The Evolution of Health Status and Health Determinants in the Cree Region (Eeyou Istchee): Eastmain 1-A Powerhouse and Rupert Diversion Sectoral Report Volume 2: Detailed Analysis Series 4 Number 3: Report on the health status of the population Cree Board of Health and Social Services of James Bay The Evolution of Health Status and Health Determinants in the Cree Region (Eeyou Istchee): Eastmain-1-A Powerhouse and Rupert Diversion Sectoral Report Volume 2 Detailed Analysis Jill Torrie Ellen Bobet Natalie Kishchuk Andrew Webster Series 4 Number 3: Report on the Health Status of the Population. Public Health Department of the Cree Territory of James Bay Cree Board of Health and Social Services of James Bay 1 The views expressed in this document are those of the authors and do not necessarily reflect those of the Cree Board of Health and Social Services of James Bay. Authors Jill Torrie Cree Board of Health & Social Services of James Bay (Montreal) [email protected] Ellen Bobet Confluence Research and Writing (Gatineau) [email protected] Natalie Kishchuk Programme evaluation and applied social research consultant (Montreal) [email protected] Andrew Webster Analyst in health negotiations, litigation, and administration (Ottawa) [email protected] Series editor & co-ordinator: Jill Torrie, Cree Public Health Department Cover design: Katya Petrov [email protected] Photo credit: Catherine Godin This document can be found online at: www.Creepublichealth.org Reproduction is authorised for non-commercial purposes with acknowledgement of the source. Document deposited on Santécom (http://www. Santecom.qc.ca) Call Number: INSPQ-2005-18-2005-002 Legal deposit – 2nd trimester 2005 Bibliothèque Nationale du Québec National Library of Canada ISSN: 2-550-443779-9 © April 2005. All rights reserved Cree Board of Health & Social Services of James Bay, Chisasibi, Quebec JOM 1E0 2 Contents of Volume 1 Chapter 1 Introduction Chapter 2 Methodology Chapter 3 Literature Review: Health and Social Impacts of Large Development Projects on Small Remote Communities Chapter 4 Highlights of Analysis on Health Determinants and Health Status Chapter 5 The Evolving Status of Health Determinants Chapter 6 The Evolution of Cree Health Status Chapter 7 The Evolution of Health Services Chapter 8 Expected Impacts and Implications for Intervention: Lessons from the Literature Review Chapter 9 Measuring the Cree Board of Health against Benchmarks of the Canadian Health Services Research Foundation Appendix A Biographies of Project Team Members Appendix B Critical events in the Development of Health Programmes and Services in the Cree Region Appendix C Health Services Facilities, 1932 – 2004 Bibliography for Volumes 1 and 2 CONTENTS OF VOLUME 2 Chapter 10 Introduction to Volume 2 Chapter 11 Detailed Analysis of the Evolving Status of Health Determinants 1970-2003 Chapter 12 Analysis of Traditional Health Status Indicators Chapter 13 Evolution of Health Services Appendix D Drinking Water and Waste Water Facilities in the Cree Region Appendix E Historical Tables of Mortality and Hospitalisation Data Bibliography for Volumes 1 and 2 i Contents of Volume 2 Glossary................................................................................................................................... vi Chapter 10 - Introduction to Volume 2...........................................................................................1 10.1. Volume 2 in Context........................................................................................................... 1 10.2. Organisation of Volume 2.................................................................................................. 1 10.3. Approach to Chapters 11 and 12–Health determinants and health status, 1970-2003.... 2 10.4. Approach to Chapter 13 – Evolution of Health Services................................................... 3 Chapter 11 – Detailed Analysis of the Evolving Status of Health Determinants, 1970-2003........ 4 11.1. Physical Environment ................................................................................................. 4 11.1.1.Profile of the Cree Communities ................................................................................. 5 11.1.2.Road Access to the Communities ................................................................................ 6 11.1.3.Housing........................................................................................................................ 7 11.1.4.Moulds and Indoor Air Quality.................................................................................. 11 11.1.5. Fire Protection........................................................................................................... 12 11.1.6.Water and Sanitation in the Cree Communities......................................................... 13 11.1.7.Mercury Contamination............................................................................................. 17 11.1.8.Other Contaminants ................................................................................................... 24 11.1.9. Monitoring and Remediation of Contaminated Sites................................................ 26 Endnotes – 11.1. Physical Environment ............................................................................... 27 11.2.Social Environment........................................................................................................... 29 11.2.1.Demographics ............................................................................................................ 29 11.2.2.Culture........................................................................................................................ 33 Endnotes – 11.2. Social Environment................................................................................... 38 11.3.Employment, Occupation and Income.............................................................................. 40 11.3.1.Income........................................................................................................................ 40 11.3.2.Employment............................................................................................................... 43 11.3.3.Occupation ................................................................................................................. 44 Endnotes – 11.3. Income, Occupation and Employment...................................................... 47 11.4.Education .......................................................................................................................... 48 11.3.1.Education - Background ............................................................................................ 48 11.4.2.Trends in Education ................................................................................................... 48 11.4.3.Education Levels in the Cree Region vs. Other Regions........................................... 50 Endnotes – 11.4. Education .................................................................................................. 51 11.5. Personal Health Practices................................................................................................. 52 11.5.1.Nutrition and Body Weight........................................................................................ 52 11.5.2.Smoking ..................................................................................................................... 58 11.5.3.Alcohol and Illicit Drugs ........................................................................................... 61 11.5.4.Preventative Health Practices .................................................................................... 66 11.5.5.Physical Activity........................................................................................................ 67 Endnotes – 11.5. Personal Health Practices.......................................................................... 68 11.6.Health of Mothers and Infants .......................................................................................... 71 11.6.1.Birth Rates ................................................................................................................. 71 11.6.2.Characteristics and Lifestyle Habits of Mothers........................................................ 72 11.6.3.Infant Feeding Practices............................................................................................. 76 11.6.4.Maternal Health ......................................................................................................... 81 ii 11.6.5.Infant Health .............................................................................................................. 84 Endnotes – 11.6. Health of Mothers and Infants .................................................................. 92 11.7.Children’s Health.............................................................................................................. 95 11.7.1.Children’s Health - Self-Rated Health....................................................................... 95 11.7.2.Children’s Health - Communicable Diseases (Enteric, Vaccine-Preventable, and Sexually Transmissible)........................................................................................................ 95 11.7.3.Children’s Health - Disability.................................................................................... 96 11.7.4.Children’s Health - Injury.........................................................................................