville, considerably higher than the provincial average. However, in addition to sense of belonging, support from families, friends, communities and health and social services is associated with better personal and community health and, as such, is important in helping solve social and health problem problems and in coping during stressful circumstances.
1) There has been a marked increase in demand for senior’s care facilities and services in the past five years. The lack of senior care facilities and services in the Study Area, specifically in the non- Innu communities and urban areas, is an important concern. There is no consistent database that allows community health workers to identify the elderly and where they live. 2) The increase in the proportion of the population requiring senior care facilities is less pronounced in the Innu communities of Sheshatshiu and Natuashish, where only 4 and 3.5 percent of the population, respectively, is >65 years of age, in comparison to 6.3 percent for the Labrador region and 13.9 percent for the Province. 3) For those Innu who use the mainstream health care system, there is concern over the availability of traditional foods and that non-Innu health providers do not adequately understand Innu culture and health practices.
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4) The number of criminal code offences in the Upper Lake Melville District peaked at 4,582 in 2004, occurring more frequently than any other type of crime on the region. A study of media presentations found that approximately 15 percent of the news stories concerning the Innu placed them in the context of crime and deviance, fuelling stereotypes about the Innu held by the public. 5) Aboriginal people are three times more likely to be victims of spousal violence than those who are non-Aboriginal. In Sheshatshiu the 24-hour Nukum Munik Shelter has experienced a markedly high level of use. In its first year of operation, the shelter housed 130 women and children. 6) Access to affordable housing is a basic necessity for human health. There is currently an overall lack of available housing in the Study Area, and in particular subsidized or low-income housing. There is a waiting list of approximately 40 to 45 names for Newfoundland and Labrador Housing. The availability of housing suitable for health care workers and police staff is also limited in Labrador. There is considerable variability in dwelling condition across the Study Area, with Sheshatshiu and Wabush having a relatively higher proportion of dwellings that are in need of major repair in comparison to the provincial statistic.
13.1.7 Physical Environments
Health is dependent on the elements in the natural environment such as air, water, shelter and, in the case of the Innu of Labrador, traditional foods (Health Canada 1999). 1) Water supplies and sewage systems on reserve pose no immediate threat to health. Currently, three communities within the Study Area have piped water systems: Happy Valley-Goose Bay; Sheshatshiu; and North West River. From 1997 to 2002, contractors constructed a distributed water supply system in Natuashish, including an intake from Sango Brook and chlorination treatment plant. Most homes in Sheshatshiu have septic systems, while homes in North West River and Happy Valley-Goose Bay have piped sewage systems. Sewage from Happy Valley-Goose Bay is discharged into the Churchill River. Overcrowding and houses in need of repair are also issues of concern in the Innu communities in the Study Area. 2) Elevated levels of cadmium have been found in caribou, and low levels of PCBs. Although caribou have traditionally represented approximately 75 percent of the Innu traditional diet, concentrations of contaminants were not found at high enough levels to cause harm.
13.2 Conclusion
When considering the effects of development projects on the health of the residents within the Study Area, an integrated approach, based on the recognition that health and social and environmental well- being are inextricably linked, and that health must include social, cultural and psychological effects in addition to environmental change (Kemm 2000), must be taken. Incorporating methods that are best suited to the environment in which the project is taking place, in conjunction with contextually relevant health determinants, will assist EA practitioners to focus on the desired as well as the likely effects of project actions, including indirect and cumulative change, on those determinants. For example, Corvalán et al. (1999: 656-657) suggest: People experience the environment in which they live as a combination of physical, chemical, biological, social, cultural, and economic conditions that differ according to their local geography.
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To be effective, EA practice in remote locations must therefore be sensitive to the uniqueness of the communities (First Nations Inuit Health Branch 2001) and the understandings and beliefs of the people who live there. This is particularly true for the communities within the Study Area. This study provides a baseline from which social and community health effects may be understood and appropriate mitigation and issues-based health indicator monitoring programs be developed. Further research is needed, however, to ensure the values, claims and concerns of the Innu communities within the Study Area are understood and incorporated into relevant project-based decisions.
