The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study March 2002 Manitoba Centre for Health Policy Department of Community Health Sciences Faculty of Medicine, University of Manitoba Patricia Martens, PhD Doreen Sanderson and the Health Ruth Bond, MA Information and Research Committee, Laurel Jebamani, BA(Hons) Assembly of Manitoba Chiefs Charles Burchill, MSc Noralou Roos, PhD Marilyn Tanner-Spence, RN, BN, MA Shelley Derksen, MSc Audrey Leader Marcella Beaulieu, BSc Brenda Elias, MA, PhD(c) Carmen Steinbach John O’Neil, PhD Leonard MacWilliam, MSc, MNRM Randy Walld, BSc, B Comm (Hons) Natalia Dik, MSc ISBN 1-896489-04-4 ACKNOWLEDGMENTS The principal author, Patricia Martens, would like to acknowledge the contributions of the many individuals whose efforts and expertise made it possible to produce this report: • The individual members of the Health Information and Research (HIR) Committee, who have been working group members of this report. We first began to meet with this committee in June 1999. All members of the HIR Committee from June 1999 through December 2001 inclusive are: Doreen Sanderson (Senior Health Director, Assembly of Manitoba Chiefs), Audrey Leader (former Health Advisor of Assembly of Manitoba Chiefs), Gloria Cameron and Carolyn Chartrand (West Region Tribal Council), Cecelia Stevenson (Fisher River Health Centre), Eli Beardy and Emile Garson (Keewatin Tribal Council), Garry Munro (Cree Nation Tribal Health Centre), Larry Starr (Southeast Resource Development Council), Shirli Ewanchuk, Lorraine McLeod and Marge Roscelli (Dakota Ojibway Health Services), Mike Burdett and Marilyn Tanner-Spence (Norway House Cree Nation), Andy Wood and Pauline Wood Steinman (Four Arrows Island Lake Tribal Council), Tracy Scott and Dr. Lorne Clearsky (Anishinaabe Mino-Ayaawin), Jenni Wastisecoot (Manitoba Keewatinowi Okimakanak). • The Chiefs Health Committee of the Assembly of Manitoba Chiefs, for their support of this project from its inception in June 1999 • Manitoba Health personnel including Louis Barré, Loretta Bayer, Valerie Mann, Susan Rodgers, and André Wadja • Mike Anderson (Manitoba Keewatinowi Okimakanak), who collaborated with Charles Burchill (MCHP) in producing a geographically-based Tribal Council area map for purposes of this report • Manitoba First Nations and Inuit Health Branch personnel who helped facilitate the linkage, including Richard Legault, Dr. Cathy Cook, Suzanne Martel and Mike Burdett • Indian and Northern Affairs Canada, and the First Nations and Inuit Health Branch of Health Canada, for their assistance in updating our files with more complete data and in facilitating the linkage • The external academic reviewers of this proposal, including Dr. Jeff Reading, Dr. Bruce Martin, Dr. Brian Postl, Dr. Michael Moffatt, Dr. Kue Young • The MCHP personnel who helped extensively in the editing and producing of the report and the summary, including RJ Currie, Greg Finlayson, Fred Toll, Shannon Lussier, Eileen Pyke, and Carolyn DeCoster. We acknowledge the Faculty of Medicine Health Research Ethics Board for their thoughtful review of this project. The Health Information Privacy Committee of Manitoba Health is kept informed of all MCHP deliverables for Manitoba Health. Strict policies and procedures to protect the privacy and security of data have been followed in producing this report. i We acknowledge the financial support of the Department of Health of the Province of Manitoba. The results and conclusions are those of the authors and no official endorsement by Manitoba Health was intended or should be inferred. This report was prepared at the request of Manitoba Health as part of the contract between the University of Manitoba and Manitoba Health. On a more personal note, I would like to thank the First Nations people of Manitoba for helping this report become a reality. I would also like to dedicate this report to my dear friend and colleague, Dr. Christine Egan, who worked for the First Nations and Inuit Health Branch at the time of her death. Chris truly had a heart for First Nations health issues, and inspired me to look at health from varying perspectives. She died September 11, 2001, in the New York World Trade Centre. ii THE MANITOBA CENTRE FOR HEALTH POLICY The Manitoba Centre for Health Policy (MCHP) is located within the Department of Community Health Sciences, Faculty of Medicine, University of Manitoba. The mission of MCHP is to provide accurate and timely information to health care decision-makers, analysts and providers, so they can offer services which are effective and efficient in maintaining and improving the health of Manitobans. Our researchers rely upon the unique Population Health Research Data Repository to describe and explain patterns of care and profiles of illness, and to explore other factors that influence health, including income, education, employment and social status. This Repository is unique in terms of its comprehensiveness, degree of integration, and orientation around an anonymized population registry. Members of MCHP consult extensively with government officials, health care administrators, and clinicians to develop a research agenda that is topical and relevant. This strength along with its rigorous academic standards enables MCHP to contribute to the health policy process. MCHP undertakes several major research projects, such as this one, every year under contract to Manitoba Health. In addition, our researchers secure external funding by competing for other research grants. We are widely published and internationally recognized. Further, our researchers collaborate with a number of highly respected scientists from Canada, the United States and Europe. We thank the University of Manitoba, Faculty of Medicine, Health Research Ethics Board for their review of this project. The Manitoba Centre for Health Policy complies with all legislative acts and regulations governing the protection and use of sensitive information. We implement strict policies and procedures to protect the privacy and security of anonymized data used to produce this report and we keep the provincial Health Information Privacy Committee informed of all work undertaken for Manitoba Health. iii TABLE OF CONTENTS EXECUTIVE SUMMARY.................................................................................. xvii CHAPTER 1. INTRODUCTION AND METHODS ............................................1 1.1 Introduction – The Collaborative Network ................................................................1 1.2 What’s in this report? ......................................................................................................2 1.3 The geographical areas used for comparisons.............................................................2 1.4 The methods used (also refer to the Appendix/Glossary)........................................3 1.5 Where the information was obtained ...........................................................................5 1.6 How to use this report....................................................................................................6 References ..............................................................................................................................7 CHAPTER 2.INTERPRETING THE DATA FOR LOCAL USE ...................... 9 2.1 What’s in this chapter......................................................................................................9 2.2 How the chapters are set up...........................................................................................9 2.3 How the groupings of geography and people are defined (Chapter 3) ...................9 2.4 How the graphs in Chapters 4 through 10 are set up ..............................................11 2.5 Adjusted and crude rates, and actual client numbers ...............................................12 2.6 Health status indicators of your region (Chapter 4) .................................................14 2.7 Major disease profiles of your region (Chapter 5) ....................................................16 2.8 Are preventive programs “working” in your region? (Chapter 6).........................17 2.9 How do people in your region use physician services? (Chapter 7).......................18 2.10 How do people in your region use hospital services? (Chapter 8) .........................20 2.11 What are the rates of selected surgical procedures for people in your area? (Chapter 9)......................................................................................................................21 2.12 What other factors (determinants of health) could be affecting health in your region, such as housing and unemployment? (Chapter 10).....................................24 2.13 Closing comments .........................................................................................................25 References ............................................................................................................................26 CHAPTER 3. DESCRIPTIONS OF THE AREAS AND THE POPULATION ......................................................................................................27 3.1 What’s in this chapter?..................................................................................................27 3.2 Key findings....................................................................................................................28 3.3 Canadian Comparisons.................................................................................................28