"It’s not just typical that a family has lost one member to the toxic drug crisis; we’re talking five members, six members. Multi-generations of a family," says Dr. Nel Wieman, chief medical officer for the First Nations Health Authority.

Image Credit: Michelle Gamage, Local Journalism Initiative

Editor’s note: This story contains discussion about the wide-ranging health impacts resulting from settler colonialist policies against First Nations people in B.C. This includes references to self-harm and harm experienced by children.

A report on a project tracking First Nations health from 2020 to 2030 in British Columbia has released “gut-wrenching” data in its first interim update.

The First Nations Population Health and Wellness Agenda tracks 22 indicators and last week provided an update on 14 of them. The First Nations Health Authority had comparable data from previous years to track changes for 10 of those indicators. Four indicators worsened, four had no change or minimal change, and two improved.

The data paints a tough picture, highlighting the impact that the twin health crises of toxic drugs and COVID-19 had on First Nations communities during the early years of the pandemic, said Dr. Danièle Behn Smith, deputy provincial health officer for Indigenous health, at a press conference last week.

Life expectancy at birth, mortality rates, diabetes incidence and healthy birth weight all worsened.

“This life expectancy data is gut-wrenching. It is gut-wrenching,” Behn Smith said.

Behn Smith is Eh Cho Dene of the Fort Nelson First Nation with French Canadian and Métis roots in the Red River Valley.

Life expectancy for First Nations people plummeted to 67.2 years in 2021, from 73.3 years in 2017, compared with non-First Nations people whose life expectancy decreased by one year over the same period.

“Over the past two years it’s not just typical that a family has lost one member to the toxic drug crisis; we’re talking five members, six members. Multi-generations of a family,” said Dr. Nel Wieman, chief medical officer for the First Nations Health Authority.

Wieman is Anishinaabe from the Little Grand Rapids First Nation in Manitoba. She pointed to how the toxic drug crisis is rooted in stigma, stereotypes and bias towards people who use substances.

“First Nations people are disproportionally represented [in toxic drug deaths], partly because of racism,” she said, noting how although First Nations people make up four per cent of the total provincial population, they account for 14 to 19 per cent of all toxic drug deaths.

“These are not throw-away people, not a segment of society that we shouldn’t care about or are not connected to,” she said.

The mortality rate also was pushed up to 156 per 10,000 people in 2021, up from 117.3 per 10,000 in 2017.

People are reluctant to seek health care because they fear how they will be treated while accessing that care, Wieman said. When First Nations people were suffering from severe COVID infections, Wieman said, they tended to delay getting medical treatment and, when they finally did, needed more critical care and had a higher risk of death.

Anti-Indigenous racism in the health-care industry is widespread and well documented in B.C. and across Canada. In one horrific case in 2020 in Quebec, Joyce Echaquan, an Atikamekw mother of seven, was openly mocked by hospital staff as she screamed and cried out in pain after going to the hospital with a stomach ache. Echaquan livestreamed the event on Facebook, capturing slurs and swearing used against her. Echaquan died two days after she was admitted to hospital.

Echaquan’s death pushed the government of B.C. to review anti-Indigenous racism and discrimination in the province’s own health-care system, which it laid out in the 2020 “In Plain Sight” report.

This report, alongside the 94 Truth and Reconciliation Commission Calls to Action, the Missing and Murdered Indigenous Women, Girls and 2SLGBTQIA+ People Call for Justice and the British Columbia Cultural Safety and Humility Standard lay out “thousands of detailed directions” to improve life for First Nations, Métis and Inuit people, Behn Smith said.

“The path is there,” Behn Smith said, but governments, institutions and systems partners have not done enough to “take courageous actions that create uncomfortable change.”

“Our leaders, our ancestors and our families have done tremendous work in laying out the path for how to improve education, how to get more families together, how to have fewer of our family members dying,” Behn Smith said. “We just need to be very consistent, conscientious and coherent across governments and systems to take the actions required to follow through on these directions.”