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14.0 REFERENCES
14.1 Personal Communications Abbass, D. Principal, Peacock Primary School, Happy Valley-Goose Bay Baikie, M. (Dr.) Medical Officer of Health, Labrador-Grenfell Health, Happy Valley-Goose Bay Battcock, A. Labrador School Board Best, C. Labrador Central Economic Development Board Bruce, T. Retired Teacher, Sheshatshiu Connell, D. Community and Aboriginal Affairs, Labrador-Grenfell Corbin, G. Regional Director, Child Youth and Family Services Costello, D. Regional Director, Mental Health and Addictions Services Dooley, D. Program Consultant, Health and Community Services Dredge, B. Regional Director, Rehabilitation and Intervention Services Dymond, J. Regional Director, Consumers’ Health Awareness Network Newfoundland and Labrador Edwards, N. Newfoundland and Labrador Centre for Health Information Fallow, B. Labrador North Chamber of Commerce Flynn, N. Regional Director Newfoundland and Labrador Housing MacKinnon, Cpl. K. Labrador District Drug Awareness Coordinator RCMP Moore, P. Occupational Therapist Penney, S. Addictions Service Coordinator Ramey, S. Public Health Nurse, Labrador Health Centre Rumbolt, A. Regional Director, Newfoundland and Labrador Human Resources Simms, B. District Administrator, College of the North Atlantic Simpson, O. Chief Operating Officer, Captain William Jackman Memorial Hospital St. Marie, S. Hyron Economic Development Board Voisey, D-D Public Health Nurse, Labrador Taylor, J. Planning Analyst (Acting), ‘B’ Division, Royal Canadian Mounted Police, Happy Valley-Goose Bay, Newfoundland and Labrador Whelan, J. Regional Director for Community Youth Corrections, Community Agencies and Child Care Services Windeler, H. Labrador School Board
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14.2 Literature Cited Adams, O. 1988. Health Status. In: Health and Welfare Canada. Canada’s Health Promotion Survey 1985: Technical Report. Minister of Supply and Services Canada, Ottawa, ON. Alaghehbandan, R., K.D. Gates and D. MacDonald. 2007. Hospitalization due to pneumonia amoung Innu, Inuit and non-Aboriginal communities, Newfoundland and Labrador, Canada. International Journal of Infectious Diseases. 11(1): 23-28. Andrew, B. and P. Sarsfield. 1985. Innu health: The role of self-determination. Pp. 428-430. In: R. Fortuine (ed.). Circumpolar Health 84: Proceedings of the Sixth International Symposium on Circumpolar Health. University of Washington Press, Seattle, WA. Armitage, P. 1990. Land Use and Occupancy Among the Innu of Utshimassits and Sheshatshit. Report to the Innu Nation. Innu Nation, Sheshatshiu, NL. Armitage, P. 1991. The Innu (the Montagnais-Naskapi). Chelsea House, New York, NY and Philadelphia, PA. Arquiaga, M., L. Canter and D. Nelson. 1994. Integration of health impact considerations in environmental impact statements. Impact Assessment, 12(2): 175-197. Backhouse, C. and D. McRae. 2002. Report to the Canadian Human Rights Commission on the Treatment of the Innu of Labrador by the Government of Canada. Baikie, M. 1985. Turberculosis in Northern Labrador. Grenfell Clinical Quarterly, 1(2): 37-39. Bailey, M. and S. McLaren 2005. Physical activity alone and with others as predictors of sense of belonging and mental health in retirees. Ageing and Mental Health, 9(1): 82-90. Banken, R. 1999. From concept to practice: Including the social determinants of health in environmental assessment. Canadian Journal of Public Health, 90(1): S27-S30. Birley, M. 2002. A review of trends in health-impact assessment and the nature of the evidence used. Environmental Management and Health, 13(1): 21-39. Boyer, Y. 2006. First Nations, Metis, and Inuit Women's Health. Discussion paper series in Aboriginal health: legal issues. Native Law Centre, University of Saskatchewan. Brady, M. 1995. Culture in treatment, culture as treatment: A critical appraisal of developments in addictions programs for indigenous North Americans and Australians. Social Science and Medicine. 41(11): 1487-1498. Bronson, J. and B. Noble. 2006. Health determinants in Canadian northern environmental impact assessment. Polar Record, 42(4): 1-10. Burnaby, B. 2004. Linguistic and cultural evolution in an unyielding environment. Pp. 31-50. In: M.F.C. Nesbit and G.H. (eds.). Jeffery Cultural Diversity and Education: Interface Issues. Memorial University of Newfoundland, St. John's, NL. Burns, A. 2006. Moving and moving forward: Mushuau Innu relocation from Utshimassits to Natuashish. Acadiensis, XXXV(2): 64-84. Butt, R. 2006. Development of the water and sewer system, Natuashish, Nunatsiavut. Journal of the Northern Territories Water and Waste Association, 14-17. Clark, M., P Riben and E. Nowgesic. 2002. The association of housing density, isolation and tuberculosis in Canadian First Nations communities. International Journal of Epidemiology, 31(5): 940-945.
