APPENDIX A A Life Course Approach to the Social Determinants of Health for Aboriginal Peoples’ Jeff Reading PhD for The Senate Sub-Committee on Population Health March 2009 APPENDIX A TABLE OF CONTENTS SYNTHESIS ....................................................................................................................... A-1 END POVERTY NOW................................................................................................ A-1 ACTIONS ..................................................................................................................... A-3 THE BURDEN OF CHRONIC DISEASES AMONG ABORIGINAL PEOPLES IN CANADA ............................................................................................................................ A-4 1.INTRODUCTION..................................................................................................... A-4 2. THE BURDEN OF DIABETES IN ABORIGINAL POPULATIONS ............... A-4 2.1 DEFINITION OF DIABETES AND IMPAIRED GLUCOSE TOLERANCE A-4 2.2 BURDEN OF TYPE 2 DIABETES IN ABORIGINAL POPULATIONS ........ A-4 2.3 UNDERSTANDING THE NUMBERS NOW AND IN THE FUTURE ........... A-7 3. THE BURDEN OF CARDIOVASCULAR DISEASE IN ABORIGINAL POPULATIONS ........................................................................................................... A-8 3.1 DEFINITION AND DESCRIPTION OF CARDIOVASCULAR DISEASE ... A-8 3.2 BURDEN OF CARDIOVASCULAR DISEASE IN ABORIGINAL POPULATIONS ........................................................................................................... A-9 THE BURDEN OF CHRONIC RESPIRATORY DISEASES IN ABORIGINAL POPULATIONS ......................................................................................................... A-10 4.1 DEFINITION AND DESCRIPTION OF CHRONIC RESPIRATORY DISEASES .................................................................................................................. A-10 4.2 GENERAL BURDEN OF CHRONIC RESPIRATORY DISEASE IN ABORIGINAL POPULATIONS ............................................................................. A-11 4.3 TUBERCULOSIS ................................................................................................ A-11 4.4 CHRONIC OTITIS MEDIA ............................................................................... A-13 4.5 CHRONIC/RECURRING RESPIRATORY TRACT INFECTIONS ........... A-14 4.6 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND ASTHMA .................................................................................................................... A-16 5. THE BURDEN OF MUSCULOSKELETAL CONDITIONS IN ABORIGINAL POPULATIONS ......................................................................................................... A-17 5.1 DEFINITION AND DESCRIPTION OF MUSCULOSKELETAL DISEASE AND DISORDERS .............................................................................................................. A-17 5.2 BURDEN OF ARTHRITIS IN ABORIGINAL POPULATIONS .................. A-18 5.3 OSTEOPOROSIS ................................................................................................ A-20 6. THE BURDEN OF CANCER IN ABORIGINAL POPULATIONS ................ A-21 APPENDIX A 6.1 DEFINITION AND DESCRIPTION OF CANCER ........................................ A-21 6.2 CANCER SURVEILLANCE IN ABORIGINAL POPULATIONS ............... A-21 6.3 BURDEN OF CANCER IN ABORIGINAL POPULATIONS ....................... A-22 PROVINCE ................................................................................................................ A-23 RELATED LITERATURE ....................................................................................... A-23 7. BURDEN OF SEVERE MENTAL ILLNESS IN ABORIGINAL POPULATIONS ......................................................................................................... A-26 7.1 DEFINITION AND DESCRIPTION OF CHRONIC MENTAL ILLNESS . A-26 7.2 BURDEN OF SEVERE MENTAL ILLNESSES IN ABORIGINAL POPULATIONS ......................................................................................................... A-27 7.3 BURDEN OF SEVERE MENTAL ILLNESSES ON COMMUNITY HEALTH ................................................................................................................... A-33 8. THE IMPACT OF CHRONIC DISEASES ON MENTAL HEALTH ............. A-34 8.1 DEFINING THE PARAMETERS OF THE ASSOCIATION BETWEEN CHRONIC DISEASE AND MENTAL HEALTH .................................................. A-34 8.2 UNPACKING THE ASSOCIATION BETWEEN CHRONIC DISEASE AND MENTAL HEALTH .................................................................................................. A-37 8.3 COMMON THEMES .......................................................................................... A-45 8.4 CO-MORBIDITY ................................................................................................ A-50 8.4.1 CANCER AND DIABETES ............................................................................ A-50 8.4.2 DIABETES AND CVD ..................................................................................... A-51 8.4.3 OSTEOPOROSIS AND CHRONIC DISEASES ........................................... A-51 8.4.4 HEALTH IMBALANCE AND CO-MORBIDITY ....................................... A-51 A LIFE COURSE APPROACH: CHRONIC DISEASE RISK FACTORS IN ABORIGINAL POPULATIONS IN CANADA ............................................................ A-53 1. INTRODUCTION: TAKING A LIFE COURSE APPROACH ....................... A-53 1.1 THE LIFE COURSE PERSPECTIVE AND ABORIGINAL HEALTH ....... A-54 1.2 APPLYING THE LIFE COURSE APPROACH.............................................. A-55 2. COMMUNITY RISK FACTORS ........................................................................ A-55 2.1 SOCIOECONOMIC RISK FACTORS ............................................................. A-56 MENTAL HEALTH DIAGNOSIS ................................................................................ A-63 2.2 GEOGRAPHIC RISK FACTORS ..................................................................... A-66 3. PRENATAL RISK FACTORS ................................................................................... A-73 3.1 MATERNAL DIABETES ................................................................................... A-73 APPENDIX A 3.2 MATERNAL OBESITY ..................................................................................... A-73 3.3 MATERNAL SMOKING ................................................................................... A-74 3.4 MATERNAL ALCOHOL USE .......................................................................... A-76 4. NATAL RISK FACTORS ........................................................................................... A-77 4.1 ABNORMAL BIRTH WEIGHTS...................................................................... A-78 4.2 BREASTFEEDING ............................................................................................. A-79 5. EARLY CHILDHOOD RISK FACTORS ................................................................ A-81 5.1 POPULATION INFLUENCES .......................................................................... A-81 5.2 CHILD POVERTY AND HUNGER .................................................................. A-82 5.4 PARENTAL SMOKING AND HOUSEHOLD SMOKE ................................ A-86 6. CHILDHOOD AND ADOLESCENT RISK FACTORS ......................................... A-87 6.1 CHILDHOOD OBESITY ................................................................................... A-87 6.2 SMOKING ............................................................................................................ A-88 6.3 SEXUAL HEALTH ............................................................................................. A-91 6.5 ABORIGINAL CHILD WELFARE .................................................................. A-97 7. ADULTHOOD AND THE ELDERLY RISK FACTORS ..................................... A-100 7.1 SMOKING .......................................................................................................... A-100 7.2 ALCOHOL ABUSE ........................................................................................... A-101 7.4 EMPLOYMENT AND EDUCATION ............................................................. A-103 7.5 ELDER HEALTH .............................................................................................. A-104 APPENDIX A Synthesis That population level factors which determine the health and well being for any collectivity have their origins is upstream historic, cultural, social, economic and political forces affecting the lives of Aboriginal Peoples‘ living in Canada, has been articulated for almost two decades. Many determinants of health for Aboriginal peoples‘ are beyond the scope of the health care delivery system to provide such as: changing diets from traditional to non-traditional foods, food insecurity, stress due to economic factors, pollution and environmental degradation, global capitalism and others. It is important to understand that words and their interpretation are very important in the discourse on determinants of health especially if the aim is to better understand the causes. Aboriginal Peoples‘ historically and to the present day, have not been full participants in the nation state called Canada. As the political economy of Canada evolved it became necessary to dislocate Aboriginal peoples‘ from their traditional lands in order to make way for settler societies. The process of