COMMUNITY HEALTH PURSUANT TO CLAUSE 19 OF ENVIRONMENT ACT LICENCE NO. 3055 AND CLEAN ENVIRONMENT COMMISSION RECOMMENDATION 9.11 TABLE OF CONTENTS 1.0 INTRODUCTION .................................................................................. 1-5 2.0 BACKGROUND ...................................................................................... 2-7 3.0 COMMUNITY HEALTH ASSESSMENT .......................................... 3-11 3.1 KEEYASK CREE NATIONS ............................................................................... 3-11 3.1.1 Perspectives on Health and Well-being ............................................. 3-11 3.1.2 Community Health Assessment ........................................................ 3-13 3.1.2.1 Health Characteristics Associated with Population Characteristics ................................................................................. 3-18 3.1.2.2 Diseases of Interest to the Keeyask Cree Nations ........................... 3-23 3.2 GILLAM ........................................................................................................... 3-54 3.2.1 Health Characteristics Associated with Population Characteristics .................................................................................... 3-54 3.3 THOMPSON ..................................................................................................... 3-62 3.3.1 Health Characteristics Associated with Population Characteristics .................................................................................... 3-62 4.0 LITERATURE CITED ......................................................................... 4-75 1-I LIST OF TABLES Page Table 2-1: Factors Contributing to Health ....................................................................................................... 2-8 Table 3-1: Physician Visits by Selected Cause, KCNs Community Members (1984-2006) ................... 3-24 Table 3-2: Hospitalizations by Selected Cause, KCNs Community Members (1984-2006) .................. 3-25 Table 3-3: Risk Factors for Diabetes ............................................................................................................... 3-29 Table 3-4: Physician Visits for Mental and Behavioural Disorders by Gender and Age Group, Keeyask Cree Nations (1984-2006) ................................................................................ 3-40 Table 3-5: Hospitalizations for Infections of Skin by Gender and Age Group, KCNs (1984- 2006) .................................................................................................................................................. 3-47 Table 3-6: "Other" Causes of Mortality in Keeyask Cree Nations Communities, All Residents (1980-2005)..................................................................................................................... 3-50 Table 3-7: “Other” Causes of PYLL in Keeyask Cree Nations Communities, All Residents (1980-2005) ....................................................................................................................................... 3-53 LIST OF FIGURES Page Figure 3-1: Keeyask Cree Nations Communities Change in Population Structure (1984 and 2006) .................................................................................................................................................. 3-20 Figure 3-2: Pregnancy Rates Over Time, Females Age 15-49 (1984-2006)................................................ 3-21 Figure 3-3: Birth Rates Over Time (1984-2006) ............................................................................................. 3-22 Figure 3-4: High Birth Weight Rates (1984-2006) .......................................................................................... 3-23 Figure 3-5: Average Physician Visit Rates For Cardiovascular Disease by Area (1997-2006) ................ 3-26 Figure 3-6: Patient Treatment Rates for Cardiovascular Disease by Year, All Residents (1984- 2006) .................................................................................................................................................. 3-27 Figure 3-7: 10-year Hospitalization Rates for Cardiovascular Disease by Area (1987-1996 and 1997-2006) ........................................................................................................................................ 3-28 Figure 3-8: Patient Treatment Rates for Diabetes by Year, All Residents (1984-2006) ........................... 3-30 Figure 3-9: Hospitalization Rates for Diabetes by Year, All Residents (1984-2006) ................................ 3-31 Figure 3-10: Percentage Change in Numbers of Hospitalizations for Diabetes (1984-1988 and 2002-2006) ........................................................................................................................................ 3-32 1-II Figure 3-11: Percentage Change in Numbers of Hospitalizations for Injuries (1984-1988 and 2002-2006) Averages ....................................................................................................................... 3-34 Figure 3-12: Hospitalization Rates for Injuries by Year, All Residents (1984-2006) .................................. 3-35 Figure 3-13: Hospitalization Rates for Injuries by Area (1997-2006) Average ............................................ 3-36 Figure 3-14: 10-Year Physician Visit Rates for Mental and Behavioural Disorders by Area, All Residents (1987-1996 and 1997-2006) ......................................................................................... 3-38 Figure 3-15: Female 10-year Physician Visit Rates for Mental and Behavioural Disorders by Area (1987-1996 and 1997-2006) .................................................................................................. 3-39 Figure 3-16: Male 10-year Physician Visit Rates for Mental and Behavioural Disorders by Area (1987-1996 and 1997-2006) ........................................................................................................... 3-39 Figure 3-17: Average Hospitalization Rates for Mental and Behavioural Disorders by Area, All Residents (1997-2006)..................................................................................................................... 3-41 Figure 3-18: Physician Visits for Infections of Skin and Subcutaneous Tissue by Gender and Age Group, Keeyask Cree Nations (2006) .................................................................................. 3-43 Figure 3-19: Patient Rates for Infections of Skin and Subcutaneous Tissue by Year (1984- 2006) .................................................................................................................................................. 3-44 Figure 3-20: Percentage Change in Numbers of Patients for Infections of Skin and Subcutaneous Tissue, All Residents (1984-2006) ....................................................................... 3-45 Figure 3-21: Percentage Change in Numbers of Physician Visits for Infections of Skin and Subcutaneous Tissue, All Residents (1984-2006) ....................................................................... 3-46 Figure 3-22: Total Mortality Rate by Area (1985-1994 and 1995-2005) ....................................................... 3-48 Figure 3-23: Causes of Mortality in Keeyask Cree Nations Communities, All Residents (1980- 2005) .................................................................................................................................................. 3-49 Figure 3-24: Premature Mortality Rates by Area (1998-2006) ........................................................................ 3-51 Figure 3-25: Causes of PYLL in Keeyask Cree Nations Communities, All Residents (1980- 2005) .................................................................................................................................................. 3-52 Figure 3-26: Gillam Change in Population Structure (1984 and 2006) ......................................................... 3-55 Figure 3-27: Physician Visits for Injuries by Gender and Age Group, Gillam (2006)................................ 3-58 Figure 3-28: Hospitalization Rates for Injuries by Year, All Residents (1984-2006) .................................. 3-59 Figure 3-29: Thompson Change in Population Structure (1984 and 2006) ................................................. 3-63 Figure 3-30: Birth Rates for Thompson, MB First Nations on-Reserve and Manitoba (1984- 2006) .................................................................................................................................................. 3-64 Figure 3-31: High Birth Weight Rates for Thompson, MB First Nations on-Reserve and Manitoba (1984-2006) ..................................................................................................................... 3-65 Figure 3-32: Patient Rates for Cardiovascular Disease by Year, All Residents (1984-2006) ..................... 3-66 Figure 3-33: Hospitalization Rates for Cardiovascular Disease by Year, All Residents (1984- 2006) .................................................................................................................................................. 3-67 Figure 3-34: Patient Rates for Diabetes by Year, All Residents (1984-2006) ............................................... 3-68 Figure 3-35: Hospitalization Rates for Injuries by Year, All Residents (1984-2006) .................................. 3-70 Figure 3-36: Hospitalization Rates for Mental and Behavioural Disorders by Year, All Residents