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Claxton-Oldfield, S. and S.M. Keefe. 1999. Assessing stereotypes about the Innu of Utshimassits, Labrador. Canadian Journal of Behavioural Science, 31(2): 86-91. Collins, K., T. O’Keefe, D. MacDonald, K. Sikdar, M. Murphy, A. Roberts, M. Organ and D. Benoit. 2007. Diabetes Prevalence, related Comorbidities and Health Service Utilization among Miawpukek First Nation, Newfoundland and Labrador. NLCHI. Davies, K. 1992. An Introduction to Human Health and Environmental Assessment in Canada. A background paper prepared for the Canadian Environmental Assessment Research Council. Dengen, C. 1996. Healing Sheshatshit: Innu Identify and Community Healing. Unpublished Master of Arts thesis. Department of Anthropology, McGill University, Montreal, QC. Degnen, C. 2001. Country space as a healing place: Community healing at Sheshatshiu. Pp. 357-378. In: C.H. Scott (ed.). Aboriginal Autonomy and Development in Northern Quebec and Labrador. UBC Press, Vancouver, BC. Demont, J. 2000. Crisis in the north. Maclean's, 113: 56. Demont, J. and P. Sibbald. 1994. Crisis in the north. Maclean's, 107: 20. Denov, M., and K. Campbell. 2002. Casualities of Aboriginal displacement in Canada: Children at risk among the Innu of Labrador. Refuge, 20(2), 21 Denton, M., S. Prus and V. Walters. 2004. Gender differences in health: A Canadian study of the psychosocial, structural and behavioral determinants of health. Social Science and Medicine, 58: 2585-2600. Dooley, D., J. Fielding and L. Levi. 1996. Health and Unemployment. Annual Review of Public Health. 17: 449-465. Department of Indian Affairs and Northern Development Canada. 1999. A Second Diagnostic on the Health of First Nations and Inuit People in Canada. Ottawa, ON. Dreaddy, K. 2002. Moving Toward Safety: Responding to Family Violence in Aboriginal and Northern Communities in Labrador. Report prepared to the Provincial Association Against Family Violence. Dumont-Smith, C. and P. Sioui Labelle. 1991. National Family Violence Abuse Study/Evaluation. Indian and Inuit Nurses of Canada, Ottawa, ON. Federal/Provincial/Territorial Committee on Environmental and Occupational Health. 1999. Canadian Handbook on Health Impact Assessment Volume 1: The Basics (Draft). Minister of Public Works and Government Services Canada, Ottawa, ON. Federal, Provincial and Territorial Advisory Committee on Population Health. 1999. Calculated from data in Statistical Report on the Health of Canadians, 1999. Federal, Provincial and Territorial Advisory Committee on Population Health. 1994. Strategies for Population Health: Investing in the Health of Canadians for the Meeting of Ministers of Health. Minister of Supply and Services Canada. September.14-15, Halifax, NS. Fleet, C. 2003. Labrador School Board Senior High Retention Rates, June 1992 to June 2002. Fitzgerald, R. 2006. Assaults against children and youth in the family. Juristat. Volume 17, No. 11. Fouillard, C. 1997. Mining extracts toll on Innu women of Labrador. Herizons, 11(1): 6. Frank, J.W., R.S. Moore and G.M. Ames. 2000. Historical and cultural roots of drinking problems among American Indians. American Journal of Public Health, 90 (3): 344-351.
