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1Tobacco Interventions with Aboriginal Peoples

Tobacco Interventions with Aboriginal Peoples TEACH Specialty Course

November 17 & 18, 2011 Toronto, Ontario

Opening Prayer Elder Vern Harper Resident Elder, CAMH Aboriginal Service

Housekeeping • Learning Assessments &

Evaluation• CEPD Certificate• Course Structure• Networking Excursion (Thursday

night)• Expense reimbursement forms• Disclosures• Disclaimers

Have you completed your Learning Assessment 1?

A. I don’t knowB. Yes, I completed it before I walked into

the training roomC. Learning Assessment 1, what is that?

How long is the course?

a. 8:30 AM – 4:30 PM Thursday & Friday b. Start at 8:30 AM, and it’s over when I’m tiredc. This is a course? I thought I was at a tobacco

conference?

Agenda – Brief OverviewDAY 1 DAY 2

Opening, Intro & Overview Opening

Reflections from a Métis Perspective on Commercial Tobacco Cessation Interventions

Best or Promising Practices in Aboriginal Tobacco Cessation

Tobacco from the Past to the Present Diabetes and Commercial Tobacco Misuse

Social Determinants of Health and Legal and Political Framework

Tobacco Interventions with Aboriginal Youth (Panel)

Story Weaving Communities and Context: Adapting Interventions/Examples of Successful Programs and Initiatives

Day 1 Review Drumming Circle

Day 2 Review, Closing

Social Event – Thursday, Nov 17

Big Drum Social• Every Thursday from 6pm – 9pm • Native Canadian Centre of Toronto (NCCT) • www.ncct.on.ca , 416 – 964 – 9087• Located at 16 Spadina Road, North of Bloor by Spadina

Station.

When are the expense forms due?

a. I can send them whenever b. Friday December 16, 2011c. 4 weeks after TEACH weekd. Answers b and c

Have you turned off/silenced your cell, BlackBerry or iphone?

a. No, I don’t have one/didn’t bring mine.

b. No, you’ve got to be kidding, I need to be connected!

c. Yes, I don’t want to disturb others and their learning environment.

The College of Family Physicians of Canada: MAINPRO C (19 credits)

Canadian Addiction Counselling Certification Federation (CACCF) (13 credits)

Ontario College of Pharmacists (13 CEUs)

…and is part of the TEACH Certificate Program in Intensive Cessation Counselling (University of Toronto, Faculty of Medicine)

This course is accredited forCE credits by the following:

A Question or Comment? Please

use the Microphones.

Diversity and Tobacco Cessation• Language

• Openness to feedback

• Respect

• Support

Dr. Peter Selby

Disclosures

Dr. Rita SelbySpousal: Sanofi-Aventis, Boehringer Ingelheim, Bayer(Speaker's honorarium, Advisory board)

Schering Canada (Buprenorphine training 2000)Johnson & Johnson Consumer Health Care CanadaPfizer Inc. Canada, Pfizer GlobalSanofi-Synthelabo CanadaGSK CanadaGenpharm and Prempharm CanadaNABI Pharmaceuticals(Paid consultant and advisory board member)V-CC Systems Inc. and eHealth Behaviour Change Software Co. (Paid consultant)Grants: Health Canada, Smoke Free Ontario, MHP, CTCRI, CIHRAlberta Health Services (formerly Alberta Cancer Board), Vancouver Coastal Authority(Research Funding: Principal & Co-Investigators)

The recipient of the funding is in compliance with the CMA and the CPA guidelines / recommendations for interaction with the pharmaceutical industry.

Disclaimer

Other Disclosures

Elder Vern Harper, Kathryn Leblanc, Ghislaine Goudreau, Helen Bobiwash, Kevin FitzMaurice, Brian Slegers, RichardSan Cartier, AJ Elliot, Jeff Stewart

> No other faculty disclosures

CopyrightCopying or distribution of these materials ispermitted providing the following is noted on all electronic or print versions:© CAMH/TEACH

No modification of these materials can bemade without prior written permission ofCAMH/TEACH.

