Prepared for

DeDwaDaDehsNey>sAboriginal HealthCentre,
OntarioFederationofIndianFriendshipCentres,
HamiltonExecutiveDirectorsAboriginalCoalition,
andtheOurHealthCountsGoverningCouncil
by:
JanetSmylie,MichelleFirestone,LeslieCochran,
ConradPrince, SylviaMaracle,MarilynMorley,
SaraMayo,TreySpillerandBellaMcPherson
April :o::
4
ACKNOWL E DGE ME NT S
TisprojectwasaboutenhancingcommunitywaysofgatheringurbanAboriginalhealth
information,andassuch,couldneverhaveexistedwithouttheactiveparticipationand
vitalenthusiasmofhundredsFirstNationscommunitymemberslivingintheCityof
Hamilton.Itistheintentionofthisreporttohonourthegenerosityofyourparticipation
andwethereforededicatethisreporttomembersoftheFirstNationscommunityin
Hamilton.
Specialthank-youstoallthemembersoftheFirstNationscommunityinHamiltonwho
participated,DonnaLyons,ConnieSiedule,LisaPigeau,JessicaHill,BettyKennedy,
DennisCompton,MandyBerglund,ChesterLangille,theHamiltonExecutiveDirectors
AboriginalCoalition,theSocialPlanningandResearchCouncilofHamilton,Gordon
Gong,CindySueMcCormack,ReneeWetselaar,CrystalBurning,AmyeAnnett,Ashly
MacDonald,TrishaMcDonald,DianeTerrien,AlishaHines,PatOCampo,Rick
Glazier,KellyMcShane,RoseanneNisenbaum,DionneGesinkLaw,CyprianWejnert,
andBrandonZagorski.
TisprojectwasfundedbytheOntarioFederationofIndianFriendshipCentres,the
MinistryofHealthandLong-TermCareAboriginalHealthTransitionFund,andthe
CentreforResearchonInnerCityHealth(cvicu)atSaintMichaelsHospital.Te
InstituteforClinicalEvaluativeSciences(icis)contributedthecostsofthein-houseicis
dataanalysisandDr. SmyliewassupportedbyaCanadianInstitutesforHealthResearch
NewInvestigatorinKnowledgeTranslationawardduringthecourseoftheproject.
TisstudywassupportedbytheInstituteforClinicalEvaluativeSciences(icis),whichis
fundedbyanannualgrantfromtheOntarioMinistryofHealthandLong-TermCare
(moui1c).Teopinions,resultsandconclusionsreportedinthispaperarethoseofthe
authorsandareindependentfromthefundingsources.Noendorsementbyicisorthe
Ontariomoui1cisintendedorshouldbeinferred.
5

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Ann Duggan, MD, FCFP, MPH
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
aduggan@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Connie Siedule, Director of Health
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
csiedule@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Dr. Indu Gambhir
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
igambhir@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Heather Burke, Medical Receptionist
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
hburke@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Aigah Attagutsiak, Case Manager/ Interpreter
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
aattagutsiak@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


#300, 24 Selkirk St
Ottawa, ON, K1L 0A4
Phone: (613)-740-0999
Fax: (613)-740-0991




Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Ann Duggan, MD, FCFP, MPH
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
aduggan@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Connie Siedule, Director of Health
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
csiedule@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Dr. Indu Gambhir
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
igambhir@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Heather Burke, Medical Receptionist
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
hburke@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Aigah Attagutsiak, Case Manager/ Interpreter
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
aattagutsiak@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team






Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Colleen Arngnanaaq
Community Health Researcher
Tungasuvvingat Inuit
297 Savard Ave,
Ottawa, ON K1L 7S1
Tel: (613) 749-4500 Ext. 21
Fax: (613) 749-8713
tirereseacher@tungasuvvingatinuit.ca
www.tungasuvvingatinuit.ca
Hepatitus C

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Ann Duggan, MD, FCFP, MPH
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
aduggan@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Connie Siedule, Director of Health
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
csiedule@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Dr. Indu Gambhir
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
igambhir@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Heather Burke, Medical Receptionist
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
hburke@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Aigah Attagutsiak, Case Manager/ Interpreter
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
aattagutsiak@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


#300, 24 Selkirk St
Ottawa, ON, K1L 0A4
Phone: (613)-740-0999
Fax: (613)-740-0991




Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Ann Duggan, MD, FCFP, MPH
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
aduggan@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Connie Siedule, Director of Health
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
csiedule@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Dr. Indu Gambhir
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
igambhir@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Heather Burke, Medical Receptionist
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
hburke@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team


Aigah Attagutsiak, Case Manager/ Interpreter
#300, 24 Selkirk St. Ottawa, ON, K1L 0A4
Phone: (613)-740-0999 Fax: (613)-740-0991
aattagutsiak@tifht.ca



Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Tungasuvvingat Inuit
_____________________________________
Family Health Team






Your next appointment is:

Date: _______________________________

Time: _______________________________

Comment: ___________________________


*Please give 24 hour notice if cancelling an appointment*

Colleen Arngnanaaq
Community Health Researcher
Tungasuvvingat Inuit
297 Savard Ave,
Ottawa, ON K1L 7S1
Tel: (613) 749-4500 Ext. 21
Fax: (613) 749-8713
tirereseacher@tungasuvvingatinuit.ca
www.tungasuvvingatinuit.ca
Hepatitus C
OUR HE ALT H COUNT S
GOV E RNI NG COUNCI L
WegratefullyacknowledgethefnancialcontributionstothisprojectfromtheMinistry
ofHealthandLong-TermCare,OntarioFederationofIndianFriendshipCentres
andSt.MichaelsHospital.
WewouldliketoacknowledgetheawardgiventoDr.JanetSmyliebytheciuv
NewInvestigatorAwardinKnowledgeTranslation.
7
TABL E OF CONT E NT S
8 EXECUTIVE SUMMARY
16 PROJECT OVERVIEW
:o Introduction
:, Objectives
:8 ProjectDevelopment
: ProjectGovernance
:o ResearchTeam
:o HamiltonSite
22 METHODS
:, CommunityBasedParticipatoryResearch
:, ConceptMapping
: RespectfulHealthSurvey
:, RespondentDrivenSampling
:, icisDataLinkage
:8 CommunityImplementation
29 RESULTS
: ConceptMapping
,: RespectfulHealthSurveyData
o, icisDataLinkage
77 IMPLICATIONS FOR URBAN ABORIGINAL
HEALTH POLICY AND PRACTICE
8, References
8 .vviuix.CommunitysmuResearchAgreement
.vviuixvicisdatasharingagreement
:oo .vviuixcFirstNationsAdultandChildSurveyTool
:: .vviuixuConceptMappingStatements
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E X ECUT I V E S UMMARY
I NT RODUCT I ON T O T HE OUR HE A LT H COUNT S
PROJ E CT A DDRE S S I NG T HE GA P S I N URBA N F I RS T
NAT I ONS HE A LT H DATA I N ONTA RI O:
OverooofOntariosAboriginalpopulationlivesinurbanareas.'Publichealth
assessmentdataforthispopulationisalmostnon-existent,despiteitssize(:,o,,,opersons).
TisisprimarilyduetotheinabilityofOntarioscurrenthealthinformationsystemto
identifyurbanAboriginalindividualsinitshealthdatasets.Healthassessmentdatathatdo
existaremostofenprogramornon-randomsurveybased,notpopulationbased.When
urbanAboriginalpeoplehavebeenincludedincensusbasednationalsurveys(suchasthe
CanadianCommunityHealthSurvey(ccus)thesesurveysarevastlyunderpoweredand
FirstNations,Inuit,andMtisdatacannotbedisaggregated.Fromapopulationandpublic
healthperspective,thisnearabsenceofpopulationbasedhealthassessmentdatais
extremelyconcerning,particularlygiventheknowndisparitiesinsocialdeterminantsof
health.TissituationisunacceptableinadevelopedcountrysuchasCanada.
AsaresultofthesedefcitsinurbanAboriginalhealthinformation,policymakersin
communityorganizations,smallregions,andprovincialandfederalgovernmentsare
limitedintheirabilitiestoaddressurbanAboriginalcommunityhealthchallengesand
aspirations.WithoutAboriginalhealthinformation,efectivehealthpolicy,planning,
program/servicedelivery,andperformancemeasurementarelimited.Movingtoward
basicpopulationhealthmeasuresisessentialtoimprovethehealthstatus,accessto
services,andparticipationinhealthplanningprocessesafectingAboriginalpeople.
Forthepastthreeyears,theOntarioFederationofIndianFriendshipCentres(oiiic),
MtisNationofOntario(mo),OntarioNativeWomensAssociation(ow.),and
TungasuvvingatInuit(1i)havebeenworkingwithahealthresearchteamledby
Dr. JanetSmyliebasedattheCentreforResearchonInnerCityHealth(cvicu),
SaintMichaelsHospital,ontheOurHealthCountsUrbanAboriginalHealthDatabase
project.FortheFirstNationsarmoftheproject,thecommunityorganizationalpartner
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wasDedwadadehsney>sAboriginalHealthAccessCentre,whichrepresentedthe
interestsoftheFirstNationscommunityinHamiltononbehalfofthebroader
HamiltonExecutiveDirectorsAboriginalCoalition.
TegoaloftheOurHealthCounts(ouc)projectwastoworkinpartnershipwith
Aboriginalorganizationalstakeholderstodevelopabaselinepopulationhealthdatabase
forurbanAboriginalpeoplelivinginOntariothatisimmediatelyaccessible,useful,and
culturallyrelevanttolocal,smallregion,andprovincialpolicymakers.
TeOurHealthCountsUrbanAboriginalHealthDatabaseprojectwasfundedbyoiiic,
theMinistryofHealthandLongTermCare(moui1c)AboriginalHealthTransition
Fund,andcvicu.Organizationalpartnersincludedoiiic,mo,ow.,1iandSaint
MichaelsHospital.CommunitypartnersincludedDedwadadehsney>sAboriginal
HealthAccessCentre(onbehalfoftheHamiltonExecutiveDirectorsAboriginal
Coalition),moand1i.
Terewerethreeprojectcommunitysites:FirstNationsinHamilton,InuitinOttawa,and
MtisinOttawa.TisreportfocusesontheFirstNationsinHamiltoncommunitysite,
whichwaschosenastheFirstNationsprojectcommunitysitebecauseofitssignifcant
Aboriginalpopulation(:,,,,,personsreportingAboriginalancestryaccordingtothe:ooo
Census)andstronginfrastructureofAboriginalcommunityhealthandsocialservices.
I NNOVAT I V E ME T HODS :
Community Based Participatory Research Partnerships:
Tisprojectwascarriedoutusingcommunitybasedparticipatoryresearchmethods.
OurapproachpromotedbalanceintherelationshipsbetweentheAboriginal
organizationalpartners,academicresearchteammembers,Aboriginalcommunity
participantsandcollaboratingAboriginalandnon-Aboriginalorganizationsthroughout
thehealthinformationadaptationprocess,frominitiationtodissemination.
TiswasachievedthroughtheprojectgoverningstructureincludingtheprojectGoverning
Councilandresearchanddatasharingagreementsdescribedaboveaswellasensuringthat
capacitybuilding,respect,culturalrelevance,representation,andsustainabilitywerecore
featuresoftheprojectsongoingoverallanddaytodayimplementation.
Concept Mapping and Respectful Health Assessment Survey:
Brainstormingandsortingofideasandtopicsforthesurveyswasdoneusingconcept
mappingwithhealthandsocialservicestakeholdersinHamilton.Onehundredandtwo
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statementsweresortedintoaconceptmapoftendomains.Tesedomainsandstatements
wereusedbytheresearchteamandtocreatequestionnairesforbothadultsandchildren.
Surveyswereconductedinpersonbytrainedinterviewersinitiallywithpaper-based
questionnairesandlaterondirectlyonacomputer.
Respondent Driven Sampling and ICES data linkage
Arespondentdrivensampling(vus)techniquewasusedtorecruitindividualstobe
interviewedfortheresearch.TismethodinvolvedgivingticketstoeachFirstNation
participantwhocompletedaninterview,andtheparticipantscouldgivetheseticketsto
otherFirstNationspeopletheyknew,includingfriendsandfamily.Foreachparticipant
recruited,thepersonwhomadetherecruitreceiveds:o.TeoucFirstNations
Hamiltonsamplingwasextremelysuccessful.Overacourseoffourandahalfmonthsa
totalof,opersonswererecruited,including,,adultsand:,ochildren.Ninety-two
percentofparticipantsgavepermissiontousetheirouivnumbertolinktotheirdataon
healthcaresystemusageavailablethroughtheInstituteforClinicalEvaluativeSciences.
Allthedatafndingspresentedintheresultssectionareadjustedforbiasusingvus
statisticstotakeintoaccounthowspreadoutdiferentparticipantsarewithinthesocial
networkthroughwhichtheywererecruited.
KE Y PROJ E CT F I NDI NGS A ND I MPL I CAT I ONS
F OR HE AT H P OL I CY A ND PR ACT I CE :
Housing, Services for Low Income and Marginalized Populations,
and Addressing Inequities in the Social Determinants of Health:
TeoucstudyidentifedstrikinglevelsofpovertyamongFirstNationsresidentslivingin
Hamilton.Forexample,,8.:oftheFirstNationspersonslivinginHamiltonearnless
thans:o,oooperyearand,ooftheFirstNationspopulationinHamiltonlivesinthe
lowestincomequartileneighbourhoodscomparedto:,ofthegeneralHamilton
population.
Tispovertyisaccompaniedbymarkedchallengesinaccesstohousingandfood
security.Forexample,ooftheFirstNationspopulationlivinginHamiltonhad
movedatleastonceinthepast,yearsandover,oofthepopulationhadmovedthree
ormoretimesinthepast,years.Furthermore,:,oftheFirstNationspopulation
livinginHamiltonreportedbeinghomeless,intransition,orlivinginanyothertypeof
dwellingnotlisted.Inaddition,,,.,ofFirstNationspersonsinHamiltonreported
thattheyliveincrowdedconditions,comparedtoarateof,generalCanadian
population.Finally,o,ofFirstNationscommunitymembersinHamiltonhadtogive
upimportantthings(i.e.buyinggroceries)inordertomeetshelter-related[housing]
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costsandonly::oftheFirstNationspopulationalwayshadenoughofthekindsof
foodthattheywantedtoeat.
Tesefndingshaveresultedinthefollowingpolicyrecommendationsintheareasof
housing,servicesforlowincomeandmarginalizedpopulationsandaddressinginequities
inthesocialdeterminantsofhealth:
Housing:
1. Tatprovincialgovernmentsthathaveresponsibilityforhousingandsupports
(MinistryofHealthandLongTermCareandtheMinistryofCommunityandSocial
Services)engagewithurbanAboriginalcommunitiesandorganizationsforthe
purposeofensuringthatthecommunitiesprioritiesandcriticalneedsintheareasof
afordablerentalhousing,supportiveandtransitionalhousing,andassistedhome
ownershipareaddressedinaccordancewithhumanrightslegislation.
Services for Low Income and Marginalized Populations:
2. Tatalllocalandprovincialagenciesthatoferservicestosignifcantnumbersoflow
income/marginalizedurbanAboriginalpopulationscollaboratedirectlywithurban
Aboriginalagenciesandorganizationsanddevelopandimplementmandatory
Aboriginalculturaldiversitytraining.
Addressing Inequities in the Social Determinants of Health:
3. TatprovincialgovernmentsengagewithurbanAboriginalcommunitiesand
organizationsforthepurposeofestablishingpriorities,resourceandfunding
allocationsandactionplanstoaddressthecriticalinequitiesinalleconomicand
socialconditionsafectingAboriginalhealthincludingpoverty,homelessness,food
insecurity,education,employment,healthaccess,genderequalityandsocialsafety.
Chronic Disease and Disability:
AnotherkeyfndingoftheoucstudywasthatFirstNationspeoplelivinginHamilton
arelivingwithadisproportionateburdenofchronicdiseaseanddisability.Forexample,
therateofdiabetesamongtheadultFirstNationsHamiltonpopulationis:,.o,more
thanthreetimestherateamongthegeneralHamiltonpopulation,despiteamuch
youngeragedemographicoftheFirstNationsHamiltonpopulation.Furthermore,the
prevalencerateofhighbloodpressureamongtheadultFirstNationspopulationin
Hamiltonwas:,.8(comparedtoageneralHamiltonrateof:.,);theprevalencerate
ofarthritiswas,o.,(comparedtoageneralHamiltonrateof:.);andtheprevalence
rateofHepatitisCwas8.,(comparedtoanestimatedOntarioprevalencerateofo.8).
Inaddition,,:ofthetotaladultpopulationandoverthreequarters(,,)ofperson
over,oyearsreportedofenorsometimesexperiencinglimitationsinthekindsor
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amountofactivitydoneathome,workorotherwisebecauseofaphysicalormental
conditionorhealthproblem.Finally,,oofalladultsreportedfairorpoormentalhealth
and:reportedthattheyhadbeentoldbyahealthcareproviderthattheyhada
psychologicaland/ormentalhealthdisorder.Tesefndingshaveledtothefollowing
policyrecommendationregardingchronicdiseaseanddisability:
4. Tatmunicipalandprovincialgovernmentscommittolongtermresourcesand
fundingallocationsandengageswithurbanAboriginalcommunitiesand
organizationsforthepurposesofestablishingpriorities,preventativeactionand
promotionplanstowardsthereductionoftheburdenofchronicdiseaseand
disabilityintheurbanAboriginalcommunity.
Health Care Access:
Teoucstudyfndingsarecompellingwithrespecttotheneedtourgentlyaddressbarriers
inaccessinghealthcareservicesacrossthespectrumofpreventative,primary,andtertiary
care.Forexample,ooftheFirstNationspopulationinHamiltonratestheirlevelof
accesstohealthcareasfairorpoor.Identifedbarriersincludedlongwaitinglists(8),
lackoftransportation(,,),notabletoaforddirectcosts(,:),doctornotavailable(:),
andlackoftrustinhealthcareprovider(:).Strikingdiferencesinemergencyroom
admissionratesbetweenforFirstNationsinHamiltoncomparedtothegeneralHamilton
andOntariopopulationsforbothacuteandnon-acuteillnessesarelinkedbyparticipant
narrativetothebarrierslistedabovetoaccessoftimelypreventativeandprimaryhealth
care.FifytwopercentoftheFirstNationspopulationinHamiltonreportedatleastone
visittotheemergencyroomoverthepast:yearsforacuteproblemscomparedto::of
theHamiltonand:ooftheOntariopopulation.TenpointsixpercentoftheFirstNations
populationinHamiltonreportedoormoreemergencyroomvisitsintheprevious:years
comparedto:.oand:.oftheHamiltonandOntariopopulationsrespectively.
Notwithstandingthisheavyuseofemergencyroomservices,oftheHamiltonFirst
Nationspopulationratedthequalityoftheemergencycareasfairorpoor.Tesefndings
haveledtothefollowingpolicyrecommendationregardinghealthcareaccess:
5. Tatmunicipal,provincialandfederalgovernmentsengagewithurbanAboriginal
communitiesandorganizationsforthepurposesofeliminatingbarriersinaccessto
equitablecommunityhealthcare,emergencydepartmentservicesandinpatient
hospitalservicesforacuteandnon-acuteconditions.
Aboriginal Specific Services, Cultural Safety,
and Aboriginal Self-Determination of Health Care Delivery
Despitethechallengesdescribedabove,FirstNationspeoplelivinginHamilton
demonstrateremarkableculturalcontinuityandresilience.Eventhoughresourcesand
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programmingforAboriginalculturalprogramminginHamiltonhavebeenextremely
limitedtodateandtheimpactsofcolonizationhavebeensignifcant,oucstudymeasures
indicateastrongsenseofFirstNationsidentityamongtheFirstNationspopulationliving
inHamiltonaswellasastrongdesiretopasscultureandlanguageontothenext
generation.Teoucpre-surveyconceptmappingstudyhighlightedtheideathatOur
HealthDeservesAppropriateandDedicatedCareandthesubsequentrespectfulhealth
assessmentsurveydocumentedthedesireformoreNativehealthcareworkersand
prejudiceandlackoftrustanddiscriminationassignifcantbarriersinaccessing
care.Inresponsetothesefndingsweadvancethefollowingpolicyrecommendations:
Aboriginal Specifc Services for Family Treatment, Mental Health and Maternal Health
6. Tatmunicipal,provincialandfederalgovernmentsensuretheprovisionofadequate
fundingtotheurbancommunityandorganizationsdirectedtowardsthe
developmentandexpansionofculturallyrefective,communitybased,long-term
traditionalfamilytreatmentcentres,urbanAboriginalchild,youthandadultmental
healthfundedstrategiesandmaternalhealth,programsandservices.
Cultural Safety:
7. Tatmunicipal,provincialandfederalgovernmentsandhealthstakeholdersdevelop
andinitiatepoliciestowardstheimplementationofculturalcompetencyand/or
culturalsafetyprogramsthataredesignedanddeliveredbyAboriginalpeoplethat
includestherecognitionandvalidationofAboriginalworldviewsandfullinclusion
ofAboriginalhealers,medicinepeople,midwives,communitycounselorsandhealth
careworkersinallcollaborativeefortswithwesternmedicine.
Aboriginal Self-Determination of Health Care Delivery:
8. Tatmunicipal,provincialandfederalgovernmentsrecognizeandvalidatethe
Aboriginalculturalworldviews(thatencompassesthephysical,mental,emotional,
spiritual,andsocialwell-beingofAboriginalindividualsandcommunities)andthat
self-determinationisfundamentalandthusAboriginalpeoplemusthavefull
involvementandchoiceinallaspectsofhealthcaredelivery,includinggovernance,
research,planninganddevelopment,implementationandevaluation.
Childrens Health:
ParentsandcaregiversofFirstNationschildreninHamiltonhighlyvaluethe
transmissionofFirstNationscultureandlanguagetothenextgeneration.Forexample,
theoucstudyfoundthat,ofparentsandcaregiversfeltitwasveryorsomewhat
importantfortheirchildtolearnaFirstNationslanguageandofparentsand
caregiversfeltthattraditionalculturaleventswereveryorsomewhatimportantintheir
childslife.
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AdditionalkeystudyfndingsregardingFirstNationschildrenshealthincludedthe
burdenofchronicillnessfacingFirstNationschildreninHamilton;concernsregarding
childdevelopment;andlongwaitinglistsasabarriertoaccessinghealthcare.Asthma
andallergieswerethemostcommonlyreportedchronicconditions.Ratesofasthmawere
twiceashighforHamiltonFirstNationschildrencomparedtogeneralCanadianratesfor
children.Ratesofchronicearinfectionswerealsohigh.Twenty-twopercentofparents
andcaregiverswereconcernedabouttheirchildsdevelopment.While8,ofparticipants
indicatedthattheirchildhadseenafamilydoctor,generalpractitionerorpediatricianin
thepast::months(comparedto88forthegeneralCanadianpopulationagedo-o
years),therewereasignifcantnumberofreportedbarrierstoaccessingcare.Tenumber
onebarriertoreceivinghealthcarereportedbychildcustodianswasthatthewaitlistwas
toolong.Inresponsetothesefndings,werecommendthefollowingpolicies:
9. Tatmunicipalandprovincialgovernments,includingschoolboards,recognizethe
importanceofandcommitlongtermfundingandresourcestowardsAboriginal
childrenslanguageandculturalprogrammingincollaborationwithurban
Aboriginalorganizationsandagencies.
10. Tatmunicipalandprovincialgovernmentsworkincollaborationwithurban
AboriginalagenciesandorganizationstoreduceurbanAboriginalchildrenshealth
statusinequitiesbyeliminatingbarrierstourbanAboriginalchildrenaccessing
regularprimaryhealthcare,reducinglongwaitinglistsandrespondingtothe
increasedprevalenceofhealthconditionssuchasasthmaintheurbanAboriginal
childpopulationwithcustomizedculturallyappropriateprimaryhealthcare
programming.
11. Tatmunicipalandprovincialgovernmentsworkinpartnershipwithurban
AboriginalagenciesandorganizationstoensurethaturbanAboriginalchildrenare
accordedtheirhumanrightstoliveinhealthyhomesandcommunitiesandattend
dayprograms/schoolsinhealthyenvironmentsthatdonotexacerbatechronichealth
conditionssuchasasthmaandallergies.
Research:
UrbanFirstNationsorganizationsandcommunitymembersinHamiltonsuccessfully
partneredwithprovincialAboriginalorganizationsandacademicresearchersinthe
collection,governance,management,analysisanddocumentationoftheirownurban
FirstNationshealthdatabase.Successfulresearchoutcomesincluded:
CompletionofacommunityconceptmappingprojectthatidentifedFirstNations
specifchealthdomains.
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DevelopmentandimplementationofacustomizedFirstNationsadultandchild
healthneedsassessmentsurveywhichwasadministeredto,,adultsandonbehalf
:,ochildren(total,ocommunitymembers)livinginthecityofHamilton.
SuccessfullinkageofrecruitedFirstNationscohorttotheInstituteofClinical
EvaluativeSciencesdatabase.
StatisticallyrigorousRespondentDrivenSampling(vus)allowedforsuccessful
derivationofpopulationbasedestimatesofsurveyandInstituteforClinical
EvaluativeSciences(icis)FirstNationscohortmeasures.
Collaborativeproductionofthisprojectreport.
TeOurHealthCountsresearchprojectdemonstratesthatresearchcanbedoneby
AboriginalpeopleforAboriginalcommunitybeneft.Asaresult,weputforwardthe
followingpolicyrecommendationregardingresearch:
12. Tatmunicipal,provincialandfederalgovernmentsandurbanAboriginal
organizationsrecognizethehealthstatusinequitiesanddisparitiesofurban
AboriginallivinginthecityofHamiltonandadvocateforfundedurbanAboriginal
specifcappliedhealthservicesresearch.
System Planning:
Teabovepolicyrecommendationsareprefacedontheneedforthere-establishmentof
keyrelationshipsbetweenmunicipal,provincial,andfederalgovernmentsandurban
Aboriginallocalandprovincialorganizations.Inparticularthereisaneedtoensurethat
unresolvedjurisdictionalaccountabilitiesdonotcontinuetoperpetuateunnecessaryand
resolvablehealthdisparitiesforurbanAboriginalpeoples.Suchpressingandsignifcant
healthinequitiesareunacceptablegiventherelativeamuenceofOntarioandCanada
globally.Toaddressthesedevastatinghealthandsocialinequitiesanddisparities
experiencedbyurbanAboriginalpeopletodaythesefnalpolicyactionsarerequired:
13. Tatmunicipal,provincialandfederalgovernmentssupportinteragency
collaborationandcooperationamongsturbanAboriginalserviceproviderstowards
thedesignanddeliveryofservicesandidentifcationoffundingandresearch
opportunities.
14. Tatmunicipal,provincialandfederalgovernmentscollaboratewithurban
AboriginalagenciesandorganizationsandgainknowledgeoftheurbanAboriginal
healthdeterminantsandhealthinequitiesandfurtheracknowledgetheurban
Aboriginalcommunitiesrighttoself-determinationinthecontrolofplanning,
design,developmentanddeliveryofculturallyspecifchealthservices,programs
andpolicy.
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PROJ ECT OV E RV I E W
I NT RODUCT I ON
OverooofOntariosAboriginalpopulationlivesinurbanareas.'Publichealth
assessmentdataforthispopulationisalmostnon-existent,despiteitssize(:,o,,,opersons).
TisisprimarilyduetotheinabilityofOntarioscurrenthealthinformationsystemto
identifyurbanAboriginalindividualsinitshealthdatasets.Healthassessmentdatathatdo
existaremostofenprogramornon-randomsurveybased,notpopulationbased.Existing
potentialsamplingframesareeithernotaccessible(ie.StatisticCanadaCensus)orrefect
biased,non-randomsubpopulations(ie.program/serviceclientslists,membershiplists,
andMtisregistry).WhenurbanAboriginalpeoplehavebeenincludedincensusbased
nationalsurveys(suchastheCanadianCommunityHealthSurvey(ccus))thesesurveys
arevastlyunderpoweredandFirstNations,Inuit,andMtisdatacannotbedisaggregated.
WedoknowfromtheCanadianCensusthatFirstNations,Inuit,andMtispopulations
experienceongoingdisparitiesinsocialdeterminantsofhealthsuchasincomesecurity,
employment,education,andadequatehousingcomparedtonon-AboriginalCanadians
andthatthesedisparitiespersistwithurbanresidence.`Fromapopulationandpublic
healthperspective,thisnearabsenceofpopulationbasedhealthassessmentdatais
extremelyconcerning,particularlygiventheknowndisparitiesinsocialdeterminantsof
health.TissituationisunacceptableinadevelopedcountrysuchasCanada.
AsaresultofthesedefcitsinurbanAboriginalhealthinformation,policymakersin
communityorganizations,smallregions,andprovincialandfederalgovernmentsare
limitedintheirabilitiestoaddressurbanAboriginalcommunityhealthchallengesand
aspirations.WithoutAboriginalhealthinformation,efectivehealthpolicy,planning,
program/servicedelivery,andperformancemeasurementarelimited.Movingtoward
basicpopulationhealthmeasuresisessentialtoimprovethehealthstatus,accessto
services,andparticipationinhealthplanningprocessesafectingAboriginalpeople.
Forthepastthreeyears,theOntarioFederationofIndianFriendshipCentres(oiiic),
MtisNationofOntario(mo),OntarioNativeWomensAssociation(ow.),and
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TungasuvvingatInuit(1i)hasbeenworkingwithahealthresearchteamledbyDr. Janet
SmyliebasedatCentreforResearchonInnerCityHealth(cvicu),SaintMichaels
Hospital,ontheOurHealthCountsUrbanAboriginalHealthDatabaseproject.Forthe
FirstNationsarmoftheproject,thecommunityorganizationalpartnerwasDedwada
dehsney>sAboriginalHealthAccessCentre,whichrepresentedtheinterestsoftheFirst
NationscommunityinHamiltononbehalfofthebroaderHamiltonExecutiveDirectors
AboriginalCoalition.
TegoaloftheOurHealthCounts(ouc)projectwastoworkinpartnershipwith
Aboriginalorganizationalstakeholderstodevelopabaselinepopulationhealthdatabase
forurbanAboriginalpeoplelivinginOntariothatisimmediatelyaccessible,useful,and
culturallyrelevanttolocal,smallregion,andprovincialpolicymakers.
TeOurHealthCountsUrbanAboriginalHealthDatabaseprojectwasfundedbyoiiic,
theMinistryofHealthandLongTermCare(moui1c)AboriginalHealthTransitionFund,
andcvicu.Organizationalpartnersincludedoiiic,mo,ow.,1iandSaintMichaels
Hospital.CommunitypartnersincludedDedwadadehsney>sAboriginalHealthAccess
Centre(onbehalfoftheHamiltonExecutiveDirectorsAboriginalCoalition),moand1i.
Terewerethreeprojectcommunitysites:FirstNationsinHamilton,InuitinOttawa,and
MtisinOttawa.TisreportwillfocusontheFirstNationsinHamiltoncommunitysite.
PROJ E CT OB J E CT I V E S
Formalizing Intersectoral Partnerships and Establishing Priority Measures
1. ToformalizepartnershipsbetweenthefourcoreurbanAboriginalprovincial
organizations,themultidisciplinaryacademicteam,theOntariomoui1c,andthe
InstituteforClinicalEvaluativeSciences(icis)forthisprojectthroughresearch
agreementsanddatamanagement/governanceprotocols.Tiswillincludethe
establishmentofanAboriginalHealthDataGovernanceCouncilcomprisedofthe
fourcoreurbanAboriginalprovincialorganizations.
2. Toconfrmpriorityhealthdomainsandbestindicatorsforeachdomainthrough
thesepartnerships.
Knowledge Development through Establishment of a Population Health Data Base
3. Togeneratenewhealthdatasetsrefectiveoftheseprioritiesforasampleofurban
FirstNations,Inuit,andMtisadultsandchildrenusingrespondentdrivensampling,
securedatalinkagewithicisandarapidhealthassessmentquestionnaire.
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Capacity Building, Training and Mentoring
4. TostrengthencapacityandleadershipamongOntariosurbanAboriginal
communitiesandtheirpolicy,programandhealthservicecollaboratorsintheareaof
Aboriginalhealthinformationcollection,analysis,andapplicationthrough:a.the
involvementofcommunityrepresentativesasactiveresearchteammembersinall
aspectsofthisproject;b:aseriesofcommunity-basedhealthdatauseworkshops.
5. Toprovideascientifcallyexcellentandculturallyrelevanttrainingandmentorship
environmentforAboriginalhealthresearchersattheundergraduate,graduate,post-
doctoralandnewinvestigatorlevel.
Knowledge Dissemination, Application, and Contribution to Future Projects
6. Tosupportcommunity-based,smallregion,provincial,andfederaluptakeand
applicationofhealthdatageneratedthrough:-,abovetoFirstNations,Inuit,and
Mtishealthpolicies,programs,andservices.Tiswillincludetheestablishmentof
anAboriginalhealthdatausersgroup,whichwillhaveopenmembershipandallow
diversestakeholdersinputandaccesstodatageneratedbytheproject.
7. Tobuildontheoutcomesofthisstudytodesignfuturelongitudinalhealthstudiesin
partnershipwithFirstNations,Inuit,andMtisgoverning/organizational
stakeholdersaswellasadditionalstrategiestoimprovethequalityofFirstNations,
Inuit,andMtishealthdatainOntario.
8. TosharestudyresultsandadaptationprocesseswithFirstNations,Inuit,andMtis
stakeholdersinotherprovincesandterritoriesandtherebycontributetothe
developmentofurbanAboriginalhealthdataenhancementstrategies.
PRE L I MI NA RY PROJ E CT DE V E L OPME NT
Inthefallof:oo,SylviaMaracle(oiiic)approachedDr. Smylie(cvicu)toseeifshewas
interestedincollaboratingontheimprovementofurbanAboriginalhealthdatasets.
Overthenextfewmonths,1i,moandow.joinedtheprojectteam.Ofnote,
Dr. Smyliehadapre-existingresearchrelationshipwithoiiic,1i,andmo.Ina
previouslyunfundedprojectproposalwritteninpartnershipwiththeTungasuuvingat
InuitFamilyResourcesCentre,Smylieandcolleagueshadidentifedrespondentdriven
samplingasapromisingmethodforidentifyinganurbanInuitcohortforhealth
assessment.AsmallgrantfromthePublicHealthAgencyofCanadawasusedtofunda
researchplanningmeetinginMarch:oo8.Atthismeeting,researchprinciples,
partnerships,andmethodswerefurtherdeveloped.Afullresearchproposalwas
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submittedbyoiiiconofbehalfoftheresearchpartnerstotheAboriginalHealth
TransitionFund,moui1cOntarioinJune:oo8.
Teprojectteamwastentativelyinformedofthesuccessoftheirapplicationinlate:oo,
howeverfederalandprovincialfundingdelaysresultedinno.u1imoniesarrivinguntil
theendofMarch:oo.FortunatelybothoiiicandcvicuatSaintMichaelsHospital
wereabletoidentifyprojectstart-upfundsandtheprojectwasformallyinitiatedin
January:oo.
PROJ E CT GOV E RNA NCE
AllofthecoreorganizationsinvolvedintheOurHealthCountsProject(oiiic,mo,
1i,ow.,andcvicu)agreeduponthefollowingresearchprinciples:
AboriginalLeadership
ResearchAgreementsandDataManagement/GovernanceProtocols
CapacityBuilding
Respect
CulturalRelevance
Representation
Sustainability
Tefrstprinciple,Aboriginalprojectleadership,wasoperationalizedbythe
establishmentoftheOurHealthCountsprojectGoverningCouncil,whichwas
comprisedofrepresentativesfromoiiic,mo,1i,andow.asvotingmembersand
Dr. JanetSmyliefromcvicuasanon-votinggoverningcouncilparticipantwhowas
alsoidentifedasthescientifcdirectorfortheproject.MonthlyGoverningCouncil
meetingswereheldthroughoutthelengthoftheproject.
Tesecondprinciple,researchagreementsanddatamanagementandgovernance
protocols,wasoperationalizedinawaythatensuredthattheoucGoverningCouncil
aswellastheFirstNations,Inuit,andMtiscommunityprojectpartnerswereableto
exercisetheirrightstogovernandmanageprojectdata,includingtherightstoown,
control,haveaccesstoandpossessprojectdata.Tostartwith,thefourGoverning
CouncilorganizationalmembersdevelopedandsignedaprojectmoU.Next,theouc
projectteamsuccessfullydevelopedandnegotiatedcommunityresearchagreements
witheachofthethreecommunityprojectsites.TeFirstNations(oiiicanduu.c)
smuresearchagreementisattachedinAppendixA.Finally,atri-partydatasharing
agreementwasnegotiatedbetweentheInstituteofClinicalandEvaluativeService,the
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oucGoverningCouncil(oiiic,mo,ow.and1i)andthecvicuatStMichaels
hospital(AppendixB).
RE S E A RCH T E A M
Aboriginal Governing Council Members:
SylviaMaracle(oiiic),ConnieSiedule(1i),DonnaLyons(mo),BettyKennedy(ow.),
JanetSmylie(cvicu)
Academic Research Team Members:
JanetSmylie(ScientifcDirector),PatOCampo,RickGlazier,MarciaAnderson,Kelly
McShane,RoseanneNisenbaum,DionneGesinkLaw,MichelleFirestone
Project Staff:
CherylMcPherson,ConradPrince(cvicu);DeborahTagornak,ColleenArngnanaaq,
JessicaDemeria,LeslieCochran,CrystalBurning(CommunitySiteLeads);Amye
Annett,AshlyMacDonald,TrishaMcDonald,DianeTerrien,AlishaHines(Community
Interviewers)
Additional Collaborators:
VasanthiSrinivasan(Director,HealthSystemPlanningandResearchBranch,moui1c);
FredrikaScarth(ActingManager,Research,HealthSystemPlanningandResearch
Branch,moui1c);SueVanstone(Manager,AboriginalHealthStrategyUnit,moui1c);
DonEmbuldeniya(Manager,HealthSystemInformationandManagementBranch,
moui1c);KellyMurphy(DirectorofKnowledgeTranslation,cvicu);LeslieMcGregor,
Director,NoojamawinHealthAuthority,PaulaStewart(CentreforChronicDisease
PreventionandControl,PublicHealthAgencyofCanada)
HA MI LT ON S I T E
TeoiiicidentifedtheCityofHamiltonasapromisingFirstNationscommunity
projectsite,basedonitssignifcantAboriginalpopulation(:,,,,,personsreporting
Aboriginalancestryaccordingtothe:oooCensus)andstronginfrastructureof
Aboriginalcommunityhealthandsocialservices.
Inthespringof:oo8,oiiicExecutiveDirectorSylviaMaracletravelledtoHamiltonwith
Dr. SmylietomeetwiththeHamiltonExecutiveDirectorsAboriginalCoalition(uiu.c)
totellthemabouttheproject.Teuiu.cagreedtomoveforwardwiththeprojectand
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identifedtheDedwadadehsney>sAboriginalHealthAccessCentre(u.uc)asthe
organizationalprojectlead.
TeCityofHamiltonislocatedinsouthernOntario,,ominuteswestofTorontoand:.,
hourseastofLondon.LocatedonwhatwastraditionallyHaudenosaunee(Iroquoian)
territory,HamiltonissituatedneartwoFirstNationsreserves:SixNationsoftheGrand
RiverandMississaugasoftheNewCredit.Te:oooCensusstatisticsshowthatthetotal
AboriginalpopulationinHamiltonis:,,,,,byancestrycomprising:.8oftheoverall
populationofthecity(,,,,).Te:oooCensusisknowntohavesignifcantunder-
representationoftheFirstNationspopulationintheHamiltonarea,includingbutnot
limitedto:personswhochoosenottoparticipateintheCensusforpersonaland/orpolitical
reasons;personswhoparticipateinthecensusbutchoosenottoidentifyasFirstNationsor
donotidentifybecausetheethnicityquestionsdontmatchtheirself-identify;andpersons
whoarehomelessorwithoutapermanentaddress.Treethousand,twohundredandsixty
peoplelivingintheCityofHamiltondeclaredtheyareregisteredIndians,accordingtothe
IndianAct.TisnumberofpersonswhoidentifedasRegisteredIndiansislikelyagross
underestimateasforpoliticalandculturalreasonsmanyFirstNationspersonslivingin
Hamiltonmayhaverejectedanotionofself-identifcationthatdrawsonfederalIndianAct
legislationeventhoughtechnicallytheyarerecognizedbythislegislationasRegistered
Indians.Ofnote,SixNationswasoneof::reservesthatdidnotparticipateinthe:ooo
censusandgiventhegeographicandfamilytiesthatmanyFirstNationspersonsin
HamiltonhavewithSixNationsthisboycottwouldhavehadanimpactonthecensus.
Teu.ucprovidesprimarycare,traditionalhealingandhealthpromotionprogramsto
nearlyooooAboriginalpeoplelivinginbothHamiltonandBrantford,Ontario.Its
missionisimprovingthewellnessofAboriginalindividualsandthecommunityby
providingservicesthatrespectpeopleasindividualswithadistinctiveculturalidentity
anddistinctivevaluesandbeliefs.Whileu.uciscentrallylocatedandatouchstonefor
manyAboriginalpeoplelivinginbothHamiltonandBrantford,theOurHealthCounts
studyonlycollectedhealthinformationfromtheFirstNationspopulationwhowere
residenttotheCityofHamilton.
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RE S E ARCH ME T HODS
ME T HODS S UMMA RY
Tisprojectwascarriedoutusingcommunitybasedparticipatoryresearchmethods.
OurapproachpromotedbalanceintherelationshipsbetweentheAboriginal
organizationalpartners,academicresearchteammembers,Aboriginalcommunity
participantsandcollaboratingAboriginalandnon-Aboriginalorganizations
throughoutthehealthinformationadaptationprocess,frominitiationto
dissemination.
Tiswasachievedthroughtheprojectgoverningstructureincludingtheproject
GoverningCouncilandresearchanddatasharingagreementsdescribedaboveas
wellasensuringthatcapacitybuilding,respect,culturalrelevance,representation,
andsustainabilitywerecorefeaturesoftheprojectsongoingoverallanddaytoday
implementation.
Brainstormingandsortingofideasandtopicsforthesurveyswasdoneusingconcept
mappingwithhealthandsocialservicestakeholdersinHamilton.Onehundredand
twostatementsweresortedintoaconceptmapoftendomains.
Tesedomainsandstatementswereusedbytheresearchteamandtocreate.
Questionnairesforbothadultsandchildren.Surveyswereshortenedaferpilot
testinginthecommunity.
Surveyswereconductedinpersonbytrainedinterviewersinitiallywithpaper-based
questionnairesandlaterondirectlyonacomputer.
Arespondentdrivensampling(vus)techniquewasusedtorecruitindividualstobe
interviewedfortheresearch.TismethodinvolvedgivingticketstoeachFirstNation
participantwhocompletedaninterview,andtheparticipantscouldgivethesetickets
tootherFirstNationspeopletheyknew,includingfriendsandfamily.Foreach
participantrecruited,thepersonwhomadetherecruitreceiveds:o.
TeoucFirstNationsHamiltonsamplingwasextremelysuccessful.Overacourseof
fourandahalfmonthsatotalof,opersonswererecruited,including,,adultsand
:,ochildren.
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:ofparticipantsgavepermissiontousetheirouivnumbertolinktotheirdataon
healthcaresystemusageavailablethroughtheInstituteforClinicalEvaluative
Sciences.
Allthedatafndingspresentedintheresultssectionareadjustedforbiasusingvus
statisticstotakeintoaccounthowspreadoutdiferentparticipantsarewithinthe
socialnetworkthroughwhichtheywererecruited.
COMMUNI T Y BA S E D PA RT I CI PAT ORY RE S E A RCH
Community-basedresearchtakesplaceincommunitysettingsandinvolvescommunity
membersinthedesign,implementation,anddocumentationofresearchprojects.Its
principlesandmethodsensurethatprocessesarerelevantandthattheoutcomeshave
tangiblebeneftsforthecommunitiesinvolved.Ithasbeenwidelyusedandadaptedin
researchwithAboriginalcommunities.
Community-based,participatoryresearch(cvvv)wasdeemedthemostappropriate
researchmethodologyfortheoucprojectbecauseituniquelyemphasizesshareddecision
makingamongstudypartnersandbecauseitsupportedtheprinciplesofAboriginaldata
governanceandmanagement.Teoucprojectscvvvapproachdrewontheexisting
researchexperiencesoftheparticipantcoreorganizationsandtheprojectscientifcdirec-
torandsuccessfulmodelsofandrecommendationsregardingcommunity-based
participatoryIndigenoushealthresearch.`Ourapproachpromotedbalanceinthe
relationshipsbetweentheAboriginalorganizationalpartners,academicresearchteam
members,AboriginalcommunityparticipantsandcollaboratingAboriginalandnon-
Aboriginalorganizationsthroughoutthehealthinformationadaptationprocess,from
initiationtodissemination.Tiswasachievedthroughtheprojectgoverningstructure
includingtheprojectGoverningCouncilandresearchanddatasharingagreements
describedaboveaswellasensuringthatcapacitybuilding,respect,culturalrelevance,
representation,andsustainabilitywerecorefeaturesoftheprojectsongoingoveralland
daytodayimplementation.
CONCE P T MA PPI NG
AccordingtoTrochimandKane,conceptmappingisconsideredastructured
methodologyfororganizingtheideasofagroupororganization,tobringtogether
diversegroupsofstakeholdersandhelpthemrapidlyformacommonframeworkthat
canbeusedforplanning,evaluation,orboth.Teoucresearchteamemployedconcept
mappinginordertocreatethreesitespecifcandculturallyappropriatecommunity
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healthsurveyquestionnaires(FirstNations,Inuit,andMtis).Temethodwasidentifed
aspromisinggiventhelonghistoryofusingmapsasatooltodocumenttraditionalland
useandknowledgeinIndigenouscommunities.
Teoucconceptmappingmethodinvolvedthreemaincommunityparticipatorysteps:
(:)GroupBrainstorming,(:)Groupand/orOnlineSortingandRatingand(,)Group
MapInterpretation.
Keyhealthandsocialservicestakeholderswereidentifedinpartnershipwithuu.cand
invitedtoattendagroupbrainstormingsession.Participantswerepurposelyselectedto
ensureadiversityofrepresentationaccordingtoorganizationrepresented,gender,age,
andorganizationalrole(ie.bothstafandclients)wereincluded.Sixteenpersons
participatedintwobrainstormingsessionsandrespondedtothefollowingquestion:
Health and health related issues and topics in the Hamilton First Nations community that
are prevalent, serious, have the fewest solutions, or otherwise important include.
Teresultwas:o:statements.Inasubsequentsortingandratingsession,participants
sortedthesestatementsintopilesthatmadesensetothemandratedeachstatement
accordingtoserviceavailability,needforhealthinformationandoverallhealthconcern.
Conceptsystemssofwarewasusedtocreatepreliminarypointandclustermaps
refectingtheoverallgroupsortandrate.Communitystakeholderswerethenengagedin
twofurthergroupsessionstorefnethesepreliminarymaps.Conceptmappingfndings
arepresentedintheresultssection.
RE S PE CT F UL HE A LT H S URV E Y
Itwasdeterminedveryearlyintheresearchprocessthattheneedsassessmentsurvey
shouldberenamedandreconceptualizedasrespectfulratherthanrapidasthis
wouldbemorefttingwithcommunityprocessesandvalues.
InMarch:oo,GoverningCouncilrepresentativesidentifedpriorityhealthandsocial
issuesthattheywantedtobeincludedintheneedsassessmentsurveys.Drawingonthis
preliminarylistofpriorityareasandexistingsurveytoolstheacademicresearchteam
developedabankofquestions.
Oncetheconceptmappingprocesseswerecomplete,thehealthstatementsandhealth
domainsidentifedintheFirstNationsconceptmappingwereusedtodevelopa
communityspecifcadultandchildhealthsurveyforFirstNationsinHamilton.Survey
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toolswerepilotedwithFirstNationscommunitymemberswhowereotherwiseineligible
forthesurvey(i.e.theirresidencewasoutsideofthecityofHamilton).Tworoundsof
piloting(whichincludedinformedverbalconsent)occurred.Eachsessionprovided
valuablesuggestionsonhowtoimprovethesurvey,howtoadjustlanguagetobecome
morerespectful,andhowtopromotealogicalfowtothequestions.Tesurveyswere
alsosubsequentlyshortened.Academicresearchteammembersthenincorporatedthe
changestothesurveytoolandreturnedafnishedproducttothelocalsurvey
administrationteam.TefnalsurveytoolisattachedinAppendixC.
Tesurveywaslaunchedusingpapersurveyswhiletheacademicresearchteamworked
onfnalizingacomputerbasedversion.TeResearchTeamworkedwithaconsultanton
thedevelopmentofaComputerAssistedPersonalInterviewing(c.vi);however,this
consultantfailedtodeliver.TeResearchTeamthereforeprogrammeditsownc.vi
usingimplementedStatisticalPackagesfortheSocialSciences(svss)sofware.
Specifcally,thesvssDataCollectionAuthorProfessionalwasusedtodevelopand
programthesurveytoolandthesvssDataCollectionInterviewerpackagewasusedto
administerthesurvey.Tispresentedasignifcanttechnicalchallengefortheresearch
teamaswellasdelaysinlaunchingtheelectronicsurvey.Uponcompletionofthe
computerprogram,localsurveyadministratorswereinvolvedinthepilotingprocessof
thesvss c.viandcontributed,inanon-goingmanner,toidentifyissuesarisingwiththe
electronicsurvey.TeHamiltonteamstartedusingthesvsselectronicsurveyinMarch
:o:oonagoforwardbasisandworkedwiththecvicuresearchteamtoinputoveroo
paperflespriortofscalyearend.
RE S P ONDE NT DRI V E N S A MPL I NG
Intheabsenceofanaccessibleandaccuratepopulationbasedsamplingframeforurban
FirstNations,Inuit,andMtiscommunities,theacademicteamandkeyAboriginal
stakeholdersselectedarespondentdrivensamplingtechnique(vus)togenerate
representativesamples.vushasemergedasatechniqueforsamplinghardtoidentify
populationsandhasbeenusedinurbancentresacrosstheworld.''''`Itcombinesa
modifedsnowballorchainreferralsampletechniquewithamathematicalsystemfor
weighingthesamplebasedonself-reportedsocialneworkdatatocompensateforitnot
havingbeendrawnasarandomsample.Eachparticipantisaskedquestionsregarding
theirrelationshiptothepersonwhoreferredthemtothestudyandthesizeoftheir
network,whichallowsthebiasinthesamplingprocesstobeestimatedandunbiased
estimatesofapopulationscomposition(e.g.,age,gender,birthplace),behaviorsand
diseaseprevalencetobeobtained.'`
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SamplesizeswerecalculatedusingtheformulaprovidedbySalgunik''forvus,who
recommendssamplesizesthataretwiceaslargeasthosethatwouldbeneededunder
simplerandomsampling.Basedonthisformulateweoriginallyaimedtorecruit,ooFirst
Nationsadultsand,oochildreninHamilton.Tiswasmodifedto,ooadultsand:,o
childrenasthestudyprogressedasitbecameapparentthatthechildsamplerecruitment
wasrefectingtheagemake-upoftheHamiltonFirstNationspopulation,andthat
childrenwouldmakeupone-thirdofthetotalsampleasopposedtoonehalf.
Invus,thesamplingisdonebystudyparticipantswhoaregiventicketsandaskedto
recruitotherstudyparticipantbygivingoutthetickets.IntheoucFirstNations
Hamiltonvuseachparticipantwasgiven,,ticketsforrecruitment.Foreach
participantrecruited,thepersonwhomadetherecruitreceiveds:o.Anvussampleis
initiatedbyprovidingalimitednumberofpersons(ie.o-::),whothenbecomeknownas
seedswithticketsforrecruitment.ItisnoteworthythatinthepastFirstNationswereat
timescoercedintoparticipatinginharmfulcolonialprocessesbytheuseofincentives,
suchascheeseormoney,whichwouldbedispensedbytheIndianagentinreturnfor
participationincolonialactivites,whichattimesincludedhealthtreatmentsanddata
collection.Ethicallythismeansthatextracautionmayberequiredwhenconsidering
incentivesforparticipationinaresearchstudy,evenwhentheresearchstudyisbeingrun
byFirstNationscommunitymembers.Inthiscase,eventhoughtheuseofincentives
mayhavenegativehistoricalconnotations,thestudydesigniscarefullystructuredto
ensurethatstudyresultswillempowerratherthanharmcommunitymembers.
IntheoucFirstNationsHamiltonvustheuu.coutreachworkeraswellasmembersof
theresearchteamidentifedpotentialseedswhorepresentedadiversedemographicof
FirstNationspeoplelivinginHamilton.Gender,age,familysize,occupation,andwhere
inthecityapersonlivedwereallfactorswhichwereconsideredseedselection.
Inclusioncriteriaforparticipationinthestudyincludedadultswhowereresidentwithin
thegeographicboundariesoftheCityofHamiltonandself-identifedFirstNations/
Native/Indianidentity.Adultsweredefnedaspersons:8yearsofageandolderor
personsyoungerthantheageof:8yearswhowereparents.Techildsurveywas
completedbyparentsorcustodialrelatives/guardiansforallchildrenwhoresidedwith
theadultandwereundertheageof:years.InordernottoexcludeFirstNations
childrenwhowerelivingwithanon-FirstNationbiologicoradoptiveparent/relative/
guardianweadditionallyallowedcouponstobegiventonon-FirstNationspersonswho
werethecustodialparent/relative/guardianofoneormoreFirstNationschildren.
Approximately:opeopleidentifedaspotentialseedsattendedalunchandlearnsession
atuu.cwherethecommunityresearchteamexplainedthestudyanditspotentialto
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improveFirstNationshealthstatusandaccesstoservices.Ofthisgroup,sixpeople
agreedtobecomeseedsandcompletedthesurveywithinaweekoftheirstated
commitment.Eachseedreceivedthreecouponstoreferafriend,acquaintance,family
member,orstrangerintothestudy.Fiveofthesixseedsproducedreferralswithinthe
twoweeksleadinguptotheDecember:ooholidayclosureatu.uc.InFebruary:o:o,
inordertoincreasethenumberofcompletedchildsurveys,twoadditionalseedswere
addedspecifcallytargetingfamilieswithchildren.
TeoucFirstNationsHamiltonsamplingwasextremelysuccessful.Overacourseoffour
andahalfmonthsatotalof,opersonswererecruited,including,,adultsand:,ochildren.
Wewillfurtherdetailintheresultssectionbelowhowlongrecruitmentchainsresultedin
departurefromtheoriginalsamplingbiasandtheachievementofastateofequilibriumin
whichtheprobabilityofrecruitmentintothestudyrefectsthedemographicsofthe
population.Stafatthehealthcentreverifedthissuccessfuldeparturefromtheoriginal
samplingbiasbyobservingstudyparticipantswhotheyhadneverseenbeforeatuu.c.
Usingthevusstatprogramweusedtheself-reportedsocialnetworkandreferral
informationtogeneratepopulationbasedestimatesofthehealthandsocialindicators
includedintheoucFirstNationsHamiltonsurveys.Allthedatafndingspresentedin
theresultssectionarevus-adjustedestimates.
I CE S DATA L I NK AGE
TeInstituteforClinicalandEvaluativeSciences(icis)isanindependent,notforproft
organizationwhosecorebusinessistocontributetotheefectiveness,quality,equity,and
emciencyofhealthcareandhealthservicesinOntario.Itisabletoanonymouslylink
populationhealthinformationcompiledfromanumberofsourcesusingaparticipants
healthcardnumber.Teopportunitytoconnectwithicisenabledtheoucresearch
teamtoproduce,forthefrsttime,urbanAboriginalpopulationbasedratesofemergency
roomuse,hospitaladmissionandparticipationinpreventativescreeningprograms,
includingmammography,Papanicolaou(Pap)testing,andcolorectalcancerscreening.
AdultparticipantsintheoucFirstNationssurveywereabletooptinoroutoftheicis
datalinkageforthemselvesandtheirchildrenontheirconsentforms.
FirstNationsadultandchildparticipantsinoursamplewereidentifedinthelargericis
databaseusingadeterministiclinkagebasedontheirOntariohealthcardnumber,date
ofbirth,andname.Inordertoprotecttheconfdentialityofstudyparticipants,this
linkagewasdoneinternallyaticis,byicisstaf.
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Atotalof,:,FirstNationsstudyparticipants(:ofallstudyparticipants)optedinto
thebaselineicisdatalinkageandweresuccessfullyidentifedintheicisdatabase.Tis
included,:,adults(,ofadultparticipants)and:oochildren(8,ofchildren
participants).
Tablesdescribingincomequintilebycensuspostalcode,emergencyroomadmissions,
hospitaladmissions,andparticipationinpreventativecarescreeningbymammography,
Papanicolaou(Pap)testingtestingandcolorectalscreeningbyoccultbloodwere
producedfortheFirstNationscohort,theCityofHamiltonandtheprovinceofOntario.
TeestimatesfortheFirstNationsincomequintileandhealthcareutilizationwere
adjustedusingthevusstatsofwareprogram,whichwasdescribedinthepreceding
section.vususestheself-reportedsocialnetworkandreferralinformationoftheouc
FirstNationsHamiltoncohorttogeneratepopulationbasedestimates.Tesetablesare
presentedintheresultssection.
COMMUNI T Y I MPL E ME NTAT I ON
TelocalsurveyadministrationteaminHamiltonconsistedoftwositecoordinatorsand
fvesurveyadministrators.Acommunityresearchomcewasestablishedintheuu.c
Hamiltonfacility.Acustomizedtrainingwasconductedforallsurveystafdrawingona
customizedprojecttrainingmanual,whichwaspreparedbythecvicuresearchteam.
Telocalteamwasfurthersupportedbymonthlylargergroupresearchteammeetings
andweeklyvusworkgroupmeetingswhichincludedanvusdataanalyst.Furtherdetails
regardingthespecifcsofcommunityimplementationareavailableuponrequest.
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RE S ULT S
CONCE P T MA PPI NG
Figure 1: First Nations Hamilton Concept Map
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Teinitialbrainstormingsessiongenerated:o:statements,whichareattachedin
AppendixD.Teconceptmappingprocessrevealedtheteninterconnecteddomainsthat
providedtheframeworkfortheFirstNationshealthsurvey.
Atthefnalconceptmapinterpretationmeetingthemapwasplacedinsideacircleandtwo
perpendiculararrowsweredrawnacrossthecircle.Tefrstarrowconnectedthe
disconnectionfromwhoweareclustertothereclaimingwhoweareclusterandthe
secondarrowconnectedtheimpactsofcolonizationclustertotheourhealthdeserves
appropriateanddedicatedcarecluster.Teresultingfgureresonatedwithmedicinewheel
andHaudenosauneelodgeteachings,fgures,anddirections.Teseviewsrefected
traditionalwaysofinterpretingandcontextualizinginformationinalocalmanner.Onekey
stakeholdergavetheresearchteamateachingofthetraditionalwaysoftheHaudenosaunee
peopleandhowthismapinterpretationwasinfactrefectiveofthatteaching.
Forthepurposesofthesurveythehousingandissueslinkedtopovertywerecombined
inthefrstsectionofthesurvey,whichwastitledsocio-demographics.Surveydomains
areasfollows:
Socio-demographics: Tissectionaddressedhousingandmobility,socio-economic
status,foodsecurity,waterquality,andlinkstopoverty.
What happens when we are out of balance: Tissectionaddressedphysical,mental,and
emotionalhealthproblems.Questionsexploredchronicdisease,mentalhealth,fetal
alcoholspectrumdisorder,injuryandacuteillness,sexualandreproductivehealth.
Reclaiming who we are: TissectionaddressedaspectsofFirstNationsidentity.Aseries
ofidentitystatementswerereadtosurveyrespondentsthatspoketoissuesofbelonging,
participationinculturalpractices,self-esteem,andunderstanding.
Disconnection from who we are:Tissectionaddressedsubstanceuse,including
cigarettes,alcohol,illicitandprescriptiondrugs.Perceptionsonthelevelofaccessand
availabilityofhealthserviceswerealsosurveyed,whichincludedtraditionalmedicines
andexperienceswithnon-insuredhealthbenefts.Tissectionalsoaddressedbarriersto
healthcareanduseofanyAboriginalspecifcservicesinthecommunity.
Impacts of colonization: Tissectionaddressedthehealthimpactsofresidentialschools,
childprotectionagencyinvolvement,anddislocationfromtraditionallandsinthelives
ofurbanFirstNationspeople.Questionsaboutracism,discrimination,violence,and
abusewerealsoincluded.
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Lack of government responsibility: Tissectionaskedsurveyrespondentstolistthemain
challengesandstrengthsofthecommunity.Communityserviceswerealsoassessedfor
adequacyforparticularpopulations(i.e.youth,singlemen,TwoSpiritLesbianGay
BisexualTransQueerQuestioningIdentities)andservices(i.e.legal,uivprevention,
pandemicplanning).Tissectionincludedopenendedquestionsforrespondentstolist
anyareasforwhichcommunityresourceswereparticularlylacking.
Importance of the gifs of our children and youth: Wedevelopedachildspecifcsurvey,
theresultsofwhichwillbesummarizedinasubsequentreport.
RE S PE CT F UL HE A LT H S URV E Y DATA
Recruitment Dynamics
AmongthevussampleofFirstNationsinHamilton,,8.ofparticipantswererecruited
viareferraltreesoriginatingfromtwoseeds(seefgure:).Tisisquitetypicalofvus.
Telengthofbothoftheserecruitmentchainsislongenoughthatbothchainswere
abletoovercometheoriginalsamplingbias.Tisusuallyhappensaferoor,wavesof
recruitment.Tesetworecruitmentchainshad:and,:wavesofrecruitmenteach.
Therelationshipbetweenrecruiterandrecruit(accordingtorecruit)wasfriendin
oofrecruitments,relativeorboyfriend/girlfriendin:.oofrecruitments,
acquaintancein8.oofrecruitments,andstrangerin,ofrecruitments.Teaverage
networksizevariedamongparticipants,withameanofo.o,amedianof:o,andarange
of[:,:ooo].Atotalofofrespondentsrecruitedothersintothesample.Temean
numberofrecruitmentsforallsamplemembersis.o;themeannumberofrecruitments
amongthosewhorecruitedis:.o.
Figure 2. Recruitment Tree of First Nations in Hamilton, Our Health Counts
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Methodological Note Regarding the Interpretation of Self-Report Data
Itisimportanttorecognizethatthecycleofpovertyexperiencedbythispopulation
(i.e.reportingofhighmobility,overcrowdingandverylowincome)islikelyassociated
withanunder-reportingofsocio-economicstressorsandillhealth.Tisneedstobe
takenintoconsiderationwheninterpretingtheresultsofself-reportquestionssuchas:
havingtogiveupimportantthingstomeetshelterrelatedcosts;self-reportedbalanced
diet;self-ratedhealth)foranumberofreasons.Firstly,theremaybesomestigmaaround
self-reportingofnothavingthefnancialstabilitytopayrentandmeetotherneeds.
Secondly,individualsinapopulationthathasexperiencedlongstandingadverse
conditionsmayhaveinternalizednotionsofnotbeinggoodenoughandtherefore
acceptwhatothersmightperceiveashardship.Tirdly,loweringexpectationsisa
strategyforsurvivalwhenonefaceschronicandrecurrenthardship.Finally,multi-
generationalexperiencesofadversitymayresultinthenormalizationofwhatoutsiders
livinginmoreprosperouscircumstancesmightconsiderunmetneedsorillhealth.
TefollowingresultsarepresentedaccordingtothedomainsoftheFirstNationshealth
assessmentsurveytool.AsoutlinedintheConceptMappingsectionofthisreport,the
contentofeachdomainanditstitlerefectthehealthprioritiesofFirstNation
communitystakeholders.Teresultsbelowareforadults.Childsurveyresultsare
presentedinalatersectionofthisreport.
DOMA I N 1 : S OCI ODE MOGR A PHI CS
Highlights from Domain 1
NinetypercentoftheFirstNationspopulationlivinginHamiltonhadmovedatleast
onceinthepast,yearsandover,oofthepopulationhadmovedthreeormore
timesinthepast,years.
TirteenpercentoftheFirstNationspopulationlivinginHamiltonreported
beinghomeless,intransition,orlivinginanyothertypeofdwelling.
UsingtheStatisticsCanadadefnitionofcrowdedhousingasmorethanone
personperroom,,,.,ofFirstNationspersonsinHamiltonliveincrowded
conditions.
Sixty-threepercentofFirstNationscommunitymembersinHamiltonhadto
giveupimportantthings(i.e.buyinggroceries)inordertomeetshelter-related
[housing]costs.
Twenty-twopercentoftheFirstNationspopulationsometimesorofendidnot
haveenoughfoodtoeat.
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Demographics
TeOurHealthCounts(ouc)FirstNationsadultpopulationinHamiltonwascomprised
ofatotal,,,participants:oomenandowomen.Formen,aboutathirdofthe
populationfellineachofthefollowingagecategories::8-,years(,.,),,,-(,,.:)
yearsand,o+(,o.,)years.Overall,thefemalepopulationhoweverwasyounger,with
,.,betweentheagesof:8-,,,o.,between,,-and:oovertheageof,o.Among
thisFirstNationspopulation,,o.8indicatedthattheywereStatus(RegisteredIndian
accordingtotheIndianAct).Itisimportanttonotethatthisfgureislikelyan
underestimateoftheproportionofparticipantswhoareRegisteredIndiansasfor
politicalandculturalreasonssomeparticipantsmayhaverejectedanotionofself-
identifcationthatdrawsonfederalIndianActlegislationeventhoughtechnicallythey
arerecognizedbythislegislationasRegisteredIndians.Forexample,community
membersfromSixNationsmayvaluetheirnationidentity(i.e.Haudenosaunee,Mohawk,
Oneida,Onondaga,Cayuga,SenecaandTuscarora)morethantheyvaluebeingIndian.
Whenaskedwhatlanguagewasspokenmostofenathome,,spokeEnglishonly,,spoke
anAboriginallanguageonlyand:spokeFrenchonlyorEnglishandanotherlanguage(see
fgure,).TesenumbersclearlyrefectthedeclineofIroquoianlanguagesduetolongstanding
contactwithcolonizers,theimpactofresidentialschoolsandotherchallenges.Despitesuch
highnumbersofEnglishspokenathome,theimportanceofchildrenlearningaFirstNations
languageathomewasratedveryhighamongthispopulation.
Asfornumberofchildren,,oofthesamplehadnochildren,:8ofthepopulationhad
either:or:children,:,had,children,and:,hadormorechildren.
Figure 3. Language spoken at home for First Nations Adults, Our Health Counts
94.9%
2.7% 2.4%
English Only Aboriginal Language
Only
French Only or
English and Another
Language
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
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Overall,theoucFirstNationspopulationreportedlowlevelsofformaleducation.
Whenaskedthehighestlevelofeducationcompleted,theouc vusadjustedestimatesfor
FirstNationsadultsovertheageof:8yearswere:,,hadcompletedsomehighschoolor
lessand:ocompletedhighschool,:8hadcompletedsomeorallofcollegeandonly
,hadcompletedsomeorallofuniversity.Asacomparison,accordingtothe:ooo
census,:,ofresidentsofthecityofHamiltonaged:,andolderhadsomehighschool
orless,:,hadcompletedahighschooldiploma,:ohadcompletedcollegeand:
hadcompleteduniversity.'IntheoucFirstNationspopulation,thereisevidenceto
suggestatrendtowardsmorewomencompletinghigherlevelsofeducationcomparedto
men.Forexample,:,ofwomencompletedsomeorallofcollegecomparedto:oof
men(seefgure).
Figure 4. Level of Education by Gender for First Nations Adults, Our Health Counts
Whenaskedtoindicatethesource(s)ofthetotalincomeforallhouseholdmembersin
thepast::months,thefollowingresultsemerged:wagesandsalaries(:8.:),income
fromself-employment(,.,),employmentinsurance(.o),ChildTaxBenefts(:,),
Provincialormunicipalsocialassistanceorwelfare(e.g.ousv,OntarioWorks)(o.:),
childsupport(,),anyotherincomesource(:,.,).Clearly,thispopulationisrelying
heavilyonsocialassistance.Whilemorewomenthanmenreportedchildbeneftsand
childsupportasincomesources,moremenreportedincomefromself-employment
(::vs.,)(seefgure,).
Male
Female
59.8%
20.6%
15.6%
4.0%
52.6%
17.4%
23.0%
7.0%
Some High
School or less
Completed High
School
Some or
Completed
College
Some or
Completed
University
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
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Figure 5. Sources of Income by Gender for First Nations Adults, Our Health Counts
Inadditiontosourcesofincome,theoucHamiltonpopulationwasalsoaskedtoindicate
theirpersonalincomefortheyearendingonDecember,:st,:oo8.Basedontheanswers
tothisquestionwedeterminedthefollowingpopulationestimatesforincome::8.,
earnedlessthans,,:,.:earnedbetweens,,oooands,,::.earnedbetween
s:o,oooands:,,:.8earnedbetweens:,,oooands:,and::.8earnedover
s:o,ooo.Asacomparison,accordingtothe:ooocensus,:,ofresidentsofthecityof
Hamiltonaged:,andolderearnedlessthans,,ooo,earnedbetweens,,oooand
s,,:oearnedbetweens:o,oooands:,,earnedbetweens:,,oooands:,
and,,earnedovers:o,ooo.'
WhentheoucFirstNationspopulationwasstratifedbygender,weobservedthatmore
womenfellintothelowerincomebracketwith,:.:ofallwomenwhoreportedearningless
thans,comparedto.,ofmen.Intermsofhigherincome,:o.:ofallmenreported
earningmorethans:o,ooocomparedto:o.ofwomen,howeverthisdiferencewasnot
statisticallysignifcant(seefgureo).Teincomediferencesbetweenmenandwomenare
largerintheoucFirstNationspopulationthanwithinthegeneralpopulationinHamilton.'
Tisincomedatamaybeconsideredamorerigorousrepresentationoftheactualincome
profleoftheFirstNationspopulationinHamiltonthanthe:oooCensusdataasitwas
validatedandadjustedforbiasusingvusstatistics,andtheCensusisknowntohave
signifcantunder-participationbyFirstNationscommunitymembers,particularlyin
HamiltonwheremanyFirstNationsresidentshaveclosetiestothenearbySixNations
FirstNationscommunitywhichdidnotparticipateinthe:ooocensus.TeCensusis
alsoknowntounder-representpersonswhoarehomeless,transientorwhohavelow
literacyskills,allissueswhichhavehigherprevalenceinFirstNationspopulations,and
allissuesthatareassociatedwithlowerincomelevels.Finally,theoucsurveyincome
dataisalsovalidatedbytheouc vusadjustedicisincomequintiledata(reportedinthe
nextsection),whichplacesover,ooftheouccohortintothelowestincomequartile
comparedto:,ofthegeneralHamiltonpopulationand:ooftheOntariopopulation.
Female
Male
13.4%
7.4%
75.4%
28.4%
7.5%
3.0%
26.3%
13.3%
0.0%
64.7%
8.3%
11.0%
10.9%
29.3%
0 10% 20% 30% 40% 50% 60% 70% 80% 90%
Any other Income Source
Child Support
Provincial or Municipal Social Assistance
or Welfare (e.g. ODSP, Ontario Works)
Child Tax Benefit
Employment Insurance
Income from Self-Employment
Wages and Salaries
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Clearly,thispopulationisfacinghighlevelsofpoverty.Povertyissoprevalentinfactthat
thebreakdownofstudyfndingsbyincomecategorieswasnotpossibleduetosuchhigh
numbersinthelowerincomebracketsandlittlevariationintotalearnings.
Figure 6. Income Categories by Gender for First Nations Adults, Our Health Counts
Housing and Mobility
Withrespecttocurrentdwellingtype,around:,ofthepopulationlivedineachofthe
following:asinglehouse(notattachedtoanyotherdwelling),asemi-detached,duplex
house,rowhouse,ortownhouseoraself-containedapartmentwithinasingledetached
house.Mostofthepopulation(:)livedinanapartmentorcondominium.Te
distributionofdwellingtypeacrossgenderswasfairlyconsistent,withtheexceptionthat
amongwomen,:reportedlivinginasemi-detachedhomeorduplexcomparedto8.o
ofmenandthesediferenceswerestatisticallysignifcant.Withintheoveralldwelling
typesinthecityofHamilton,:oofdwellingsareapartments,'whichindicatesthatthe
oucFirstNationspopulationismuchmorelikelytobelivinginapartmentbuildings
thanaverageHamiltonians.
Inaddition,:,oftheoucFirstNationspopulationdescribedthemselvesashomeless,in
transition,orlivinginanyothertypeofdwelling.Tereisalsoatrendtosuggestthat
moremeninthispopulationarehomelessorexperiencetransitionalhousingcompared
towomen(seefgure,).
Terewasastrikinglyhighmobilityreportedamongthestudypopulation.Only:oof
thepopulationhadnomovesoverthepast,years.Over:oofthepopulationhad
moved:timesinthepastfveyears,while:hadmovedbetween,and,timesinthe
past,yearsand:ohadmovedoto:otimesinthepast,years(seefgure8).Tese
numbersareveryhighcomparedtototalurbanpopulationsinCanada.Forexample,
accordingtothe:oooCensus,amongallpeoplelivinginthecityofHamilton,oohad
Male
Female
9.3%
24.8%
25.3%
14.5%
26.1%
31.2%
19.4%
17.5%
14.9%
16.9%
$
0
-
4
,
9
9
9
$
5
.
0
0
0
-
9
,
9
9
9
$
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0
,
0
0
0
-
1
4
,
9
9
9
$
1
5
,
0
0
0
-
1
9
,
9
9
9
$
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,
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0
0