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Fraser-Lee, N.J. and P.A. Hessel. 1994. Acute respiratory infections in the Canadian Native Indian population: A review. Canadian Journal of Public Health, 85(3): 197-200. Fremouw, W.J., de Perczel, M., and Ellis, T.E. (1990). Suicide risk: assessment and response guidelines. Elmsford, NY: Pergamon Press. Friendly, M., Beach, J., and M. Turiano. 2002. Early childhood education and care in Canada 2001. Childcare Resource and Research Unit, December 2002. Gelles, R. and M. Straus. 1988. Intimate Violence: The Causes and Consequences of Abuse in the American Family. Simon and Schuster, New York. Gibson G., Martin, J., Zoe, J, Edwards, K., Gibson, N. 2007. Setting our minds to it: community-centred research for health policy development in northern Canada. Pimatisiwin: A Journal of Inidgenous and Aboriginal Community Health. 5(2): 33-54. Government of Canada. 1974. A New Perspective on the Health of Canadians: A Working Document. Marc Lalonde, Minister of National Health and Welfare. Government of Newfoundland and Labrador. 2002. Reaching Consensus and Planning Ahead: Health Forums 2001, Regional Profile: Health and Community Services - Labrador Region. Department of Health and Community Services Policy Development Division. Government of Newfoundland and Labrador. 2004a. Attempted Suicide Among Adolescents: Fast Facts, Newfoundland and Labrador Centre for Health Information. Government of Newfoundland and Labrador. 2004b. Stepping into the future Strengthening Children, Families and Communities. Newfoundland and Labrador’s Early Childhood Development and Early Learning and Child Care, Annual Report 2003-04. Government of Newfoundland and Labrador. 2005a. My People Where: Hospital Utilization by Patient Residency, Residents of Newfoundland and Labrador, 2003-2004. Centre for Health Information, Research and Evaluation Department. Government of Newfoundland and Labrador. 2005b. Newfoundland and Labrador Gambling Prevalence Study. Submitted by Market Quest Research Group Inc. for the Department of Health and Community Services Policy Development Division Government of Newfoundland and Labrador. 2006a. Live Birth Trends 2000-2004. Province and Regional Integrated Health Authorities. Research and Development Division, Newfoundland and Labrador Centre for Health Information. Government of Newfoundland and Labrador. 2006b. Tobacco Use: Fast Facts. Newfoundland and Labrador Centre for Health Information. Government of Newfoundland and Labrador. 2006c. Mortality Statistics: Government of Newfoundland and Labrador Regional Integrated Health Authorities 2000-2004. Newfoundland and Labrador Centre for Health Information. Government of Newfoundland and Labrador. 2007a. Survey Says: A Report on Health Indicators from the Canadian Community Health Survey, 2000/01-2005. Centre for Health Information, Research and Evaluation Department, St. John's, NL. Government of Newfoundland and Labrador. 2007b. The Future of Our Land, A Future for Our Children: Northern Strategic Plan for Labrador. Government of Newfoundland and Labrador. 2007c. My People Where: Hospital Utilization by Patient Residency, Residents of Newfoundland and Labrador, 2004-2005. Centre for Health Information, Research and Evaluation Department.