These materials (and any other materials provided in connection with this presentation) as well as the verbal presentation and any discussions, set out only general principles and approaches to assessment and treatment pertaining to tobacco cessation interventions, but do not constitute clinical or other advice as to any particular situations and do not replace the need for individualized clinical assessment and treatment plans by health care professionals with knowledge of the specific circumstances.

Disclaimer

Disclaimer: TEACH Curriculum DevelopmentThe TEACH Curriculum and slides were developed and compiled with funding from the Government of Ontario, Ministry of Health Promotion. Content of slides are primarilybased on evidence based guidelines and current literature including:

US Guidelines Treating Tobacco Use and Dependence: clinical Practice Guideline 2008 Update. US Department of Health and Human Services, Public Health ServiceCAN-ADAPTT Practice GuidelinesRethinking Stop-Smoking Medications: Treatment Myths and Medical Realities OMA Position Paper, January 2008.

The development or delivery of the TEACH curriculum was not influenced or funded in any part by tobacco industry. TEACH has not received funding from the tobacco industry. The development of the TEACH curriculum has not been influenced by pharmaceutical industry. TEACH project did receive a $10 000 unrestricted grant from Pfizer, to develop video vignettes that are used in our training. Information presented on pharmacotherapy refers to generic products only, and recommendations are based on existing research, including the US guidelines. An algorithm is provided to help practitioners determine if and which pharmacotherapy is appropriate for a smoker.

Special Thanks: Curriculum Working Group

This course has been developed collaboratively thanks to the invaluable work and support of the Curriculum Working Group:

• Nicole Brisson, De dwa da dehs nye>s Aboriginal Health Centre• Robin Chapchuk, Centre for Addiction and Mental Health• Hillary Connolly, Centre for Addiction and Mental Health• Yvonne Corbiere, Aboriginal Tobacco Strategy• Jean-François Crépault, Centre for Addiction and Mental Health• Jeff D'Hondt, Centre for Addiction and Mental Health• Kevin FitzMaurice, Native Studies Department, University of Sudbury• Marilyn Herie, Centre for Addiction and Mental Health, University of Toronto• Alethea Kewayosh, Ministry of Health Promotion• EJ Kwandibens, Ontario Federation of Indian Friendship Centers• Matthew Louie• Peggy Osawanimiki, Ngwaagan Gamig Recovery Centre Inc.• Allan Pelletier, De dwa da dehs nye>s Aboriginal Health Centre• Luciana Rodrigues, Cancer Care Ontario• Richard San Cartier, North Shore Tribal Council• Peter Selby, Centre for Addiction and Mental Health, University of Toronto• Sasha Sky, Thunder Bay District Health Unit• Brian Slegers, Sudbury Regional Hospital• Beverley Sunday, Odawa Native Friendship Centre

What type of work do you do? (Your main job)

a. Direct clinical practiceb. Policy / advocacyc. Management / administrationd. Education / clinical traininge. Other

Ice-Breaker

“What’s your relationship to tobacco?”

Tobacco & Aboriginal Health: Introduction and Overview

Kathryn LeBlancAboriginal Services, CAMHKathryn_leblanc@camh.net

Purposes of Presentation

1. Clarify key concepts and terms

2. b) Introduce CAMH Model of Care and CAMH Aboriginal Service

3. c) Provide broad context for tobacco use/misuse by Aboriginal peoples

Key Concepts and Terms

• When thinking about language it’s important to consider historical and cultural context.

• The terms "Aboriginal“ and "Indigenous" are used as general terms to collectively describe three distinct cultural groups known as the "Inuit", the "Métis" and "First Nations“

• Some terms may be used inclusively and interchangeably during the next two days

Diversity within Aboriginal Population

• Inuit and Métis views will be highly underrepresented

• The term Aboriginal will be used as often as possible in an effort to be inclusive, but it is a broad general term that includes an incredibly diverse set of communities and peoples.

