improving the health of older indigenous canadians

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Editorial www.thelancet.com Vol 382 December 7, 2013 1857 Improving the health of older Indigenous Canadians Refreshingly, 2013 has been a year in which the health inequalities between Indigenous and non-Indigenous peoples have gained greater attention. An early example of this attention was the announcement, in July, by the Australian Government of their 10 year plan to address these inequalities. And, on Nov 28, the Health Council of Canada added to this progress with the publication of Canada’s Most Vulnerable: Improving Health Care for First Nations, Inuit, and Métis Seniors. The authors of the Canadian report set out to explore the health challenges faced by older Indigenous Canadians. Despite the optimism brought by this new crop of publications, the Canadian report opens with a depressingly familiar statement: “little attention has been paid to the health care needs of Aboriginal seniors in either research or public policy, and this has created some growing concerns”. The report goes on to state that a significantly larger proportion of older Indigenous Canadians live on low incomes and have poor health compared with older non-Indigenous Canadians. In many cases the poor physical and mental health is attributable to the disruption of the way of life of the Indigenous people. The health inequalities faced by older Indigenous Canadians are often exacerbated by determinants of health such as poverty, poor housing, racism, language barriers, and cultural differences. Some of these determinants are because these older people are more likely than younger Indigenous Canadians to live in rural and remote communities where most of the population is Indigenous, so they can be more closely connected with their culture. The consequence of living in these remote locations is that it is more difficult and expensive (for both the government and the individuals) to meet the health needs of older Indigenous people. Further complications stem from disagreements about whose responsibility it is to provide health-care services for Indigenous people. Dealing with these jurisdictional issues will be a good place to start; a single body overseeing the provision of health care for Indigenous people will at least allow the auditing of services available and highlight gaps in provision. The only way many older Indigenous Canadians receive the long-term care they need is by leaving their communities and living the rest of their lives in institutions that the report’s authors describe as “not culturally sensitive or safe”. These institutions can be many hundreds of miles from these people’s communities and families. The loss of contact with their communities and families can lead to the deterioration of the physical and mental health of these older individuals. So, clearly, the provision of care within these Indigenous communities, however remote, is preferable to the status quo and might well prove more cost effective. Researchers and leaders of the Indigenous Canadian communities are urging national and local governments to tackle these problems now, before a greater proportion of the Indigenous populations reach an age at which they need long-term services. Demographic factors are increasing the urgency that issues of health provision are addressed soon: collectively the Indigenous population’s growth rate is twice that of the Canadian population overall. One day before the Canadian report, the Australian Bureau of Statistics published the first results of their 2012–13 survey on the health of Indigenous Australians. The findings quantified the scale of the health inequalities between Indigenous and non-Indigenous Australians and hence the size of the challenge faced by those attempting to address the inequality. For many categories of health indicator, Indigenous Australians fared worse than non- Indigenous Australians: they were half as likely to report very good or excellent health, twice as likely to have asthma, more likely to have diseases of the ear or hearing loss, more likely to have heart or circulatory diseases, three times as likely to have diabetes or high sugar levels, more likely to be current daily smokers, and more likely to be obese. These findings underscore the need to reach these communities with accessible and appropriate health services now. Any further delay is simply not acceptable. Although it is reasonable to return to the familiar refrain of asking why in 2013 these inequalities still exist, maybe it is time to look to the future with greater optimism. Both the Canadian report and the Australian survey are the products of national governments, not just special interest groups. The issues faced by Indigenous peoples are now being discussed at levels where tangible action is possible. Although the seriousness of these inequalities demands vigilance, with 2014 imminent, it is time to look to the future with hope. The Lancet For more on the Australian 10 year plan see Editorial Lancet 2013; 382: 367 For the report on older Indigenous Canadians see http://www.healthcouncilcanada. ca/rpt_det.php?id=801 For the survey on the health of Indigenous Australians see http://www.abs.gov.au/ausstats/ [email protected]/Lookup/4727.0.55.001 main+features902012-13 Marilyn Angel Wynn/Nativestock Pictures/Corbis