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Government of Newfoundland and Labrador. 2008. 2006-2007 Women’s Policy Office Annual Report. Gustafson, D.L 2006. Aboriginal and Labradorean Peoples Health Database: Research, People, Programs, and Services 2000-2005. Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL. Hanrahan, M. 2002. Identifying the needs of Innu and Inuit patients in urban health settings in Newfoundland and Labrador. Canadian Journal of Public Health, 93(2) 149-152. Hanrahan, M. 2003. The Lasting Breach: The Omission of Aboriginal People from the Terms of the Union Between Newfoundland and Canada and its Ongoing Impacts. Health Canada. 2003. Beginning the Journey to Change. Evaluation of the Community Health Component of the Innu Healing Strategy. Phase One: Baseline Component. Health Research Unit, Memorial University of Newfoundland , St. John’s, NL. Health Council of Canada. 2005. The Health Status of Canada's First Nations, Metis and Inuit peoples. A background paper to accompany Health Care Renewal in Canada: Accelerating Change. Toronto, ON. Henrikson, G. 1981. Utshimassits, Labrador. Pp. 66-672. In: W.C. Sturtevant (ed.). Handbook of North American Indians 6: Subarctic, Smithsonian Institution. Washington, DC. Hunter, D.J.W. 1988. Mortality in Labrador, 1974-1985. Grenfell Clinical Quarterly, 4(2): 24-26. INAC (Indian and Northern Affairs Canada). 2003. Canadian Arctic Contaminants Assessment Report II: Human Health. Northern Contaminants Program, Ottawa, ON. INCO. 1998. Voisey's Bay Mine/Mill Project Environmental Impact Statement. Innu Nation and Mushuau Innu Band Council. 1995. Gathering Voices: Finding Strength to Help Our Children. The Utshimassits People’s Inquiry. Douglas & McIntyre, Toronto, ON and Vancouver, BC. Jacques Whitford Environment Limited. 2003. Community Life, Employment and Business Component Study. Trans Labrador Highway - Phase III (Happy Valley-Goose Bay to Cartwright Junction). Prepared for the Newfoundland and Labrador Department of Works, Services and Transportaion, St. John’s, NL. Jong, C. 2007. Post-Secondary Education in Labrador. Memorial University, St. John’s, NL. Kahan, B. and M. Goodstadt. 1999. Understanding the determinants of health: Key decision makers in Saskatchewan health districts and Saskatchewan Health, 1998. Canadian Journal of Public Health, 90(1): S47-S52. Kegler, M.C., Kingsley, B., Malcoe, H., Cleaver, V., Reid, J., and G. Solomon.1999. The functional value of smoking and nonsmoking from the perspective of American Indian youth. Family and Community Health, 22: 31-42 Kosteniuk, G. and H. Dickinson. 2003. Tracing the social gradient in the health of Canadians: Primary and secondary determinants. Social Science and Medicine, 57: 263-276. Kuin, F. 1997. Back to the land. World Press Review, 44(36-37). Kunitz, S.J. 1996. Disease and Social Diversity: The European Impact on the Health of Non- Europeans. Oxford University Press, New York, NY. Labrador School Board. 2003. Labrador Directions 2003-2006. A Three Year Strategic Plan for the Labrador School Board. Labrador School District, Happy Valley-Goose Bay, NL.