Diversity within Aboriginal Population

• Relationship and teachings about tobacco

• Commercial vs. traditional tobacco

CAMH Philosophy

Care at CAMH…– is informed by a variety of perspectives– means building on client strengths and goals– is supported by a variety of resources both

educational and human– requires each one of us to reflect on our

assumptions, values, and beliefs– requires each one of us to commit to critical thinking– requires each one of us to commit to ongoing

learning, with and from each other.

CAMH Model of Care

• Clinical Practice Guideline & Knowledge Exchange Network

Includes sections on:– Counselling and Psychosocial Approaches– Aboriginal Peoples– Mental Health and/or Other Addiction(s)– Hospital Based Populations– Pregnant and Breastfeeding Women– Youth (Children and Adolescents)

• Opportunities to get involved & provide feedback

www.can-adaptt.net

CAN-ADAPTT Guideline

Level of Evidence Used for Guidelines Development

• Level of evidence/grade of recommendation assigned based on GRADE

Level of Evidence

Strong Weak

1A 1B 1C

2A 2B 2C

Grade ofRecommendation

CAMH Aboriginal Services

MandateAboriginal Services provides culturally appropriate clinical and educational services in partnership with the Aboriginal community and other stake holders, using a holistic approach that is based on Aboriginal values, beliefs and tradition.

Aboriginal Services OfferedDay/Residential cycle

– 21 day cycle approximately (cycle reoccurs approximately once every three months)

Outpatient Program – 6 week program offered for two days per week (cycle reoccurs every 2-3 months)

Individual Counselling – ranges from once per week to once per month, according to client need and availability of counsellors (continuous intake)

Training/Capacity Building -custom designed training in Aboriginal counselling skills is available throughout Ontario (on-going)

Aboriginal Services and Tobacco

- Traditional teachings with Elder - Psycho-educational session for residential clients- Nicotine Dependence Clinic referrals- Change plan work books completed with clients

individually

Why Take a New Approach?• There are Aboriginal people who follow traditional

teachings, there are Aboriginal people who follow some traditional teachings but not others, and there are Aboriginal people who do not practice or follow any traditional teachings.

• It is important to take a pan-Aboriginal approach to programming that addresses ALL of these perspectives.

• If we are to have an impact on commercial tobacco use we need to meet people with programming that is relevant to them whatever their beliefs may be, i.e., traditional teachings,contemporary approaches, or both.

All health care providers should offer assistance to Aboriginal peoples who misuse tobacco with specific emphasis on culturally appropriate methods.(GR/LOE: 1C)

Who is using commercial tobacco?The First Nations and Inuit Health Branch of Health Canada reports the following facts on smoking rates in First Nations and Inuit communities:

– Sixty percent of on-reserve First Nations people between the ages of 18 and 34 currently smoke;

– Seventy percent of Inuit in the north between the ages of 18 and 45 currently smoke;

– Almost half of Inuit (46%) who smoke started smoking at age 14 or younger; and

– The majority of on-reserve First Nations people who smoke (52%) started smoking between the ages of 13 and 16.

Who is using commercial tobacco?• Winter (2001) notes the increasing rates of commercial

tobacco use by Native youth and the rising rates of death among North America's indigenous peoples from lung cancer, heart disease, and other tobacco-related illnesses

• Retnakaran, Hanley, Connelly, Harris and Zinman (2005) found that cigarette smoking at an early age may be a factor contributing to the high prevalence of cardiovascular disease amongst Aboriginal youth in Canada

Who is using commercial tobacco?

• Pregnant and parenting mothers: Heaman (2005) concluded that Aboriginal women are three times more likely to be smoking during and after pregnancy then Non-Aboriginal women.

Who is using commercial tobacco?

