Cover Story: Transforming Aboriginal Health

Promise Magazine: Fall/Winter 2015
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The new First Nations Health Authority Chair in Heart Health and Wellness at St. Paul’s will lead research and education to develop a health program tailored to the needs of First Nations people

It happened in the summer of 1998. Grand Chief Edward John, a lawyer and executive member of the First Nations Summit, was on an official visit to the Haida Gwaii Museum in Skidegate when he was suddenly gripped by chest pain. It was a heart attack – a serious one – requiring an immediate emergency medevac to St. Paul’s, angioplasty procedure, months of recovery and permanent changes to John’s life style. It also marked the beginning of an idea that is set to revolutionize the understanding of health-care delivery for indigenous people across British Columbia: the creation of the new First Nations Health Authority Chair in Heart Health and Wellness at St. Paul’s.

Aboriginal Health Care Crisis

Heart health and its related conditions have long been critical issues for First Nations leaders such as Chief John. In a country with some of the healthiest people in the world, more than one-third of adult aboriginal people in Canada – and almost two-thirds of those living off reserve – report having a chronic health condition. Diabetes was first detected in aboriginal people only 50 years ago, and yet is now up to four times more prevalent in First Nations people than in non-aboriginal Canadians. Rates of heart disease and stroke, which are decreasing in the general population, are still on the upswing in aboriginal communities.

Despite these alarming statistics, John says that personal health issues, such as heart conditions, were rarely discussed among his peers at the First Nations Summit: “People are quiet about it [health issues],” says John. “I think there is even a sense of shame.”

However, that silence was about to be broken. Inspired by the professionalism and confidence of Dr. Andrew Ignaszewski and his team at the provincial Heart Centre at St. Paul’s, and struck by seeing so many others around him in a similar situation, John started thinking critically about heart health.

“It [his heart attack] was a life-altering experience in many ways,” says John. “It opened up my eyes to a very different set of circumstances.”

First Nations-Focused Programs

John’s personal experience inspired him to learn as much as he could about heart health, and to become an advocate for better awareness, speaking openly to his fellow chiefs about his own condition and encouraging others to do the same.

“He was a catalyst,” says Ignaszewski, now head of cardiology at St. Paul’s and an early champion of the recently announced Chair position. Over the years, during his regular meetings with John to provide followup care, the two spoke often about new research into cardiology. One day, John asked for information specific to First Nations.

“There wasn’t much written about it,” says Ignaszewski. “Nothing about traditional aspects of cardiovascular care: about what works; what outcomes to look for. And [John] said, ‘I ought to do something about this.’”

John set up meetings with Ignaszewski and Joe Gallagher, CEO of the newly established First Nations Health Authority (FNHA), a groundbreaking organization founded to oversee the planning and delivery of health services to First Nations and aboriginal communities in BC. Ignaszewski brought in Dr. John O’Neil, dean of health sciences at Simon Fraser University (SFU), with whom he had previously co-developed other cardiac research positions. Together with other academic and clinical experts, the group designed a unique framework. The $1.9-million FNHA Chair – the first of its kind in Western Canada – will be a partnership between the FNHA, SFU and St. Paul’s, and funding, shared roughly equally between the three founding organizations, will support the FNHA Chair for 10 years. The Chair will lead research and education into critical policy related to heart health, and the control and prevention of chronic diseases among First Nations people.

Balanced Mandate

The future appointee to the new Chair position will be a full-time professor in the faculty of health sciences at SFU; will conduct clinical research and support the development of First Nation-centred health programming at St. Paul’s; and will have a home office at the FNHA, which will set direction for the Chair and oversee the delivery of programming that arises from the work.

“It’s a three-part strategy,” says Ignaszewski. “The person will be given an academic mandate through SFU; a clinical mandate through St. Paul’s; and a political mandate through the FNHA.”

“It’s a really exciting opportunity for us,” says Joe Gallagher of the FNHA. “This Chair isn’t going to be driven by the academic world or the medical world. It’s going to be balanced. That is a systemic shift.” Gallagher says it is key that the FNHA Chair approaches research from the perspective of health and wellness, rather than disease: “We don’t want to just talk about heart health from a sickness point of view.”

Building Bridges

More than a century of colonization and the residual effects of residential schools have drastically altered the lifestyle and social determinants of First Nations people, says Gallagher, while at the same time earning distrust for outside intervention, research or planning. Effective dissemination of health information and services is further complicated by the extreme diversity of First Nations in British Columbia. There are 203 bands, 30 language groups, and a population that ranges from the Fraser Salish region that encompasses the urban streets of Vancouver to some of the most remote and isolated communities in the province.

“We have an opportunity to look at this from a lens that First Nations people can appreciate,” says Gallagher. “The research agenda, driven by First Nations and implemented as best as we can in partnership with our communities, will build our own capacity to do research on ourselves.”

Dr. John O’Neil, who is recruiting for the Chair in partnership with representatives from St. Paul’s and the FNHA, says that while the position is driven by cardiology, a broad approach to the role is critical to its mandate of supporting wellness for First Nations people.

“Chronic disease is the health condition that is the most prevalent and the most problematic in First Nations communities,” says O’Neil, “and core to chronic disease is cardiovascular health and all its complications, like diabetes, mental health problems and addictions.”

This far-reaching scope of leadership opens wide possibilities for candidates for the FNHA Chair, from clinicians to PhD researchers in chronic disease prevention to experts in community health promotion. O’Neil says the steering committee has already identified several impressive potential recruits with the necessary First Nations or indigenous backgrounds, and expects the position to be filled and “on the ground running” by January 2016.

To Ignaszewski, the creation of the FNHA Chair is a game-changing event for St. Paul’s and for the compassionate care it delivers to its First Nations patients and all of the 400,000 people it serves each year.

“It took a generation of cardiologists and policymakers to finally realize that heart disease is the number-one killer of women of all ages, and only now are programs being created to address that gap,” he says. “This could do the same for First Nations people.”

Ignaszewski hopes that, in the near future, the Chair will secure funding to become a permanent and fully endowed position: “Being a part of this gives me a great sense of achievement. This could become a model for other provinces.”

Chief John, meanwhile, says it is heartwarming to see an idea he had 17 years ago come to fruition.

“Too many of our people are dying way too young,” says John. “This could help the cardiologists, the general practitioners, the nurses, aides and all the people who work in our communities to better understand this, and have the proper training to see the signs and know what the aftercare is.”

To learn how to support heart care, research and teaching at St. Paul’s, please contact St. Paul’s Foundation at 604-682-8206 or visit www.helpstpauls.com.

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