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0.0%
10.0%
20.0%
30.0%
40.0%
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livedatthesameaddress,yearsagoand8,hadlivedatthesameaddress:yearago.'
WithrespecttothetotalurbanAboriginalpopulationsinCanada,the:oooCensus
revealedthat:,ofthetotalurbanAboriginalpopulationhasmovedatleastonceinthe
yearbeforethecensus.'
Tishighmobilitypatternrefectsthecycleofpovertyfacingthispopulation.Frequent
movesputsstressonthefamilyunit;makesitdimculttoengageinregularemployment
andeducationalprograms;andisassociatedwithpoorfoodavailabilityandunstable,
overcrowded,inadequateshelter.
Figure 8. Number of Moves in the Past 5 Years for First Nations Adults, Our Health Counts
Male
Female
15.5%
8.6%
17.5%
42.6%
15.8%
14.6%
24.0%
15.2%
37.4%
8.9%
Single House
(Not attached to
any other
dwelling)
Semi-detached,
Duplex,Row
House or
Townhouse
Self contained
Apartment
within a single
detached house
Apartment or
Condominium
Homeless.
Transistion or
Other
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
10.2%
15.5%
20.2%
41.1%
10.4%
2.7%
No Moves 1 Move 2 Moves 3-5 Moves 6-10
Moves
11+ Moves
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
Figure 7. Dwelling Type by Gender for First Nations Adults, Our Health Counts
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FollowingStatisticsCanadastandards,wecalculatedovercrowdinginthispopulationby
dividingthenumberofroomsineachhousehold(excludingbathroom)bythenumberof
peopleresidinginthehome.UsingtheStatisticsCanadadefnitionofcrowdedhousing
asmorethanonepersonperroom,,,.,ofFirstNationspersonsinHamiltonlivein
crowdedconditions.Specifcally,:,.,ofthepopulationwerelivingwithlessthanor
equalto:personperroom,owerelivingwithmorethan:-:personsperroomand
:o.,werelivingwithmorethan:personsperroom.Terateofhousingcrowdingfor
thegeneralCanadianpopulationaccordingtothe:oooCensuswas,.'
Overtwothirds(o,.:)ofthepopulationfeltthattheirdwellingwasnotinneedof
repairs,butonlyregularmaintenancewasneeded(painting,furnacecleaning,etc.).
Overonequarter(:o.:)ofthepopulationfeltthattheirdwellingneededminorrepairs
(missingorloosefoortiles,bricksorshingles,defectivesteps,railingorsiding,etc.)
ando.,ofthepopulationfeltthatmajorrepairswereneeded(defectiveplumbingor
electricalwiring,structuralrepairstowalls,foorsorceilingsetc.).Tesefndingsare
veryclosetoresultsfromthe:ooocensusfortheoverallcityofHamiltonpopulation
(o,ofHamiltonoccupantsreportedthattheirdwellingonlyneededregular
maintenance,:,reporteddwellingsneededminorrepairs,and,reporteddwellings
neededmajorrepairs).'Tesimilaritiesmaybeduetothequestionbeingverysubjective.
AsoneHamiltonAboriginalcommunitymemberstatedhousinginHamiltonisgreat
comparedtoreservehousing.Tehighproportionofpeoplelivinginunstablehousing
intheoucFirstNationspopulationmaymeanthatformanygoodhousingisjusta
roofovertheirheadandaleaseintheirname.Aswell,thehigherproportionofoucFirst
Nationspopulationwhoaretenantsofapartmentbuildings,andlowerproportionliving
insmallerhousingtypes,maybeafactor.ArecentSocialPlanningNetworkofOntario
reportnotedthattenantsoflargerbuildingsmaybeunawareoftherepairneedsoftheir
dwellings(e.g.roof,sewage,electricity,etc.)unlesstheserepairissuesareimmediately
obvioustotheindividualtenant.Assuch,theextentofapartmentbuildingsdwellingsin
needofmajorrepairmaybeundercounted.'
WithrespecttohowofenFirstNationscommunitymembersinHamiltonhadtogive
upimportantthings(i.e.buyinggroceries)inordertomeetshelter-related[housing]
costs,:,.,hadtogiveupthingsseveralthingsseveraltimesamonth,abouthalfthe
populationhadtogiveupthingsbetweenonceamonthandafewtimesayearand,,
reportedneverhavingtogiveupimportantthings.Whilewomenwereprettyevenly
distributedacrosseachcategory,amongmen,fewerreportedhavingtogiveupimportant
thingswith,sayingtheywereneverfacedwiththissituation.Terewasalsoastrong
trendofmoremenwhoreportedneverhavinggivenupimportantthingstomeetshelter-
relatedcostsascomparedtowomen(seefgure).Asdiscussedatthebeginningof
thissection,itisimportanttorecognizethatthecycleofpovertyexperiencedbythis
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population(i.e.reportingofhighmobility,overcrowdingandverylowincome)islikely
associatedwithanunder-reportingofsocio-economicstressorsandillhealthforreasons
thatweredetailedearlier.
Figure 9. Giving Up Important Things to Meet Shelter-Related Costs by Gender
for First Nations Adults, Our Health Counts
Nutrition and Food Security
I live entirely of of food banks, thats where the nutrition comes in, no choice over food.
I need access to a doctor to sign my special diet form so I can lower my cholesterol
On a fxed income, food money gets short. I fnd myself binge eating the frst two weeks,
the other two weeks I am starving. Te food bank food isnt ft to eat (expired) and high in
sodiumit is depressing.
When I was on the streets or social assistance, the health workers would tell me that I need
to watch what I eat as I am diabetic, it is expensive to eat healthy.
Forself-reportednutritiousbalanceddiet,overall,,ofeltthattheyalwaysoralmost
alwaysateabalanceddiet,ofelttheysometimesateabalanceddietand:feltthey
rarelyorneverateabalanceddiet.Acrossgender,weobservedatrendtowardsmoremen
whoreportedrarelyornevereatinganutritiousdietcomparedtowomen(seefgure:o).
Male
Female
15.0%
23.9%
16.1%
45.0%
19.7%
24.4%
28.4%
27.5%
Several times a
Month
Once a Month A few times a
Year
Never
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
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Figure 10. Self-Reported Balanced Diet by Gender for First Nations Adults, Our Health Counts
Regardingfoodsecurity,afairlyevendistributionacrosstheagegroupsrevealedthatover
,oofthepopulation,bothyoungandoldfeltthattheyandothersintheirhouseholdhad
enoughtoeat,butnotalwaysthekindsoffoodtheywanted.Asimilardistributionwas
revealedforbothmenandwomen,againwithover,oofmalesandfemalesreporting
thattheyandothersintheirhouseholdhadenoughtoeat,butnotalwaysthekindsof
foodtheywanted.Twenty-twopercentofthepopulationsometimesorofendidnothave
enoughtoeat(seefgure::).Havingenoughtoeat,butnotalwaysthedesiredtypeoffood
maybelinkedtoahigherintakeofcarbohydratesandsugars,whichcanleadtofeeling
full,butnotrepresentanutritiousbalanceddiet.Tishigherintakeofcarbohydratesand
sugarinturnislinkedtobloodsugarproblems,includingdiabetes.
DOMA I N 2 : WHAT HA PPE NS WHE N WE A RE OUT OF
BA L A NCE PHYS I CA L , ME NTA L , A ND E MOT I ONA L
HE A LT H PROBL E MS
Highlights from Domain 2
OnlyonequarteroftheFirstNationspopulationlivinginHamiltonreported
excellentorverygoodhealth.Tisself-reportedhealthstatusismuchlowerthan
forthegeneralHamiltonpopulation.
Male
Female
39.3%
33.2%
27.4%
31.9%
48.9%
19.1%
Always or Almost
Always
Sometimes Rarely or Never
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
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Highlevelsofphysicalactivitywerereported,with:oftheFirstNations
populationinHamiltonreportinghavingcompleted,ominutesormoreofmoderate
orvigorousphysicalactivity,daysaweek.
Terateofdiabetesamongtheadultpopulationis:,.o,morethanthreetimesthe
rateamongthegeneralHamiltonpopulation,despiteamuchyoungerage
demographicoftheFirstNationsHamiltonpopulation.
TerateofhighbloodpressureamongtheadultFirstNationspopulationin
Hamiltonwas:,.8.
Terateofarthritiswas,o.,.
TerateofhepatitisCwas8.,.
Fify-twopercentofthetotaladultpopulationandoverthreequarters(,,)of
personover,oyearsreportedofenorsometimesexperiencinglimitationsinthe
kindsoramountofactivitydoneathome,workorotherwisebecauseofaphysicalor
mentalconditionorhealthproblem.
Tirty-sixofalladultsreportedfairorpoormentalhealthand:reportedthat
theyhadbeentoldbyahealthcareproviderthattheyhadapsychologicaland/or
mentalhealthdisorder.
General Health Status and Exercise
OnequarteroftheFirstNationspopulationlivinginHamiltonreportedexcellentor
verygoodhealth.Aslightlyhighernumber(,,)reportedgoodhealth.Twenty-seven
percentand:,reportedfairandpoorhealthrespectively.Tesefndingsshowmuch
Male
Female
28.1%
52.0%
19.9%
24.1%
51.1%
24.8%
Always had enough of
the kinds of food you
wanted to eat
Had enough to eat, but
not always the kinds of
food you wanted
Sometimes or often did
not have enough to eat
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Figure 11. Food Availability by Gender for First Nations Adults, Our Health Counts
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lowerself-reportedhealthstatusthanhasbeenreportedfortheoverallHamilton
populationintheCanadianCommunityHealthSurvey.'Te:oo,ccusreportedthat
,ofHamiltoniansoverage:operceivedtheirhealthtobeexcellentorverygood.'
TesefndingsalsoshowtheFirstNationspopulationinHamiltonhasalowerself-rated
healththanFirst-Nationslivingon-reserve.TeFirstNationsRegionalLongitudinal
HealthSurvey(:oo:-:oo,)reportedthato.:ratedtheirhealthasexcellentorvery
good'(comparedto:,fortheoucFirstNationsPopulation).
Self-ratedhealthstatusvariedacrossagecategoriesandgender.Overall,therewasatrend
towardspersonsover,oyearsreportingpoorerself-ratedhealthstatusthantheiryounger
counterpartswith:ofthoseabove,owhofeltthattheirphysicalhealthwaspoor
comparedto:oofthosebetween:8and,years(fgure::).Tediferencesbetweenthe
oucFirstNationspopulationandtheoverallHamiltonpopulationaremoststriking
intheoldestagegroups.Whileo.ooftheHamiltonpopulationagedo,yearsorolder
consideredthemselvestobeinexcellentorverygoodhealth,'only::.ooftheoucFirst
NationspopulationinHamiltonaged,oyearsandolderreportedthemselvesinthis
samecategory.
Figure 12. Self-Rated Health by Age for First Nations Adults, Our Health Counts
Tegenderdistributionrevealedmoremenwhofelttheirhealthwasexcellentorvery
goodcomparedtowomenandfewermenfelttheirhealthwaspoorcomparedtowomen
(seefgure:,).Tesegenderdiferenceswerestatisticallysignifcant.Tecomparison
withtheCityofHamiltonccusdatashowsthatthereisamuchlargergapforwomen
thanformenbetweentheoverallHamiltonpopulationandtheoucFirstNations
18-34 Years Old
35-49 Years Old
50 Years and Older
28.0%
40.8%
21.5%
9.7%
26.1%
30.0%
27.3%
16.7%
12.6%
27.6%
36.0%
23.8%
Excellent or Very Good Good Fair Poor
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
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populationinHamilton.Whileo:.,ofHamiltonswomenoverage:oconsidered
themselvestobeinexcellentorverygoodhealth,only:,.ofoucFirstNationswomen
inHamiltonconsideredthemselvestobeinthissamecategory.'
Figure 13. Self-Rated Health by Gender for First Nations Adults, Our Health Counts
FormanyFirstNationsindividualsandcommunities,healthisconsideredmorethan
simplyphysicalwellness,butratherabalanceofthephysical,mental,emotional,and
spiritualaspectsofself.RegardingwhetherornotmembersoftheFirstNations
communityinHamiltonfeelinbalanceofthefouraspectsoflife,,felttheywerein
balanceallormostofthetime,,,felttheywereinbalancesomeofthetimeand:o
alittleornoneofthetime.Twentyeightpointthreepercentofwomencomparedto:,.
ofmenindicatedthattheirlifewasinbalanceonlyalittleornoneofthetimeandthis
diferenceisstatisticallysignifcant.Diferencesinself-reportedlifebalancearenot
statisticallysignifcantacrossagecategories(seefgure:).
Overall,thispopulationreportedhighlevelsofphysicalactivitywith:reporting
havingcompleted,ominutesormoreofmoderateorvigorousphysicalactivity,daysa
week.Notsurprisingly,whenaskedaboutphysicalactivity,moreolderindividuals(age
,o+)reportedzerooronedaysofactivityduringtheweekascomparedtoyounger
communitymembers(:8-,,years(seefgure:,).Acrossgender,therewasatrendtowards
Male
Female
29.4%
31.3%
26.9%
12.4%
17.9%
36.4%
27.6%
18.1%
Excellent or Very
Good
Good Fair Poor
0.0%
10.0%
20.0%
30.0%
40.0%
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morephysicalactivityamongmencomparedtowomen,withmorewomenthanmen
reportingzerooronedaysofactivityduringtheweekandmoremenreporting,,,or
odaysofactivityduringtheweek(seefgure:o).Likely,giventhesocio-economic
conditionsreportedamongthispopulation,thehighlevelsofphysicalactivityrefecta
lackofaccesstotransportationandlife-basedactivitiesthatmustbeconductedby
walking.
Figure 14. In Balance of 4 Aspects of Life by Age for First Nations Adults, Our Health Counts
r
18-34 Years Old
35-49 Years Old
50 Years and Olde
36.6% 36.6%
26.9%
48.0%
39.1%
12.9%
45.3%
34.1%
20.6%
All or Most of the Time Some of the Time A little or None of the Time
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
55.0%
18-34 Years Old
35-49 Years Old
50 Years and Older
9.2%
22.6%
30.1%
38.1%
11.2%
13.3%
25.5%
50.0%
20.0%
16.9%
30.1%
33.0%
0 - 1 Day 2 - 3 Days 4 - 6 Days 7 Days
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Figure 15. Physical Activity by Age for First Nations Adults, Our Health Counts
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Chronic Health Conditions
RatesofmanychronicdiseasesintheoucFirstNationspopulationarehigh(seetable:).
AmongoucHamiltonpopulation,:reportedhavingbeingtoldbyahealthcare
providerthattheyhaveasthma,withsimilarratesreportedbymenandwomen.Tisis
morethantwicetheasthmarate(.,)self-reportedbytheoverallHamiltonpopulation
inthe:oo,CanadianCommunityHealthSurvey.'
Intotal,theself-reportedrateofarthritiswas,o.,withsimilarratesreportedbymen
andwomen.Tisishigherthanthe:.ofHamiltonianswhoself-reportedbeing
diagnosedwitharthritisinthe:oo,CanadianCommunityHealthSurvey.'
Highratesofbloodpressurewerereportedinthispopulation,withaself-reported
prevalenceof:,.8.Tiscomparesto:.,oftheoverallHamiltonpopulationthatself-
reportedhighbloodpressureinthe:oo,CanadianCommunityHealthSurvey.'Within
theoucFirstNationspopulation,:8ofmenreportedhavingbeentoldbyahealthcare
providerthattheyhavehighbloodpressurecomparedto::.,ofwomen.Tisdiference
betweenmenandwomenwasnotstatisticallysignifcant.Teself-reportedrateofhigh
bloodpressureforthoseover,oyearswashigherthanthatforthosebetweentheageof
:8and,yearswith:.,ofthoseover,owhoreportedbloodpressurecomparedto
:ofpersonsage:8to,years.
Terewasatrendtowardshigherratesofheartdiseaseamongmenthanwomen(::.,vs.
,.,).Morespecifcally,:.oofmen,:yearsandolderreportedbeingtoldbyahealthcare
professionalthattheyhadheartdiseasecomparedto.:ofmen,oyearsandyounger.
Male
Female
7.6%
17.3%
33.5%
41.5%
19.3%
18.5%
21.2%
40.9%
0 - 1 Day 2 - 3 Days 4 - 6 Days 7 Days
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
Figure 16. Physical Activity by Gender for First Nations Adults, Our Health Counts
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Intotal,theself-reportedrateofstrokewas,.withnosignifcantdiferencebetween
menandwomen.TereisnocomparablegeneralCanadianratebuttheAmerican
prevalenceofstrokefornon-institutionalizedadultswas:.oin:oo,.`
Atotalof:,.ooftheadultstudypopulationreportedhavingdiabetesasdiagnosedbya
healthcareprovider.Tisisapproximatelythreetimestherateamongthegeneral
Hamiltonpopulation,whichwas.in:oo,accordingtotheCanadianCommunity
HealthSurvey.'TisisdespiteamuchyoungeragedemographicoftheFirstNations
Hamiltonpopulation.ForFirstNationsinHamilton,overoofpersonwhowereover
,oyearsreportedhavingreceivedadiabetesdiagnosiscomparedtooofpersons:8to
,years.Tispatternwasstronglyobservedamongwomen,amongwhom,ooverthe
ageof,oreporteddiabetescomparedto,ofwomenaged:8to,.Amongthosewho
reportedadiabetesdiagnosis,8.hadbeentestedforhaemoglobinA-one-Cinthe
past::months,o,.:reportedthatahealthcareprofessionalhadcheckedtheirfeetfor
anysoresorirritationsinthepast::monthsando,.,reportedthatahealthcare
professionalhadtestedtheirurineforproteininthepast::months.
HepatitisBwasnotprevalentinthestudypopulation(o.,),howeverHepatitisCwas
highlyprevalentwith8.,ofthetotalpopulationhavingbeentoldbyahealthcare
professionalthattheyhadHepatitisC.TisprevalencerateofHepatitisCisoverten
timestheestimatedHepatitisCprevalenceratefortheprovinceofOntario(o.8)and
almostthreetimestheestimatedHepatitisCprevalencerateforthetotalAboriginal
populationinCanada(,.o).`'
Teadjustedrateofchronicbronchitis,emphysema,orcovu(ChronicObstructive
PulmonaryDisease)was8..Teratesforwomenandmendidnotdifersignifcantly.
Atthetimethissurveywasconducted,:,ofthestudypopulationreportedhaving
receivedtheH:N:vaccine.Terateofvaccinationappearsconsistentacrossincome
brackets.Whilethisrateofimmunizationissimilartotheimmunizationrateforthe
generalHamiltonpopulation,'itisstrikinglylowgiventhatFirstNationspopulations
wereidentifedasextremelyvulnerabletoH:N:infectionveryearlyonintheepidemic
andexperiencedmuchhighermorbidityandmortalityfromH:N:comparedtothe
generalCanadianpopulation.
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RATE
Allergies 9.3%
Arthritis 30.7%
High blood pressure 25.8%
Heart disease 8.4%
Stroke 5.9%
Diabetes 15.6%
Hepatitis B 0.7%
Hepatitis C 8.7%
Chronic bronchitis, emphysema, or COPD
(Chronic Obstructive Pulmonary Disease) 8.4%
H1N1 vaccination 25%
Table 1. Rates of Chronic Disease For First Nations Adults in Hamilton, OHC
Breastfeeding
Atotalofo:ofwomenintheOurHealthCountsstudyreportedhavingbreastfedany
oftheirchildren.Whenaskedforhowmanychildrenthesewomenbreastfed,over,o
reportedbreastfeedingformorethantwothirdsoftheirchildren(seefgure:,).Te
averagelengthoftimethesewomenbreastfedeachoftheirchildrenwasasfollows::o
breastfedforlessthanthreemonths,,,breastfedfor,toomonths,:,breastfedfor
otomonthsand:obreastfedformorethanmonths(seefgure:8).Tehighratesof
breastfeedingobservedinthispopulationareveryconsistentwiththoseobservedamong
otherAboriginaldatasets,forexampletheFirstNationsRegionalHealthSurvey.'
Improvementsinaccessibleprogrammingandpre-natalcarehavegreatlycontributedto
anincreaseinbreastfeedingprevalence.
Figure 17. Percent of Children Breastfed for First Nations Women, Our Health Counts
19.8%
23.8%
56.3%
0-33% of Children 34-67% of Children 68-100% of Children
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
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Figure 18. Average Length of Time Breastfed for First Nations Women, Our Health Counts
Preventative Care
Papanicolaou (Pap)
AmongFirstNationswomeninthestudypopulation,,.,reportedeverhavinga
Papanicolaou(Pap)test.Ofthesewomen,8:.:reportedhavingreceivedaPaptestinthe
last,years.Tisrateisabout:ohigherthantheratefoundbytheicisdatalinkage,
whichwillfollow.OnereasonforthediferenceinthesurveyandicisPapscreening
ratesisthatthequestionsaskedwereslightlydiferent.Tesurveyquestiononlyreported
thethreeyearrateofPapscreeningforwomenwhohadeverhadaPaptestandtheicis
linkageallowedexaminationofparticipationinPapscreenforthepast,yearsforall
women,whetherornottheyhadeverhadaPaptest.Tishoweverwouldonlyaccount
forapproximatelyofthediferenceinthesurveyandicisratessincethisistheself-
reportedrateofneverhavinghadaPaptestforFirstNationswomeninHamilton,so
furtherexplorationofthisdiferenceisneeded.Intheleadresearchersclinical
experienceasawomenshealthcareproviderwhohasworkedinAboriginalcommunities
fortwodecadesitiscommonthatwomenassumethateverypelvicexaminationincludes
aPaptest,whenofenonlyswabsfors1usaretakenandnoPaptestisdone.Teicis
databasedoesreliablycaptureallPapsmearsthatweresubmittedtocommunity
laboratoriesforanalysis,butdoesnotincludePapsmearscollectedandanalysedin
hospital.However,Papsmearsarerarelycollectedintheemergencydepartmentandrates
ofhospitalizationaresimilarfortheHamiltonFirstNationsandgeneralHamiltonand
Ontariopopulation.SounlessalargeproportionofFirstNationswomeninHamiltonare
attendingahospitalbasedoutpatientclinicthatusesahospitallaboratoryforitsPap
smearanalysis,thenthemostlikelyexplanationforthediferenceintheself-reportand
icisestimateratesforPapsmeartestingfortheHamiltonFirstNationspopulationis
thatwomenareassumingthattheirhealthcareproviderisdoingPaptestingduring
pelvicexamsthatdonotincludePaptestingand/ortheirhealthcareproviderisnot
providingadequateinformationregardingtheactualteststhatarebeingdone.
16.3%
33.2%
24.9%
25.6%
1 Month to less
than 3 Months
3 Months to
less than 6
Months
6 Months to
less than 9
Months
9 Months or
longer
0.0%
10.0%
20.0%
30.0%
40.0%
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AsimilartrendisseeningeneralHamiltonpopulationdata.While,:.,ofHamilton
womenreportedhavingaPapsmearinthelastthreeyears,'theratereportedbyicisfor
womenintheCityofHamiltonisino:.o(seeicisdatalinkagesection).
TeoucsurveydataindicatesatrendtowardsdecreasingparticipationinPapscreening
withinthepast,yearswithadvancingage.Tistrendissubstantiatedbytheicislinkage
data.Ithighlightsaparticularneedtobetterunderstandandpromotecervicalcancer
screeningamongFirstNationswomenbetweentheagesof,,and,oyearsofage.Again
intheclinicalexperienceofthisprojectsleadresearcher,childbearingFirstNations
womeninurbanareashavegoodaccesstoandparticipationincervicalscreeningasitis
integratedintotheirprenatalcareduringtheirreproductiveyears,howeverparticipation
ratesincervicalscreeningaremuchloweroncetheseAboriginalwomenfnishhaving
theirchildren.Furtherefortsregardingimproveaccesstoandparticipationincervical
screeningmightthereforewanttofocusonFirstNationswomenwhodonothave
childrenorwhoarefnishedhavingtheirchildren.
HIV testing
Teadjustedrateforeverreceivinganuivtestwaso,.Furtherinterpretationofthis
statisticisrequired,asitappearstobequitehighanditmayindicateaninappropriately
highlevelofuivtestinggiventheoverallriskinthispopulation.Terewasatrendof
morewomenreceivinganuivtestthanmen.SixtyninepointfvepercentofFirst
NationswomeninHamiltonreceivedanuivtest,comparedtoo:.8ofmen.Ofering
uivtestsisofenpartofroutineprenatalcareforpregnantwomenandthelarge
proportionofmothersintheoucFirstNationspopulationmayexplaininpartthe
higheruivtestingrateinthefemalepopulation.
Ability
Teadjustedrateoflimitationinthekindsoramountofactivitydoneathome,workor
otherwisebecauseofaphysicalormentalconditionorhealthproblemwas,:.Not
surprisingly,therateofabilitylimitationwashigherforolderpersonscomparedto
youngerpersons,withoverthreequarters(,,)ofpersonover,oyearsreportingofen
orsometimesexperiencinglimitations.Teoucquestionregardingactivitylimitation
wasslightlydiferentthanthatoftheCanadianCommunityHealthSurvey,making
directcomparisondimcult.
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Mental and Emotional Health
Depression is more common than people are willing to admit. More prevalent in lower
income families/households.
Doctors need to get of their high horse, not just give you the drugs and say, see you later.
Te ones [doctors] I am with now actually care about people. Tey follow up and try and
help you solve your disorders.
Whenaskedtoratetheirmentalhealthcomparedtootherpeopletheyknew,::
reportedexcellentmentalhealth,,reportedgoodmentalhealthand,oreportedfair
orpoormentalhealth.Terewerenosignifcantdiferencesintheseratesacrossgender.
Forty-twopercentreportedthattheyhadbeentoldbyahealthcareproviderthatthey
hadapsychologicaland/ormentalhealthdisorder.Furtheranalysisintosubstanceuse,
particularlyprescriptionopioidmisusemayrevealarelationshipbetweenself-medication
andself-reportingofbettermentalhealth.
DOMA I N 3 : RE CL A I MI NG WHO WE A RE
Highlights from Domain 3
Multi-GroupEthnicIdentityMeasurescoresindicateastrongsenseofFirstNations
identityamongtheFirstNationspopulationlivinginHamilton.
InordertoexploreFirstNationsidentityinourhealthassessmentweusedtheTe
MultigroupEthnicIdentityMeasure(miim)thatwasoriginallypublishedbyDr.JeanS.
Phinney,atCaliforniaStateUniversity.``Temeasureiscomprisedoftwofactors:ethnic
identitysearch(adevelopmentalandcognitivecomponent)andamrmation,belonging,
andcommitment(anafectivecomponent).Temeasureincludes::items,whichare
listedbelow.Participantswereaskedhowstronglytheyagreedwiththestatementsona
scalefrom:towithbeingstronglyagreeand:beingstronglydisagree.Tefrst
factor,ethnicidentitysearch,containsitems:,:,,8,and:o,whilethesecondfactor,
amrmation,belonging,andcommitment,containsitems,,,,o,,,,::,::.Tepreferred
scoringistousethemeanoftheitemscores;thatis,themeanofthe::itemsforanover-
allscore,and,ifdesired,themeanofthe,itemsforsearchandthe,itemsfor
amrmation.Tustherangeofscoresisfrom:to.
1. IhavespenttimetryingtofndoutmoreaboutFirstNations,suchasourhistory,
traditions,andcustoms.
2. IamactiveinorganizationsorsocialgroupsthatincludemostlyFirstNationspeople.
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3. IhaveaclearsenseofmyculturalbackgroundasaFirstNationspersonandwhat
thatmeansforme.
4. IthinkalotabouthowmylifewillbeafectedbecauseIamFirstNations.
5. IamhappythatIamFirstNations.
6. IhaveastrongsenseofbelongingtoFirstNationscommunity.
7. IunderstandprettywellwhatbeingFirstNationsmeanstome.
8. InordertolearnmoreaboutbeingFirstNations,Ihaveofentalkedtootherpeople
aboutFirstNations.
9. IhavealotofprideinFirstNations.
10. Iparticipateinculturalpractices,suchaspowwows,Aboriginaldayevents,
ceremonies,feasts,drumming,singingetc.
11. IfeelastrongattachmenttowardsFirstNations.
12. IfeelgoodaboutmyFirstNationsbackground.
Forthetotalidentityscore(rangefrom:to)foreachofthe::items,weobservedthat
almostthreequartersofthesamplepopulationscoredabove:.8,,outof(seefgure:).
Fortheethnicidentitysearchfactor,comprisedof,items,wecalculatedthatoverthree
quartersofpopulationscoredabove:.,outof(seefgure:o).Finally,fortheidentity
amrmationfactor,comprisedof,items,weobservedthatoveroofthepopulation
scoredabove:.,outof(seefgure::).Whenwecalculatedthemeanscoresforall
::items,theidentitysearchfactorandidentityamrmationfactor,wegeneratedthe
followingthreemeanscores:,.o88:,:.8,:,,.:o8,(seefgure::).Clearlythesethree
graphsrefectastrongsenseofidentityamongFirstNationsadultsaswecanseethatthe
averageratingsonascalefrom:toisaround,.
Figure 19. Total MEIM Score for First Nations Adults, Our Health Counts
1.0% 1.0% 1.0%
5.8%
20.6%
30.3%
24.9%
15.4%
1.000-
1.374
1.375-
1.749
1.750-
2.124
2.125-
2.499
2.500-
2.874
2.875-
3.249
3.250-
3.625
3.625-
4.000
0.0%
10.0%
20.0%
30.0%
40.0%
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Figure 20. MEIM Search Subscale for First Nations Adults, Our Health Counts
Figure 21. MEIM Afrmation Subscale for First Nations Adults, Our Health Counts
Figure 22. Mean Scores for Overall Identity, Search Subscale and Afrmation Subscale
Scores First Nations Adults, Our Health Counts
2.2% 2.2% 2.2%
16.8%
32.7%
22.1%
14.8%
6.9%
1.000-
1.374
1.375-
1.749
1.750-
2.124
2.125-
2.499
2.500-
2.874
2.875-
3.249
3.250-
3.625
3.625-
4.000
0.0%
10.0%
20.0%
30.0%
40.0%
2.4% 2.4% 2.4%
7.2%
17.8%
22.5%
21.0%
31.5%
1.000-
1.374
1.375-
1.749
1.750-
2.124
2.125-
2.499
2.500-
2.874
2.875-
3.249
3.250-
3.625
3.625-
4.000
0.0%
10.0%
20.0%
30.0%
40.0%
3.09
2.83
3.27
Overall Identity Search Subscale Affirmation Subscale
0.0
1.0
2.0
3.0
4.0
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DOMA I N 4 : DI S CONNE CT I ON F ROM WHO WE A RE
Highlights from Domain 4
Sixty-eightpercentofthepopulationreporteddailysmoking.
Useofsubstancesinthepast::monthswasasfollows::.:chewingtobacco;
,omarijuana;oecstasy;:osedatives;:cocaine;and:prescription
opioiduse,whichincludedCodeine,Morphine,Percodan,Tylenol,,Fentanyl,
Talwinetc.
Sixty-sixpercentofthepopulationfeltthattheirlevelofaccesswasthesameasthe
generalCanadianpopulation,while:ofelttheyhadlessaccessand:feltthey
hadbetteraccess.
FortypercentoftheFirstNationspopulationinHamiltonratedtheirlevelofaccess
tohealthcareasfairorpoor.Barriersincludedlongwaitinglists(8),lackof
transportation(,,),notabletoaforddirectcosts(,:),doctornotavailable(:),
andlackoftrustinhealthcareprovider(:).
Substance Use
Whenaskediftheysmokedcigarettesatthepresenttime,o8ofthepopulationreported
dailysmoking.Weobservedatrendtowardshigherratesofsmokingundertheageof
,oyearsforbothmenandwomen.Teratesofsmokingbetweenmenandwomenwere
fairlyconsistent,withnostatisticallysignifcantdiferences(seefgure:,).Intotal,
8,.:oftheFirstNationspopulationinHamiltonreportedthattheysmokeddailyor
occasionally,whichismorethanthreetimestherateforthegeneralHamiltonpopulation
(:.)reportedinthe:oo,CanadianCommunityHealthSurvey.
Figure 23. Frequency of Smoking Cigarettes by Gender for First Nations Adults, Our Health Counts
Male
Female
19.2%
66.2%
14.6%
19.0%
71.1%
9.9%
Not at all Daily Occasionally
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
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Participantswereaskedhowofentheyhad,ormoredrinksononeoccasioninthepast
::months.Teadjustedpopulationdistributionwasasfollows::oanswerednever,:8.,
answeredlessthanoncepermonth,:answeredoncepermonth,:,.,answered:,
timespermonth,,answeredonceperweekand:,answeredmorethanonceperweek
oreveryday.Diferencesintheratesbetweenmenandwomenwerenotstatistically
signifcant,howeverthedatasuggestsatrendtowardsmoremenconsumingmorethan,
drinksononeoccasionmorethanonceperweekcomparedtowomen(:vs.::)and
morewomenneverconsumingover,drinksinoneoccasioncomparedtotheirmale
counterparts(,ovs.:).Still,ahighnumberofwomenreportedconsumptionof,or
moredrinksononeoccasion:-,timesaweek(seefgure:).Intotal,,,.oftheFirst
NationspopulationinHamiltonreportedthattheyhad,ormoredrinksononeoccasion
atleastoncepermonth,whichismorethantwicetherateforthegeneralHamilton
population(:o.o)reportedinthe:oo,CanadianCommunityHealthSurvey.'
Figure 24. Consumption of 5 or More Drinks on One Occasion by Gender for First Nations Adults,
Our Health Counts
TeFirstNationsOurHealthCountsparticipantswereaskedtoreportonsubstance
abuseinthelast::months,includingabuseofillicitandprescriptiondrugs.Adjusted
self-reportedrateswere::.:forchewingtobacco;,oformarijuanause;oforecstasy;
:oforsedatives;:forcocaine;and:forprescriptionopioiduse,whichincluded
Codeine,Morphine,Percodan,Tylenol,,Fentanyl,Talwinetc.Forallofthesesubstances
therewerenostatisticallysignifcantdiferencesinratesofusebetweenmenandwomen.
Asmentionedabove,higherratesofmarijuanaandprescriptionopioidmisusemay
refectmechanismsbywhichpeoplearemanagingtheirpovertyandstress/mental
emotionalhealthissues.Tisispreliminary,descriptivedata,howeveramorein-depth
analysisinthefuturewillhelptobuildamorein-depthunderstanding.
Male
Female
24.2%
16.6% 16.6%
15.5%
7.8%
19.4%
29.6%
20.8%
11.3%
20.5%
5.5%
12.3%
Never Less thanOnce
per Month
Once
per Month
2-3 times
per Month
Once per
Week
More than Once
per Week
0.0%
10.0%
20.0%
30.0%
40.0%
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Inadditiontothedrugslistedabove,wealsoaskedparticipantsaboutvcv/Angeldust,
Acid/isu/Amphetamines,InhalantsandRitalin,butthenumbersweretoosmallto
report.Forthemajorityofdrugs,theprevalenceofusedidnotvarysubstantiallyacross
agegroups,exceptforthecaseofecstasywhereweobservedmuchhigheruseforpersons
under,,yearsofage.
Health Services
We need more Aboriginal people in health care, education, places where people are looking
up to other people. More native role models.
Life just gets harder and harder and the government is not helping, they seem to
backwards, dealing with mental health issuesthey dictate and nothing gets done, you
dont get counselling or prevention. You get lip service.
I wish I had someone to talk to when my husband died. I need closure. Ive been trying to
get an appointment with a psychiatrist and it has been dif cult.
Studyparticipantswereaskedtoratethelevelofaccesstohealthservicesavailableto
themascomparedtoCanadiansgenerally.Ouradjustedrateswere:oofeltthattheir
levelofaccesswasthesameasthegeneralCanadianpopulation,while:ofelttheyhad
lessaccessand:felttheyhadbetteraccess(seefgure:,).
Figure 25. Level of Access to Health Services for First Nations Adults, Our Health Counts
Whenaskedtoratetheavailabilityofhealthservicesintheircommunity,:,felt
availabilitywasexcellent,,feltavailabilitywasgoodintheircommunity,:felt
65.9%
19.8%
14.3%
Same level of
Access
Less Access Better Access
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
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availabilitywasfairand::feltavailabilityofserviceswaspoor(seefgure:o).Tefact
thatoofthepopulationfelttheirlevelofaccesstohealthcarewasfairorpoor,
despitethegeographicproximitytoextensivehealthandsocialservicesthattheCityof
Hamiltonprovides,substantiatestheideathatjustbecausetheservicesare
geographicallyproximate,doesnotmeanthattheyareaccessibletoFirstNations
people.
Figure 26. Availability of Health Services for First Nations Adults, Our Health Counts
Participantswereaskedtoindicateanybarrierstheymayhaveexperiencedtoreceiving
healthcareinthepast::months.Telistofbarriersincludedthefollowing:Doctor
notavailableinmyarea,Nursenotavailable,Lackoftrustinhealthcareprovider,
Waitinglisttoolong,Unabletoarrangetransportation,Dimcultygettingtraditional
care,Notcoveredbyiuv,Priorapprovalforservicesunderiuvwasdenied,Could
notaforddirectcostofcare,Couldnotafordtransportationcosts,Couldnotaford
childcarecosts,Felthealthcareprovidedwasinadequate,Felthealthcareprovidedwas
notculturallyappropriate,chosenottoseehealthprofessional,servicewasnot
availableinmyareaandother.Tedistributionofpercentagesreportedforeachof
thesebarriersisdisplayedinthegraphbelow(seefgure:,).
16.7%
43.3%
28.9%
11.1%
Excellent Good Fair Poor
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
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Figure 27. Barriers to Receiving Health Care in Past 12 Months for First Nations Adults,
Our Health Counts
Other Barriers to Receiving Health Care Included:
No sweats in the city [Hamilton].
Prejudice
Lack of trust and cultural understanding
Not a fan of doctors or hospitals. I feel judged before being treated.
Lack of specialists [including psychiatrist]
Ourpopulation-basedself-reportestimateisthat,,ofFirstNationsadultsinHamilton
haveaccessedemergencycareinthepast::months.Terewerenostatisticallysignifcant
diferencesacrossgender,ageandincomecategories.Tisresultisconsistentwiththeicis
datalinkageresultsreportedinthenextsection.Specifcally,theicislinkageincluded
61.4%
6.7%
16.5%
19.0%
19.8%
20.9%
21.0%
23.9%
25.0%
25.4%
26.8%
27.9%
28.6%
32.0%
35.2%
47.9%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%
Other Barriers
Could not afford
Childcare costs
Nurse not available
Service was not available
in my area
Difficulty getting Traditional Care
(e.g. Healer, Medicine Person, Elder)
Felt Service was not
Culturally appropiate
Prior approval for Services under
NIHB Health Benefits was denied
Lack of trust in Health
Care Provider
Not covered by Non-Insured Health Benefits
(e.g. Service, Medication, Equipment)
Felt Health Care provided was Inadequate
Could not afford direct cost of Care/Service
Chose not to see Health Professional
Doctor not available in my area
Could not afford Transportation costs
Unable to arrange Transportation
Waiting list too long
70%
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emergencyroomadmissionsoverthepasttwoyears,ratherthanpastyear,andfoundthat