• Second hand smokeAboriginal households report that 32% (compared to provincial rates of 18%) of households with children under age 11 experience daily or nearly daily exposure to second hand smoke. (Heart & Stoke Foundation)

Impacts of Tobacco Use

• The Aboriginal Cancer Care Unit (ACCU) (2008a) provides a provincial context for tobacco misuse: the use of tobacco products kills 16,000 people in Ontario every year, making rates among Aboriginal youth 15- 17 years old triple those of 15-17 year olds in the general Canadian Population.

Who is trying to quit?

• Some studies suggest that Aboriginal peoples themselves are more concerned about the ill effects of smoking.

• Hayward, Campbell and Sutherland-Brown (2007) conducted an exploratory, comparative study of the utilisation and effectiveness of tobacco cessation quitlines among Aboriginal and non-Aboriginal Canadian smokers.

• This exploratory analysis shows that even without targeted promotion, Aboriginal smokers do call Canadian quitlines, primarily for health related reasons.

Who is trying to quit?

• Six months after intake, Aboriginals and non- Aboriginals had taken similar actions with 57% making a 24-hour quit attempt.

• Quit rates were higher for Aboriginals than for non- Aboriginals, particularly for men.– The 6-month prolonged abstinence rate for Aboriginal

men was 16.7% compared with 7.2% for aboriginal women and 9.4% and 8.3% for non-Aboriginal men and women, respectively. Hayward, Campbell and Sutherland-Brown (2007)

Resilience & Resistance

• Motivation to quit smoking:– Resistance against colonization– Respect for the sacred medicine – Understanding commercial tobacco use and

intentions of tobacco companies– Winter (2001) also notes that tobacco, when used

properly, can be a life-affirming and sacramental substance that plays a significant role in Native creation myths and religious ceremonies.

Final Thoughts: Rolling with resistance

“Cigarettes are so cheap on the reserve, it costs almost nothing to keep smoking.”

“My mom smoked when she was pregnant with me and I’m fine, why should I stop now that I’m pregnant?”

“I buy Native cigarettes. At least the money goes to Native communities.”

Reflections from a Métis Perspective on Commercial Tobacco Cessation Interventions

Senator Roland St.Germain

15 min Health Break

10:30 -10:45

break!

Tobacco from the Past to the Present

Ghislaine GoudreauMSc (Health Promotion), B.P.H.E.

Helen BobiwashCMA, CAFM

Session Outline

• History of Tobacco and Aboriginal People

• Traditional Use of Tobacco

• History of Commercial Tobacco

• Commercial Use of Tobacco

• The Balance Between Traditional and Commercial Use

HISTORY OF TOBACCO AND ABORIGINAL PEOPLE

History of Tobacco and Aboriginal People

• Tobacco is indigenous to the Americas– Originated in Peru– Mixture of plants were used in the North

• 1535 – Jacques Cartier smoked tobacco with Native Americans on the island of Montreal

• Early 1600, Europeans traded non-indigenous tobacco for fur

What was John Smith looking for when he went to the Americas?

a. Loveb. Goldc. Tobaccod. Corn

TRADITIONAL USE OF TOBACCO

"Tobacco was seen by our people as a gift from the Creator which would enable us to communicate with him. We were given tobacco because it affected the way we were able to think… We were given knowledge to fashion a pipe with which we could take very small puffs of tobacco smoke. We would only take small puffs, and then we would immediately blow out the smoke because smoke was not meant to be taken into our body and held there. The smoke needed to leave us in order to rise to the Creator with our prayers and thoughts. If we held it in our body, it would be an unnatural presence there. Immediately after taking the puff of smoke, our minds would race, and our whole body would be affected by this smoke since tobacco is a very powerful medicine. It has a specific purpose which must not be abused."Elder Danny Musqua, Wunska. First Nations Youth Inquiry into Tobacco use: Final Comprehensive Report to Health Canada, [Saskatchewan Indian Federated College, April 1997], p.52).