Traditional food as illness prevention and management

Diabetes incidence rose to 8.5 per 1,000 people in 2020-21, up from eight per 1,000 in 2017-18.

Wieman says diabetes rates are caused by the “intergenerational effects of the Canadian government’s assimilationist policies and systems, including the Indian residential ‘school’ system and disparities in the social determinants of health such as food insecurity and access to food.”

Work is being done to reclaim traditional knowledge and diets to prevent and manage diabetes, she added.

Healthy birth weights decreased to 72.1 per cent of newborns in 2019, down from 73.8 per cent of newborns in 2017. In one of the positive outcomes shared in the report, however, infant mortality decreased over a similar time frame.

From 2015 to 2019 there were 4.6 infant deaths per 1,000 live births, which improved from 5.3 deaths per 1,000 births in 2013 to 2017.

“Infant mortality is associated with social determinants of health such as poverty, food insecurity, unemployment, inadequate housing, lower levels of parental education and income and lack of access to health care,” Wieman said.

“Many infant deaths are preventable and reflect failures of the system to wrap around the life giver, the child and the family,” she added.

The category of youth and young adult suicides, which includes 15-to-24-year-olds, stayed around three deaths per 10,000 people from 2013 to 2021.

Suicide deaths reflect the impacts of ongoing settler colonialism and settler colonial harms including racism, discrimination, socio-economic exclusion, intergenerational and contemporary traumas, forced relocations, collective suffering and social determinants of health, Wieman said.

Avoidable hospitalizations also remained steady from 2017 to 2022, with around 73 people per 10,000 seeking emergency care for issues that could have been managed at home if they’d had access to effective health care, Behn Smith said. An example of this is asthma, she added.

Education indicators

The other indicator to show signs of improvement was high school education, which rose by more than four percentage points between 2016 and 2020.

This measures only one type of education, Behn Smith noted, adding that a lot of education happens outside of a classroom.

This indicator measured the proportion of Indigenous students (which includes First Nations, Métis and Inuit students) who complete high school within eight years of starting Grade 8. In 2019-20 this was at 74.2 per cent.

By comparison, 91.4 per cent of all B.C. students had completed high school in 2021-22 six years after they started Grade 8, according to the Ministry of Education and Child Care.

“This is an improvement but there’s still a long way to go,” Behn Smith said.

While putting together the “We Walk Together” report, which explores Indigenous resilience, provincial health officer Dr. Bonnie Henry said she spoke to many teachers and community leaders who reported that First Nations children faced anti-Indigenous racism in classrooms across the province.

This feeds into another alarming data point: only 0.39 per cent of the physicians registered with the College of Physicians and Surgeons of BC self-identified as First Nations in 2023. That’s 59 First Nations doctors compared with 15,187 non-First Nations doctors.

Out of all nurses in B.C., 1.54 per cent self-identified as First Nations. Of midwives registered with the BC College of Nurses and Midwives, 1.72 per cent self-identified as First Nations.

The reports that offer solutions for how to improve life for First Nations people all call for more First Nations health-care providers, Behn Smith said. The “dramatic” gaps between First Nations and non-First Nations doctors, nurses and midwives could be shrunk if institutions did more to create space for and supported First Nations students, and their non-Indigenous colleagues and classmates similarly worked to create space and support systems, she added.

‘We have to hope’

The Tyee asked Wieman where she thought mortality rates might be in six years, considering toxic drug deaths are continuing to rise in B.C.

“I’ve always said we can’t despair. We have to hope. What other choice do we have?” she said in response.

Substance use is a health issue and should be treated as one, she said. We shouldn’t shame people for using substances, she said.

Even public messaging around the two public health crises showed stigma, Wieman said.

“The COVID pandemic messaging was ‘We’re all in this together.’ But when it comes to people who use substances, the subtle and not-so-subtle messaging is ‘I’m glad it’s you and not me.’ And that really needs to change.”

More resources are needed to better support people who use substances, including harm reduction and treatment, she said.

— This story was originally published by The Tyee.

News from © iNFOnews, 2024