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Lawn, J. 2002. An Update on Nutrition Surveys in Isolated Northern Communities. Indian and Northern Affairs Canada, Ottawa, ON. Laws, D. and A. Sagar. 1994. Perspectives on human health impact assessment. Environmental Impact Assessment Review, 14: 311-319. Leacock, E. 2001. Women in an egalitarian society: The Montagnais-Naskapi of Canada. Pp. 49-57. In: B.J. Fox. Family Patterns; Gender Relation,. Oxford University Press, Don Mills, Ont. Lewis, C. 1998. Health Impact Assessment Guidelines Document: Review and Recommendations. Prepared for the Ministry of Health and the Ministry Responsible for Seniors, British Columbia. Mendelson 2006. Aboriginal Peoples and Post Secondary Education in Canada. The Caledon Institute. Meredith, T. 1995. Assessing environmental impacts in Canada. In: B. Mitchell (ed.). Resource and Environmental Management in Canada: Addressing Conflict and Uncertainty. Oxford University Press, Totonto, ON. METRAC (The Metropolitan Toronto Action Committee on Violence Against Women and Children). 2001. Statistics Sheet: Sexual Assault. Millar, W. and T. Stephens. 1992. Social status and health risks in Canadian adults: 1985 and 1991. Health Reports, 5: 143-156. [Statistics Canada Cat. No. 82-003-XPB.] Minaskuat Inc.. 2007. Lower Churchill Power Project Socio-Economic Baseline. Draft Report No. 1013786 In Preparation for Newfoundland and Labrador Hydro, St. John’s, NL. Moffitt, P.A. 2004 Colonialization; a health determinant for pregnant Dogrib women. Journal of Transcultural Nursing, 15(4): 323-330.National Aboriginal Organization. 2001. Native Women’s Association of Canada. 2007. Violence against Aboriginal women and girls. An issue paper prepared for the National Aboriginal Women’s Summit, June 20-22, 2007, Corner Brook, NL. Neuwelt, P.M., R.A. Kearns, D.J.W. Hunter and J. Batten. 1992. Ethnicity, morbidity and health service utilization in two Labrador communities. Social Science and Medicine, 34(2): 151-160. Newfoundland and Labrador Hydro. 2006. Lower Churchill Hydroelectric Generation Project: Project Registration Pursuant to the Newfoundland and Labrador Environmental Protection Act and Project Description Pursuant to the Canadian Environmental Assessment Act. Submitted November 30, 2006. Noble, B.F. and J.E. Bronson 2006. Practitioner survey of health integration in Canadian northern environmental impact assessment. Environmental Impact Assessment Review, 26: 410-424. Northwest Territories Health and Social Services 2005 NWT Health Status Report 2005. Yellowknife, NT: Northwest Territories Health and Social Services O’Neil, J. and J. Solway. 1990. Human Health and Environmental Assessment in the North. Background paper and workshop report. Canadian Environmental Assessment Research Council. Penashue, P. 2001. Healing the past meeting the future. Pp. 21-29. In: C.H. Scott. Aboriginal Autonomy and Development in Northern Quebec and Labrador. UBC Press, Vancouver, BC. Pfeiff, M. 2004. Social disrepair. Canadian Geographic, 124(1): 23.
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Philpott, D., M. Cahill, W. Nesbit and G. Jeffrey. 2004. An Educational Profile of the Learning Needs of Innu Youth: Brief Summary of Findings October 2004. Memorial University of Newfoundland, St. John’s, NL. Public Health Agency of Canada. 2005. Pertussis in Newfoundland and Labrador: 1991-2004. Volume 31-22, November 15, 2005. Rogan, M. 2001. An Epidemic of gas sniffing decimates Arctic Indian tribe. The New York Times: 40. Rogers, E. and E. Leacock. 1981. Montagnais-Naskapi. Pp. 169-189. In: W.C. Sturtevant (ed.). Handbook of North American Indians 6: Subarctic. Smithsonian Institution. Washington, DC. Royal Commission of Aboriginal Peoples. 1996. Royal Commission Report on Aboriginal Peoples. Ryan B.A. and G.R. Adams. 1999. How do families affect children’s success in school? Education Quarterly Review, 6(1): 30-43. Sadler, B. and P. Jacobs. 1990. A key to tomorrow: On the relationship of environmental assessment and sustainable development. In: P. Jacobs and B. Sadler (eds.). Sustainable Development and Environmental Assessment: Perspectives on Planning for a Common Future. Canadian Environmental Assessment Research Council, Hull, QC. Samson, C. and J. Pretty. 