approximatelyo8.,ofthestudyparticipantshadaccessedtheivoverthepast:years.
Whenaskedtoratethequalityofemergencycareaccessedinthepast::months,,,felt
itwasexcellentorgood,whilefeltitwasfairorpoor.Littlevariationwasobserved
betweenmenandwomen.
Studyparticipantswereaskediftheyhadeverbeentreatedunfairlybyhealth
professionalsbecauseofbeingFirstNations.Ouradjustedratewas:,yeswithsimilar
ratesreportedbymenandwomen.Reportingofunfairtreatmentalsoappearedto
increasewithageas:ofpersonsover,oreportedunfairtreatmentascomparedto
8ofpersonsbetweentheageof:8and,years,howeverthesediferenceswerenot
statisticallysignifcant.QuestionsregardingdiscriminationasaresultofbeingFirst
Nationsmoregenerallyaswellasexperiencesofethnicallyorraciallymotivatedattack
wereaskedinalatersectionofthesurvey.Teresultsforthesequestionsarereporting
inthefollowingsectiononImpactsofColonization.Furtherinterpretationoftheouc
discriminationdataisrequired,astheinterpretationofself-reportdataregarding
experiencesofracismiscomplex.Under-reportingiscommonandtheneedfor
validated,multiplemeasureshasbeenidentifedinworkingclassAfricanandLatino
Americanpopulations.``Tereisapaucityofvalidatedtoolstomeasurediscrimination
inAboriginalgroups.
Access to Traditional Medicine
Useoftraditionalmedicinewasquitecommonamongthestudypopulationwithone
thirdoftheFirstNationsstudypopulationreporteduseoftraditionalmedicine.Itshould
benoted,however,thatthesurveyitselfdidnotprovideadefnitionoftraditional
medicineinthiscontext,sotheremayhavebeensomeinconsistencywithreporting.
Specifcally,thosewhoanswered,Cantaforditmayhavebeenthinkingofothernon-
Westernservicessuchasvisitinganaturopathorchiropractorastraditionalmedicine.
Ofthosewhohaddimcultyaccessingtraditionalmedicine,weobservedthefollowing
breakdownofspecifcbarriers(seefgure:8).
ParticipantswhohadNon-InsuredHealthBenefts(iuv)wereaskediftheyhad
experiencedanydimcultyaccessinganyofthehealthservicesprovidedthroughthe
Non-InsuredHealthBeneftsProgram(iuv)providedtostatusFirstNationsandInuit
personsthroughHealthCanada.Ourpopulationbasedestimateisthato:reportno
dimcultiesaccessingtheiuvprogram.
Ofthosewhohaddimcultyaccessingservicesprovidedthroughiuv,weobservedthe
followingbreakdownofspecifcbarriers(seefgure:).
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Figure 29. Difculty Accessing NIHB For First Nations Adults, Our Health Counts
DOMA I N 5 : I MPACT S OF COL ONI Z AT I ON
Highlights from Domain 5
Sixpointonepercentofthestudypopulationreportedthattheyhadbeenastudentat
afederalresidentialschool,orafederalindustrialschool.Ofthose,o,feltthattheir
healthandwell-beinghadbeennegativelyafectedbythisexperience.
Fortypercentofparticipantsreportedthatachildprotectionagencywasinvolvedin
theirownpersonalcareasachild.
Atotalof:.,ofFirstNationsadultsinHamiltonreportedthattheirhome
communityhadoneormorelandclaim.
0.1%
0.0% 10.0% 20.0% 30.0%
Dont Know
Other
Concerned About Effects
Not covered by Non Insured
Health Benefits (NIHB)
Do not know enough about them
Not available through Health Center
Can't afford it
Too far to travel
Do not know where to get the them
2.9%
2.3%
4.1%
6.9%
9.2%
9.7%
16.1%
20.6%
7.4%
3.6%
1.2%
4.5%
5.4%
5.5%
8.0%
10.5%
60.6%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%
Don't Know
Other
Hearing Aid
Other Medical Supplies
Vision Care (glasses)
Transportation Services or Costs
Medication
Dental Care
No Difficulties
Figure 28. Difcult Accessing Traditional Medicine for First Nations Adults, Our Health Counts
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Halfofthestudypopulationreportedeverreceivingunfairtreatmentbecausethey
areFirstNations.
Highratesofcommunityandfamilyviolencewerealsoreported.
Residential School
Sixpointonepercentofthestudypopulationreportedthattheyhadbeenastudentata
federalresidentialschool,orafederalindustrialschool.Ofthose,whenaskediftheir
overallhealthandwell-beinghadbeenafectedbytheirattendanceataresidentialschool,
o,feltthattheirhealthhadbeennegativelyafected.Clearly,thesenumbersindicate
thatthelegacyofresidentialschoolcontinuespersistsinurbanareasandisnot
somethingobservedonlyonreserveorinNortherncommunities.
FortypercentofFirstNationsinHamiltonreportedthatafamilymemberhadbeena
studentatafederalresidentialschoolorafederalindustrialschool.Ofthese,:hada
grandparentwhoattended,:,hadaparentwhoattended,o.,hadasiblingwho
attended,:,hadanauntorunclewhoattendedand:ohadanotherfamilymember
whoattended.Ofthosewhohadafamilymemberwhoattendedresidentialschool,
,feltithadanegativeimpactando,feltithadnoimpactontheiroverallhealth.
Child Protection Agency Involvement
Studyparticipantswereaskedifachildprotectionagencywasinvolvedintheirown
personalcareasachild.Ouradjustedratesindicatedthatintotal,oansweredyes.
Terateformenwas,8andtherateforwomenwas.Suchahighnumberofmen
reportingtheirownexperiencewithchildprotectionagenciesspeakstotheneedfor
servicestargetingmeninthiscommunity.Weobservedthatmoreyoungerpersons
reportedchildprotectionagencyinvolvementintheircarecomparedtoolderpersons.
Whenaskedifachildprotectionagencyhadeverbeeninvolvedinthecareofoneoftheir
children,,.,reportedyes,ofwhomo:werewomen.Whiletherewasnotmuch
variationacrossage,wedidobservehigherratesofchildprotectioninvolvementin
participantschildrenamongthoseindividualswhoweremoreeconomically
marginalized.Overo:ofthepopulationwhoearnlessthans,ayearreported
childprotectionagencyinvolvementinthecareoftheirchildren.Finally,ofthosewho
reportedtheinvolvementofachildprotectionagencyintheirfamily(eitherasachildor
forthecareofoneoftheirchildren),feltthatchildcareprotectionagency
involvementhadanegativeafectontheiroverallhealthandwell-being.
Dislocation from Traditional Lands
Atotalof:.,ofFirstNationsinHamiltonreportedthattheirhomecommunityhad
oneormorelandclaim.Terateformenwas,andtherateforwomenwas,.When
askediftheiroverallhealthandwellbeingwasafectedbydislocationfromtraditional
lands,o8felttherewasnoimpactand:felttherewasanegativeimpact.
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Discrimination
Te only discrimination that I have received was from First Nations people. Being urban and
not being on reserve, not being from this area. Not being respectful of my Ojibway culture.
Whenaskedhowtheiroverallhealthandwell-beinghavebeenafectedbyracism,someof
theresponsesincluded:
in high school, being of the reserve and fnding out how white people treat native people.
Calling us wagon burners, telling us to go live in our teepees and that we dont belong here.
And it is still going on to this day.
people get racist against me and it just makes me stronger. I get stronger when I come on to
people like that.
distrust of people. Programs arent functional for Natives because we are never asked for input.
less opportunities and because of not having, you cant provide the way you would like to
for your family. Its always about survival.
Participantsoftheoucstudywereaskediftheywereevertreatedunfairlybecausetheyare
FirstNations.Halfthepopulation,includingslightlymoremen(,,)reportedthattheyhad
experiencedunfairtreatment.Trendsinthedatasuggestthatdiscriminationwasreported
moreamongpersonsovertheageof,yearsandwasprevalentamongbothlowerandhigher
incomebrackets(ooofthelowestandhighestincomegroupsreportedunfairtreatment).
Whenaskediftheyhadeverbeenthevictimofanethnicallyorraciallymotivatedverbal
orphysicalattack,weobservedthefollowing:ooreportednoexperienceofaverbalor
physicalattack,,.hadbeenavictimofaverbalattack(:withinthepast::months)
and:,.:hadbeenthevictimofaphysicalattack(,hadbeenthevictimofaphysical
attackwithinthepast::months).Diferencesinratesofethnicallyorraciallymotivated
attackbetweenmenandwomenwerenotstatisticallysignifcant.Tefollowingfgure
illustratesthebreakdownofphysicalandverbalattackinlessthan::monthsandmore
than::monthsbygender(seefgure,o).
Atotalof::ofthestudypopulationbelievedthattheiroverallhealthandwellbeingwas
afectedbyracism.Tisratewassimilarformenandwomen.
FurtherexaminationoftheFirstNationsoucself-reporteddiscriminationratedatato
betterunderstandthelinksbetweenreportedexperiencesofdiscriminationandhealth
statusoutcomesisongoing.
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Violence and Abuse
Tefollowingdatapresentsdescriptivevus-adjustedfrequenciesonviolenceandneglect
inthecommunity.Moreanalysisofthisdatasetandadditionalfocusseddatacollection
inthefuturewillfurtherourunderstandingoftheseissuesandtheirimpact.When
askedifanytypesofviolenceoccurinthecommunity,,8answeredyes.Intermsof
specifckindsofviolence,ooofthosereportingviolence,reportedfamilyviolencein
thecommunity,,reportedviolencerelatedtocrimeandcriminalbehaviourinthe
community,o,reportedviolencerelatedtoracismanddiscrimination,and8:
reportedlateralviolenceinthecommunity.Amongthosewhoreportedfamilyviolence
specifcally,ofeltthatfamilyviolenceincludedmentaloremotionalabuse,ofelt
thatfamilyviolenceincludedphysicalabuseand,:feltthatfamilyviolenceincluded
sexualabuse.Tebreakdownoftypesoffamilyviolencereportedbythosewhoreported
familyviolenceinthecommunitybygenderisillustratedinthefollowingfgure.Te
diferencesbetweenmenandwomenwerenotstatisticallysignifcant(seefgure,:).
Onegapinthecurrentstudyisitdoesntaskabouttheincidenceofandtypesofabuse
thatareperpetratedbypersonsoutsideofthefamily.
Whenaskedtoratetheimpactofviolenceandneglectintheircommunity,,.feltit
hadanextremelyhighimpact,:feltithadahighimpact,,,feltithadamoderate
impact,:ofeltithadlittleimpact,and:feltithadnoimpact.Diferencesbetween
menandwomenandtheirratingoftheimpactofviolenceintheircommunitycanbe
observedinthefollowingfgure(seefgure,:).Overallwomenratedtheimpactof
violenceinthecommunityashavingahigherimpactthanmen,withasignifcantly
highernumberofwomenratingtheimpactashighcomparedtomenanda
signifcantlyhighernumberofmenratingtheimpactaslittlecomparedtowomen.
Male
Female
13.1%
19.8%
6.2%
9.9%
61.2%
1.3%
15.0%
22.9%
2.9%
10.3%
59.4%
1.0%
Yes to Verbal
attack
within the past
12 Months
Yes to Verbal
attack more
than
12 Months ago
Yes to Physical
attack
within the past
12 Months
Yes to Physical
attack more
than
12 Months ago
No Dont Know
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Figure 30. Victim of Physical and Verbal Attack by Gender for First Nations Adults, Our Health Counts
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Figure 32. Perceived Impact of Community Violence and Neglect by Gender for First Nations Adults,
Our Health Counts
Whenaskedtolisttheimpactsofviolenceand/orneglectinthecommunity,many
participantsdescribedyouthviolencespecifcallyandneglectofyouthandchildren:
Te young people (teenagers), I see them on the street being violent to each other. You cant
step in and say something.
unattended children, young children smoking cigarettes and doing drugs
Younger children are not receiving adequate food, supervision and examples of family values.
Male
Female
6.5%
19.4%
34.8%
25.2%
14.0%
9.1%
31.6%
32.9%
13.1% 13.3%
Extremely High
Impact
High Impact Moderate Impact Little Impact No Impact
0.0%
10.0%
20.0%
30.0%
40.0%
Figure 31. Types of Family Violence Identied as Occurring in the Hamilton First Nations Community
by Gender for First Nations Adults, Our Health Counts
Male
Female
96.1%
91.6%
42.2%
94.7%
89.0%
61.0%
Mental Physical Sexual
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
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Amongthosewhofeltcomfortablesharingtheirexperiencesaboutconfictintheirown
household,:,.,reportedthatsomeoneintheirhouseholdhadphysicallyhurtthem,
,reportedbeinginsultedortalkeddownto,:,reportedbeingthreatenedwith
harm,o:reportedbeingscreamedorcursedat,:,reportedhavingtheiractions
restrictedbysomeoneinthehouseholdandfnally,:oreportedhavingsexwhenthey
didntfeellikeit.Tebreakdownbygenderforeachtypeofhouseholdconfictare
presentedinthefgurebelow.Overallthereisatrendtowardswomenreportingalltypes
ofviolencemorefrequentlythanmen.Tisdiferencebetweenwomenandmenis
statisticallysignifcantforphysicalharm(seefgure,,).
Figure 33. Types of Household Conict by Gender for First Nations Adults, Our Health Counts
DOMA I N 6 : L ACK OF GOV E RNME NT RE S P ONS I BI L I T Y
Tere are more services available to women then men (gender based.i.e. belly dancing,
sewing, quilt making) Would like more social activities geared toward men (cards, exercise)
Whenaskedwhatthemainchallengeswerefacingtheircommunity,o8feltthatalcohol
anddrugabusewereamainchallenge,o:feltthathousingwasamainchallenge,oo.,
feltthatcrimewasamainchallenge,oofeltpovertywasanissue,andooalsofeltthat
employmentandnumberofjobswasanissue.
Intermsofstrengthsofthecommunity,,:.,feltfamilyvalueswereastrength,,ofeltthat
Elderswereastrengthofthecommunity,:feltawarenessofFirstNationsculturewasa
strength,,8feltthatcommunityhealthprogramsandtraditionalceremonialactivities
wereastrengthand,,feltsocialconnectionswereastrengthintheircommunity.
Whenaskediftheyfelttherewereadequateresourcesforcommunityservices,the
followingresultswererevealed::felttherewereadequateresourcesforfamilyviolence,
,.felttherewereenoughservicesforuivprevention,,ofelttherewereadequate
Male
Female
18.5%
39.0%
23.4%
56.0%
25.6%
7.1%
40.3%
52.8%
30.8%
68.1%
29.3%
13.9%
Physically Hurt
You
Insulted or
talked
down to You
Threatened You
with harm
Screamed or
cursed at You
Restricted
Your
actions
Had sex when
You didn't feel
like it
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
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servicesforpregnantwomen,feltthereenoughlegalservices,:,.felttherewere
enoughicv11qqiservices,,ofelttherewereenoughservicesforyouth,,:.,feltthere
wereenoughservicesforsinglemen,ofelttherewereenoughsuicideprevention
servicesand,,feltthereadequateresourcesforpandemicssuchasH:N:.
I CE S DATA L I NK AGE
Highlights from ICES Linkage
oucsurveyincomedataisvalidatedbytheicislinkage,whichplacesover,oofthe
ouccohortintothelowestincomequartilecomparedto:,ofthegeneralHamilton
populationand:ooftheOntariopopulation.
FifeenpercentofHamiltonresidentsand:oofOntarioresidentsfellintothe
highestincomequartilewhileonly:oftheouccohortwereinthishighestincome
quartile.
FifypercentoftheFirstNationspopulationinHamiltonreportedatleastonevisitto
theemergencyroomoverthepast:yearsforacuteproblemscomparedto::ofthe
Hamiltonand:ooftheOntariopopulation.
TenpointsixpercentoftheFirstNationspopulationinHamiltonreportedoormore
emergencyroomvisitsintheprevious:yearscomparedto:.oand:.ofthe
HamiltonandOntariopopulationsrespectively.
UsinghealthcardnumbersprovidedbyOurHealthCountsstudyparticipants,a
successfullinktodataattheInstituteforClinicalEvaluativeScienceswascompleted.Te
dataestimatesgeneratedthroughthislinkageconsistofthefollowing:neighbourhood
incomequintiles(basedonthe:oooCensusandparticipantpostalcodeslistedintheir
ouivrecord),Papsmearintheprevious,years,emergencyroomadmissionsoverthe
previous:yearsandhospitalizationoverthepast,years.Tedatapresentedherefor
incomeandhealthcareutilizationcomparetheOurHealthCountspopulationestimates
withthetotalHamiltonpopulationandarandomsubsetof:ooftheOntarioprovincial
population.Again,itshouldbenotedthattheOurHealthCountsFirstNationsHamilton
incomeandhealthcareusenumbersrefectvus-adjustedestimates.
Sociodemographics
TestudypopulationwasverysimilartothatofthetotalHamiltonpopulationandthe
Ontariopopulationwithrespecttothegenderbreakdown.Intermsofage,theOur
HealthCounts(ouc)samplewasmuchyoungerthanthegeneralHamiltonandOntario
populations.Overall,thispatternisconsistentwithwhatweknowaboutthedemography
oftheAboriginalpopulationinHamiltonfromtheCensus,withtheexceptionthatthe
oucFirstNationssampleappearstobesomewhatunder-representedintheovero,age
category.:.,oftheoucFirstNationsHamiltonsamplewasovertheageofo,years
comparedto,.,oftheAboriginalidentitypopulation(includesFirstNations,Mtis,
andInuit)inHamiltonovertheageofo,yearsaccordingtothe:oooCensus.`
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Intermsofincomequartiles,weobservedthatover,ooftheoucpopulationfellinto
thelowestquartilecomparedto:,ofthegeneralHamiltonpopulationand:oofthe
Ontariopopulation.While:,ofHamiltonresidentsand:oofOntarioresidentsfell
intothehighestincomequartile,only:oftheFirstNationsadultssampledforouc
wereinthehighestincomequartile.Clearly,thesedatahighlightthepovertyexperienced
bythiscommunity.
OHC OHC RDS-ADJUSTED HAMILTON ONTARIO-10%
N COL% COL % 95% C.I. N COL% N COL%
ADULTS
Age on 18-34 196 37.4 41.9 [34.4, 49.9] 125,189 28.18 307,751 28.15
2010-04-01 35-49 197 37.6 36.6 [29.9, 43.1] 124,857 28.11 322,730 29.52
50-64 120 22.9 20.7 [14.7, 26.9] 110,332 24.84 271,028 24.79
65+ 11 2.1 0.8 [0.3, 1.6] 83,829 18.87 191,904 17.55
Sex F 259 49.43 37.6 [29.6, 43.6] 226,269 50.94 560,690 51.28
M 265 50.57 62.4 [56.4, 70.4] 217,938 49.06 532,723 48.72
Income 1-Low 376 71.76 73 [66.5, 79.2] 111,468 25.09 213,212 19.5
Quintile 2 85 16.22 11.8 [7.7, 16] 101,200 22.78 216,461 19.8
3 33 6.3 7.4 [3.6, 10.5] 90,069 20.28 216,614 19.81
4 13 2.48 4.9 [2.5, 9.8] 75,704 17.04 223,113 20.41
5-High 7 1.34 3 [1.1, 5.4] 65,375 14.72 220,665 20.18
Missing 10 1.91 na na 391 0.09 3,348 0.31
Total 524 100 100 na 444,207 100 1,093,413 100
CHILDREN
Age on 0-5 89 45.88 48.74 [ 42.5, 55] 34,662 37.66 88,182 38.2
2010-04-01 6-14 105 54.12 51.27 [ 45, 57.5] 57,384 62.34 142,646 61.8
Sex F 88 45.36 45.42 [ 39.2, 51.6] 44,575 48.43 112,435 48.71
M 106 54.64 54.58 [ 48.4, 60.8] 47,471 51.57 118,393 51.29
Income 1-Low 144 74.23 75.25 [ 69.9, 80.6] 23,741 25.79 46,102 19.97
Quintile 2 30 15.46 15.58 [ 11.1, 20.1] 18,857 20.49 42,636 18.47
3 9 4.64 5.4 [ 2.6, 8.2] 19,030 20.67 46,192 20.01
4 < /=5 1.03 1.26 [ 0.01, 2.7] 16,363 17.78 49,563 21.47
5-High 8 4.12 2.52 [ 0.6, 4.5] 13,975 15.18 45,675 19.79
Missing < /=5 0.52 na na 80 0.09 660 0.29
Total 194 100 100 na 92,046 100 230,828 100
Table 2. Gender, Age and Income Quartiles for Hamilton and Our Health Counts Adults
Preventative Screening
Pap Smear
Overall,FirstNationswomeninHamiltonhadsimilarlevelsofhavingreceivedaPap
smearintheprevious,years,comparedtowomeninHamiltonandOntario.With
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increasingage,however,theratesofreportedPapsmeartestsamongtheFirstNations
studypopulationdroppedsignifcantlycomparedtoboththeHamiltonandOntario
populations.TemajorityofFirstNationswomenwerereceivingadequatecervical
cancerscreeningbeforetheageof,,years,howeveramongolderwomen,and
particularlyintheover,oagegroup,ratesofparticipationweremuchlower.Inthe
clinicalexperienceoftheleadresearcher,childbearingFirstNationswomenhavegood
accesstoandparticipationincervicalscreeningasitisintegratedintotheirprenatalcare,
howeverwomenwhoarefnishedchildbearingarelesslikelytoparticipateincervical
screening.Tismaybeonereasonthatparticipationratesdropwithadvancingage.
ScreeningprogramsthatfocusonolderFirstNationswomenareindicated.Alsofurther
investigationregardingparticipationincervicalscreeningforFirstNationswomenwho
donothavechildrenisalsorequired.
Asnotedearlierinthesurveydatasectionofthisreport(Page8),self-reportedratesof
PapsmeartestingamongtheFirstNationspopulationinHamiltonwereabout:o
higherthantheseicisestimates.Tisispartlyduetosubtlediferencesinhowthe
questionwasasked(thesurveydata,yearparticipationquestionwasonlyaskedforthe
subsetofoofparticipantsthateverhadhadaPaptest).Howeverthiswouldonly
accountforofthediference.Furtherinvestigationisthereforerequiredtobetter
understandthisdiferentinself-reportandicislinkedestimatesofPapsmeartesting.
GiventhattheicisdatabasereliablygathersallPapteststhataresubmittedto
communitylaboratoriesforanalysis;thatitiscommonintheclinicalexperienceofthe
leadinvestigatorforAboriginalwomentounderstandthattheyhavehadaPaptest
duringapelvicexamwheninfacttheyhavenothadaPaptest,butratherjustswabsfor
s1us,andthatthereisnoknowndiferencebetweenratesofhospitalbasedPaptesting
forFirstNationswomenlivinginHamiltonandthegeneralHamiltonpopulation,the
icisestimateswillbeconsideredthemorerigorousestimatesatthistime.
OVERALL PAP SMEAR IN PREVIOUS 3 YEARS
NO YES
AGE N COL% N ROW% N ROW%
RDS ADJUSTED [CI] RDS ADJUSTED [CI]
All 243 100 98 40.1 [30.6, 51.2] 145 59.9 [48.8, 69.1]
18-34 106 43.6 27 28.1 [15.7, 40.0] 79 71.9 [60.0, 84.3]
35-49 93 38.3 46 46.7 [31.7,67.1] 47 53.3 [32.9, 68.3]
50-69 44 18.1 25 56.8[46.9,88.9] 19 31.6 [11.1,53.1]
Table 3. Pap Smear in Previous 3 Years by Age for Adult Women, Our Health Counts
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OVERALL PAP SMEAR IN PREVIOUS 3 YEARS
NO YES
AGE N COL% N ROW% N ROW%
All 179,134 100 66,963 37.4 112,171 62.6
18-34 61,857 34.5 23,505 38 38,352 62
35-49 58,710 32.8 18,865 32.1 39,845 67.9
50-69 58,567 32.7 24,593 42 33,974 58
Table 4. Pap Smear in Previous 3 Years by Age for Adult Women in Hamilton
OVERALL PAP SMEAR IN PREVIOUS 3 YEARS
NO YES
AGE N COL% N ROW% N ROW%
All 456,729 100 171,998 37.7 284,731 62.3
18-34 154,208 33.8 62,425 40.5 91,783 59.5
35-49 155,030 33.9 51,042 32.9 103,988 67.1
50-69 147,491 32.3 58,531 39.7 88,960 60.3
Table 5. Pap Smear in Previous 3 Years by Age for Adult Women in Ontario (10%)
Emergency Room Visits
EmergencyroomvisitsweremuchmorefrequentamongtheFirstNationspopulation
inHamiltonascomparedtothegeneralHamiltonandOntariopopulations,overalland
forbothacuteandnon-acuteillnesses.Tesediferencesarestatisticallysignifcantand
striking,particularlywithrespecttotherelativepercentagesofmultipleivvisitsforthe
FirstNationsouc,Hamilton,andOntariopopulations.TenpointsixoftheFirstNations
adultpopulationinHamiltonreportedoormoreemergencyroomvisitsintheprevious
:yearscomparedto:.oand:.oftheHamiltonandOntarioadultpopulations
respectively.FifypercentoftheFirstNationsadultpopulationinHamiltonhadatleast
onerecordedvisittotheemergencyroomforacuteproblemscomparedto::ofthe
Hamiltonand:ooftheOntarioadultpopulations.
RatesofemergencyroomuseweresimilarformenandwomenintheoucFirstNationspopu-
lationwithnosignifcantdiferencesinaccessratesdetected.Tissimilarityacrossgenderin
ivusewasalsofoundintheHamiltonandOntariopopulations.TeoucFirstNations
samplewasntadequatelypoweredtodetectdiferencesinivaccessacrossadultagestrata.
RatesofemergencyroomusewerealsosignifcantlyhigherforFirstNationschildren
betweentheagesof:and:yearsofagecomparedtoHamiltonandOntariochildren
fromthesameagegroup.Forexample,,oofFirstNationschildrenaged:-:yearshad
oneormorerecordedvisitstotheemergencyroomoverthepasttwoyears,comparedto
,oofHamiltonand,,ofOntariochildreninthesameagegroups.
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TesehighratesofemergencyroomusagebyFirstNationspersonslivinginHamiltonmay
belinkedtotheproblemsinaccessingnon-emergenthealthcarethatarerevealedbythe
surveydataanddescribedintheprecedingsectionofthisreport.Forexample,oofthe
FirstNationspopulationratedtheiraccesstohealthcareaspoororfairand8indicated
thatwaitingliststoolongwasabarrierinaccessinghealthcare.Inaddition,inatleast
somecases,primarycarereformmayhaveincreaseemergencyroomusage,sincerostered
primarycarepatientsmaybetoldbytheirprimarycareproviderstogototheemergency
departmentratherthanawalk-inclinicwhentheirprimarycareteamisnotavailable.
EMERGENCY ROOM VISITS ( ALL)
NONE 1 2-5 6+
OHC 31.5 [25.8,37.5] 26.2 [20.7,32.8] 31.7 [25.9,37.8] 10.6 [6.2,14.5]
Hamilton 66.3 18.7 13.4 1.6
Ontario 10% 69.1 16.8 12.3 1.9
Table 6. All Emergency Room Visits Percentage of Population with 0,1,2-5 or 6+ total ER
visits in the Previous 2 Years for adults aged 18 64 years, OHC First Nations Cohort
(RDS adjusted with condence intervals), Hamilton and Ontario
EMERGENCY ROOM VISITS ( ACUTE)
NONE 1 2-5 6+
OHC 50.2 [43.9, 57.5] 24.7 [18.7,30.1] 20.7 [15.3,26.1] 4 [1.6,6.9]
Hamilton 78.4 14.2 6.8 .6
Ontario 10% 80.1 13.1 6.3 .6
Table 7. Acute Emergency Room Visits Percentage of Population with 0,1,2-5 or 6+ Acute
ER visits in the Previous 2 Years for adults aged 18 64 years, OHC First Nations Cohort
(RDS adjusted with condence intervals), Hamilton and Ontario
EMERGENCY ROOM VISITS (NON-ACUTE)
NONE 1 2-5 6+
OHC 54.3 [47.6,61.2] 22.4 [17.3,28.5] 20.4 [14.5,25.4] 2.9 [1,5.6]
Hamilton 79.4 14.0 6.3 .4
Ontario 10% 81.2 12.2 6.0 .6
Table 8. Non-Acute Emergency Room Visits Percentage of Population with 0,1,2-5 or 6+
non-Acute ER visits in the Previous 2 Years for adults aged 18 64 years, OHC First Nations
Cohort (RDS adjusted with condence intervals), Hamilton and Ontario
Hospitalizations
RatesofhospitalizationappeartobesimilarbetweentheFirstNationsadultpopulationin
HamiltonbasedontheoucadjustedratesandthegeneraladultHamiltonandOntario
populations,withaslightlyhigherfrequencyofhospitalizationamongtheFirstNations
populationcomparedtotheHamiltonandOntariopopulations.Overall,,(o8.,,,.:)of
theFirstNationspopulationbetweentheagesof:8andoyearsinHamiltonhadnotbeen
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hospitalizedatalloverthepastfveyearscomparedto8:.ofthegeneralHamiltonpopula-
tionand8,oftheOntariopopulationinthesameagegroup.Tisispartlyexplainedbythe
higherbirthrateamongtheFirstNationspopulationinHamiltonwhichisrefectedby
slightlyhigherratesofobstetricshospitalizationforthisgroupcomparedtothegeneral
HamiltonandOntariopopulation.Eighty-ninepointonepercent(8.,:.)oftheFirst
Nationspopulationbetweentheagesof:8andoyearsinHamiltonhadnotbeenhospital-
izedforobstetricalreasonscomparedto.:ofthegeneralHamiltonand.:oftheOntario
populationinthesameagegroup.However,giventhehighratesofchronicdiseasessuchas
diabetesandstrokeandthemuchhigherratesofemergencyroomuseamongtheoucFirst
NationspopulationcomparedtotheHamiltonandOntariopopulationsanevenhigherrate
diferenceofhospitaladmissionsbetweentheoucFirstNationspopulationandHamilton
andOntariopopulationcouldbeanticipated.
Withrespecttothehospitalizationofchildrenages,to:,ratesofhospitalizationforFirst
NationschildrenlivinginHamiltonaresignifcantlylowerthanratesofhospitalizationfor
thegeneralpopulationofchildrenlivinginHamiltonandOntario.Twopointfourpercent
(o.o:,.)ofFirstNationschildrenhadbeenhospitalizedoneormoretimesoverthepastfve
yearscomparedtoo.:ando.oofallchildrenlivinginHamiltonandOntariorespectively.
Furtherexaminationofthisdataandadditionalstudyisthereforerequiredtobetter
understandwhetherornotthereisasystematicbiasinhospitaladmissionpractices
whichprioritizestheadmissionofnon-FirstNationscommunitymembersoverFirst
Nationscommunitymembers.
Becausehospitalizationislessfrequenteventthanemergencyroomuse,thestudywas
notadequatelypoweredtodetectdiferencesinothertypesofhospitalizations(i.e.mental
health,surgical,andmedicalhospitalizations)betweentheFirstNationsHamilton
populationandthegeneralHamiltonandOntariopopulations.
RE S PE CT F UL HE A LT H CHI L D S URV E Y DATA
Highlights from the Child Health Survey
Ninety-threepercentofparentsandcaregiversfeltitwasveryorsomewhatimportant
fortheirchildtolearnaFirstNationslanguage
Ninety-fourpercentofparentsandcaregiversfeltthattraditionalculturaleventswere
veryorsomewhatimportantintheirchildslife
Asthmaandallergieswerethemostcommonlyreportedchronicconditions.Ratesof
asthmaweretwiceashighforHamiltonFirstNationschildrencomparedtogeneral
Canadianratesforchildren.
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Ratesofchronicearinfectionswerehigh
Twenty-twopercentofparentsandcaregiverswereconcernedabouttheirchilds
development
Eighty-threepercentofparticipantsindicatedthattheirchildhadseenafamily
doctor,generalpractitionerorpediatricianinthepast::months(comparedto88
forthegeneralCanadianpopulationagedo-oyears)
Tenumberonebarriertoreceivinghealthcarereportedbychildcustodianswas
thatthewaitlistwastoolong
Asexplainedabove,thechildsurveywascompletedbyparentsorcustodialrelatives/
guardiansforallchildrenwhoresidedwiththeadultandwereundertheageof:years.
InordernottoexcludeFirstNationschildrenwhowerelivingwithanon-FirstNation
biologicoradoptiveparent/relative/guardianweadditionallyallowedcouponstobegiven
tonon-FirstNationspersonswhowerethecustodialparent/relative/guardianofoneor
moreFirstNationschildren.
Amongthetotalchildsurveysthatwerecompleted(N=:::),,:weremalechildrenand
werefemalechildren.Forty-fourpercentofthechildrenwere,yearsandyounger,
whiletheremaining,owereoveroyearsold.Afairlyevendistributionacrossgenders
wasobservedinbothoftheagecategories.
Language
WhenparticipantswereaskedhowimportantitisforthechildtolearnaFirstNations
language,saiditwasveryimportant,saiditwassomewhatimportant,whilethe
remaining,feltitwasnotveryimportantornotimportant(seefgure,).
49.0%
44.3%
4.6%
2.0%
Very Important Somewhat
Important
Not very
Important
Not Important
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Figure 34. Importance of the Child Learning a First Nations Language for
First Nations Children, Our Health Counts
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Whenaskedhowimportanttraditionalculturaleventswereinthechildslife,,felt
theywereveryimportant,ofelttheyweresomewhatimportantandtheremaining
ofeltthattheywerenotveryimportantornotimportant.
Parents(,,)andgrandparents(,,)werereportedmostofenasthefamilymembers
responsibleforhelpingthechildtounderstandFirsNationsculture,followedbyaunts
anduncles(,),otherrelatives(,:)andfriends(:).
General Health
Childcustodianswereaskedtoratetheirchildshealthona,-pointscalefromexcellent
topoor.Overall,childrenshealthinthispopulationwasratedquitehigh,with,who
reportedthattheirchildshealthwasexcellentandover,:whoreportedthattheir
childshealthwaseitherverygoodorgood.Teseratesareverysimilartotheself-rated
healthfndingsoftheAboriginalChildrensSurveyandtheNationalLongitudinal
SurveyofChildrenandYouth.`Variationacrossgenderwasnotsubstantial,however
theredoesappeartobeatrendwithmoreguardiansofmalechildrenreportingvery
goodhealthascomparedtoguardiansoffemalechildren(seefgure,,).Similarly,across
agegroups,thedatawasfairlyconsistent,althoughwedidobserveatrendtowards
guardiansofyoungerchildren(o-,years)reportingbetteroverallhealthoftheirchildren
ascomparedtoguardiansofchildrenoveroyears(seefgure,o).
Figure 35. Overall Health by Gender for First Nations Children, Our Health Counts
Participantswhocompletedthechildsurveywereaskedaboutanumberofcommonly
reportedchronicconditions.Tefollowingtabledisplaysthemostprevalent
conditionsandthepercentagesacrossgenderandage.Conditionsthatwerealso
includedinthesurvey,butarenotpresentedhereduetoverysmallnumbersincluded:
Male
Female
41.3%
25.9%
27.8%
4.3%
0.6%
44.1%
18.3%
29.6%
8.0%
0.0%
Excellent Very Good Good Fair Poor
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
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anxietyanddepression,.uu/.uuu,autism,blindnessorseriousvisionproblems,
cancer,chronicbronchitis,cognitiveormentaldisability,fetalalcoholdisorder,
hearingimpairment,hepatitis,kidneydisease,learningdisability,speech/language
dimculties,physicaldisability(otherthanvisualand/orhearingimpairment)and
tuberculosis.
OVERALL AMONG AMONG AMONG AMONG
REPORTED MALE FEMALE CHILDREN CHILDREN
RATE CHILDREN CHILDREN AGED 0-5 6 YEARS
YEARS AND OLDER
Allergies 10.3% 11.7% 9.1% 3.5% 15.7%
Asthma 18.1% 22.6% 13.7% 14.9% 20.5%
Heart Condition 4.0% 5.6% 2.4% 1.3% 6.1%
Diabetes 0.7% 0.0% 1.3% 1.5% 0.0%
Anemia 1.7% 1.6% 1.8% 2.1% 1.4%
Dermatitis 6.1% 11.3% 1.0% 7.2% 5.2%
Hearing Impairment 4.0% 4.3% 3.6% 4.2% 3.8%
Table 9. Commonly Reported Chronic Conditions by Gender and Age for
First Nations Children in Hamilton, Our Health Counts
TerateofallergiesreportedamongtheFirstNationspopulationinHamilton(:o.,)is
verysimilartotheoverallrateinCanadianchildren(:o.o)reportedintheNational
LongitudinalSurveyofChildrenandYouth(:oo/:oo,).`
Eighteenpercentofchildcustodiansreportedthattheirchildhadasthma.Tisrateis
higherthanrateof8.8ratereportedforCanadianchildren(:oo/:oo,National
LongitudinalSurveyofChildrenandYouth).`
0-5 Years Old
6 Years and Over
44.6%
24.4%
25.7%
4.6%
0.7%
41.3%
20.2%
31.1%
7.4%
0.0%
Excellent Very Good Good Fair Poor
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
Figure 36. Overall Health by Age for First Nations Children, Our Health Counts
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Ratesofchronicearinfectionswerehighinthispopulation.Atotalooofchild
custodiansreportedthattheirchildhadhadanearinfectionsincebirth,andofthose
,oreportedoneearinfectioninthepast::months(:,reported:ormoreinthepast
::months).Finally,whenspecifcallyaskediftheyhadbeentoldbyahealthcare
professionalthattheirchildhadchronicearinfectionsorearproblems,:reportedyes.
Injury
Whenaskedifthechildrequiredmedicalattentionforaseriousinjuryinthelast
::months,:orespondedyes.Whenaskedtodescribethetypeofinjury,:8reported
brokenorfracturedbones,:reportedadentalinjuryand,reportedminorcuts,
scrapesorbruises.
Access
Eighty-threepercentofparticipantsindicatedthattheirchildhadseenafamilydoctor,
generalpractitionerorpediatricianinthepast::monthsando,reportedthattheir
childhadseenadentist,dentaltherapist,ororthodontistinthepast::months.Tis
comparestoarateof88forthegeneralCanadianpopulationagedo-oyears.`
Participantswereaskediftheyhadexperiencedanybarrierstoreceivinghealthcarefor
thechildinthepast::months(seefgure,,).Tenumberonebarrierreportedbychild
custodianswasthatthewaitlistwastoolong(,:).Next,participantsreportedbeing
unabletoarrangetransportation(::.,),thattheycouldnotafordtransportation(:8),
thatadoctorwasnotavailable(:,.,),thatanursewasnotavailable(:,.:)andthatthey
couldnotaforddirectcostofcare/services(:,.:).Tefulllistofbarrierstoreceiving
healthcareforchildrenaredisplayedinthefgurebelow.
WhenaskediftheirchildhadparticipatedinanyAboriginalcommunityprograms,
:,saidtheyhadbeentoanOntarioEarlyYearsCentre,:reportedthattheirchild
hadparticipatedintheNiwasaAboriginalHeadStartProgramandoreportedthat
theirchildhadparticipatedinAboriginalHealthBabiesorHealthChildrenProgram.
Foreachoftheotherprogramslisted,thenumberswereverysmall.Atotalof,,
reportedthattheirchildhadnotparticipatedinanyofthecommunityprogramslisted
(seefgure,8).
Child Development
Whenadultswereaskediftheyhadanyconcernabouttheprogressoftheirchilds
physical,mental,emotional,spiritualand/orsocialdevelopment,::answeredyes.
Amongthosewhoindicatedtheyhadconcern,whenaskedtospecifytheareaof
developmenttheywereconcernedabout,thefollowingresultsemerged:,oreported
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54.6%
7.0%
0.4%
1.4%
1.4%
2.0%
2.5%
4.0%
5.8%
13.9%
26.6%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%
None of the Above
Other
Aboriginal FASD and Child Nutrition Institute
atOntario Native Women's Association
Aboriginal FASD and Child Nutrition Institute
at Hamilton Regional Indian Centre
Aboriginal Healthy Babies, Healthy Children Program
at Ontario Native Women' Association
Niwasa Toy Lending and Resource Program