Traditionally, tobacco is used for ..

a. Ceremonyb. Medicinec. Prayerd. All of the above

Traditional Tobacco• Protocol around tobacco use

– Ceremonial– Offering– Medicine

• Differences around the traditional protocol of tobacco

Aboriginal Teaching

• Teachings in all cultures forewarned of illness, suffering and death if tobacco was misused. Some teachings forbid humans to inhale the smoke or use tobacco for amusement.

HISTORY OF COMMERCIAL TOBACCO

The first commercial use of tobacco was in the form of …

a. Snuffb. Pipe tobaccoc. Cigarsd. Cigarettes

Bonsack Cigarette Machine

War Rations

COMMERCIAL USE OF TOBACCO

How do Aboriginal people use commercial tobacco?

a. For moneyb. For jobsc. For smokingd. For ceremonye. All of the above

Commercial Tobacco Misuse Among First Nations• 43% of First Nations adults are daily smokers in comparison, 17.1%

of the general Canadian population (2007-2008) are daily smokers. (Source: Statistics Canada, Health Indicator Maps, catalogue no. 82-583-XIE, Vol. 2010, No.1 (CANSIM Table 105-0502).

• The prevalence of smoking by Aboriginal people in Ontario is 40% (Source: Evidence to Inform Smoking Cessation Policymaking in Ontario, Ontario Tobacco Research Unit)

• In Ontario, 37% and 39% of Aboriginal women and men off-reserve are smokers, compared to 19% of non-Aboriginal women and 19% of non-Aboriginal men (Cancer System Quality Index, 2008)

Commercial Tobacco Misuse Among Aboriginal Youth

• Younger First Nations adults, aged 18 to 29 years, have the highest proportion of daily smokers (51.5%). (Source: First Nations Regional Longitudinal Health Survey (RHS) 2008/10)

• There is a significantly higher prevalence of daily smoking among First Nations female youth compared to males, across all age groups. (Source: First Nations Regional Longitudinal Health Survey (RHS) 2008/10)

• 36.6% of First Nations children were exposed to some maternal smoking use. (Source: First Nations Regional Longitudinal Health Survey (RHS) 2002/03)

Commercial Tobacco Misuse Among Aboriginal Youth

• Nearly half of First Nations youth (44.2%) are exposed to cigarette smoke in their homes.

• Children of smokers are more likely to smoke than children of non- smokers

• The average age of First Nation youth who started to smoke is 12

• Youth who smoke are more likely to engage in other substance abuse

Status Indians who purchase cigarettes on reserve are exempt from which taxes?

a. Federal Excise Taxb. HSTc. First Nation Tobacco Taxd. None of the Above

W5 Report – Cheap Cigarettes Flood Canadian Cities

Tobacco Quotas• Provincial system to facilitate the sale of cigarettes

exempt from Ontario tobacco tax

• Ministry of Revenue allocates an annual quantity of cigarettes for sale on reserve that is exempt from tobacco tax

• First Nation allocates the annual quantity among tobacco retailers

THE BALANCE BETWEEN TRADITIONAL AND COMMERCIAL USE

What issues impact a community’s decision-making on tobacco?

a. Electionsb. The latest crisisc. Access to fundingd. All of the above

Political Decisions

Community Tobacco Policy Options

Commercial Misuse

• Smoke free areas• Access to tobacco by

youth• First Nation tobacco

tax• Enforcement of

tobacco

Traditional Use

• Limit use for traditional purposes

• Acquisition of traditional tobacco

• Education about traditional use

Cancer Prevention: Tobacco Wise

Tobacco Plant

National Aboriginal Day Pow Wow

Medicine Wheel Garden

Little NHL

What will our Aboriginal youth choose?

a) Sacred Smoke OR

b) Addictive Substance

c) Talking Circles OR

d) Smoking Circles?

Lets hope a and c!!

