1) The Our Health Counts study was a collaborative research project between several First Nations organizations in Ontario that surveyed 790 First Nations people living in Hamilton on their health status and social determinants of health. 2) The study found significantly higher rates of chronic disease, disability, poverty, unstable housing, and lack of access to healthcare compared to statistics and rates for the general Hamilton population. 3) The study demonstrated the importance of using a participatory research model and First Nations ways of knowing to ensure the research priorities and findings reflected First Nations values and addressed the holistic concept of health and wellbeing from a First Nations perspective.

1. Launched December 2011
Our Health Counts
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2. Unique Partnership
Our Health Counts was a collaborative effort by:
• Ontario Federation of Indian Friendship Centres (OFIFC)
• Métis Nation of Ontario (MNO)
• Ontario Native Women’s Association (ONWA)
• Tungasuvvingat Inuit (TI)
Urban First Nations Health - Research Project Team
• De dwa da dehs ney>s Aboriginal Health Access Centre
• Hamilton Executive Directors Aboriginal Coalition
• Centre for Research on Inner City Health (CRICH) - Led
by Dr. Janet Smylie
• Multiple funders: OFIFC, MOHLTC, AHTF, CRICH
• Data linked to Institute for Clinical & Evaluative
Sciences (CEIS)
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3. First Nations Partners
Hamilton site was selected because:
• Large First Nations Pop. (>13,735 based on 2006 Census)
• Strong Native organizational infrastructure
• Well developed networks
• Implications relevant to all urban settings
Research partners:
• De dwa da dehs ney>s Aboriginal Health Access Centre
• Hamilton Executive Directors Aboriginal Coalition
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4. Unique Approach
• Community-based urban setting
• Participatory research design
• Multi-sector collaboration
• Shared decision making
• Respondent driven sampling
• Community capacity building
• Trained First Nations interviewers
• Reflective of Aboriginal beliefs
• Concept mapping - health dimensions
• Holistic - health linked to social determinants
• Respectful engagement vs rapid response
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5. ‘Ways of Knowing’
Use of ‘concept mapping’
Community partners worked with researchers to
develop a ‘concept map’ to inform survey design
• Aligns with traditional Aboriginal tools
• 102 health ‘concepts’ identified by group
• Sorted into 10 domains
• Questionnaire built on community priorities
• Ensures meaningful info is gathered
• Assesses both strengths & vulnerabilities
• Reflects Aboriginal world-view - health &
wellbeing is a balance of physical, mental, social &
spiritual dimensions
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6. Research Findings
• Historic Study
• A lack of population-based health data for First Nations
people - leading to poor planning & policy neglect
• Confirms community’s belief regarding poor health status
• Results significantly higher than Statistics Canada figures
• 790 people recruited (554 adult, 236 child)
• 92% participant allowed link to OHIP
• Allowed access to detailed health information through the
Institute for Clinical Evaluative Science (ICES). First time
access to more robust health information
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7. Demographics
• 13, 735 people in Hamilton report Aboriginal
ancestry (Census 2006) - significant underestimation
• First Nation’s people represent 2.8% of Hamilton’s
population
• OHC population much younger than general pop.
• 51% report being Registered Indians (under the
Indian Act)
• 95% most often speak English at home
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8. Housing Impacts Health
I live entirely off food banks, that’s where nutrition comes in, no choice over food
• 90% moved at least once in 5 years - vastly higher than non Natives
• 50% have move 3 or more times
• 13% report being homeless or in ‘transition’
• 74% live in crowded conditions (using Stats Canada definition)
• Housing is inadequate and in disrepair
• 70% people live in poorest neighbourhood in Hamilton (3% general pop.)
• High mobility tied to cycle of poverty
• 63% give up important things - food - to afford housing
• 22% report they do not have enough to eat
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9. Education/Employment
Low levels of formal education:
• 57% First Nations adults over 18 completed some high school
• 20% report completing high school
• 5% completed some/all university
• Women trend to more education
Income & employment:
• 28% income from wages & salaries, 8% from self-employment
• 69% provincial/municipal social assistance, 10% EI, 17% Child Tax
Benefits, 13% other income sources
• 18% earn less than $4,999, 22% between $5,000 & $15,000, 15% earn
between $15,000 & $20,000
• Only 22% earn over $20,000 (compared to 57% of Hamilton residents)
• Only 2% First Nations in highest income quartile
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10. Social Determinants of Health
First Nation people have less access to social
determinants of health
• Structural & institutional inequalities can’t be solved at individual level -
policy, practice and legal changes needed
• Striking levels of poverty
• Housing & food instability
• Lower levels of education & employment
• Less access to public transportation - impacts employment/inclusion
• Poorer health status - more chronic illnesses
• Racism, social exclusion & discrimination
• Unequal access to health, supports & services
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11. Impact of Colonization
The legacy of colonization & residential schools has a
serious impact on health, wellbeing & family cohesion
• 6% were students at residential schools
• 40% have family member
• 65% felt personal negative impacted
• 34% felt impact as family
• 40% report child protection was part of their childhood care
• 35% report their children have been involved with child protection
• 49% felt this has negatively affected their overall health/wellbeing
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12. Impact of Colonization
Violence & abuse
• 58% report violence is part of their community
• 95% report violence is related to crime with their neighbourhood
• 81% reported lateral violence - between First Nations peers
• 67% reported violence related to racism & discrimination
• 60% reported family violence
• 96% mental/emotional abuse
• 90% physical
• 52% sexual abuse
• Women experiencing more violence than men.