2006. Environmental and health benefits of hunting lifestyles and diets for the Innu of Labrador. Food Policy, 31(6): 528-553. Samson, C., J. Wilson and J. Mazower. 1999. Canada's Tibet: the Killing of the Innu. London, Survival International. Scott, K. 1997. Indigenous Canadians: Chapter 5. Pp. 133-164. InL D. McKenzie, R. Williams and E. Single (eds.). Canadian Profile: Alcohol, Tobacco and Other Drugs. Canadian Centre on Substance Addiction, Ottawa, ON. Serres, C. 1994. How to immobilize an economy. Alberta Report/Newsmagazine, 21(8): 24. Smylie, J. 2001. A guide for health professionals working with Aboriginal peoples. Journal of the Society of Obstetricians and Gynaecologists of Canada, 100: 1-15. Statistics Canada. 2000. Teenage pregnancies in Health Reports, Winter 2000, Catalogue no. 82-003- XPB, Vol. 12 No. 1. Statistics Canda. June 2001. Family Violence in Canada: A Statistical Profile 2001. Catalogue no. 85- 224-XIE. Ottawa: Minister of Industry. Statistics Canada. 2001. Aboriginal Peoples in Canada, Statistics Canada. Canadian Centre for Justice Statistics. June 2001. Catalogue no. 85F0033MIE. Statistics Canada. 2005. Family Violence in Canada: A Statistical Profile 2005. Canadian Centre for Justice Statistics. Catalogue no. 85-224-XIE. Statistics Canada. 2006a. Census 2006. Statistics Canada. 2006b. Health Indicators. Statistics Canada. Catalogue no. 82-221, Vol. 2006 No. 1 1. Steinemann, A. 2000. Rethinking human health impact. Environmental Impact Assessment Review, 20(6): 625-645. Tait C. 2003. Fetal Alcohol Syndrome Among Aboriginal People in Canada: Review and Analysis of the Intergenerational Links to Residential Schools. Aboriginal Healing Foundation, Ottawa, ON.
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Ungerleider C. and T. Burns. 2002. The State and Quality of Canadian Public Elementary and Secondary Education. A presentation and paper given at The Social Determinants of Health across the Life-Span Conference held in November 2002, in Toronto, ON. Van Oostdam, J., S. G. Donaldson, M. Feeley, D. Arnold, P. Ayotte, G. Bondy, L. Chan, É. Dewaily, C.M. Furgal, H. Kuhnlein, E. Loring, G. Muckle, E. Myles, O. Receveur, B. Tracy, U. Gill and S. Kalhok. 2005. Human health implications of environmental contaminants in Arctic Canada: A review. The Science of the Total Environment, 351-352: 165-246. Waldram, J.B., D.A. Herring and T. Kue Young. 2006. Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives, Second Edition. University of Toronto Press, Toronto, Buffalo and London. Williams, J. and G. Thomas. 1984. Malignant disease in northern Canadian native people. Grenfell Clinical Quarterly, 1(2): 24-27. Wilson, K. and M. Rosenberg. 2002. Exploring the determinants of health for First Nations peoples in Canada: Can existing frameworks accommodate traditional activities? Social Science and Medicine, 55(11): 2017-2031. Wolff, L. and B. Reingold. 1994. Drug use and crime. Juristat Service Bulletin, 14(6). WHO (World Health Organization). 1986. Ottawa Charter for Health Promotion. Paper presented at: First International Conference on Health Promotion; November 21, 1986; Ottawa, ON. WHO (World Health Organization). 1987. Health and Safety Component of Environmental Impact Assessment. Report on a World Health Organization Meeting. Copenhagen, Denmark. Wotton, K. 1985. Mortality of Labrador Innu and Inuit: 1971-1982. Pp. 139-142. In: R. Fortuine (ed.). Circumpolar Health 84: Proceedings of the Sixth International Symposium on Circumpolar Health. University of Washington Press, Seattle, WA. Wynne H., and J. McCready. 2005. Examining gambling and problem gambling in Ontario Aboriginal Communities. Final Summary Report. Young, T.K. 1991. Health Care and Cultural Change: The Indian Experience in the Central Subarctic. University of Toronto Press, Toronto, ON. Young, T.K. 1988. Are subarctic Indians undergoing the epidemiologic transition? Social Science and Medicine, 26(6): 659-671. Zakir, M. and P. Wunnava. 1999. Factors affecting infant mortality rates: evidence from cross-sectional data. Applied Economics Letters. 6: 271-273.