Lunch 12:15-12:45

Social Determinants of Health and Aboriginal People in CanadaDr. Kevin FitzMauriceAssistant Professor, Native Studies University of Sudbury

kfitzmaurice@usudbury.ca

Maclean’s Special Report On Health (May 18-25 2009)

Popular View of Health Choices

• Profile of Jaring Timmerman

• 100 years old and in excellent health

• Setting world records in his age category (100 to 104) in 50 to 100m freestyle and backstroke

• Doesn’t drink or smoke and trains every day

• GEDS: Genes, exercise, diet, and maintaining good spirit

Highlights Q-Gap Test: Mental and Physical Well Being

• Prevention through assessment of 100 symptoms of disease and/or discomfort

• Top five Issues: – Hair and skin symptoms– Joint pain and stiffness– Gastrointestinal (bloating and indigestion) – Fatigue

• Provides insight into our lifestyle and personal health choices

• Individual Indicators of Health

Social Determinants of Health

• Compliment Individual Indicators of Health

• Offers Critique of Popular Bias Towards / Reliance Upon Individual Indicators of Health

• Discussion Occurring over Last 50 years: – From Bio-medical / Behavioural Causes to Holistic

Understanding

• World Health Organization 1948: Health is a State of Complete Physical, Mental, and Social Wellbeing

• Ottawa Charter for Health Promotion 1986: The Political, economic, Social/Cultural, Environmental, Behaviour, Biological Factors can all Favour Health or be Harmful to it.

• Health Canada 1998: Proposes Diverse List of Factors of Health, From Culture to Income

‘Across the Life-Span’ 2002• 2002 Conference York University (400 social / health

workers, community reps. and health researchers)

Income Inequality Social inclusion and exclusion

Employment and Job Security Working Conditions

Contribution of the Social Economy Early Childhood Care

Physical environment Education

Food Security Housing

Universal Health Care Peace

How often do you take the Social Determinants of Health into account when working with clients?

a. Never b. Sometimesc. Oftend. All the timee. I’m not sure what determinants of

health are

• The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system.

• These circumstances are shaped by the distribution of money, power and resources at global, national and local (community) levels, which are themselves influenced by policy choices.

• Differences in social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. (WHO 2008)

World Health Organization

• WHO Commission on Social Determinants of Health (2005 to 2008) ‘Closing the Gap in a Generation Report’– Equity in early childhood development– Healthy Spaces– Health Education– Fair, meaningful, and secure employment– Social protection throughout life – Universal health care– Equitable distribution of power, money and

resources

2008 Ontario Public Health Standards‘the health of individual and communities is significantly

influenced by complex interactions between social and economic factors, the physical environment, and

individual behaviours and conditions.’

Income and social status Social and physical environments

Social support networks Personal health practices and coping skills

Education and literacy Healthy child development

Employment and working conditions Biology and genetics

Gender Health services

Culture Language

2009 Report on the State of Public Health in Canada: Growing Up Well – Priorities for a Healthy Future

• Considered a variety of indicators for measuring and improving the state of public child health.

• Top determinant of health: Income and socioeconomic status

‘Children raised and born in low-income families are often impacted by inadequate access to food, affordable housing, and other necessities. This can lead to long-term health problems.’ (2009)

‘Chronic diseases such as coronary heart disease and Type II diabetes are strongly related to living in poverty, as is the incidence of respiratory disease, lung cancer, and some other cancers’ (Smith 2003, Raphael, Anstice, and Raine 2003, Raphael and Farrel, 2002.)