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13. Being Out of Balance
• First Nations people see health as more than physical wellness
• Includes physical, mental, emotional and spiritual dimensions
• 43% feel ‘in balance’ in the four aspects of wellness
• 37% balanced some of the time, 20% little/no balance all of the time
• Women less likely to feel balanced than men (28% vs 14%)
• 42% report having a psychological or mental health disorder
• Men more physically active than women (30 min. daily exercise)
• Older adults (50+) report zero / 1 day exercise per week
• 54% drink more than 5 drinks at least once a month vs 27% general
population
• 87% smoke (higher underage of 50 years), same for men and women
vs 24% of general Hamilton population
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14. Chronic Disease & Disability
First Nations people carry a greater health burden,
at a younger age, that limits functional activity
• 16% have diabetes (3 x general pop.)
• 26% high blood pressure (20% general pop.)
• 31% have arthritis (20% general pop.)
• 9% Hepatitis C (> 1% within the general population)
• 36% report their health is fair to poor
• 1/2 - 3/4 adults have limitations due to illness
• First Nations men feel their health is better than women
• 18% of First Nations women feel health is excellent/good vs 61% women
within general population.
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15. Health Care Access
“Our health deserves appropriate and dedicated care”
Urgent need for improved health care access
• 40% rate access to health care as fair to poor
Barriers to care reported:
• Long waiting lists - 48%
• Access to transportation - 35%
• Can’t afford direct costs - 32%
• Doctors not available
• 24% report a lack of trust in health care providers
• Stigma & discrimination contributing role
We need more Aboriginal people in health care, education, places where people are looking
up to other people. More native role models.”
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16. Emergency Room Use
First Nations more likely to use Emergency Room
• Using emergency department for acute & non-acute illness
• 50% report using ER in past year (22% general population)
• 11% had more than 6 visits (< 2% general population)
• ER use holds for both children and adults
Children less likely to be admitted
• Compared to non native children - lower rates of admission
• With comparable or more severe symptoms of illness
• Is there a systemic bias toward admitting non-native children?
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17. Challenges & Strengths
Main challenges people identified
• Drugs & alcohol are main concerns - 68%
• Housing - 61%
• Crime, poverty, & employment - 60%
Community strengths
• Strong family values - 53%
• Awareness of First Nations culture - 41%
• Community health programs/ traditional ceremonies - 38%
• Presence of elders within community - 36%
• Social connections within the community - 35%
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18. Reclaiming identity
Strong sense of identity as First Nations people
• Over 93% of people feel it is import/very import for their children
learn their language and culture
• 1/3 people report using traditional medicine
• Hamilton’s First Nation’s community has remarkable cultural
continuity, resilience & hope - despite alarming inequalities
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19. Whole Government Approach
Problems facing Urban Aboriginals in Hamilton are complex
Solutions require a whole government approach - working with
First Nations leaders
• Our Health Data demonstrates increasing disparities in
the social determinants of health for urban Aboriginals
• Needs inter sectorial partnerships to resolve
• Requires urban Aboriginal specific, cultural based,
community driven strategy
• Address inequalities in accessing social determinants
of health in accordance with human rights legislation
(housing, food security)
• Chronic disease & disability is disproportionally felt.
Requires municipal & provincial governments
working with Aboriginal community to set priorities,
preventative action & health promotion plans
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20. Whole government cont...
Work with Aboriginal community leaders municipal,
provincial & federal governments to...
• Collaborate to remove barriers to equitable access
to community health care, emergency departments
& inpatient hospital services
• Fund the development & expansion of culturally
reflective, community based traditional family
treatment centres, mental & maternal health
programs & services
• Build cultural safety & competence skills
recognizing Aboriginal world-view & healing
practices
• Promote self-determination in health care
delivery, governance, research, planning,
development, delivery & evaluation
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21. Child Health Approach
Our children are our future... a shared commitment to their
health & wellbeing is critical
• Support children’s language & cultural programming
- include Aboriginal organizations & school boards
• Eliminate barriers to primary health care, reduce wait
lists, target health concerns in culturally sensitive
ways
• Support First Nations families in parenting their
children in culturally supportive ways
• Accord Aboriginal children their human right to live
in healthy homes & attend schools/ programs which
do not worsen their health
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22. Research & Planning
‘Our Health Counts’ demonstrates that research can be
done by Aboriginal people for the community’ benefit
• Fund First Nations led applied service research
• Planning is best done in respectful partnership
• Support interagency collaboration & cooperation
• Work with Aboriginal agencies & organizations
to gain knowledge, promote self-determination
in planning, design, development & delivery of
culturally specific health services programs &
policies
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