Hamilton's Regional Indian Centre's Canada
Action Program for Children Program
Hamilton Regional Indian Centre's AKWE:GO Program
Aboriginal Healthy Babies, Healthy Children Program
at Hamilton Regional Indian Centre
Niwasa Aboriginal Head Start Program
Ontario Early Years Centre
Figure 38. Participation of Child Aboriginal Community Programs for First Nations Children,
Our Health Counts
5.8%
8.1%
8.3%
8.5%
8.7%
13.8%
15.1%
15.1%
15.3%
18.3%
22.5%
31.7%
0.0% 10.0% 20.0% 30.0% 40.0%
Prior approval of NIHB was denied
Chose not to see Health Care Provider
Difficulty getting Traditional Care
Felt Health Provider was inadequate
Not covered by NIHB
Could not afford Childcare costs
Nurse not available
Could not afford direct costs of Care/Services
Doctor not available
Could not afford Transportation costs
Unable to arrange Transportation
Waiting list too long
Figure 37. Barriers to Receiving Health Care for Child in Past 12 Months for First Nations Children,
Our Health Counts
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thatthiswasaconcernabouttheirchildsphysicalhealth,,wereconcernedabout
emotionaldevelopment,:wereconcernedaboutthechildsspeech/language,,8were
concernedaboutthechildsmental/intellectualdevelopment,and:,wereconcerned
aboutsocialdevelopment(seefgure,).
Figure 39. Area of Concern for Childs Development for First Nations Children, Our Health Counts
56.2%
38.2%
41.3%
54.0%
25.1%
Physical Mental /
Intellectual
Speech /
Language
Emotional Social
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
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I MPL I CAT I ONS F OR URBAN
ABORI GI NAL HE ALT H POL I CY
AND PR ACT I CE
I NT RODUCT I ON
Troughthedevelopmentofasustainableinfrastructureofpartnerships,data
governanceandmanagementofprotocols/agreementsbetweenfourcoreurban
Aboriginalprovincialorganizations,theCentreforResearchonInnerCityHealth
SaintMichaelsHospital,theMinistryofHealthandLong-TermCare,Institutefor
ClinicalandEvaluativeServicesandtheHamiltoncommunity,the Our Health Counts
Urban Aboriginal Health Database project hassuccessfullyestablishedaFirstNations
UrbanHealthDatabase.WithlimitedpublichealthdataavailableforOntariosurban
FirstNationspopulations,theincreasingdisparitiesinsocialdeterminantsofhealthfor
urbanAboriginalpeoples,andjurisdictionalcomplexities,policymakersinsmall
regions,andprovincialandfederalgovernmentsandurbanAboriginalstakeholderswere
restrictedintheirabilitiestoaddresssuchinequitablehealthchallenges.
TeOur Health Counts Urban Aboriginal Health Database projectisnowableto
provideforthefrsttime,FirstNationshealthdatathatclearlydemonstratesalarming
inequitiesinareassuchashousing,income,servicesforlowincomeandmarginalized
populations,chronicdisease,healthcareaccess,culture-basedprogrammesand
services,healthempowermentandself-determination,researchandsystemplanning,
andchildandfamilyhealth.TeprojectsfndingsalsoindicatethattheFirstNations
Hamiltoncommunitymaintainremarkableculturalcontinuity,resilienceandhope,
inthelightofsuchalarminginequities.WiththisnewurbanAboriginalhealthdata
andhealthmeasures,allhealthstakeholderswillnowbeabletoworktogetherin
intersectoralpartnershipstoimprovethehealthstatus,accesstoservices,and
participationinhealthplanningprocessesafectingurbanAboriginalpeopleinOntario.
Inordertodrivesystemicpolicychangestowardstheimprovementofthehealthand
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socialstatusofurbanAboriginalpeoplelivinginOntario,thedevelopmentofanurban
Aboriginalspecifc,culturalbasedcommunitydrivenstrategyisessential.Sucha
strategywouldincorporatetheurbanAboriginalcommunitysleadershipand
governancestructuresinallhealthplanning,programmeandservicedevelopmentand
resourceallocationatalocal,provincialandfederallevel.
Immediateactionisrequiredbylocal,provincialandfederalgovernmentstore-establish
keyrelationshipswithurbanAboriginallocalandprovincialorganizationstoaddressthe
policyactionsrequiredtoaddressthedevastatinghealthandsocialinequitiesand
disparitiesexperiencedbyurbanAboriginalpeopletoday.Unresolvedjurisdictional
accountabilitiesandsystemicdisparitiesinaccesstocareforAboriginalpeoplearefar
tooofenillustratedbythefateofAboriginalchildren.Suchcasesshouldnotexist,asin
theexampleofJordanRiverAndersonofNorwayHouseCreeNation,achronicallyill
anddisabledFirstNationschild,whodiedfarawayfromhisfamily,becauseof
jurisdictionalconfictsbetweenthefederalandprovincialgovernment,overthecostof
hishomehealthcare.InhonourofJordanRiverAnderson,theJordans Principlewas
establishedwiththegoalofensuringequitableaccesstogovernmentservicesforFirst
Nationschildren.Jordans Principleisconsistentwithgovernmentobligationssetoutin
theUnitedNationsConventionontheRightsoftheChild,theCharterofRightsand
Freedomsandmanyfederal,provincialandterritorialchildfocusedstatutes.While
Jordans Principlearosefromajurisdictionalconfictoveron-reservehealthcarecosts,
theprincipleisrelevantandrequiredwithrespecttoensuringtimelyandequitableaccess
tohealthcareforallAboriginalchildren,includingAboriginalchildrenlivinginurban
areasinOntariowhoareofenalsolefbehindduetodebatesbetweenmunicipal,
provincialandfederalstakeholdersregardingaccountability.Todate,noprovincial/
territorialgovernmenthasfullyimplementedJordans Principle.`
TeRoyalCommissiononAboriginalPeoplesidentifedtheneedtonegotiateand
reconcileAboriginalgovernmentswithinCanadaasonekeysteptowardsresolvingthe
concernsofAboriginalpeoplesandbuildinganewrelationshipbetweenAboriginaland
non-Aboriginalpeoplesbasedonmutualrespect,recognitionandsharing.`Te
establishmentofacommitment,byalllevelsofgovernmentstoestablishcollaborative
policiesandplannedprincipledapproaches,toworkacrosslocal,regionalandnational
jurisdictionswithurbanAboriginalhealthstakeholderswillensurethatallgovernments
meetstheirjudicialobligationsandAboriginalpeopleinCanadaareafordedtheirfull
humanrightsassetoutintheUnitedNationsDeclarationontheRightsofIndigenous
People`andthe:8:ConstitutionActofCanada`'andinternationallaw.
TeFirstNationsHamiltoncommunityprojectparticipantshavedemonstratedtheir
resilienceinthelightofextremeadversityinmanyareasofthesocialdeterminantsof
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healthandnowthroughtheirparticipationintheHealth Counts Urban Aboriginal
Health Database project wecannowillustrate,throughanewlyestablishedFirst
Nationshealthdatabase,cleardataandmeasurestowardsmakingstrategicdirections
towardstheimprovementofthehealthandsocialstatusofurbanAboriginalpeople
inOntario.
P OL I CY RE COMME NDAT I ONS :
Housing, Services for Low Income and Marginalized Populations, and
Addressing Inequities in the Social Determinants of Health:
TeoucstudyidentifedstrikinglevelsofpovertyamongFirstNationsresidentslivingin
Hamilton.Forexample,,8.:oftheFirstNationspersonslivinginHamiltonearnless
thans:o,oooperyearand,ooftheFirstNationspopulationinHamiltonlivesinthe
lowestincomequartileneighbourhoodscomparedto:,ofthegeneralHamilton
population.
Tispovertyisaccompaniedbymarkedchallengesinaccesstohousingandfood
security.Forexample,ooftheFirstNationspopulationlivinginHamiltonhadmoved
atleastonceinthepast,yearsandover,oofthepopulationhadmovedthreeormore
timesinthepast,years.Furthermore,:,oftheFirstNationspopulationlivingin
Hamiltonreportedbeinghomeless,intransition,orlivinginanyothertypeofdwelling
notlisted.Inaddition,,,.,ofFirstNationspersonsinHamiltonreportedthattheylive
incrowdedconditions,comparedtoarateof,generalCanadianpopulation.Finally,
o,ofFirstNationscommunitymembersinHamiltonhadtogiveupimportantthings
(i.e.buyinggroceries)inordertomeethousingcostsandonly::oftheFirstNations
populationalwayshadenoughofthekindsoffoodthattheywantedtoeat.
Tesefndingshaveresultedinthefollowingpolicyrecommendationsintheareasof
housing,servicesforlowincomeandmarginalizedpopulationsandaddressinginequities
inthesocialdeterminantsofhealth:
Housing:
1. Tatprovincialgovernmentsthathaveresponsibilityforhousingandsupports
(MinistryofHealthandLongTermCareandtheMinistryofCommunityandSocial
Services)engagewithurbanAboriginalcommunitiesandorganizationsforthe
purposeofensuringthatthecommunitiesprioritiesandcriticalneedsintheareasof
afordablerentalhousing,supportiveandtransitionalhousing,andassistedhome
ownershipareaddressedinaccordancewithhumanrightslegislation.
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Services for Low Income and Marginalized Populations:
2. Tatalllocalandprovincialagenciesthatoferservicestosignifcantnumbersoflow
income/marginalizedurbanAboriginalpopulationscollaboratedirectlywithurban
Aboriginalagenciesandorganizationsanddevelopandimplementmandatory
Aboriginalculturaldiversitytraining.
Addressing Inequities in the Social Determinants of Health:
3. TatprovincialgovernmentsengagewithurbanAboriginalcommunitiesand
organizationsforthepurposeofestablishingpriorities,resourceandfunding
allocationsandactionplanstoaddressthecriticalinequitiesinalleconomicand
socialconditionsafectingAboriginalhealthincludingpoverty,homelessness,food
insecurity,education,employment,healthaccess,genderequalityandsocialsafety.
Chronic Disease and Disability:
AnotherkeyfndingoftheoucstudywasthatFirstNationspeoplelivinginHamilton
arelivingwithadisproportionateburdenofchronicdiseaseanddisability.Forexample,
therateofdiabetesamongtheadultFirstNationsHamiltonpopulationis:,.o,more
thanthreetimestherateamongthegeneralHamiltonpopulation,despiteamuch
youngeragedemographicoftheFirstNationsHamiltonpopulation.Furthermore,the
prevalencerateofhighbloodpressureamongtheadultFirstNationspopulationin
Hamiltonwas:,.8(comparedtoageneralHamiltonrateof:.,);theprevalencerate
ofarthritiswas,o.,(comparedtoageneralHamiltonrateof:.);andtheprevalence
rateofHepatitisCwas8.,(comparedtoanestimatedOntarioprevalencerateofo.8).
Inaddition,,:ofthetotaladultpopulationandoverthreequarters(,,)ofperson
over,oyearsreportedofenorsometimesexperiencinglimitationsinthekindsor
amountofactivitydoneathome,workorotherwisebecauseofaphysicalormental
conditionorhealthproblem.Finally,,oofalladultsreportedfairorpoormentalhealth
and:reportedthattheyhadbeentoldbyahealthcareproviderthattheyhada
psychologicaland/ormentalhealthdisorder.Tesefndingshaveledtothefollowing
policyrecommendationregardingchronicdiseaseanddisability:
4. Tatmunicipalandprovincialgovernmentscommittolongtermresourcesand
fundingallocationsandengageswithurbanAboriginalcommunitiesand
organizationsforthepurposesofestablishingpriorities,preventativeactionand
promotionplanstowardsthereductionoftheburdenofchronicdiseaseand
disabilityintheurbanAboriginalcommunity.
Health Care Access:
Teoucstudyfndingsarecompellingwithrespecttotheneedtourgentlyaddress
barriersinaccessinghealthcareservicesacrossthespectrumofpreventative,primary,
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andtertiarycare.Forexample,ooftheFirstNationspopulationinHamiltonrates
theirlevelofaccesstohealthcareasfairorpoor.Identifedbarriersincludedlong
waitinglists(8),lackoftransportation(,,),notabletoaforddirectcosts(,:),
doctornotavailable(:),andlackoftrustinhealthcareprovider(:).Striking
diferencesinemergencyroomadmissionratesbetweenforFirstNationsinHamilton
comparedtothegeneralHamiltonandOntariopopulationsforbothacuteandnon-
acuteillnessesarelinkedbyparticipantnarrativetothebarrierslistedabovetoaccess
oftimelypreventativeandprimaryhealthcare.FifypercentoftheFirstNations
populationinHamiltonreportedatleastonevisittotheemergencyroomoverthepast
:yearsforacuteproblemscomparedto::oftheHamiltonand:ooftheOntario
populationand:o.ooftheFirstNationspopulationinHamiltonreportedoormore
emergencyroomvisitsintheprevious:yearscomparedto:.oand:.ofthe
HamiltonandOntariopopulationsrespectively.Notwithstandingthisheavyuseof
emergencyroomservices,oftheHamiltonFirstNationspopulationratedthe
qualityoftheemergencycareasfairorpoor.Tesefndingshaveledtothefollowing
policyrecommendationregardinghealthcareaccess:
5. Tatmunicipal,provincialandfederalgovernmentsengagewithurbanAboriginal
communitiesandorganizationsforthepurposesofeliminatingbarriersinaccessto
equitablecommunityhealthcare,emergencydepartmentservicesandinpatient
hospitalservicesforacuteandnon-acuteconditions.
Aboriginal Specific Services, Cultural Safety, and Aboriginal Self-
Determination of Health Care Delivery
Despitethechallengesdescribedabove,FirstNationspeoplelivinginHamilton
demonstrateremarkableculturalcontinuityandresilience.Eventhoughresourcesand
programmingforAboriginalculturalprogramminginHamiltonhavebeenextremely
limitedtodateandtheimpactsofcolonizationhavebeensignifcant,oucstudymeasures
indicateastrongsenseofFirstNationsidentityamongtheFirstNationspopulationliving
inHamiltonaswellasastrongdesiretopasscultureandlanguageontothenext
generation.Teoucpre-surveyconceptmappingstudyhighlightedtheideathatOur
HealthDeservesAppropriateandDedicatedCareandthesubsequentrespectfulhealth
assessmentsurveydocumentedthedesireformoreAboriginalhealthcareworkersand
prejudiceandlackoftrustanddiscriminationassignifcantbarriersinaccessing
care.Inresponsetothesefndingsweadvancethefollowingpolicyrecommendations:
Aboriginal Specifc Services for Family Treatment, Mental Health and Maternal Health
6. Tatmunicipal,provincialandfederalgovernmentsensuretheprovisionofadequate
fundingtotheurbancommunityandorganizationsdirectedtowardsthe
developmentandexpansionofculturallyrefective,communitybased,long-term
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traditionalfamilytreatmentcentres,urbanAboriginalchild,youthandadultmental
healthfundedstrategiesandmaternalhealth,programsandservices.
Cultural Safety:
7. Tatmunicipal,provincialandfederalgovernmentsandhealthstakeholdersdevelop
andinitiatepoliciestowardstheimplementationofculturalcompetencyand/or
culturalsafetyprogramsthataredesignedanddeliveredbyAboriginalpeoplethat
includestherecognitionandvalidationofAboriginalworldviewsandfullinclusion
ofAboriginalhealers,medicinepeople,midwives,communitycounselorsandhealth
careworkersinallcollaborativeefortswithwesternmedicine.
Aboriginal Self-Determination of Health Care Delivery:
8. Tatmunicipal,provincialandfederalgovernmentsrecognizeandvalidatethe
Aboriginalculturalworldviews(thatencompassesthephysical,mental,emotional,
spiritual,andsocialwell-beingofAboriginalindividualsandcommunities)andthat
self-determinationisfundamentalandthusAboriginalpeoplemusthavefull
involvementandchoiceinallaspectsofhealthcaredelivery,includinggovernance,
research,planninganddevelopment,implementationandevaluation.
Childrens Health:
ParentsandcaregiversofFirstNationschildreninHamiltonhighlyvaluethe
transmissionofFirstNationscultureandlanguagetothenextgeneration.Forexample,
theoucstudyfoundthat,ofparentsandcaregiversfeltitwasveryorsomewhat
importantfortheirchildtolearnaFirstNationslanguageandofparentsand
caregiversfeltthattraditionalculturaleventswereveryorsomewhatimportantintheir
childslife.
AdditionalkeystudyfndingsregardingFirstNationschildrenshealthincludedthe
burdenofchronicillnessfacingFirstNationschildreninHamilton;concernsregarding
childdevelopment;andlongwaitinglistsasabarriertoaccessinghealthcare.Asthma
andallergieswerethemostcommonlyreportedchronicconditions.Ratesofasthmawere
twiceashighforHamiltonFirstNationschildrencomparedtogeneralCanadianratesfor
children.Ratesofchronicearinfectionswerealsohigh.Twenty-twopercentofparents
andcaregiverswereconcernedabouttheirchildsdevelopment.While8,ofparticipants
indicatedthattheirchildhadseenafamilydoctor,generalpractitionerorpediatricianin
thepast::months(comparedto88forthegeneralCanadianpopulationagedo-oyears),
therewereasignifcantnumberofreportedbarrierstoaccessingcare.Tenumberone
barriertoreceivinghealthcarereportedbychildcustodianswasthatthewaitlistwastoo
long.Inresponsetothesefndings,werecommendthefollowingpolicies:
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9. Tatmunicipalandprovincialgovernments,includingschoolboards,recognizethe
importanceofandcommitlongtermfundingandresourcestowardsAboriginal
childrenslanguageandculturalprogrammingincollaborationwithurban
Aboriginalorganizationsandagencies.
10. Tatmunicipalandprovincialgovernmentsworkincollaborationwithurban
AboriginalagenciesandorganizationstoreduceurbanAboriginalchildrenshealth
statusinequitiesbyeliminatingbarrierstourbanAboriginalchildrenaccessingregular
primaryhealthcare,reducinglongwaitinglistsandrespondingtotheincreased
prevalenceofhealthconditionssuchasasthmaintheurbanAboriginalchild
populationwithcustomizedculturallyappropriateprimaryhealthcareprogramming.
11. Tatmunicipalandprovincialgovernmentsworkinpartnershipwithurban
AboriginalagenciesandorganizationstoensurethaturbanAboriginalchildrenare
accordedtheirhumanrightstoliveinhealthyhomesandcommunitiesandattend
dayprograms/schoolsinhealthyenvironmentsthatdonotexacerbatechronichealth
conditionssuchasasthmaandallergies.
RE S E A RCH:
UrbanFirstNationsorganizationsandcommunitymembersinHamiltonsuccessfully
partneredwithprovincialAboriginalorganizationsandacademicresearchersinthe
collection,governance,management,analysisanddocumentationoftheirownurban
FirstNationshealthdatabase.Successfulresearchoutcomesincluded:
CompletionofacommunityconceptmappingprojectthatidentifedFirstNations
specifchealthdomains.
DevelopmentandimplementationofacustomizedFirstNationsadultandchild
healthneedsassessmentsurveywhichwasadministeredto,,adultsandonbehalf
:,ochildren(total,ocommunitymembers)livinginthecityofHamilton.
SuccessfullinkageofrecruitedFirstNationscohorttotheInstituteofClinical
EvaluativeSciencesdatabase.
StatisticallyrigorousRespondentDrivenSampling(vus)allowedforsuccessful
derivationofpopulationbasedestimatesofsurveyandInstituteforClinical
EvaluativeSciences(icis)FirstNationscohortmeasures.
Collaborativeproductionofthisprojectreport.
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TeOurHealthCountsresearchprojectdemonstratesthatresearchcanbedoneby
AboriginalpeopleforAboriginalcommunitybeneft.Asaresult,weputforwardthe
followingpolicyrecommendationregardingresearch:
12. Tatmunicipal,provincialandfederalgovernmentsandurbanAboriginal
organizationsrecognizethehealthstatusinequitiesanddisparitiesofurban
AboriginalpeopleslivinginthecityofHamiltonandacrosstheprovinceand
advocateforfundedurbanAboriginalspecifcappliedhealthservicesresearch.
SYS T E M PL A NNI NG:
Ashighlightedintheintroductionofthissection,alloftheabovepolicy
recommendationsareprefacedontheneedforthere-establishmentofkeyrelationships
betweenmunicipal,provincial,andfederalgovernmentsandurbanAboriginallocaland
provincialorganizations.Inparticularthereisaneedtoensurethatunresolved
jurisdictionalaccountabilitiesdonotcontinuetoperpetuateunnecessaryandresolvable
healthdisparitiesforurbanAboriginalpeoples.Suchpressingandsignifcanthealth
inequitiesareunacceptablegiventherelativeamuenceofOntarioandCanadaglobally.
Toaddressthesedevastatinghealthandsocialinequitiesanddisparitiesexperiencedby
urbanAboriginalpeopletodaythesefnalpolicyactionsarerequired:
13. Tatmunicipal,provincialandfederalgovernmentssupportinteragency
collaborationandcooperationamongsturbanAboriginalserviceproviderstowards
thedesignanddeliveryofservicesandidentifcationoffundingandresearch
opportunities.
14. Tatmunicipal,provincialandfederalgovernmentscollaboratewithurban
AboriginalagenciesandorganizationsandgainknowledgeoftheurbanAboriginal
healthdeterminantsandhealthinequitiesandfurtheracknowledgetheurban
Aboriginalcommunitiesrighttoself-determinationinthecontrolofplanning,
design,developmentanddeliveryofculturallyspecifchealthservices,programs
andpolicy.
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Research, Data, Statistics, and Publication Agreement
Between
Ontario Federation of Indian Friendship Centres
(ov:vc)
and
De dwa da dehs ney>s Aboriginal Health Access
Centre (nnnc)
and
Centre for Research on Inner City (cu:cn)/ Michaels
Hospital (smn)
Projecr: Our Healrh Counrs: Development and
Application of a Baseline Population Health Database for
Urban Aboriginal People in Ontario
1uis.cviimi1m.uiiuUviic.1ithisday
(::/,o/:oo)
wi1issi1u.sioiiows:
P UR P OS E OF AGR E E ME NT:
Tepurposeofthisagreementistoensurethattheproject
Our Health Counts:Development and Application of a
Baseline Population Health Database for Urban
Aboriginal People in Ontarioisrespectfultothecultures,
languages,knowledge,values,andrightstoself-
determinationofoiiicand.u.c.Tisagreementwill
alsoprovideaframeworkfortheuseofdatacollected
duringtheResearchProject.Tisagreementsupports
principlesofAboriginalcollectiveandself-determined
datamanagementandgovernance.Tisisnotafnancial
agreement.Teagreementsupportstheinformation
needsofoiiicand.u.c,aswellasacknowledgingthe
desireofDr.JanetSmylieandtheoucresearchteamto
conductthiscollaborativeresearch.Itdefnesthe
opportunity(ies)todevelopresearchcapacityatoiiic
and.u.c.oiiicand.u.canticipatesthisresearch
projectwillassisttoenhancecapacityandleadership
amongoiiicand.u.ccommunitiesandtheirpolicy,
programandhealthservicecollaboratorsintheareaof
FirstNationurbanhealthinformationcollection,
analysis,andapplicationthrough:
a. theinvolvementofcommunityrepresentativesas
activeresearchteammembersinallaspectsof
thisproject;
b. aseriesofcommunity-basedhealthdatause
workshopsinprogramandservicepolicymaking,
planning,delivery,andevaluation.
AGREEMENT PRINCIPALS:
Maintainmutualrespectandaccountabilitybetween
theparties;
Recognizethecomplementaryanddistinctexpertise,
responsibilities,mandates,andaccountability
structuresofeachparty;
Ensurethehigheststandardsofresearchethics,
includingtheacknowledgementofoiiicand.u.c
specifcprinciplesofself-determineddata
management;
Respecttheindividualandcollectiveprivacyrights
ofoiiicand.u.cstaf;
Recognizethevalueandpotentialofresearchthatis
scientifcallyandculturallyvalidated;
Recognizethevalueofcapacitybuildingatalllevels;
Supportoiiicand.u.cprocesses,includingthe
analysisanddisseminationofsurveyresults.
A PPE NDI X A
COMMUNI T YS MH RE S E ARCH
AGRE E ME NT
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PROJECT DESCRIPTION (see page 91)
AGREEMENT:
.uwuivi.soiiicand.u.caredevelopingapolicy
frameworkofprinciplesfordatacollection,self-
determineddatamanagement,analysis,and
dissemination;
.uwuivi.stheoiiicand.u.cprincipleswillbe
articulatedinawrittenformatasaresultofthegapin
legislationapplicabletooiiicand.u.cclientsandstaf
withrespecttothecollectiveownershipandpossessionof
data,statistics,andinformation;
.uwuivi.soiiicand.u.cwishtousethis
opportunitytobuildresearchcapacityand/orprovide
researchopportunitiestoitsmembersandstafby
workingincollaborationwithsmuandicis;
.uwuivi.soiiicand.u.cwouldliketomaintaina
positiveandgoodfaithrelationshipwithsmuandicis;
ow1uiviiovicvicu/smucovenantsandagreesas
followsfortheconsiderationofthesumofOne(s:.oo)
dollarpaidtocvicu/smubyoiiicand.u.c,andother
valuableconsideration,thereceiptandsumciencyof
whichisherebyacknowledged;
3. smuandicisacknowledgesthatanyandalldata
collectedbyoiiicand.u.casaresultofthis
researchprojectisrightfullyownedbyoiiicand
.u.conbehalfoftheHamiltonFirstNation
community.Utilizationofthedatacollectedfor
thepurposeandbythemeansoutlinedinthe
researchproposalisacknowledgedandgrantedby
oiiicand.u.ctocvicu/smuinaccordancewith
thetermsandconditionscontainedinthis
agreement.
4. oiiicand.u.cagreetoundertaketheresearch
roles,responsibilitiesandactivitiesdescribedin
AppendixB.Fundingfortheseactivitieswillbe
providedbyOntarioFederationofIndian
FriendshipCentresaspertheiragreementwith
.u.c.
5. smuandicisagreestotheinclusionofprojectteam
representative(s)fromoiiicand.u.casco-
investigatorsandtheywillbeacknowledgedinany
andallpublications,reports,documents,orother
writtenmaterialfromwhichthisdataisutilized.Te
representative(s)fromoiiicand.u.cwillbe
includedbycvicu/smuinthecompleteresearch
processortotheleveltherepresentative(s)is
directedbyoiiicand.u.ctobeinvolved.Any
presentations,workshopsorconferenceswheresmu
ProjectTeammemberswishtoattendforpurposes
ofdiscussingOurHealthCountsshallinvolveoiiic
and.u.crepresentatives.
6. Teoiiicand.u.cResearchProject
Representative(s)shallbeabletoprovidea
dissentingopinionoffndings.Anydissenting
opinionswillbeincludedaspartoftheoverall
reportinallpublicationsand/orpertinentpublished
orproducedmaterials.
7. Utilizingthedatagatheredfromthisresearch
projectbycvicu/smuforsecondarypublishingwill
requirespecifcwrittenpermissionofoiiicand
.u.c.cvicu/smuistoprotectthedataandactas
stewardsofthisdataonbehalfoftherightfulowner.
8. oiiicand.u.caretherightfulownersofalldata
collectedfromtheHamiltonFirstNation
community.cvicu/smuwillrequireoiiicand
.u.cconsenttomaintainacopyofthedatasetwith
Drs.Smyliesdatabank.cvicu/smuwillberequired
toprotectthedatafromunauthorizeduseandactas
stewardsonbehalfoftherightfulowner.oiiicand
.u.chaveprovidedpriorconsenttoDr.Janet
SmylieoftheCentreforResearchonInnerCity
HealthatSt.MichaelsHospitaltomaintainacopy
ofthedatasetsgeneratedbythisprojectin
accordancewiththeStudyProtocolreviewedand
approvedbycvicu/smuresearchethicsboardand
oiiicand.u.cmanagementforthepurposeof
publishingresearchreportsassetouthereinand
havingaccesstoacopyofthesourcedataofsuch
researchreports
9. Tisagreementisinforcefromthedateofthelast
authorizingsignatureandcvicu/smuagreesthat
thisagreementisirrevocableandshallensuretothe
beneftofandbebindinguponcvicu/smuits
employees,administratorsandlegalandpersonal
representatives.
10. cvicu/smurepresentsthattheyunderstandand
agreetothetermscontainedwithinthisagreement
andsuchperformancewillnotbeunreasonably
withheld.
11. cvicu/smudeclaresthatithasbeengiventhe
opportunitytoobtainindependentlegaladvicewith
respecttothedetailsofthetermsevidencedbythis
Agreementandconfrmsthattheyareexecutingthis
Agreementfreelyandvoluntarily.
12. cvicu/smuwillprovideoiiicand.u.cthe
opportunityforreviewofanyapprovedresearch
reportsbeforethesubmissionofreportsfor
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publication.oiiicand.u.cwillbeprovided
weekstoreviewtheresearchresultsand
accompanyingmanuscript.Intheeventthatoiiic
and.u.candDrs.Smyliecannotagreeonthe
contentofthewrittenreport,oiiicand.u.cwill
beinvitedtowriteaneditorialtoaccompanythe
reporttobesubmittedforpublication.
13. oiiicand.u.c,andcvicu/smuagreetoperform
theirrespectivestudyactivitiesinaccordancewith
theresearchproposalasapprovedbythesmuviv,
participantconsentforms,andallapplicablelaws,
regulationsandguidelines,includingwithout
limitation,theTri-CouncilPolicyStatement,
EthicalConductforResearchInvolvingHumans
andtheCanadianInstitutesofHealthResearch
Guidelines,GuidelinesforHealthResearch
InvolvingAboriginalPeople,allasamendedfrom
timetotime
14. oiiicand.u.c,andcvicu/smuconfrmtheir
respectfortheprivacyofindividualparticipantsin
theresearchproject.oiiicand.u.c,andcvicu/
smuagreetofollowapplicableprivacylawsand
regulationsandtonotifyeachotherifeitherreceives
acomplaintaboutbreachofprivacy
15. Neitherpartyshallusethenameoftheotherparty
oritsstafinanypublication,newsrelease,
promotion,advertisement,orotherpublic
announcement,whetherwrittenororal,that
endorsesservices,organizationsorproducts,
withoutthepriorwrittenconsentofthepartywhose
nameistobeused
16. oiiicand.u.c,theReleasor,confrmsthatifthey
transmitthisAgreementbyfacsimileorsuchdevice,
thatthereproductionofsignaturesbyfacsimileor
suchsimilardevicewillbetreatedasbindingasif
originalsandundertakestoprovideallpartieswith
acopyofthisAgreementbearingoriginalsignatures
forthwithbycourier.
17. NoticestoeachPartyshallbesentto:
cvicu/smu:
,oRichmondStreetEast
Toronto,o
m,c:8
OntarioFederationofIndianFriendshipCentre
SylviaMaracle
::FrontSt.East
Toronto,o
m,.:i8
Dedwadedehsney>sAboriginalHealthCentre:
DenisComptono,8MainSt.East.Hamilton,o
i8m:x:
18. Tisagreementmaybeexecutedincounterpart.
Copiescollectivelybearingthesignaturesofall
partiesshallconstitutethefullyexecutedagreement.
s:cNn1cuvs:
s1. m:cnnvts nosv:1nt
For,Dr.ArthurS.Slutsky
Dr.JanetSmylie
Ontario Federation of Indian Friendship Centres
oiiicAuthorizedSignature
NameandTitle:
De dwa de dehs ney>s Aboriginal Health Centre
.u.cAuthorizedSignature
NameandTitle:
P ROJ E CT DE S CR I P T I ON
Background:
Dr.JanetSmylieisaMtisfamilydoctorandpublic
healthresearcherwithaninterestinimprovinghealth
servicesandprogramsinFirstNationsInuitandMtis
communitiesbyprovidinghealthworkers,program
managers,andpolicymakerswithusefulandrelevant
information.Asaresultofherexperiencesproviding
medicalcaretoyoungAboriginalfamilies,sheis
especiallyinterestedinthehealthandwellbeingof
infants,children,andfamilies.Dr.Smyliebelievesthat
healthservicesandprogramsmaybeimprovedby
enhancingOntarioshealthinformationsystemin
ordertoprovideaccessible,useful,andculturally
relevanturbanAboriginalpopulationhealthdatato
local,smallregion,andprovincialpolicymakers.
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Key Adaptations:
InordertomeetourgoalofimprovingOntarios
healthinformationsysteminordertoprovide
accessible,useful,andculturallyrelevanturban
Aboriginalpopulationhealthdatatolocal,small
region,andprovincialpolicymakers,wehave
designedseveralkeyadaptations,whichwillbe
implementedandevaluatedduringthistwoyear
adaptationprogram.Teseinclude:
1. Community-basedparticipatoryactionapproaches
tohealthdatacollection
2. Respondentdrivensampling
3. Longitudinallinkagestotheicisdatabase
4. Respectfulhealthassessmentsurvey
5. Datagovernanceandmanagementprotocols
Goal:
ToworkwithprovincialurbanFirstNations,Inuit,
andMtisorganizationsandtheOntarioMinistryof
HealthandLongTermCaretoadaptOntarioshealth
informationcollectionsystemsothatitprovides
accessible,useful,andculturallyrelevanturban
Aboriginalpopulationhealthdatatolocal,small
region,provincialandfederalpolicymakers.
Objectives:
Formalizing Intersectoral Partnerships and Establishing
Priority Measures
1. Toformalizepartnershipsbetweenthefourcore
urbanAboriginalprovincialorganizations,the
multidisciplinaryacademicteam,theOntario
MinistryofHealthandLongTermCare(moui1c),
andtheInstituteforClinicalEvaluativeSciences
(icis)forthisprojectthroughresearchagreements
anddatamanagement/governanceprotocols.Tis
willincludetheestablishmentofanAboriginal
HealthDataGovernanceCouncilcomprisedofthe
fourcoreurbanAboriginalprovincialorganizations.
2. Toconfrmpriorityhealthdomainsandbest
indicatorsforeachdomainthroughthese
partnerships.
Knowledge Development through Establishment of a
Population Health Data Base
3. Togeneratenewhealthdatasetsrefectiveofthese
prioritiesforasampleofurbanFirstNations,Inuit,
andMtisadultsandchildrenusingrespondent
drivensampling,securedatalinkagewithicisanda
respectfulhealthassessmentquestionnaire.
Capacity Building, Training and Mentoring
4. Tostrengthencapacityandleadershipamong
OntariosurbanAboriginalcommunitiesandtheir
policy,programandhealthservicecollaboratorsin
theareaofAboriginalhealthinformationcollection,
analysis,andapplicationthrough:a.theinvolvement
ofcommunityrepresentativesasactiveresearch
teammembersinallaspectsofthisproject;b:a
seriesofcommunity-basedhealthdatause
workshops.
5. Toprovideascientifcallyexcellentandculturally
relevanttrainingandmentorshipenvironmentfor
Aboriginalhealthresearchersatthe
undergraduate,graduate,post-doctoralandnew
investigatorlevel.
Knowledge Dissemination, Application, and Contribution
to Future Projects
6. Tosupportcommunity-based,smallregion,
provincial,andfederaluptakeandapplicationof
healthdatageneratedthrough:-,abovetoFirst
Nations,Inuit,andMtishealthpolicies,programs,
andservices.Tiswillincludetheestablishmentof
anAboriginalhealthdatausersgroup,whichwill
haveopenmembershipandallowdiverse
stakeholdersinputandaccesstodatageneratedby
theproject.
7. Tobuildontheoutcomesofthisstudytodesign
futurelongitudinalhealthstudiesinpartnership
withFirstNations,Inuit,andMtisgoverning/
organizationalstakeholdersaswellasadditional
strategiestoimprovethequalityofFirstNations,
Inuit,andMtishealthdatainOntario.
8. Tosharestudyresultsandadaptationprocesseswith
FirstNations,Inuit,andMtisstakeholdersinother
provincesandterritoriesandtherebycontributeto
thedevelopmentofurbanAboriginalhealthdata
enhancementstrategies.
Team:
Tisadaptationprogrambringstogetherrepresentatives
fromOntariosfourkeyurbanAboriginalhealthpolicy
andservicedeliverystakeholderorganizations(Ontario
FederationofIndianFriendshipCentres(oiiic),Mtis
NationofOntario(mo),TungasuvvingatInuit(1i),
OntarioNativeWomensAssociation(ow.)and
multidisciplinarybiomedicalandsocialscience
academicsfromfvediferentinstitutions(Centrefor
ResearchonInnerCityHealth(cvicu)-St.Michaels
Hospital;UniversityofTorontoDepartmentofPublic
HealthSciences;icis;UniversityofManitoba;andthe
IndigenousPeoplesHealthResearchDevelopment
Program).TefoururbanAboriginalorganizationswill
worktogetherasacoalition,withoiiictakingtheleadas
signatoryandactingasdeliveryagentforoiiic,mo,
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andow.andcvicu,supportingtheinterestsand
fnancingforTungasuvvingatInuit.Teteamwillbuild
onexistinglongstandingresearchpartnershipsbetween
theresearchdirector(Smylie)andthecoreAboriginal
organizationalpartnersDr.Smyliehasbeenengagedin
communitybasedpartnershipresearchwith1iandmo
(OttawaCouncil)since:oo:andoiiicsince:oo.Te
multidisciplinaryacademicresearchteambringstogether
expertsfromthedisciplinesofpublichealth,family
medicine,epidemiology,healthdatabaseresearch,
biostatistics,psychiatry,internalmedicine,andpsychology.
Alloftheacademicteammembershaveexperiencein
communitybasedAboriginalhealthresearchandseveral
havededicatedtheircareerstothisarea.
Core Aboriginal Organizational Partners: Ontario
FederationofIndianFriendshipCentres(oiiic),Mtis
NationofOntario(mo),TungasuvvingatInuit(1i),
OntarioNativeWomensAssociation(ow.)
Academic Research Team Members: JanetSmylie,Pat
OCampo,RickGlazier,MarciaAnderson,Kelly
McShane,RoseanneNisenbaum,DionneGesinkLaw,
CorneliaWieman,SanjeevSridharan
Aboriginal Organizational Research Team Members:
SylviaMaracle(oiiic),ConnieSiedule(1i),DonnaLyons
(mo),MarianneBorg(ow.)
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DATA S H A R I NG AGR E E ME NT
1uis.cviimi1madethis:othJanuary,:o:o
nv1wvvN:
:Ns1:1c1v vou ct:N:cnt vvntcn1:vv sc:vNcvs
acorporationhavingitsheadomceat
:o,,BayviewAvenue,intheCityofToronto
[hereinaferreferredtoasicis]
-.u-
1nv ocu nvnt1n cocN1s covvuN:Nc cocNc:t
oN1nu:o vvovun1:oN ov :No:nN vu:vNosn:v cvN1uv
oN1nu:o Nn1:vv womvNS nssoc:n1:oN
1cNcnscvv:Ncn1 :Nc:1
mv1:s Nn1:oN ov oN1nu:o
[hereinaferreferredtoasthecoviviccoUcii]
.u
cvN1uv vou uvsvnucn oN :NNvu c:1v nvnt1n/s1.
m:cnnvts nosv:1nt
,oRichmondStreetEast
Toronto,om,c:8