A Structural Challenge to Individualism

• Social Justice – Health Justice

• Behavioural choices structured by material conditions

• Behavioural choices poor indicators of health

What do you think has the greatest impact on your health?

a. Where you went to schoolb. The number of fruits and vegetables you eatc. The neighbourhood that you currently live ind. The amount of exercise you do everydaye. Your income

Traditional 10 Tips For Better Health

Don’t Smoke...or cut down Balanced diet: Fruit & Veggies

Keep Physically Active Manage Stress

Alcohol in Moderation Sun Screen

Drive Defensively Learn First Aid

Safe Sex Cancer Screening

(Donaldson, L. 1999. Ten Tips For Better Health)

Traditional 10 Tips For Better Health

• Intuitive / Social Norms: Focus on individual freedom and choices

• Good health as function of merit and/or reward for good behavior

• Facilitates blaming of client / patient

• Seductive in that it allows us to deny negative social behaviours and systemic patterns of social oppression

10 Tips For Better Health

Don’t be Poor…if unavoidable, reduce Don’t have poor parents

Own a car Don’t work in stressful, menial job

Don’t live in a damp, low-quality house

Be able to afford foreign holidays in order to relax and sunbathe

Don’t lose your job Access health benefits

Don’t live close to a busy road or polluting factory

Learn how to apply for social housing before you become homeless

(Gordon. 1999. Ten Tips For Better Health)

10 Tips For Better Health

• Focus on systemic factors often beyond one’s individual control (marginal voice)

• A core determinant of health: income / social class (social gradient)

• Points to social responsibility / justice = health equity

• Maintain / re-construct local communities and larger welfare state

11th Tip For Better Health

For the most part, don’t be an Aboriginal person living in Canada: First Nation or urban area.

Kashechewan, 2005

Colonial – Postcolonial Tensions

• Michael Thrasher– Body, Mind, Spirit

• Tom Porter– The scattering to Aboriginal bodies

• Colonialism: Systemic control of Aboriginal people and their lands and resources in the interest of accumulating state political and economic power.

We need to move beyond discussions of who colonized who and make the best of our situation today?a. True?b. False?c. Unsure?

Colonization Today

• Negation / denial Gus-Wen-Tah, Treaties, Nation to Nation

• Legacy of explicit policies of cultural repression and forced assimilation

• Systemic federal and provincial regulatory control of Aboriginal lives: jurisdictional confusion, ambivalent policy intentions (White Paper in disguise?)

• Residential School Syndrome

• Post Traumatic Stress Disorder

• Ethno-Stress

• Intergenerational trauma

Colonization Today

For further reading please see: Czyzewski, K. 2011. ‘Colonialism as a Broader Social Determinant of Health’

• Individual and systemic racism• Social isolation • Housing• Water• Incarceration• Unemployment and poverty

Colonization Today

1) Health Canada. 2003. Statistical Profile of Health of First Nations in Canada, Determinants of Health: 1999 to 20032) Statistics Canada. 2006. Aboriginal Peoples Survey3) McCaskill, FitzMaurice. 2007. Urban Aboriginal Task Force: Ontario Final Report4) National Aboriginal Health Organization 2007: Broader determinants of Health in an Aboriginal Context5) McCaskill, FitzMaurice, Cidro. 2011. Toronto Aboriginal Research Project

Sources:

• State possession of Aboriginal land base• Family and community violence• Violence against Aboriginal women specifically • Low relative educational attainment• Low relative health care access• Food insecurity and availability

Colonization Today

Sources:

• Aboriginal governance / indigenization• Exponential expansion of Aboriginal NGOs • Aboriginal women in leadership• A growing urban Aboriginal middle class

Postcolonial Trends

Sources:

• Modern-day treaties / comprehensive land claims • Cultural Revitalization• Governance• Increased educational and employment• Developing Aboriginal rights paradigm

Postcolonial Trends

Sources:

• Physical and discursive struggle– Content of Aboriginal Rights (Section 35)– Boundaries of Aboriginal – Canadian sovereignty– Meaning of nation to nation relations today– The nature of Aboriginal governance

Much Aboriginal distrust and angerMuch non-Aboriginal misunderstanding and confusion

Postcolonial Trends

Today, Nation to Nation / Treaty Relations Can Reasonably Mean?

a. Aboriginal Self-government as a Section 35 Right?b. Status Indians/lands as a federal responsibility.c. Provincial jurisdiction of a diversity of programs