14.3 Websites Amnesty International. 2004. Stolen sisters: a human rights response to discrimination and violence against indigenous women in Canada. Available on-line at http://www.amnesty.ca/stolensisters/amr2000304.pdf Community Accounts. 2008. Available on-line at: http://www.communityaccounts.ca Ferris, J., and H. Wynne. 2001. The Canadian Problem Gambling Index: User Manual. Report to the Canadian Inter-Provincial Task Force on Problem Gambling. Available on-line at: http://www.ccsa.ca/pdf/ccsa-009381-2001.pdf First Nations Inuit Health Branch. 2001. Guide to Health Management Structures. Available on-line at: http://www.hc-sc.gc.ca/fnihb-dgspni/fnihb/bpm/hfa/transfer_publications/ health_mgmnt_guide.htm#intro. [Accessed July 24, 2007].
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Health Canada. 1999. The Canadian Handbook on Health Impact Assessment: The Basics. Available on-line: http://www.hc-sc.gc.ca/hecs-sesc/ehas/publications.htm. [Accessed May 15, 2007]. Government of Newfoundland and Labrador, Department of Health and Community Service. Departmental Profile. Available on-line at: http://www.health.gov.nl.ca/health/department/default.htm Government of Newfoundland and Labrador, Department of Education. Education Statistics – Elementary-Secondary, 2007-08. Available on-line at: http://www.ed.gov.nl.ca/edu/pub/stats07_08/ATT_07_7.PDF Labrador-Grenfell Health Authority. 2007. Available on-line at: http://www.lghealth.ca/. [Accessed June 14, 2007]. Labrador School Board. 2008. Labrador Schools and Communities. Available on-line at: http://www.lsb.ca/schoolcommunities/schoolscommunities.htm. Newfoundland and Labrador Statistics Agency. 2008. Road Distance Database Version 1.21. Available on-line at: http://www.stats.gov.nl.ca/DataTools/RoadDB/Distance/ Public Health Agency of Canada. 2003. Available on-line at: http://www.phac-aspc.gc.ca/ph- sp/phdd/determinants/index.html. [Accessed May 24, 2007]. Samson, C. 2005. Burdened with Change: Land, Health and the Survival of Indigenous Peoples. Available on-line at: http://www.ncrm.ac.uk/research/documents/LandHealthandLife- ColinSamson.pdf [Accessed June 11, 2007]. Statistics Canada. 2003. Problem Gambling: Selected Findings from the 2002 Canadian Community Health Survey. Available online at: http://www.statcan.ca/Daily/English/031212/d031212c.htm Statistics Canada. 2007 Crimes by Offences, by Province and Territory. Available online at www40.statcan.ca/l01/cst01/Legal04a.htm
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15.0 LIST OF ACRONYMS ABE Adult Basic Education ARI Aboriginal Research Institute AIDS Acquired Immunodeficiency Syndrome BMI Body Mass Index CNA College of the North Atlantic COPD Chronic Obstructive Pulmonary Disease CWJ Captain William Jackman Memorial Hospital DR Dependency Ratio DTap Diphtheria Tentanus Cecellular Pertussis EIS Environmental Impact Statement FASD Fetal Alcohol Spectrum Disorder HIV Human Immunodeficiency Virus Hydro Newfoundland and Labrador Hydro IER Institute of Environmental Research IMR Infant Mortality Rate MBNS Mother Baby Nutrition Supplement MIHC Mushuau Innu Health Commission MIRA Mushuau Innu Relocation Agreement MOH Medical Officer of Health MRI Magnetic Resonance Imaging NAHO National Aboriginal Health Organization NLCB Newfoundland and Labrador Child Benefit NLCHI Newfoundland and Labrador Centre for Health Information NLDE Newfoundland and Labrador Department of Education NLHC Newfoundland and Labrador Housing Corporation POP Persistent Organic Pollutant The Project Lower Churchill Hydroelectric Generation Project RIHA Regional Integrated Health Authority RNI Recommended Nutrient Intake SIDS Sudden Infant Death Syndrome WHO World Health Organization
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APPENDIX A Letter of Permission from Health Canada