[hereinaferreferredtoascvicu]
wnvuvns iciswasestablishedin::inordertocarry
outresearchwithrespecttophysiciansservicesand
relatedhealthservicesonbehalfoftheMinistryofHealth
andLongTermCare(moui1c)andtheOntarioMedical
Association;
wnvuvns icismandatenowincludestheconductof
clinicalevaluativestudiesandhealthservicesresearchin
ordertoimprovetheemciencyandefectivenessof
physiciansservicesandrelatedhealthcareservices;
wnvuvns moui1chasenteredintoanagreementwith
icistoprovideannualfundingtoicisforthepurposeof
conductingsuchresearch;
wnvuvns icishasenteredintoadatasharingagreement
withthemoui1cforaccesstoinformation,including
personalhealthinformation,thatisinthecustodyor
controlofmoui1cforthepurposeofconductingclinical
evaluativestudiesandhealthservicesresearch;
wnvuvns icisisaprescribedentityundersection,(:)
ofthePersonal Health Information Protection Act, S.O.
:oo,c.,Sched.A(theAct)andO.Reg.,:/osection
:8(,)andwarrantsandrepresentsthatthepersonalhealth
informationrequestedinthisagreementisnecessaryto
conductingclinicalevaluationstudiesandhealthservices
research;
wnvuvns pursuanttosection,(:)oftheAct,theHealth
InformationCustodianmaydisclosetoaprescribed
entitypersonalhealthinformationforthepurposeof
clinicalevaluationstudiesandhealthservicesresearchif
theentitymeetstherequirementsundersubsection(,).
:oo,c.,,Sched.A,s.,(:);
wnvuvns icishasinplacethepracticesandprocedures
necessaryundersubsection(,).:oo,c.,,Sched.A,s.,
(:)toprotecttheprivacyofindividualsandthe
confdentialityandsecurityofpersonalhealth
informationitreceives;
A PPE NDI X B
I CE S DATA S HA RI NG AGRE E ME NT
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wnvuvns theInformation&PrivacyCommissioner/
Ontariohasreviewedtheprivacy,confdentialityand
securitypracticesandproceduresoficisandapproved
theminOctober:oo8;
nNo wnvuvnstheFirstNations,Mtis,andInuitpeople
inCanadahaveinherentrightstoself-government,
specifcrightsasnegotiatedinthenumberedTreatiesand
rightsasoutlinedandenshrinedintheConstitutionAct
ofCanada(:8:);
Now 1nvuvvouv intheconsiderationofthepromises
andthemutualcovenantshereinafercontained,the
partiesheretoagreeasfollows:
1.0 PURPOSE OF THE AGREEMENT
Tepurposeofthisagreementis:
1.1 tosetoutthetermsandconditionsgoverningthe
provisionofdata,includingpersonal
healthinformation,toicistoenableittoconduct
clinicalevaluativestudiesandhealth
servicesresearchonbehalfofthecovivic
coUciiandcvicu.
2.0 INFORMATION TO BE PROVIDED
2.1 cvicuandcoviviccoUciihaveagreedto
providetoicisacopyoftheOurHealthCounts
RespectfulHealthSurveydataset,(henceforththe
oucvusdataset).Tedatabasewillcontainthe
name,gender,dateofbirth,ouivnumber,and
RespectfulHealthSurveyresponsedataofself-
identifedFirstNationspeoplelivinginHamilton
andInuitandMtispeoplelivinginOttawa(see
ScheduleAforvariableslist).Terewillbethree
linkagesoftheoucvusDatabasetotheicis
databaseatbaseline(:o:o)andin:(:o::)and,
(:o:,)yearsfrombaseline.Followingthecompletion
oftheproject,in:o:,theoucvusDatabasewillbe
permanentlyerasedfromicisfles.
3.0 USE OF THE INFORMATION
icisshallusethepersonalhealthinformationcollected
underthisagreementonlyasnecessaryforthefollowing
purposes:
3.1. TolinktheoucvusDatabasewiththeRegistered
PersonDatabase(vvuv)tocreateacohortofFirst
NationspeoplelivinginHamiltonandInuitand
MtispeoplelivinginOttawa.Tiscohortwillbe
linkedwiththeotheradministrativedata,anda
varietyofmeasureswillbedeterminedandanalyses
willbeconductedfortheFirstNationscohortin
HamiltonandtheInuitandMtiscohortinOttawa.
Tesemayinclude,butwillnotbelimitedto:
3.1.1. Teincidenceandprevalenceofchronic
diseasessuchasdiabetes,cardiovascular
disease,arthritis,covu,cancer,andstroke.
3.1.2. Emergencycare
3.1.3. Physiciancare(visitswithandcontinuityof
primarycare,visitswithspecialists)
3.1.4. Ageandgenderspecifchospitalizationrates
3.1.5. Medicationuse(glucose-lowering
medications,cardioprotectivemedications)
3.1.6. Participationinpreventativecareactivities
(asdefnedbyicis)
3.1.7. Accesstomentalhealthcare(asdefnedby
icis)
3.1.8. Terelationshipbetweensocial
determinantsofhealthandacuteand
chronichealthstatusoutcomes
3.1.9. Terelationshipbetweensocial
determinantsofhealthandaccesstohealth
services
3.1.10. Chronicdiseasecomplications(myocardial
infarction,bypasssurgery/angioplasty,heart
failure,stroke,amputation,dialysis)
3.2 iciswillonlyreleaserequestedmeasuresand
analysestocvicuandthecoviviccoUciiin
anaggregatedformatthatpreventstheidentifcation
ofindividuals.Tisdoesnotprecludethereleaseof
FirstNations,Inuit,Mtisspecifcdatasets.
3.3 AttherequestofTungasuvvingitInuit,icismay
releaseInuitspecifcmeasuresandanalyses.
3.4 AttherequestofMtisNationofOntario,icismay
releaseMtisspecifcmeasuresandanalyses.
3.5. Researchreportsandpublications,includingpeer
reviewedscholarlymanuscripts,willbecreatedat
thediscretionofthecoviviccoUciiand
cvicu.
3.6 Allresearchreportsandpublicationswillcreditthe
coviviccoUcii,relevantcvicustafandthe
relevanticisscientists/stafwithauthorship.
3.7 TecoviviccoUciiwillhavetheopportunity
toreviewallresearchreportsandpublicationsthat
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arepreparedbycvicubeforetheyaremadepublic,
submittedtothemou1icasper,.obelow,or
submittedforpublication.Te
coviviccoUciiwillbeprovidedaminimumof
,odaysforthis
reviewunlessotherwiseagreedbycovivic
coUciiRepresentativesshallbeabletoprovidea
dissentingopinionoffndingsandanydissenting
opinionswillbeincludedaspartoftheoverall
reportinallpublicationsand/orpertinentpublished
orproducedmaterials.
3.8 Underitscontractualobligationtothemoui1c,icis
willprovidethemoui1cwithcopiesofallreports
thathaverequiredtheuseofhealthcaredata
obtainedfromthemoui1cforthepurposesof
compilingtheinformation,odayspriorto
submittingsuchreportsforpublicationormaking
suchreportspublic,asthecasemaybe.Temoui1c
shallkeepallsuchreportsconfdential.
4.0 MECHANISMS FOR TRANSMISSION
4.1 Tepartiesshallmutuallydeterminethemethod,
medium,frequencyandtimetabletobeusedwith
respecttotheprovisionofinformationunderthis
agreement.Teseparametersshallenableicisto
meetitsivc-approvedstandards,mustftwith
availabletechnology,andwithavailabilityofstafto
efectivelyandsecurelymanagethevui.
5.0 CONFIDENTIALITY
5.1 Tepersonalinformationdisclosedunderthis
agreementisconfdentialandmechanismsfor
maintainingtheconfdentialityofthisinformation
aredescribedinArticle,..
5.2 Beforedisclosinganypersonalhealthinformation
underthisagreement,cvicu,thecovivic
coUciiandicisshallexerciseduecautionin
providingonlythatpersonalhealthinformationthat
isdeterminedtobenecessaryforthepurposesetout
inArticle,.:.
5.3 icis,inrequestingpersonalinformationunderthis
agreement,warrantsandrepresentsthatthe
personalinformationisnecessaryforthepurposes
setoutinArticle,.:.
5.4 icisagreestothefollowingprecautionsand
safeguardsinhandlingconfdentialpersonal
informationandpersonalhealthinformation:
5.4.1 iciswillgiveaccesstopersonalhealth
informationinaforminwhichthe
individualtowhomitrelatescanbe
identifedonlytothefollowingpersons:Mr.
DonDeBoer,Director,DataManagement,
Mr.NelsonChong,HealthData
Administrator,andMrNicholasGnidziejko,
Analyst.
5.4.2 iciswillkeepthepersonalhealth
informationinaphysicallysecurelocation
towhichaccessisgivenonlytothepersons
mentionedinSection,..:,above.
5.4.3 Identifyingnumbersonlinkedoucvus
Databasewillbeencryptedimmediately
aferthedataarefrstread,andallworking
fleswillhaveonlytheencryptednumberon
them.
5.4.4 Tedatafromcvicu,thecovivic
coUciiandmoui1cwithidentifying
informationaboutanindividualwillbe
copiedbyicistoelectronicmediaand
storedseparatelyinalockedsafeinaroom
withsecuritylocks.Teoriginalmediawill
bereturnedtothesourceordestroyed.
5.4.5 icislinkedworkingfleswillnotcontain
identifyinginformationaboutanindividual.
5.4.6 OtherthantheindividualsnamedinArticle
,..:,thestafinicisInformationSystems,
themembersoficisProgrammingand
BiostatisticsteamandicisScientistswillbe
accessingtheworkingfles
onlyinananonymizedformandwillbe
producinganalysesrequiredfor
reportsfromsuchfles.
5.4.7 Allpersonneloficisshallsigna
confdentialityagreementtoensurethat
theydonotdisclosepersonalhealth
informationtoanyotherperson.Insodoing,
eachpersonworkingforicisacknowledges
thatthedisclosureofpersonalhealth
informationisgroundsforimmediate
dismissalortermination.
5.4.8 Inaccordancewithitsprivacypolicy,icis
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willonlypresentaggregateddatainits
reportssoastopreventtheindirect
identifcationofindividuals.Tiswillnot
precludethepresentationofFirstNations,
Inuit,and/orMtisspecifcdatasets.
Informationinthecellswillbesuppressed
whentheycontainfve(,)observationsor
less.Informationinsparsecellsmaybe
combinedwithothercellstoavoidcell
countsoffve(,)observationsorless.
5.5 WhereapersonspecifedinArticle,..:nolonger
hasaccesstoidentifyinginformation,icisshall
notifycvicuandthecoviviccoUciiofthe
substituteforthatperson.
5.6 iciswillnotcontactanyindividualtowhom
personalhealthinformationrelates,directlyor
indirectly.
5.7 iciswillensurethatnoinformationregardingthe
cohortofFirstNationspeopleinHamiltonand
MtisandInuitpeopleinOttawawillbeusedor
disclosedtoanyotherpartywithouttheprior
writtenauthorityofthecoviviccoUciiexcept
toicisemployeesidentifedinArticle,..:whoare
responsibleforencryptingtheidentifyingnumbers,
doinglinkagesandstoring,retrievingordestroying
thedata.
5.8 iciswillnotifycviucandthecoviviccoUcii
assoonasithasbecomeawareofabreachofthe
termsandconditionssetoutinthisagreementand
iciswilladvisecvicuandthecoviviccoUcii
ofthesteps
takentocorrectanysuchdefaultandtopreventany
recurrence.
6.0 FINANCIAL ARRANGEMENTS
o.: Eachpartyshallbearitsowncostofimplementing
thisagreement.
7.0 AMENDMENTS
7.1 Tisagreementmaybeamendedifthepartiesagree
tosuchamendmentsinwriting.Anyamendments
somadeshallbeconsistentwiththerequirementsof
thePersonalHealthInformationProtectionActand
theciuvGuidelinesforResearchwithAboriginal
Peoplesandshallnotbecontrarytoanylaws
regardingconfdentialityofhealthinformation.
9.0 TERMS, COMMENCEMENT AND TERMINATION
OF AGREEMENT
9.1 Tisagreementshalltakeefectonthedatesetout
onpage:.
9.2 Tisagreementshallcontinueinefectforaslongas
theu.1.cUs1oui.providesdataidentifedinthis
agreement,unlessthereisanamendmentor
termination,subjecttoArticle:o.:.
9.3 cvicuandthecoviviccoUciimaycease
disclosinganyoneormoredataelements,without
cause,bygivingicisnoticeinaccordancewith
Article::.
9.4 IfcvicuandthecoviviccoUciicease
disclosingofpersonalinformationunderArticle.,,
theentireagreementisnotterminatedbutcontinues
withrespecttotheremainingdataelementswhich
cviucandthecoviviccoUciiarewillingto
continuetodisclose.
9.5 Tisagreementmaybeterminatedbyeitherparty
withoutcauseonatleastthreemonthsnoticeandon
breachbytheotherpartyimmediatelyonnotice.
9.6 Tisagreementmaybeamendedorterminatedon
mutualagreementbytheparties.
9.8 Onterminationthecvicuandthecovivic
coUciishallcease
disclosingdataandicisshallceaseusingdata.
9.9 Ontermination,icisshalldestroyallthedataand
allcopiesimmediately,inaccordancewithicis
procedures
10.0 SURVIVAL OF OBLIGATIONS
10.1 Termsandconditionsrelatingto
(a) useanddestructionoftheinformation
(b) confdentiality;and
(c) indemnifcationshallsurvivethetermination
ofthisagreement.
11.0 NOTICE
11.1 Noticeofintentiontoterminateshallbegivenin
writingtotheotherpartyatleastthreemonths
beforethedateonwhichthisagreement,oranypart
ofthisagreement,asthecasemaybe,istobe
terminated.
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11.2 Noticeshallbedeemedtohavebeensumciently
givenseventy-twohoursaferithasbeenmailed,
postageprepaid,oronthedateofreceiptwherethe
noticehasbeendeliveredbyhandorbyfacsimile
transmission.
11.3 Anynoticeorothercommunicationrequiredor
permittedtobegivenbyeitherpartytotheother
shallbesenttothefollowingaddresses:
Iffor:cvs:
Dr.DavidA.Henry
ChiefExecutiveOmcer
GWing,Room:oo,
:o,,BayviewAvenue,
Toronto,om,m,
Phone::o-8o-:,
IfforthecovvuN:Nc cocNc:t:
SylviaMaracle
ExecutiveDirector
OntarioFederationofIndianFriendshipCentres
::FrontSt.
Toronto,om,.:i8
ConnieSiedule
HealthDirector
TungasuuvingatInuit
.uui.uuviss
DonnaLyons
HealthDirector
MtisNationofOntario
,ooOldSt.PatrickStreet,Unit-,
Ottawa,ox:c
CoraLeeMcGuire-Cyrette
ExecutiveDirector
OntarioNativeWomensAssociation
.uui.uuviss
.u
Ifforcu:cn
JanetSmylie
ResearchScientist
CentreforResearchonInnerCityHealth
,oRichmondSt.
Toronto,om,c:8
12.0 INDEMNIFICATION
12.1 icisshallindemnifyandsaveharmlessthe
coviviccoUciiandcvicuandthecovivic
coUciiandcvicusCustodiansdirectors,omcers,
employees,independentcontractors,subcontractors,
agents,andassignsfromallcosts,losses,damages,
judgments,claims,demands,suits,actions,causesof
action,contracts,orotherproceedingsofanykind
ornaturebasedonorattributabletoanydisclosure
ofpersonalhealthinformationtowhomitrelates
canbeidentifedbyicisoritsdirectors,omcers,
employees,independentcontractors,subcontractors,
agentsorassignsincontraventionofthisagreement.
Tisprovisionsurvivestheterminationofthis
agreement.
12.2 cvicuandthecoviviccoUciishallindemnify
andsaveharmlessicisandicisdirectors,omcers,
employees,independentcontractors,subcontractors,
agents,andassignsfromallcost,losses,damages,
judgments,claims,demands,suits,actions,causesof
action,contracts,orotherproceedingsofanykind
ornaturebasedonorattributabletoanyinaccuracy
oftheinformationprovidedbycvicuandthe
coviviccoUciitoicisunderthisagreement.
Tisprovisionsurvivestheterminationofthis
agreement.
:N w:1Nvss wnvuvov 1nv vnu1:vs heretohave
executedthisAgreement:
oN1nu:o vvovun1:oN ov :No:nN vu:vNosn:v
cvN1uvs
svtv:n mnunctv
Per:
Authorized Signing Of cer Witness
Print Authorized Signing Of cer Name Date
oN1nu:o Nn1:vv womvNs nssoc:n1:oN
coun tvv mcqc:uv
Per:
Authorized Signing Of cer Witness
Print Authorized Signing Of cer Name Date
1cNcnscvv:Ncn1 :Nc:1
moucnN nnuv
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Per:
Authorized Signing Of cer Witness
Print Authorized Signing Of cer Name Date
mv1:s Nn1:oN ov oN1nu:o
oocc w:tsoN
Per:
Authorized Signing Of cer Witness
Print Authorized Signing Of cer Name Date
cvN1uv vou uvsvnucn oN :NNvu c:1v nvnt1n/ s1.
m:cnnvts nosv:1nt
ou. nu1ncu S. stc1sv
Per:
Authorized Signing Of cer Witness
Print Authorized Signing Of cer Name Date
:Ns1:1c1v vou ct:N:cnt vvntcn1:vv sc:vNcvs
ou. onv:o A nvNuv
Per:
DavidA.Henry Witness
ChiefExecutiveOmcer
Print Authorized Signing Of cer Name Date
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QUE S T I ONN A I R E :
H A MI LT ON F I R S T N AT I ON S
RDS Screening Questions
1. Coupon-Presented:
2. Doyouself-identifyasbeingFirstNations:
vis