/services to Aboriginal people.d. Some devolution of Fed/Prov responsibility to

municipalities for urban Aboriginal people. e. All of the above

An Unpopular Discourse

‘Yes yes…we understand that we are part of a Nation to Nation relationship….and we accept this, but here is what we have to do to regulate second hand smoke within First Nations environments’

Policy and Regulatory Implications

• Unmet challenges in First Nations tobacco policy development and implementation– Inability to effectively regulate the First Nations

tobacco industry– Inability to manage on-reserve tax regime in

tobacco sales (Indian Act, Section 87)– Inability to effectively implement second-hand

smoke legislation within First Nations communities

(PFSFC. 2007. Towards Effective Tobacco Control in First Nations and Inuit Communities)

Policy and Regulatory Implications cont’d

• Unmet challenges in policy development and implementation– Inability to effectively regulate quality control in

First Nations tobacco production

– Inability to prohibit tobacco advertising and under- age sales within First Nations communities

(PFSFC. 2007. Towards Effective Tobacco Control in First Nations and Inuit Communities)

Challenges to Change: Tobacco Control, Aboriginal Rights, and SDOH

• Limited local health activities in SDOH– Peterborough, Sudbury, and Waterloo D.H.U.

• Encouragement through 2008 Ontario Public Health Standards

• Limited SDOH health policy overall

• Reluctance to focus public health service to Aboriginal people

• Absence of voluntary sector in Aboriginal communities

• Decline of social welfare state

• Globalization and decline of domestic social control

• Growth of market-driven political ideologies: primacy on individual responsibility

• Western cultural health focus on bio-medical model and behavioural choices

• In-spite of an Aboriginal cultural tendency towards a wholistic / SDOH approach to health

• Aboriginal people and their knowledge remain a minority political voice (4% of pop., 2006)

• Widespread ignorance of Indigenous knowledge and issues

• Few allies, and much anti-Aboriginal racism

The Path Forward

• Adopt framework of social inclusion• Promote full employment and job security• Protect universal access to quality health care• Protect and maintain quality education system• Uphold right to adequate housing and food• Reduce income disparities (Social Determinants

of Health Across the Lifespan. 2002)

• Honour Treaty relations• Support Aboriginal governance initiatives in all

sectors• Support Aboriginal efforts towards healing from

colonization and cultural re-emergence• Support quality education of non-Aboriginal society

on Aboriginal issues and knowledge• Support Aboriginal efforts towards the reduction and

elimination of violence

The Path Forward

• Meaningful Nation to Nation,Treaty relations

– Grand Council Chief John Beaucage:‘First Nations call for internal regulation of legitimate

tobacco market’ May 09/09 NFIC

– WHO Framework Convention for Tobacco Control (FCTC)

The Path Forward

The Role of the Health Sector

• Leadership

• Influencer

• Communicator and Knowledge Broker (Social Determinants of Health Across the Lifespan. 2002)

Discussion

Understanding that change is often slow and contingent upon many factors, what are some of the things that you can do to include the SDOH within your daily practice with Aboriginal people?

15 min Health Break

2:15-2:30

Story WeavingBrian Slegers

“What’s your relationship to tobacco?”

Day 1ReviewKathryn Leblanc

Questions?

If you didn’t get enough of TEACH, where can get more ?

– Our website

– Our Online Store

– The resource tab of your Student Homepage

– Our bi-monthly Community of Practice teleconferences and the TEACH ListServ

– All of the above

Please remember to leave your i-clicker on your table, Thanks.

You’re invited to the Social at the Native Canadian Centre of Toronto!

Big Drum SocialEvery Thursday from 6pm – 9pm

www.ncct.on.ca , 416 – 964 – 9087Includes men’s big drum circle, women’s hand drum circle, dancing, feast and Kid’s Arts and Crafts (basement). Located at 16 Spadina Road, North of Bloor by Spadina Station.

Tobacco Interventions with Aboriginal Peoples Interventions with Aboriginal Peoples 1 Tobacco...

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