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Page 1: Improving the health of older Indigenous Canadians

Editorial

www.thelancet.com Vol 382 December 7, 2013 1857

Improving the health of older Indigenous Canadians Refreshingly, 2013 has been a year in which the health inequalities between Indigenous and non-Indigenous peoples have gained greater attention. An early example of this attention was the announcement, in July, by the Australian Government of their 10 year plan to address these inequalities. And, on Nov 28, the Health Council of Canada added to this progress with the publication of Canada’s Most Vulnerable: Improving Health Care for First Nations, Inuit, and Métis Seniors. The authors of the Canadian report set out to explore the health challenges faced by older Indigenous Canadians.

Despite the optimism brought by this new crop of publications, the Canadian report opens with a depressingly familiar statement: “little attention has been paid to the health care needs of Aboriginal seniors in either research or public policy, and this has created some growing concerns”. The report goes on to state that a signifi cantly larger proportion of older Indigenous Canadians live on low incomes and have poor health compared with older non-Indigenous Canadians. In many cases the poor physical and mental health is attributable to the disruption of the way of life of the Indigenous people.

The health inequalities faced by older Indigenous Canadians are often exacerbated by determinants of health such as poverty, poor housing, racism, language barriers, and cultural diff erences. Some of these determinants are because these older people are more likely than younger Indigenous Canadians to live in rural and remote communities where most of the population is Indigenous, so they can be more closely connected with their culture. The consequence of living in these remote locations is that it is more diffi cult and expensive (for both the government and the individuals) to meet the health needs of older Indigenous people. Further complications stem from disagreements about whose responsibility it is to provide health-care services for Indigenous people. Dealing with these jurisdictional issues will be a good place to start; a single body overseeing the provision of health care for Indigenous people will at least allow the auditing of services available and highlight gaps in provision.

The only way many older Indigenous Canadians receive the long-term care they need is by leaving their communities and living the rest of their lives in institutions that the report’s authors describe as

“not culturally sensitive or safe”. These institutions can be many hundreds of miles from these people’s communities and families. The loss of contact with their communities and families can lead to the deterioration of the physical and mental health of these older individuals. So, clearly, the provision of care within these Indigenous communities, however remote, is preferable to the status quo and might well prove more cost eff ective.

Researchers and leaders of the Indigenous Canadian communities are urging national and local governments to tackle these problems now, before a greater proportion of the Indigenous populations reach an age at which they need long-term services. Demographic factors are increasing the urgency that issues of health provision are addressed soon: collectively the Indigenous population’s growth rate is twice that of the Canadian population overall.

One day before the Canadian report, the Australian Bureau of Statistics published the fi rst results of their 2012–13 survey on the health of Indigenous Australians. The fi ndings quantifi ed the scale of the health inequalities between Indigenous and non-Indigenous Australians and hence the size of the challenge faced by those attempting to address the inequality. For many categories of health indicator, Indigenous Australians fared worse than non-Indigenous Australians: they were half as likely to report very good or excellent health, twice as likely to have asthma, more likely to have diseases of the ear or hearing loss, more likely to have heart or circulatory diseases, three times as likely to have diabetes or high sugar levels, more likely to be current daily smokers, and more likely to be obese. These fi ndings underscore the need to reach these communities with accessible and appropriate health services now. Any further delay is simply not acceptable.

Although it is reasonable to return to the familiar refrain of asking why in 2013 these inequalities still exist, maybe it is time to look to the future with greater optimism. Both the Canadian report and the Australian survey are the products of national governments, not just special interest groups. The issues faced by Indigenous peoples are now being discussed at levels where tangible action is possible. Although the seriousness of these inequalities demands vigilance, with 2014 imminent, it is time to look to the future with hope. ■ The Lancet

For more on the Australian 10 year plan see Editorial Lancet 2013; 382: 367

For the report on older Indigenous Canadians see http://www.healthcouncilcanada.ca/rpt_det.php?id=801

For the survey on the health of Indigenous Australians see http://www.abs.gov.au/ausstats/[email protected]/Lookup/4727.0.55.001main+features902012-13

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