o[endinterview]

uo1xow[endinterview]

ovisvosi[endinterview]
3. DoyouliveinHamilton:
vis

o[endinterview]

uo1xow[endinterview]

ovisvosi[endinterview]
4. ouiv-
5. uov
6. ParticipantName
7. DoyouhaveFirstNationchildrenthatareunder
yourcareandresidewithyou:
vis
o[sxiv1oix1sic1io]
8. Wouldyoubewillingtocompletethechildportion
ofthesurvey:(informthemitwilltakeanadditional
:ominutesaskwewillbeaskingforalltheir
childrenundertheageof:)
vis

o[Skiptonextsection]
9. Howmanychildrendoyouhave:
RDS Questions
Tesenextquestionsareaboutgatheringinformationon
yourpersonalnetwork.Wewillusethisinformationto
determinehowlongwewillcontinuetorecruitresearch
participants.
1. HowmanyFirstNationspeopledoyouknowby
namewhocurrentlyliveinthecityofHamilton[Not
includingthosewholiveon-reserve]
-ofpeople
uo1xow
ovisvosi
2. Whatisyourrelationshiptothepersonwhogave
youthecoupon:(readoutlist)
Relative
Girlfriend/boyfriend;partnerorspouse
Friend
Acquaintance
Stranger
uo1xow
ovisvosi
Introduction
TeRespectfulHealthAssessmentSurvey(vu.s)for
UrbanFirstNationpeoplelivinginHamiltonOntariois
directed,operated,controlledandownedbyDedwada
dehsnye>sandtheOntarioFederationofIndian
FriendshipCentresonbehalfoftheFirstNationspeople
livinginHamilton.
A PPE NDI X C
F I RS T NAT I ONS A DULT A ND CHI L D
S URV E Y T OOL
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Temainobjectiveofthevu.sistoobtainaccurate,
usefulhealthdatafortheFirstNationspopulationliving
inHamilton.TisdatawillbeusedbyFirstNations
organizationsandservicesinHamiltontoadvocatefor
enhancedresourcesandbetterTesurveyconsistsof
twosections:
Adultsurvey
Childrensurvey(:andUnder)
Tevu.siscollectedusingaComputerAssistedPersonal
Interviewsystem.Tedataisgatheredbytrained
communitysurveyinterviewers.Tevu.swas
developedinpartnershipwithHamiltonFirstNation
serviceprovidersandcommunitymembers.Tevu.s
hasbeenreviewedandapprovedbyDedwadadehsnye
>sandtheOurHealthCountsGoverningCommittee.
S E CT I ON 1 : S OCI ODE MOGR A P HI C S
( I NCL UDI NG HOUS I NG, S OCI OECONOMI C S TAT US ,
AND F OOD S ECURI T Y )
A. Demographics
1. What is your gender:
m.ii
iim.ii
1v.sciuiv
o1uiv
2. In what year were you born:

uo1xow

ovisvosi
3. How do you self-identity?
a. AreyouFirstNations:
vis

o[sxiv1oiu]

uo1xow[sxiv1oiu]

ovisvosi[sxiv1oiu]
b. Areyou:
Status(RegisteredIndianaccordingtothe
IndianAct)
Non-status
uo1xow
ovisvosi
c. WhatisyourNation(e.g.Ojibway,Cree,Mohawk:)
d. Whatisyourreserveandorbandamliationifany:
4. What language do you speak most oen at home:
(please specify)
uo1xow
ovisvosi
5. What is your marital status: (Show Card t).
Married
Separated
Divorced,marriageannulment
Widowed
Cohabiting,commonlaw
Nevermarried
uo1xow
ovisvosi
6. Have you had any children:
vis
o[sxiv1o:o]
uo1xow[sxiv1o:o]
ovisvosi[sxiv1o:o]
7. Howmanychildrendoyouhave:
(please specify)
uo1xow
ovisvosi
8. How old are your children:
-:
-:
-,
-
-,
-o
-,
-8
o1uivs:
(please specify all ages)
uo1xow
ovisvosi
9. How many of these children currently live in your
household:
-ofchildren
uo1xow
ovisvosi
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10. What is the highest level of schooling you have ever
completed: Please choose one from the following
categories. (Show Card z).

Lessthangrade

Somehighschool

Completedhighschool

Sometradesortechnicaltraining(college)

Completedtradesortechnicaltraining(college)

Someuniversity

Completeduniversity

Somepost-graduateeducation

uo1xow

ovisvosi
11. Which of the following best describes your current
employment status: Please choose one from the
following categories. (Show Card )
Part-time
Full-time
Seasonal
Self-employed
Homemaker
Anyotherinformalpaidworksuchas
babysitting,housekeeping
Student
Retired
Unemployed
uo1xow
ovisvosi
12. Tinking about the total income for all household
members, from which of the following sources did
your household receive any income in the past :i
months: Please select all that apply. (Show Card {)
Wagesandsalaries
Incomefromself-employment
Employmentinsurance
Workerscompensation
ChildTaxBeneft
Provincialormunicipalsocialassistanceor
welfare
Childsupport
Alimony
Moneyfromfamilyonaregularbasis
BeneftsfromCanadaorQuebecPensionPlan
Retirementpensions,superannuationand
annuities
OldAgeSecurityandGuaranteedIncome
Supplement
Dividendsandinterest(e.g.,onbonds,savings)
o1uiv(e.g.,rentalincome,scholarships,Indian
Afairssupportforschool)
(please specify)
uo1xow
ovisvosi
13. Do you have any additional thoughts/comments:
B. Housing and Mobility
1. Which of the following best describes the type of
dwelling you live in: Please choose one from the
following categories. (Show Card y)
Singlehouse(notattachedtoanyotherdwelling)
Semi-detached,duplexhouse,rowhouse,or
townhouse
Self-containedapartmentwithinasingle
detachedhouse
Apartmentorcondominiuminalow rise
buildingorapartmentblock(< ,storeys)
Apartmentorcondominiuminahigh rise
buildingorapartmentblock(> ,storeys)
Homeless[Skipto:o]
Transition(ie.Couchsurfng,shelter,welfare
residence,drugtreatmentcentre)[Skipto:o]
Other:
(please specify)
uo1xow[Skipto:o]

ovisvosi[Skipto:o]
2. Forhowlonghaveyoulivedinyourcurrenthome:

vi.vs mo1us

uo1xow

ovisvosi
3. For how long have you lived in the city of
Hamilton: (f rhe parrcpanr has lved n Hamlron
more rhan once, specfy rhar rhs refers ro rhe rme
snce rhe respondenr lasr moved ro Hamlron).

vi.vs mo1us

uo1xow

ovisvosi
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4. How many times have you moved in the past years:
1imis
uo1xow
ovisvosi
5. Is your home: (Show Card o)
Ownedwithoutamortgagebyyourhousehold
Ownedwithamortgagebyyourhousehold
Rentedbyyourhousehold
NativeHousing(ie.UrbanNativeHomesInc.)
othersocialhousing
Occupiedrent-freebyyourhouseholdwhereno
memberownsandnorentischarged
Other
(please specify)
uo1xow
ovisvosi
6. How many rooms are there in your home: (We
would like to know the total number of rooms,
including the kitchen, bedrooms, hnished rooms
in attic or basement, etc. Do not count bathrooms,
hallways and rooms used solely for business
purposes.)
vooms
uo1xow
ovisvosi
7. Including yourself, how many people currently live
in your household:
:vivso

:viovii

,viovii

viovii

,viovii

oviovii

,viovii

8viovii

viovii

:oovmoviviovii

uo1xow

ovisvosi
8. Which of the following best describes your
household: Please choose one from the following
categories. (Show Card ,)

Oneadultpersonlivingalone

Oneadultwithchildren

Oneadultwithchildrenandadditionalfamily
(ie.parents,grandparents,sisters,brothers,
aunties,uncles,cousinsetc.)
Amarriedorcommonlawcouplewitho
children
Amarriedorcommonlawcouplewitho
childrenandadditionalfamily(ie.parents,
grandparents,sisters,brothers,aunties,uncles,
cousinsetc.)
Amarriedorcommonlawcouplewithchildren
Amarriedorcommonlawcouplewithchildren
andadditionalfamily(ie.parents,grandparents,
sisters,brothers,aunties,uncles,cousinsetc.)
Twoormoreunrelatedpersons
Other:
(please specify)
uo1xow
ovisvosi
9. Is your dwelling in need of any repairs: (Not
including desirable remodeling or additions)
(Show Card 8)
No,onlyregularmaintenanceisneeded
(painting,furnacecleaning,etc.)
Yes,minorrepairsareneeded(missingorloose
foortiles,bricksorshingles,defectivesteps,
railingorsiding,etc.)
Yes,majorrepairsareneeded(defective
plumbingorelectricalwiring,structuralrepairs
towalls,foorsorceilings,etc.)
uo1xow
ovisvosi
10. In the last i years, have you had a problem in your
home with mice, rats or roaches:
vis
o
uo1xow
ovisvosi
11. In general, how do you rate the day-to-day comfort
provided by your homes heating system: Is it:
(Show Card )
Excellent
VeryGood
Good
Fair
Poor
uo1xow
ovisvosi
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12. How concerned are you about poor air quality in
your home due to things like dampness, mold,
pollution, or bad air exchange/venting: Are you:
(show card to)
Veryconcerned
Somewhatconcerned
Alittleconcerned
Notconcernedatall
uo1xow
ovisvosi
13. How much do you spend monthly on shelter costs
[including rent/mortgage, utilities, repair,
upkeep]:
s
uo1xow

ovisvosi
14. How oen do you have to give up important things
(ie. buying groceries) in order to meet shelter-
related[housing]costs:(readlist)
Severaltimesamonth

Onceamonth

Afewtimesayear

Never[Skipto:o]

uo1xow[Skipto:o]

ovisvosi[Skipto:o]
15. How long has this been going on: (show card tt)

Lessthan:month

:-,months

,monthsto:year

:yearto,years

Morethan,years

uo1xow

ovisvosi
16. It has been shown that hnancial hardship can have
an impact on health.Do you believe that your
overall health and well-being has been aected by
hnancial hardship:
Yes

No[Skipto:8)

uo1xow[Skipto:8)

NoResponse[Skipto:8)
:,. Howlonghasthisbeengoingon:(showcard::)
Lessthan:month

:-,months

,monthsto:year

:yearto,years
Morethan,years
uo1xow
ovisvosi
18. Do you believe that your ability to engage in
preventative health activities (i.e. regular exercise,
going to the doctor or nurse for health screening
tests, accessing preventative dental care) has been
aected by hnancial hardship:
Yes
No(SkiptoNextSection)
uo1xow(SkiptoNextSection)
ovisvosi(SkiptoNextSection)
19. How long has this been going on: (show card :)
Lessthan:month
:-,months
,monthsto:year
:yearto,years
Morethan,years
uo1xow
ovisvosi
C. Nutrition, Water Quality, and Food Security
1. Do you eat a nutritious balanced diet: (show
card t{)
Always
Almostalways
Sometimes
Rarely
Never
uo1xow
ovisvosi
2. Which of the following statements best describes
the food eaten in your household in the past :i
months: (Show Card ty)
Youandothersalwayshadenoughofthekinds
offoodyouwantedtoeat
Youandothershadenoughtoeat,butnot
alwaysthekindsoffoodyouwanted
Sometimesyouorothersdidnothaveenough
toeat
Ofenyouorothersdidnothaveenoughtoeat
uo1xow
ovisvosi
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3. Do you have a place to go if you or your family
doesnt have enough to eat: [Tis could be to a
family member or friends place, a food bank, or
any other place]

vis

Ihaveneverneededtogotosuchaplace

uo1xow
ovisvosi
4. Does anyone in your household grow foodthat
is vegetables, fruit, berries, nuts, or herbsin
youryard,onyourbalconyorinacommunity
garden:
vis
o
uo1xow
ovisvosi
5. Do you consider the tap water in your home safe
for drinking year round:
Yes
No
Donthaverunningwater/tapwater
uo1xow
ovisvosi
6. Do you have any additional thoughts/comments
about the issues we have discussed so far:[open end]
S E CT I ON 2 : WH AT H A P P E N S WHE N
WE A R E OUT OF B A L A NCE
P H Y S I CA L , ME N TA L , A N D E MOT I ON A L H E A LT H
P R OB L E MS
A. General Health Status and Exercise
1. Please rate your health. Compared to other
people your age, would you say your health is:
(show card to)

Excellent

VeryGood
Good
Fair
Poor
uo1xow
ovisvosi
2. How oen do you feel that you are in balance in the
four aspects of your life: (Physical, emotional,
mental and spiritual) (Show Card t,)
Allofthetime
Mostofthetime
Someofthetime
Alittleofthetime
Noneofthetime
uo1xow
ovisvosi
3. On average, how many days per week do you do
o minutes or more of moderate or vigorous
physical activity: Tis activity can be part of
work, transportation, or recreation, and need not
be all at once, but is a total of at least o minutes
per day. Moderate activity includes brisk
walking, for example; and vigorous activity
makes you work up a sweat. Based on this
dehnition, how many days per week do you at
least do o minutes of moderate or vigorous
activity: (show card t8)
ou.vs
:u.v/wiix
:u.vs/wiix
,u.vs/wiix
u.vs/wiix
,u.vs/wiix
ou.vs/wiix
,u.vs/wiix
uo1xow
ovisvosi
106
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B. Chronic Health Conditions
Iwouldnowliketoaskyouaboutcertainchronichealth
conditionsthatyoumayhave.Weareinterestedinlong-
termconditionswhichareexpectedtolastorhave
alreadylastedomonthsormoreandthathavebeen
diagnosedbyahealthcareprovider.
1. Have you been told by a health care provider that
you have any of the follow health conditions:
If Yes, Please answer follow-up questions
Read through the entire list of conditions and answer
yes or no
Listconditionsthathavelastedatleastomonthsor
areexpectedtolastatleastomonths.
Yes=Y
No=N
uo1xow=ux
Noresponse=R
CONDITION TOLD THAT YOU HAVE OR I F YES:
BEEN DI AGNOSED WITH:
Asthma N Y DK R Have you had any symptoms N Y DK R
or attacks in the last 12 months?
In the past 12 months have N Y DK R
you taken medication for asthma
(i.e. inhalers, nebulizers, pills, liquids
or injections)
Arthritis N Y DK R In the past 12 months, did you N Y DK R
ever have pain in your joints (i.e.
hips, knees, hands) that limited
the amount or type of activity that
you were able to do?
Heart disease N Y DK R
Stroke N Y DK R
Liver disease N Y DK R
High Blood Pressure N Y DK R In the past month have you N Y DK R
taken medication for high blood pressure
Hepatitis B N Y DK R
Hepatitis C N Y DK R
Allergies N Y DK R
Chronic bronchitis, N Y DK R
Emphysema, or COPD
(Chronic Obstructive
Pulmonary Disease)
Attention Decit N Y DK R
Disorder/ Attention
Decit-Hyperactivity
Disorder (ADD/ADHD)
Learning disability N Y DK R
2. Do you have diabetes (as diagnosed by a health
care provider)
vis
o[sxiv1oquestion-:o]

uo1xow[sxiv1oquestion-:o]

ovisvosi[sxiv1oquestion-:o]
3. Do you currently take insulin for your diabetes:
vis

uo1xow

ovisvosi
4. In the last month, did you take pills to control your
blood sugar:
vis
o
uo1xow
ovisvosi
5. In the past :i months, has a health care
professional tested you for haemoglobin
A-one-C: (An A-one-C haemoglogin test
measures the average level of blood sugar over a
month period.)
vis
o
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uo1xow
ovisvosi
6. In the past :i months, has a health care
professional checked your feet for any sores or
irritations:
vis
o
uo1xow
ovisvosi
7. In the past :i months, has a health care
professional tested your urine for protein (i.e.
Microalbumin):

vis
o
uo1xow
ovisvosi
8. Have you ever had an eye exam where the pupils of
your eyes were dilated: (Tis procedure would
have made you temporarily sensitive to light.)
vis
o[sxiv1oix1sic1io]

uo1xow[sxiv1oix1sic1io]

ovisvosi[sxiv1oix1sic1io]
9. When was the last time: (show card t)

Lessthanonemonthago

:monthtolessthan:yearago

:yeartolessthan:yearsago

:ormoreyearsago

uo1xow

ovisvosi
10. Did your mother consume alcohol during any part
or all of her pregnancy with you:

vis

uo1xow

ovisvosi
C. INJURY AND ACUTE ILLNESS
1. Were you injured in the past :i months:
vis

o[Skiptoquestion,]

uo1xow[Skiptoquestion,]

ovisvosi[Skiptoquestion,]
2. For your most serious injury in the past :i months,
please indicate which of the following was the
cause of this injury: Show Card zo)
Fall
Burn
Poisoning
Near-drowning
Animalbite
Roadtramccrashasapassenger
Roadtramccrashasadriver
Roadtramccrashasapedestrian
Other
(please specify)
uo1xow
Noresponse
3. In the past :i months, how many times have you
had an upper respiratory tract infection (ie. cough,
cold, bronchitis, ear infection, sore throat, sinus
infection): (read list)
o
:
:
,
Morethan,
uo1xow
ovisvosi
4. In the past :i months, how many times have you
had a lower respiratory tract infection (ie.
pneumonia): (read list)
o
:
:
Morethan,
uo1xow
ovisvosi
5. Have you received the H:N: u vaccine:
vis
o[Skiptonextsection]
uo1xow
ovisvosi
108
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6. What was the reason(s) you did not receive the
vaccine: (Check all that apply) (Show card i:)
Iwasnotamemberofthelistedatriskgroups
Iwasworriedabouttheside-efectsofthe
vaccine
Myhealthcareprovider(ie.doctor/nurse/clinic)
didnothavethevaccineorranoutofthe
vaccine
Tewaittogetthevaccinewastoolong
Ididnthavetimeinmyscheduletogoandget
thevaccine
Ididnthavetransportationtogoandgetthe
vaccine
Idonttrustmyhealthcareprovider
Ialreadyhadthefu
uo1xow
NoResponse
Other
(please specify)
D. Sexual and reproductive health.
For Women:
1. Have you ever had a Pap test:(APaptestisatest
performedbyadoctor,nurse,ornursepractitioner
whereasampleofcellsistakenfromthecervix.)
vis
o[sxiv1oqUis1io,]

uo1xow[sxiv1oqUis1io,]

ovisvosi[sxiv1oqUis1io,]
2. When was that last time you had a Pap test:
Monthsago

Yearsago

uo1xow

ovisvosi
For Women with children:
3. Did you breastfeed any of your children:
vis

o[sxiv1oqUis1ioo]

uo1xow[sxiv1oqUis1ioo]

ovisvosi[sxiv1oqUis1ioo]
4. If yes, for how many children:
-ofchildren

uo1xow

ovisvosi
5. For each child, how long did you breastfeed:
Child::
monthsyears
Child::
monthsyears
Upto:oChildren
uo1xow
ovisvosi
For Men and Women:
6. Without revealing test results, have you ever been
tested for n:v:
vis
o
uo1xow
ovisvosi
7. Have you ever had a sexually transmitted
infection:
Yes
No[sxiv1oix1sic1io]
uo1xow
NoResponse
8. Have you ever been diagnosed and treated for:
(show card ii)
Chlamydia
Genitalherpes
Genitalwarts
Gonorrhea
Syphilis
Other
(please specify)
E. Ability
1. Are you limited in the kinds or amount of activity
you can do at home, work or otherwise because
of a physical or mental condition or health
problem: (read list)
Yes, ofen
Yes,sometimes
No
uo1xow
Noresponse
2. Do you suer from blindness or serious vision
problems that cant be corrected:
vis
o
uo1xow
ovisvosi
O
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109
3. Do you suer from hearing impairment (i.e. need a
hearing aid or have problems hearing when there
is background noise):
vis
o
uo1xow
ovisvosi
F. Mental and Emotional Health
Tenextsectionasksaboutyourpersonalmentaland
emotionalhealth.Pleaserememberyoudonothaveto
answeranyquestionsyoudonotwanttoanswer.Te
reasonwhyweareaskingthesequestionsisthatwewant
toensurethatthereareadequateandappropriateservices
forFirstNationsinHamilton.Anythingyousaywill
remaincompletelyconfdential.
1. Compared to other people you know, how would
you rate your mental health:(Show card i)

Excellent

Good

Fair

Poor

Unsure

uo1xow

ovisvosi
2. Have you ever been told by a health care worker
that you have a psychological and/or mental health
disorder: (i.e. Depression, anxiety)
vis

o[sxiv1o,]

uo1xow[sxiv1o,]

ovisvosi[sxiv1o,]
a. At what age were you hrst told:
Years

uo1xow

ovisvosi
b. Are you currently taking medication for this
condition:
vis

uo1xow

ovisvosi
c. Are you currently undergoing treatment
(other than medication) for this condition:
vis
o
uo1xow
ovisvosi
d. Has this condition limited the amount or
kinds of activities you can do:
vis
o
uo1xow
ovisvosi
3. Have you ever experienced discrimination because
of an emotional or mental health problem:
vis
o[sxiv1oqUis1io,]
uo1xow[sxiv1oqUis1io,]
ovisvosi[sxiv1oqUis1io,]
4. Did this prevent or delay you from getting health
care for it:
vis
o
uo1xow
ovisvosi
110
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Tefollowingquestionsaskabouthowyouhavebeen
feelingduringthepast,odays.
5. About how oen during the past o days did you
feel [Insert A through J here]. Would you say all of
the time, most of the time, some of the time, a
little of the time, or none of the time:
[If A THRUOUGH J are None of the time, then skip to next
section]
ALL OF MOST OF SOME OF A LITTLE OF NONE OF DONT NO
THE TIME THE TIME THE TIME THE TIME THE TIME KNOW RESPONSE
A Tired out for no
good reason?
B Nervous? Skip to D
C So nervous that
nothing could calm
you down?
D Hopeless?
E Restless or dgety? Skip to G
F So restless you
cannot sit still?
G Depressed Skip to I
H So depressed that
nothing could cheer
you up?
I That everything is
an effort?
J Worthless?
6. During the past o days, how many days out of o
were you unable to work or carry out your normal
activities because of these feelings:
-ofdays
uo1xow
ovisvosi
G. Post-Traumatic Stress Disorder
1. In your life, have you ever had any experience that
was so frightening, horrible, or upsetting that, in
the past month, you:
a. Havehadnightmaresaboutitorthoughtabout
itwhenyoudidnotwantto:
vis

uo1xow

ovisvosi
b. Triedhardnottothinkaboutitorwentoutof
yourwaytoavoidsituationsthatremindedyou
ofit:
vis
o
uo1xow
ovisvosi
c. Wereconstantlyonguard,watchful,oreasily
startled:
vis
o
uo1xow
ovisvosi
d. Feltnumbordetachedfromothers,activities,
oryoursurroundings:
vis
o
uo1xow
ovisvosi
O
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H. Suicide
Tefollowingsectionmayhavequestionsthatmaybe
upsetting.Pleaserememberthatyoudonothaveto
answeranyquestionsyoudonotwanttoanswerandyou
cantakeabreakatanytime.Tereasonwhyweare
askingthesequestionsisthatwewanttoensurethat
thereareadequateandappropriateservicesforFirst
NationsinHamilton.
1. Has a close friend or family member ever
committed suicide:
vis
o
uo1xow
ovisvosi
2. Have you ever harmed yourself on purpose:(e.g.
cutyourself,burnedyourself,takenpoisonor
overdosedonmedications)
vis
o
uo1xow
ovisvosi
3. Have you ever thought about committing suicide:
vis
o[sxiv1oqUis1io,]
uo1xow
ovisvosi
4. Have you ever attempted suicide:
vis
o
uo1xow
ovisvosi
5. Do you have any additional thoughts/comments
about the issues we have discussed so far:[open end]
S E CT I ON 3 :
R E CL A I MI NG WHO WE A R E
A. Now,IamgoingtoreadyouseveralstatementsaboutyourFirstNationsidentity.Afereach
statement,pleasetellmeifyou:
({) Strongly agree () Agree (i) Disagree (:) Strongly disagree
4 3 2 1 DN NR
1 I have spent time trying to nd out more about First Nations, such as our
history, traditions, and customs.
2 I am active in organizations or social groups that include mostly First Nations people.
3 I have a clear sense of my cultural background as a First Nations person and what
that means for me.
4 I think a lot about how my life will be affected because I am First Nations.
5 I am happy that I am First Nations.
6 I have a strong sense of belonging to First Nations community.
7 I understand pretty well what being First Nations means to me.
8 In order to learn more about being First Nations, I have often talked to other
people about First Nations.
9 I have a lot of pride in First Nations.
10 I participate in cultural practices, such as pow wows, Aboriginal day events,
ceremonies, feasts, drumming, singing etc
11 I feel a strong attachment towards First Nations.
12 I feel good about my First Nations background.
112
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S E CT I ON 4 : DI S CONNE CT I ON
F ROM WHO WE A R E
Substance Use
Tefollowingsectionmayhavequestionsthatmaycause
milddistress.Pleaserememberthatyoudonothaveto
answeranyquestionsyoudonotwanttoanswerandyou
cantakeabreakatanytime.
1. Atthepresenttime,doyousmokecigarettes:
(readlist)
Notatall
Daily[Gotoquestion,]
Occasionally[Gotoquestion,]
Noresponse
2. Haveyoueversmokedcigarettes:(Currentnon-
smokersonly)
Yes,daily
Yes,occasionally
No[sxiv1oqUis1ioo]

uo1xow

Noresponse
3. On average, how many cigarettes do you currently
smoke each day:
*Approximate if necessary*
-
4. At what age did you begin smoking cigarettes:
(Age in years)

5. In the past :i months, how many times have you

tried to quit smoking: (For current smokers and
ex-smokers) (Show card i{)
o(nevertriedtoquit)

::tries

,tries

,ormoretries

uo1xow

Noresponse
6. Do you have a smoke free home: (Show card i)
viscomvii1iivsmoxiivii

vis1uivi.vismoxivsiivici1ui
uomi,vU11uivsmoxioU1siuioiv

uo1xow

ovisvosi
7. During the past o days, have you had a drink of
beer, wine, liquor or any other alcoholic beverage:
vis
o[sxiv1oqUis1io:o]
uo1xow[sxiv1oqUis1io:o]
ovisvosi[sxiv1oqUis1io:o]
8. On how many days of the o did you drink:
9. What was the average number of drinks per day on
those days that you drank: One drink includes one
beer, one glass of wine or one shot (ounce) of hard
liquor.
-ofdrinks

uo1xow
ovisvosi
10. During the past :i months, how oen have you had
or more drinks on one occasion: Onedrink
includes one beer, one glass of wine or one shot
(ounce) of hard liquor. (Show card io)
Never
Lessthanoncepermonth
Oncepermonth
:-,timespermonth
Onceperweek
Morethanonceperweek
Everyday
uo1xow
ovisvosi
B. Substance Use - Illicit Drugs and
Prescription Drugs
Tefollowingquestionsareaboutsubstanceabusethat
includesbothillicitandprescriptionsdrugs.Tequestions
maynotapplytoyou.Weareaskingallresearch
participantsthesequestions.Ourintentistousethe
informationcollectedtoensurethereareadequateresources
andservicesinthecommunity.Rememberanythingyou
saywillremaincompletelyconfdential.Answering
questionshonestlywillassistustobringaboutchange.
1. Have you used any of the following substances in the
last :i months (Includes prescription drugs if they
were used without a prescription or out of keeping
with how they were prescribed): For each, please select
the answer that best describes your frequency of use.
Forthesubstancesyouselectedin-:,whatisthe
drugorcombinationofdrugsyouarecurrently
usingthemost:[Chooseonlyonedrugorone
combinationofdrugs.]
O
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113
ITEM ABOUT ABOUT 2-3 ABOUT 2-3 ABOUT CURRENTLY
2-3 TIMES/ ONCE A TIMES A TIMES ONCE USING
YEAR MONTH MONTH A WEEK A DAY THE MOST
Chewing tobacco YES YES
NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Marijuana YES YES
(weed, grass)/Hash NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
PCP/ Angel dust YES YES
NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Acid/ LSD/ YES YES
Amphetamines NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Ecstasy YES YES
NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Inhalants (glue, YES YES
gas, paint) NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Sedatives/ Downers YES YES
(Valium etc.) NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Cocaine/Crack/ YES YES
Freebase NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Codeine/ Morphine/ YES YES
Opiates (Percodan, NO NO
Tylenol 3, Fentanyl, DONT KNOW DONT KNOW
Talwin etc.) NO RESPONSE NO RESPONSE
Ritalin YES YES
NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Combination YES YES
Specify: NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
Other YES YES
NO NO
DONT KNOW DONT KNOW
NO RESPONSE NO RESPONSE
2. Have you ever used a needle to inject any illicit drug:
vis
o[sxiv1oix1sic1io]

uo1xow[sxiv1oix1sic1io]

ovisvosi[sxiv1oix1sic1io]
3. Have you ever shared needles with anyone including
your spouse, partner, or close friend:
vis
o
uo1xow
ovisvosi
114
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C. Health Services
Tefollowingsectionasksquestionsaboutaccessto
healthservices.Pleaserememberthatyoudonothaveto
answeranyquestionsyoudonotwanttoanswerandyou
cantakeabreakatanytime
1. How would you rate the level of access to health
services available to you compared to Canadians
generally: (please read list)
Samelevelofaccess
Lessaccess
Betteraccess
uo1xow
ovisvosi
2. Overall, how would you rate the availability of
health services in your community: (Show card i,)
Excellent
Good
Fair
Poor
uo1xow
ovisvosi
3. During the past :i months, have you experienced any of the following barriers to receiving health care:Read
each item and mark all that apply.
YES NO DONT NO
KNOW RESPONSE
Doctor not available in my area
Nurse not available
Lack of trust in health care provider
Waiting list too long
Unable to arrange transportation
Difculty getting traditional care (e.g. healer, medicine person or elder)
Not covered by Non-insured Health Benets (e.g. service, medication, equipment)
Prior approval for services under Non-Insured health benets (NIHB) was denied
Could not afford direct cost of care/service
Could not afford transportation costs
Could not afford childcare costs
Felt health care provided was inadequate
Felt service was not culturally appropriate
Chose not to see health professional
Service was not available in my area
Other
4. Have you accessed emergency care for yourself in
the last :i months:
vis
o[sxiv1oqUis1ioo]

uo1xow[sxiv1oqUis1ioo]

ovisvosi[sxiv1oqUis1ioo]
5. How would you rate the quality of the emergency
care you received at that time: Would you say it
was (show card i8)
Excellent
Good
Fair
Poor
uo1xow
ovisvosi
O
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115
6. In the past :i months, have you seen or talked on the
telephone about an emotional or mental health issue
or problem to any of the following:Answeryesor
noforeachperson/professional.(Show card i)
YES NO
Immediatefamilymember
Otherfamilymember
Friend
Traditionalhealer
Familydoctor
Psychiatrist
cuv(communityhealthrepresentative)
Nurse
Counselor
Psychologist
Socialworker
Crisislineworker
uo1xow
ovisvosi
7. Have you spent one night or more as a patient in a
hospital at any time in the past years:
Yes

