Environment Healthand Alberta First Nations Children

Child Health and the Environmentin Aboriginal Communities

Dr Wadieh Yacoub, MD MSc FRCPCMOH/Dir, Health Protection

First Nations and Inuit HealthHealth Canada

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ACKNOWLEDGMENTS

Alberta Health and Wellness – Larry Svenson

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OUTLINE

1. Introduction2. Key determinants of the health of children3. Model of risk exposure4. The various child environments and some of the health impacts

-intrauterine-home: physical and non-physical-outdoor

5. Summary6. Questions

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Introduction

Children are the future 2.3 billion (0-19) in the world (WHO)

Boundless potential Exposed to health risks from environmental hazards Over 40 % of the global burden of disease attributed

to environment falls on children below 5 years of age (who account for 10 % of the world population)

The Numbers in the World                (WHO) 

Each year in the world , 3 million children under 5 die from environment‐related diseases

60% of acute respiratory infections are related to environmental conditions; they kill 2 million children

Diarrheal diseases claim 2 million every year; 80‐90% are related to environmental conditions such as contaminated water and inadequate sanitation

One million under 5 died of malaria in 1998; 90% are attributed to environmental factors

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Key Determinants of Health in Children

Families and relationships Nutrition Income Poverty Physical and social environment Risk behaviour Genetics Health service provision Social attitude and stigma

Adapted from Blair et al, 2004

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The Formula

Risk + risk + risk + social conditions + economic + conflict + poverty

Multiple Exposures Multiple Effects (MEME) model (WHO)

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Child Environment

Physical and social E:major impact on children’s life and health

Traffic, industrial emissions/respiratory illness Housing quality, dampness, poor heating,

overcrowding Lack of good public transport/lack of access to

leisures/adequate safe play space/more TV

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All-Children’s Environments

In the womb

In the home: physical; non-physical (social)

Outdoor: Head start, day care and school yard

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In the Womb

Tobacco smoke

Drugs

Alcohol

Home stress

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In the Home

Age‐Specific Treated Prevalence for Influenza Seen in Physician Offices,First Nations and Non‐First Nations, Alberta, 2008

Age

< 11 - 4 5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89 90+

Trea

ted

Prev

alen

ce p

er 1

00

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

First NationsNon First Nations

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Age‐Specific Treated Prevalence for Pneumonia Seen in Physician Offices,First Nations and Non‐First Nations, Alberta, 2008

Age

< 11 - 4 5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89 90+

Trea

ted

Prev

alen

ce p

er 1

00

0

5

10

15

20

25

30

First NationsNon-First Nations

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Age‐Specific Influenza Rate Ratio (Physician Offices) –First Nations to Non‐First Nations, 1998 to 2008

Age

< 11 - 4 5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89 90+

Rat

e R

atio

0.5

1.0

1.5

2.0

2.5

3.0

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Age‐Specific Pneumonia Mortality Rate Ratio, First Nations to Non‐First Nations, Alberta, 2007

Age

< 11 - 4 5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89 90+

Rat

e R

atio

0

5

10

15

20

25

30

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Age‐Specific Pneumonia Hospital Separation Rate Ratio,First Nations to Non‐First Nations, Alberta, 2008

Age

< 11 - 4 5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89 90+

Rat

e R

atio

0

4

8

12

16

20

17

Age‐Specific Hospital Separation Rate per 100,000 Population for Pneumonia, Alberta, 2008

Age

< 11 - 4 5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89 90+

Sepa

ratio

n R

ate

per 1

00,0

00

0

1000

2000

3000

4000

5000

6000

7000

8000

First NationsNon-First Nations

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Age‐Specific Pneumonia Rate Ratio – First Nations to Non‐First Nations, 1998 to 2008

Age

< 1 1 - 4 5 - 910 - 1

415 - 1

920 - 2

425 - 2

930 - 3

435 - 3

940 - 4

445 - 4

950 - 5

455 - 5

960 - 6

465 - 6

970 - 7

475 - 7

980 - 8

485 - 8

9 90+

Rat

e R

atio

0

1

2

3

4

5

6

7

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Age‐Specific Percent of Patients Seen in Emergency Departments for Influenza, First Nations and Non‐First Nations, Alberta, 2008

Age

< 11 - 4 5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89 90+

Rat

e pe

r 100

0.0

0.2

0.4

0.6

0.8

1.0

First NationsNon First Nations

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In the Home

Non-physical (Social) E and its impact: Emotional stress (family break up and domestic violence) Emotional and behavioural problems Poor personal relationships and difficulty in dealing with

conflict Increased risk of child abuse Increased risk of violence in children Poverty

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Outdoors

Playground safety Water safety Transportation and pedestrian safety Infectious diseases Vaccine preventable diseases Chemical exposure

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Summary: Health Effects of the Environment

Poor air quality respiratory disease

Poor housing asthma, respiratory infections

No safe play areas injuries on streets, obesity, lack of exercise

TV obesity, delayed language development, violence

Social isolation fear of crime, lack of social support

School ethos impact on emotional wellbeing and behaviour

Source: Blair et al, 2004

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YOUR QUESTIONS, PLEASETHANK YOU FOR LISTENING