Partnerships key to Aboriginal health promotion

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Improving the health of Aboriginal people across Canada is one of the priorities of the Canadian Medical Association's (CMA) newly formed Office for Public Health, but the initiatives won't work without the support of the Aboriginal community, said CMA president Dr. Henry Haddad.

The Office for Public Health was created in order to allow the CMA to strengthen its efforts in health promotion. While public health promotion has been a priority at the CMA for a number of years, the creation of the office for Public health strengthens that commitment, and provides a formal structure for addressing health promotion issues.

"The intent, of course, is to get much more involved in health promotion than the CMA was previously," Haddad said of the new office. "And the issue at the top of mind for the office right now, the number one issue, is Aboriginal health.

"When we look at the whole field of health inequalities in Canada-there are a number of them, but this is one of the more striking ones-as far as health inequalities, when you look at the difference in health status between the Aboriginal citizens and the other citizens in this country, it's obvious we can't do it alone. Government has had some degree of success, but not as much, I think, as it had hoped to. I don't think any one constituency can do it alone. So this is where we have partnered with NAHO, the National Aboriginal Health Organization, to look at four areas, and we have signed a letter of intent with them."

NAHO is an Aboriginal-designed and controlled organization working to improve the physical, mental, emotional, social and spiritual health of Aboriginal people. The partnership would seem a good fit, as all four of the areas CMA hopes to work with NAHO on are already among the objectives of the national organization.

One of the four areas the CMA and NAHO will be working together on is developing workforce initiatives.

"The object is to increase recruitment and retention of physicians and other health professionals, especially of Aboriginal descent, who serve the Aboriginal community," Haddad explained.

"We also want to look at, secondly, research and practice enhancement initiatives. To promote research into effective clinical practice. And there are a number of health issues which we'd like to look at," he said.

"The issue of diabetes is striking, when you look at it. There was nearly no diabetes amongst the Aboriginal community 25 years ago, and now the incidence, I think, is about four times that of the general Canadian population. And we do know that this is probably related to the change in diet, a less physically active life, and there may be other issues. But I think we have to develop a proper research, and find out exactly what has happened in the last 25 years to really have an explosion in the incidence of diabetes amongst our Aboriginal communities."

The third area the two organizations will be looking at is development of public and community health programs for promotion of healthy living in Aboriginal communities.

"Which means things like tobacco," Haddad said. "We know that tobacco use in Aboriginal communities is higher than the rest of the country. The use of illicit drugs is higher. So these are issues. We have to promote healthy living."

The fourth is leadership development.

"It's very important that the Aboriginal community can count on its own leaders," Haddad said, adding that, in order to help in leadership development the office will help identify potential leaders, support them, and "encourage and celebrate their success when it occurs."

One of the keys to the success of the health promotion initiatives is support from the Aboriginal communities themselves, Haddad said.

"There's absolutely no way to get any success on this issue if we don't have a buy-in from the communities, from Aboriginal communities across the country. And, of course, the issue also of our Aboriginal citizens within the inner city, too, is ging to have to be looked at," he said.

"What we're bringing to the table," Haddad said of the CMA's contribution to the partnership, "is 53,000 physicians who are committed to work to attain that objective, an association that has quite a strong advocacy structure. I think it's quite well listened to among the deciders in this country, and also has good research capabilities and a very strong staff. So I think we're bringing something to the table that's very interesting."

The CMA will be holding a forum in April to try to set a direction for the initiatives aimed at improving Aboriginal health.

"We're going to ask ourselves several questions," Haddad said, "Like, for example, where are we now? What is the present situation? Where do we want to go? What do we want to reach in a year, in three years, and five years? And how are we going to get there, and who's going to do it? I think the intent is there. There's still a lot of work to do. It's going to need a lot of partnering to get success. Because we do know that the federal government has invested a reasonable amount of good money in this. There has been some degree of success on the issue of Aboriginal health, but not nearly, I think, where any one of us wants to be at today.

"And so I think we have to learn why we haven't been able to get more success. And I have a feeling that the federal government can't to it alone. We can't do it alone. The Aboriginal communities won't be able to do it alone. We need a partnership amongst many constituencies," he said.

"I think the number one challenge right now is to get the people that should be sitting around the table in fact sitting around the table. And that means the Aboriginal communities, the Aboriginal leaders, the government leaders, the research people, physicians of this country. Because there's a lot of people interested in those issues across the country. I think we have to get all those people sitting around the table, and see if we can get them to deelop common objectives, and find out how to get there, without each one going their own way, and then none of us getting where we want to go. I think that's our number 1 challenge right now."