No[sxiv1oqUis1io]

uo1xow[sxiv1oqUis1io]

ovisvosi[sxiv1oqUis1io]
8. Tinking of your most recent hospital stay, how
would you rate the quality of the hospital care you
received at that time: Would you say it was
(Show card o)

Excellent

Good

Fair

Poor

uo1xow

ovisvosi
9. Have you ever been treated unfairly (e.g. treated
dierently, kept waiting) by a health professional
(e.g. doctor, nurse, dentist, etc.) because you are
First Nations:
vis

o[sxiv1o::]

uo1xow[sxiv1o::]

ovisvosi[sxiv1o::]

10. How long ago did this happen: (show card :)

Withinthepast,months
Withinthepastomonths
Withinthepast::months
Longerthanayearago
uo1xow
ovisvosi
11. Has this stopped or delayed you from returning to
a health service:
vis
o
uo1xow
ovisvosi
12. In the past :i months have you participated in any
of the following programs: (check all that apply)
HamiltonRegionalIndianCentre
EmploymentServices
AlternativeEducation(su.v)
CourtWorker
AlcoholWorker
Lifelongcareprogram
Arts,DanceandCrafcourses
FoodandClothingbank
Otherprogram
(Please specify)
uo1xow
ovisvosi
De dwa da dehs ney>s Aboriginal Health Centre
PrimaryHealthCare(physician,nurse
practitionerand/ortraditionalhealer)
AdvocacyServices(forissueswithincome,
healthcare,education,housing)
ComplementaryServices(naturopath,needle
exchange)
MentalHealth(Counselingandaddictions)
raditionalHealthprogram(womens/mens
circles,drumming,teaching,healers,grief
recoveryprogram)
Outreach(transportationservices)
Otherprogram
(Please specify)
uo1xow
ovisvosi
116
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Native Womens Centre
CommunityCounselling
WomanAbuseEducationProgram
TransitionalHousingandSupports
EmergencyOutreach(foodandclothing)
AboriginalHealingandOutreachProgram
(.uov)
Otherprogram
(Please specify)
uo1xow
ovisvosi
Southern Ontario Aboriginal Diabetes Imitative
Footcareprogram
DiabetesPreventionprogram
Otherprogram
(Please specify)
uo1xow
ovisvosi
D. Access to Traditional Medicine
1. Do you use traditional medicine:
vis

o[sxiv1oqUis1io,]

uo1xow[sxiv1oqUis1io,]

ovisvosi[sxiv1oqUis1io,]
2. Have you had any of the following dim culties
accessing traditional medicines: Readlist.Mark
allthatapply.Show Card i
No Dimculties

Donotknowwheretogetthem

Cantafordit

Toofartotravel

Concernedaboutefects

Donotknowenoughaboutthem

Notavailablethroughhealthcentre

Notcoveredbynon-insuredhealthbenefts
(HealthCanada)

Otherprogram
(Please specify)

uo1xow

Noresponse
3. Have you had any dim culty accessing any of the
health services provided through the Non-Insured
Health Benehts Program (N:nn) provided to status
First Nations and Inuit persons through Health
Canada.
Read all options and check all that apply. Note: Other
Medical Supplies includes: wheelchair, magnifying
aid, walker, crutches, cane, artifcial limb, modifed
kitchen utensils, modifed clothing or shoe, special
cushions. Show Card
NoDimculties
Medication
DentalCare
VisionCare(glasses)
Hearingaid
OtherMedicalSupplies
Transportationservicesorcosts(airorroad)
Other
uo1xow
ovisvosi
S E CT I ON 5 : I MPACT S OF
COL ONI Z AT I ON
Tefollowingsectionmayhavequestionsthatmaycause
milddistress.Pleaserememberthatyoudonothaveto
answeranyquestionsyoudonotwanttoanswerandyou
cantakeabreakatanytime.
A. Residential School
1. Were you ever a student at a federal residential
school, or a federal industrial school:(federal
industrialschoolswereschoolsforyoungmenthat
mostlyoperatedintheprairieprovincesandthe
UnitedStates)
vis
o[sxiv1oqUis1io,]
uo1xow[sxiv1oqUis1io,]
ovisvosi[sxiv1oqUis1io,]
2. Do you believe that your overall health and well-
being has been aected by your attendance at
residential school: Show Card {
vis,negativelyimpacted
vis,positivelyimpacted
oimpact
uo1xow
ovisvosi
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3. Were any of the following members of your family
ever a student at a federal residentialschoolora
federalindustrialschool:Selectallthatapply.
Show Card y

Yourgrandmothers

Yourgrandfathers

Yourmother

Yourfather

Yourcurrentspouseorpartner

Yourbrothersorsisters

Yourauntsoruncles

Yourcousins

Otherrelatives

o[sxiv1oix1sic1io]

uo1xow[sxiv1oix1sic1io]

ovisvosi[sxiv1oix1sic1io]
4. Do you believe that your overall health and well-
being has been aected by a member of your
family attending residential school: Show Card o
vis,negativelyimpacted

vis,positivelyimpacted

oimpact

uo1xow

ovisvosi
B. Child Protection agency involvement
1. Was a child protection agency (i.e. Childrens Aid
Society, Catholic Family Services) ever involved in
your care when you were a child:
vis

uo1xow

ovisvosi
2. Has a child protection agency (ie. Childrens Aid
Society, Catholic Family Services) ever been
involved in the care of one of your children:

vis

o[SkiptonextsectionifNoto:&:]

uo1xow[Skiptonextsection]

ovisvosi[Skiptonextsection]
3. Do you believe that your overall health and wellbeing
has been aected by the involvement of child
protection agencies in your family: Show Card ,

vis,negativeimpact

vis,positiveimpact

oimpact

uo1xow

ovisvosi
C. Dislocation from Traditional Lands
1. Does your home community have one or more land
claims:
Yes
No[sxiv1o,]
uo1xow
Noresponse
2. What is the current status of your home
communitys land claim(s):
Settled
Unsettled(i.e.innegotiation,awaitingdecision)
uo1xow
Noresponse
3. Do you believe that your overall health and
wellbeing has been aected by dislocation from
your traditional lands: Show Card 8
vis,negativeimpact
vis,positiveimpact
oimpact
uo1xow
ovisvosi
D. Discrimination
1. Have you ever been treated unfairly because you
are First Nations:
vis
o[sxiv1o]
uo1xow
ovisvosi
2. How long ago was your last experience of this type
of unfair treatment: (Show card )
Withinthepast,months
Withinthepastomonths
Withinthepast::months
Longerthanayearago
uo1xow
ovisvosi
3. Has that experience negatively aected your self-
esteem: Show Card {o
Noefect
Littleefect
Someefect
Strongefect
Verystrongefect
uo1xow
Noresponse
118
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4. Have you ever been the victim of an ethnically or
racially motivated attack (verbal or physical abuse
to person or property):Responseoptions:(show
card {:)
Yes,verbalwithinthepast::months

Yes,verbalmorethan::monthsago

Yes,physicalwithinthepast::months

Yes,physicalmorethan::monthsago

No

uo1xow

Refuse

5. Do you believe that your overall health and

wellbeing have been aected by racism:
vis

o[sxiv1oqUis1io,]

uo1xow

ovisvosi
6. If so, how: Can you share an example with me:
[oviiuiu:]
7. Have you ever been treated unfairly because of
your gender:
vis
o
uo1xow
ovisvosi
8. Do you have any additional thoughts/comments
about the issues we have discussed so far:[open end]
E. Vio lence and Abuse
Tenextsectionasksyouaboutexperiencesaboutfamily
violence.Youmayencounterquestionsthatyoucause
milddistress.Pleaserememberthatyoudonothaveto
answeranyquestionsyoudonotwanttoanswerandyou
cantakeabreakatanytime.Againwewouldliketo
remindyouthatanythingyousaywillremaincompletely
confdential.
1. Do any types of violence occur in your community:
Yes
No[sxiv1oqUis1io]
uo1xow[sxiv1oqUis1io]
ovisvosi[sxiv1oqUis1io]
2. What kinds of violence occur in your community (check all that occur):
YES NO DONT NO
KNOW RESPONSE
Family Violence If YES, proceed to questions
3 to 5.
Violence related to crime and criminal behaviour
in the community
Violence related to racism/discrimination
Lateral violence (violence directed laterally from
one community member to another as a result of
rage, anger and frustration from being constantly
put down).
O
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3. What kinds of family violence occur in your
community:
YES NO DONT NO
KNOW RESPONSE
Mental/emotional
Physical
Sexual
4. Sometimes abuse includes neglect. Are there
people in your community who are neglected:

Yes

No[sxiv1oqUis1ioo

uo1xow[sxiv1oqUis1ioo]

ovisvosi[sxiv1oqUis1ioo]
5. Who are the people who are neglected:
YES NO DONT NO
KNOW RESPONSE
Husband/Male
partner
Wife/Female
Partner
Children
Elders
Wife/Female partner
and children
Husband/Male Partner
and children
Elders and children
Other Relatives
Others
6. Can you list some of the impacts of violence and/or
neglect in your community:
7. Overall, how would you rate the impact of violence
and/or neglect in your community: (show card {i)
ix1vimiivuicuimv.c1
uicuimv.c1
mouiv.1iimv.c1
ii11iiimv.c1
oimv.c1
uo1xow
ovisvosi
Tefollowingquestionsaskyouaboutstressandeven
confictyoumayhaveexperiencedinyourhousehold.It
isimportanttorememberthatthisisnotatest,sothere
arenorightorwronganswers.Pleaserememberthatall
youranswerswillremaincompletelyconfdentialand
thatyoudonothavetoansweranyquestionyoudonot
wanttoanswer.
8. We are wondering if you can share experiences
about conict in your household. We think it is of
concern in the community. Do you feel
comfortable sharing your experiences today:
vis
o[skiptoendofsection]
uo1xow[skiptoendofsection]
ovisvosi[skiptoendofsection]
Answereachitemascarefullyandasaccuratelyasyoucan.Pleaserememberthatallofyouranswersarestrictly
confdential.Ifyourequireassistanceindealingwiththefollowingissues,wecanprovideyouwithalistofappropriate
resourcesandemergencycontactsinyourneighbourhood.
9. Has anyone in your household..
YES NO DONT NO IF YES NO DONT NO
KNOW RESPONSE YES KNOW RESPONSE
Physically hurt you? Has this
Insulted or talked down to you? happened
Threatened you with harm? in the
Screamed or cursed at you? last year?
Restricted your actions?
Had sex when they didnt
feel like it?
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10. Is there anything you would like add about
personal violence in your house hold: [open ended]
11. What kinds of support are needed in your
community to address personal violence:[open
ended ]
12. Are you interested in seeking personal violence
services if they are available in your community:
[open ended]
S E CT I ON 6 : L ACK OF
GOV E R NME NT R E S P ON S I B I L I T Y
A. Lack of Government responsibilty
1. What are the main challenges your community is
currently facing (check all that apply): Show Card
{

Educationandtrainingopportunities

Housing

Culture

Poverty

Controloverdecisions

Naturalenvironment

Recognitionoftreatyrightsof-reserve

Funding

Health

Crime

Employment/numberofjobs

Legalproblemsincludingincarceration

Familybreakdownincludingapprehensionof
children
Alcoholanddrugabuse
Shortageofcommunityhealthand/orsocial
serviceworkers
DisregardforFirstNationsneeds
Otherprogram
uo1xow
ovisvosi
2. What are the main strengths of your community:
(Show card {{)
Familyvalues
AwarenessofFirstNationsculture
Socialconnections(communityworkingtogether)
Community/healthprograms
Traditionalceremonialactivities(e.gpowwow)
Lowratesofsuicide/crime/drugabuse
Goodleisure/recreationfacilities
Elders
UseofFirstNationlanguage
Educationandtrainingopportunities
Naturalenvironment

Strongeconomy
Strongleadership
Other:
uo1xow
ovisvosi
B. Community Services
1. Do you think there are adequate community
resources available for:
Pleaseansweryesornoforeachofthefollowing
vvs No o Nu
Familyviolence
uivprevention
Pregnantwomen
Legalservices
Teicv11qqicommunity
(Lesbian,Gay,Bisexual,
Transgender,Two-Spirited,
Queerandquestioning
Youth
Singlemen
Suicideprevention
PandemicssuchasH:N:
(swinefu)
2. Can you list areas for which community resources/
services are particularly lacking::
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Wearealmostfnishedthesurveyandyouaredoing
reallywell.Tereareonlyafewquestionslef.
C. INCOME AND POVERTY
1. For the year ending December :, ioo8, please
think of your total personal income, before
deductions, from all sources. Please look at these
categories and tell me which range it falls into
(Show Card {)
Check only one category

Nopersonalincome

s:tos,

s,,oootos,
s:o,oootos:,
s:,,oootos:,
s:o,oootos:,
s:,,oootos:,
s,o,oootos,,
so,oootos,
s,o,oootos,,
soo,oootoso,
s,o,oootos,,
s8o,oooandover
uo1xow:a
ovisvosi
IF YOU DONT KNOW OR YOU ARE UNSURE YES NO DK NR
1 a would it amount to $30,000 or more? 1b 1e
1 b If YES, would it amount to $50,000 or more? 1c 1d
1 c If YES, would it amount $80,000 or more? check box for #1 check box for #1
and proceed to and proceed to
next section next section
1 d If NO, would it amount to $40,000 or more? check box for #1 1e
and proceed to
next section
1 e If NO, would it amount to $15,000 or more? 1f 1g
1 f If YES, would it amount to $20,000 or more? check box for #1 1g
and proceed to
next section
1 g If NO, would it amount to $10,000 or more? check box for #1 check box for #1
and proceed to and proceed to
next section next section
D. HEIGHT AND WEIGHT
Finally,withyourpermission,wewouldliketomeasure
yourheightandweight.Willbeusingthisinformationto
measureyourBodyMassIndex(vmi).Tevmiisa
measureofbodyfatbasedonaformulathatcalculates
theratioofyourheightandweight.Yourvmiisan
indicatorofyourappropriateweightforyourheightand
isamorereliableindicatorofbodyfatthanjustweight
alone.
Ifyourvmiisabovethenormalrangethenyouareat
greaterriskfordevelopingtype:diabetes.Ifyoualready
havediabetes,losingweightandtryingtokeepyour
weightasneartonormalaspossiblecanhelpyoumanage
thediseasemoreefectively.
Tomakeyoufeelmorecomfortable,thereisascaleinthe
privateareawhereyoucanweighyourselfandthenwrite
thenumberdownonapieceofpaper.
1. How tall are you without your shoes on:
ci1imi1vis
on
iii1 icuis
uo1xow
ovisvosi
2. How much do you weigh: [IF RESPONDENT IS
PREGNANT, ASK HER WHAT WAS HER PRE-PREGNANCY
WEIGHT?]
xiiocv.ms
on
ivs.
uo1xow
ovisvosi
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Participant Education Section (adult survey)
Surveywillnoweducatetheparticipanttorecruithere.
Coupons given:
Coupon =
Coupon =
Coupon =
Honorarium Provide Yes
Amount given
INTERVIEWER IMPRESSION ITEMS
(To be completed by the interviewer after
completion of the survey adult survey complete)
1. Please rate the participants orientation to the
interview on a scale of : to ,where : is very poor
and is very good on the following items:
Interest
Cooperation
Abilitytounderstand
Abilitytorecall
Abilitytoformulate/articulatearesponse
Sincerity/truthfulness
2. Did the participant show any signs of dim culty in
reading the response cards:
No
Some
Alot
3. How conhdent are you in the overall validity of the
information collected in this interview:
CompletelyConfdent
SomeDoubts
NoConfdence
4. Other Comments:
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OUR HE A LT H COUNT S :
CHI L DR E N S R E S P E CT F UL
HE A LT H S URV E Y
IMPORTANCE OF GIFTS OF
OUR CHILDREN AND YOUTH
v:Surveyshouldbeadministeredtoadultswhohave
currentcustodyofthechildforwhomthesurveyisbeing
completed
Section A: Personal
1. What is the name of the child:
Ifnoanswer,writeinthechild.(Tisinformationis
usedforthec.viversionandisdeletedbeforethe
surveyissaved.)
2. What is your relationship to the child: (Choose
one) [Read Lsr]

Birthparent

Grandparent

Stepparent(includingcommon-lawstep
parent)

Sisterorbrother

Adoptiveparent

Fosterparent

Otherprogram
(Please specify)
3. What is the childs date of birth:
Child-:
Day Month Year
Child-:
Day Month Year
Child-,
Day Month Year
Child-
Day Month Year
Child-,
Day Month Year
4. Is your child male or female: [Read Lsr]
Child-:
Male
Female
ChildsouivNumber
Section B: Language
6. Which language(s) does the child use in his or her
day-to-day life: (please choose only one) [Read
Lsr]
English
French
FirstNationsLanguage
Other
7. Can the child understand or speak a First Nations
language: [Read Lsr]
Yes
No[Skipto:o]
uo1xow[Skipto:o]
NoResponse[Skipto:o]
8. Please list all First Nations Languages spoken:
9. How well can the child understand and speak the language: [Read Defnrons]
A few words:understandorcanspeakafewwords(hello,goodbye,etc)
Basic:understandbasicphrases,asksimplequestions(whereamI:),andwritebasicsentences
Intermediate:understandmainideaofeverydayspeech(1v,radio),engagedinconversations,writeparagraphs/text
Fluent:nodimcultyunderstandingspokenword,carryingoncomplexconversations,writecomplexreports/letters/etc.
FIRST UNDERSTAND SPEAKING
NATION FLUENT I NTERMEDI ATE BASIC A FEW WORDS N/A FLUENT I NTERMEDI ATE BASIC A FEW WORDS N/A
LANGUAGE
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10. How important is it for the child to learn a First
Nations language: [Read Lsr]

Very important

Somewhatimportant

Notveryimportant

Notimportant

uo1xow

NoResponse
11. How important are traditional cultural events in
the childs life: [Read Lsr]
(Cultural events vary, but may include powwows,
sweat lodges, and community feasts)

Very important

Somewhatimportant

Notveryimportant

Notimportant

uo1xow

NoResponse
12. Who helps the child understand their culture:
[Read Lsr]
(Check all that apply)

Grandparents

Parents(motherand/orfather)

Auntsanduncles

Otherrelatives(siblings,cousins,etc.)

Friends

Schoolteachers

CommunityElders

Othercommunitymembers

Noone

uo1xow

NoResponse

Otherprogram
(Please specify)

Section C: Education
13. Has the child ever attended an Aboriginal Head
Start Program:[Read Lsr]
Yes
No
uo1xow
NoResponse
Section D: General Health
14. Does the child live in a smoke-free home:[Read
Lsr]
Yes,completelysmokefree
Yes,smokeoutside
No
uo1xow
NoResponse
15. In general, would you say that the childs health is:
[Read Lsr]
Excellent
VeryGood
Good
Fair
Poor
uo1xow
NoResponse
Section E: Health Conditions
16. Have you been told by a health care professional
that the child has any of the follow health
conditions:
If yes, what age was the diagnosis given:
If Yes, are you currently undergoing treatment(s)
or taking medication(s) for these conditions:
Readthroughtheentirelistofconditionsandanswer
yesorno
Listconditionsthathavelastedatleastomonthsor
areexpectedtolastatleastomonths.
Yes=Y
No=N
uo1xow=ux
NoResponse=R
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CONDITION 16. TOLD THAT 17. AGE WHEN 18. IF YES, UNDER-
YOU HAVE: DIAGNOSED GOING TREATMENT
Allergies Y N DK R Y N DK R
Anemia Y N DK R Y N DK R
Anxiety/Depression Y N DK R Y N DK R
Asthma Y N DK R Y N DK R
Attention Decit Disorder/ Attention
Decit-Hyperactivity Disorder Y N DK R Y N DK R
Autism Y N DK R Y N DK R
Blindness or serious vision problems Y N DK R Y N DK R
Cancer Y N DK NR Y N DK NR
Chronic Bronchitis Y N DK NR Y N DK NR
Cognitive or Mental Disability Y N DK NR Y N DK NR
Dermatisit, atopic ecxema Y N DK NR Y N DK NR
Diabetes Y N DK NR Y N DK NR
Fetal Alcohol Disorder (FASD, FASE, FAS) Y N DK NR Y N DK NR
Hearing impairment Y N DK NR Y N DK NR
Heart Condition Y N DK NR Y N DK NR
Hepatitis (If yes what type: Y N DK NR Y N DK NR
Type A Type B Type C DK
Kidney Disease Y N DK NR Y N DK NR
Learning Disability Y N DK NR Y N DK NR
Speech/Language difculties Y N DK NR Y N DK NR
Physical Disability (other than visual
and/or hearing impairment) Y N DK NR Y N DK NR
Tuberculosis (if yes is it Y N DK NR Y N DK NR
Active Inactive DK)
17. Since Birth, has the child ever had an ear infection:
[Read Lsr]
Yes
No[sxiv1o:o]
uo1xow[sxiv1o:o]

NoResponse
18. How many ear infections has the child had in the
past :i months:

19. Have you been told by a health care professional

that the child has chronic ear infections or ear
problems: (Chronic ear infections happen
frequently and/or last a long time)[Read Lsr]
Yes
No
uo1xow
NoResponse
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20. Does the child take the following medications:
(check all that apply)[Read Lsr]
Y N DK NR
Asthma Drugs (inhalers,
puffers, ventolin)
Antibiotics
Antihistamines
Ritalin (or other ADD meds)
Vitamins
Traditional Medicines
Section F: Injury
21. Has the child required medical attention for a
serious injury in the last :i months: [Read Lsr]
Yes
No(IfnogotosectionG).
uo1xow
NoResponse
22. What type of injury(ies) did the child have: For
example, was it a burn, a broken bone, etc.(Please
select all that apply)[Read Lsr]
Brokenorfracturedbones
Poisoning
Burnsorscalds
Injurytointernalorgan
Dislocation
Dentalinjury
Majorsprainorstrain
Hypothermia,frostbite
Minorcuts,scrapesorbruises
Repetitivestrain
Concussion
Otherprogram
(Please specify)
uo1xow
NoResponse
Section G: Access
23. Has your child seen a family doctor, general
practitioner or pediatrician in the past :i months:
[Read Lsr]
vis
o
uo1xow
o visvosi
24. Has your child seen a dentist, dental therapist, or
orthodontist in the past :i months: [Read Lsr]
vis
o
uo1xow
ovisvosi
25. During the past :i months, have you experienced
any of the following barriers to receiving health
care for the child: (please answer for each
question) [Read Lsr]
Note:iuvornon-insuredhealthbeneftsisthe
HealthCanadaprogramthatprovidessupportto
helpcoverhealthcarecostsmedications,dental
care,visioncare,medicalsupplies/equipment,etc.
A. ACCESS BARRIER Y N DK NR
B Doctor not available
C Nurse not available
D Waiting List is too long
E Unable to arrange
transportation
F Difculty in getting
traditional care (e.g. healer
Medicine person, or Elder)
G Not covered by non-insured
Health Benets(NIHB)
H Prior approval of non-insured
Health Benets was denied
I Could not afford direct cost
of care/services
J Could not afford
transportation costs
K Could not afford childcare
costs
L Felt health provider was
inadequate
M Chose not to see health
care professional
N Service was not available
in my area
26. Has your child participated in any of the following
programs: (check all that apply)
NiwasaAboriginalHeadStartProgram
OntarioEarlyYearsCentre
AboriginalHealthyBabies,HealthyChildren
Program
atHamiltonRegionalIndianCentre
atOntarioNativeWomensAssociation
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HamiltonRegionalIndianCentresCanada
ActionProgramforChildrenProgram
HamiltonRegionalIndianCentres.xwi:co
program

NiwasaToyLendingandResourceProgram

Aboriginali.suandChildNutritionInitiative

Otherprogram
(Please specify)
27. Has your child been referred by their family doctor,
general practitioner or program worker to see a
specialist in the past :i months:
vis

o[Skiptonextsection]

uo1xow

ovisvosi
28. Did your child attend this specialist appointment:
vis

uo1xow

ovisvosi
29. Did you encounter any of the following barriers in
getting your child to this specialist appointment:
Y N DK NR
Transportation not available
Trouble getting through to the
specialist ofce to make
the appointment
Trouble getting messages from
the referring doctor and/or
specialist doctor regarding
the appointment time
Trouble nding time in my
schedule to attend the specialist
appointment
Trouble nding the specialists ofce
Referral letter didnt get to
the specialist
Could not afford transportation
Could not afford childcare
Felt specialist was inadequate
Chose not to see specialist
Other (please specify)
Section H: Child Immunizations
1. Has the child received his/her routine (regular)
vaccinations/immunizations: [Read Lsr]
Yes
No
uo1xow
NoResponse
Section I: Child development
1. Have you ever had a concern about the progress of
your childs physical, mental, emotional, spiritual
and/or social development: [Read Lsr]
Yes
No(iiisucuiiusUvviv)
uo1xow
NoResponse
2. What areas of development were you concerned
about: (check all that apply) [Read Lsr]
Physical
Mental/Intellectual
Speech/Language
Emotional
Social
Otherprogram
(Please specify)
uo1xow
NoResponse
3. Did you access any of the following supports:
(check all that apply) [Read Lsr]
Familymember
Doctor
Nurse
Traditionalhealer
Psychologist
Physiotherapist
Occupationaltherapist
SpeechLanguagetherapist
Teacher
HeadStartProgramStaf
Healthybabies,healthchildrenprogramstaf
OntarioEarlyYearsCentreprogramstaf
c.v-Cprogramstaf
Otherprogramstaf
(Please specify)
Otherprogram
(Please specify)
uo1xow
NoResponse
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4. Did you encounter any of the following barriers:
Remember, that we are talking about barriers you
might have encountered when seeking support for any
developmental concerns you may have had about
your child. (check all that apply) [Read Lsr]
A. ACCESS BARRIER Y N DK NR
B Health provider not available
C Waiting List is too long
D Unable to arrange transportation
E Difculty in getting traditional
care (e.g. healer, Medicine
person, or Elder)
F Assessment (ie. developmental
standards/scales) were
culturally inappropriate
G Service was otherwise
culturally inappropriate
H Not covered by non-insured
Health Benets (NIHB)
I Prior approval of non-insured
Health Benets was denied
J Could not afford direct cost
of care/services
K Could not afford
transportation costs
L Could not afford
childcare costs
M Felt health care provided
was inadequate
N Chose not to see health
care professional
O Service was not available
in my area
5. Is there anything else about your childs health
that you feel is important and would like to
mention: [open ended]
Participant Education Section (Children Survey)
Surveywillnoweducatetheparticipanttorecruithere.
Coupons given:
Coupon =
Coupon =
Coupon =
Honorarium Provide Yes
Amount given
INTERVIEWER IMPRESSION ITEMS
(To be completed by the interviewer after
completion of the survey child survey complete)
1. Please rate the participants orientation to the
interview on a scale of : to ,where : is very poor
and is very good on the following items:
Interest
Cooperation
Abilitytounderstand
Abilitytorecall
Abilitytoformulate/articulatearesponse
Sincerity/truthfulness
2. Did the participant show any signs of dim culty in
reading the response cards:
No
Some
Alot
3. How conhdent are you in the overall validity of the
information collected in this interview:
CompletelyConfdent
SomeDoubts
NoConfdence
4. Other Comments:
O
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Accesstomentalhealthservices,including
psychiatristsandmentalhealthassessments
Suferingfrommultiplechronicdiseasesatthesame
time
Stress
Concurrentdisorders(i.e.suferingfrombotha
mentalhealthandaddictionissue)
Obesity
Highincidenceofuivand.ius
Mentalillness(includingdepressionand
schizophrenia)
HighBloodPressure
Cancer
HeartDiseaseandStroke
HepatitisC
Diabetes
Environmentalallergies
Arthritis
FetalAlcoholSpectrumDisorder/FetalAlcohol
Syndrome/FetalAlcoholEfects
DiscriminationagainstandstereotypingofFirst
Nationspeoplewhoareinneedofhealthcare
Negativeimpactsonclientsofshorttermprogram
funding(i.e.neededprogramsdisappear,poor
continuityofserviceproviders,resultant
discouragingofprogramattendance)
Educationasadeterminantofhealth
Needforholisticdefnitionsandapproachesto
health
Needforincreasedawarenessofalternatewaysof
receivingcare(i.e.naturopath,traditionalhealing)
Enhancedfundingforhealthpromotionworkersto
upgradetheirskills
Needfortrainingandeducationathospitals
regardingFirstNationscommunicationandculture
Teneedtoenhanceevaluationofservicesand
programs
Communitylevelsuicidepreventionand
interventionwithclients,healthworkers,and
caregivers
Needforincreasedservicesandemployment
opportunitiesforpeoplewithillnessand/or
disabilities
Inadequateresourcesforandinclusionoftwo-
spirited/lesbian/gay/bisexual/transgendered/
transexual/queer/questioningcommunity
Inadequatecoverageofmedicationandhealth
servicesbynon-insuredhealthbenefts/Indian
Afairs
Shortageofdoctorsandnurses
Needtoincreasefundingforhealthprofessionals
andequipmentinAboriginalHealthCentre
HealthfundingsystemsthatmarginalizeAboriginal
healthneeds(ie.Localhealthintegrationnetworks)
LackoftrustbyFirstNationsindividualsintheir
healthcareproviders
Waitingtimeforambulanceandemergency
departmentservices
Waitingtimesformedicaltestsandoperations
Shortageofuiv/.iusworkers
LackofdirectresponseforFirstNationshealth
workerswhoareseekingassistancefortheirclients
Lackoftransportationtoandfromhealthservices
andprograms
Youthhealth(:,-:8years)
Childhealth(o-::years)
Childhealth(:-,years)
InfantHealth(o-:years)
Accesstoinformationregardingnutritionandfood
additives
Pre-prenatal,prenatalandpostnatalhealth
promotion
Inappropriatefamilyassessmenttoolsandculturally
incompetentlawyersandjudgesleadingtothehigh
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incidenceofapprehensionofFirstNationschildren
bychildprotectionservices
DisruptionandlossofpositiveFirstNationsidentity
Disproportionatenumberofchildrenunderthecare
ofand/orapprehendedbychildprotectionagencies
andtheimpactofthisonfamilyandcommunity
Lowself-esteem
LackofunderstandingofFirstNationscultureby
mainstream
Developmentofidentityandself-awareness
Disconnectionfromfamilyandcommunityandits
impactsonmentalandphysicalhealth
Dealingwithsocialisolationinurbanareas
Needtounderstandourchildrenasgifsfromthe
creatorthatweneedtotakecareof
Needtoimprovetheabilityofindividualstoengage
instablerelationships
Needtomoveawayfromavictimmentalitytowards
self-emcacy
Impactsofdislocationfromtraditionallandsand
unresolvedlandclaims,includingovercrowding,
inadequatehousingandspiritualimpacts
Needforrecognitionbypersonslivingon-reserve
thatpersonslivingof-reservearestillpartofthe
community
TefailureofgovernmenttorecognizeFirstNations
andtoacceptfduciaryresponsibilities/inherent
rights
TeneedforenhancedabilityofFirstNations
individualstoself-advocate
Needforrecognitionoftheculturaldiferences
betweenFirstNations
MobilityofFirstNationsandthechallengesthis
createsfortracking
Spiritualawareness/spiritualhealth
LackofrecognitionofFirstNationscommunity
knowledgeandexperience(i.e.Toomuchemphasis
insteadonnon-Aboriginalacademicsystems)
Accesstotraditionalspiritualityandculture
Communityimpactsofcommunityworkersand
boardmembersinneedofpersonalgrowth
Lackoffundingfortraditionalart,drawingand
language
Teneedtoreturntotraditionalcultureand
lifestyles(i.e.traditionalroles,ceremonies,parenting
skills)
Teneedtocareforland/environmentinorderto
havehumanhealth
Workoverloadforcommunityserviceworkers
NeedforgovernmenttounderstandFirstNations
cultureinordertoappropriatelyallocatefundsand
programs
Enhancedfundingandtrainingforholisticand
spiritualhealing
Teneedforenhancedservicesandsupportsfor
youth
Teimportanceofkinshipsystems/extendedfamily
tohealth
Teneedforurbanspecifcpandemicpreparedness
thatbuildsontraditionalFirstNationsworldviews
Impactofdomesticviolenceonindividuals,families,
andcommunities
Intergenerationaltrauma,includingtheimpactof
residentialschools
Lateralviolence(i.e.ViolencebetweenpeersinFirst
Nationscommunityand/ororganizations)
Disproportionateratesofincarceration
Inadequateservicesfordomesticviolence
Intergenerationalabuse
ElderNeglectandAbuse
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Needforimprovedlegalservices
Povertyfacingfemalesingleparentsandtheir
families
Impactofinadequatesocialassistanceand
minimumwageonaccesstoservices
Needforimprovedaccesstohealthandsocial
servicesforinmatesandpastinmates
InadequatehousingforFirstNationsseniors
Inadequate/overcrowdedhousing
Teneedtoprovideasupportivefoundationin
additiontohousingforthehardtohouse
Lackofprogramsandsupportsforsinglemen(i.e.
housing,talkingcircles)
Housesinneedofrepair/Inadequatehome
maintenance
Increasingnumberoffemalesextradeworkersasa
resultofincreasingpoverty
Alcoholaddiction
Drugaddiction(nonprescription)
Addictiontoprescriptiondrugs
Toomuchortoomanyprescriptionmedication(s)
Smoking
Cycleofpoverty(i.e.povertyleadstostressleadsto
mentalhealthissuesleadstoinabilitytoworkleads
topoverty)
Foodsecurity
Teimpactofhomelessnessand/ortransienceon
health(i.e.inabilitytocareforself,inabilitytosee
thesamehealthcareprovider)
Healthyandsafewater
Focusonsurvivalratherthanpreventativehealth
Culturallyinadequateassessmentprocessesfor
childrenandyouthresultinginmissed/wrong
diagnosis
Mentalhealthstigmaasabarriertoaccessingmental
healthcare
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