First Nations Health Authority aims to improve access for B.C. aboriginal communities

Before Grand Chief Doug Kelly embarked on a wellness challenge with other B.C. First Nations leaders in April 2013, he was “failing” his annual physical exams.

“[My] stress level was too high, blood pressure was too high—I was a heart attack waiting to happen three years ago,” the chair of the First Nations Health Council recounted in a phone interview.

“Today, as a result of making changes to my lifestyle, I eat healthy foods, I am physically active, I make sure that I get eight hours of sleep a night, and I take care of my spirit.”

That first annual health initiative, which was followed by a step-up challenge to track physical activity, is part of a broader emphasis on health promotion and disease prevention in aboriginal health care in B.C.

“With our leadership accepting our responsibility as role models and beginning to make those changes to our lifestyle, that will help our citizens realize that they have more control over their own well-being than a physician or any other health professional,” said Kelly, who is also president of the Stó:lō Tribal Council.

The health council, formed in 2010, has been part of B.C.’s First Nations health governance structure since the First Nations Health Authority took over responsibility in October 2013 for programs and services that were formerly delivered by Health Canada.

The body is the first permanent provincial First Nations health authority in Canada. On May 6 and 7, more than 850 delegates from across B.C. are attending the seventh annual Gathering Wisdom for a Shared Journey conference in Vancouver, which focuses on health issues and solutions in First Nations communities.

Dr. Evan Adams, who has been the chief medical officer of the authority since December, said indigenous communities have signalled that they want their health-care system to incorporate a traditional, holistic approach.

“They don’t want to inherit a system that’s like the western system, which can be a little bit downstream-focused,” Adams said during an interview in his West Vancouver office.

“The western system spends most of its money on you in the last 10 years of your life.…Rather than focusing on the last 10 years of life, we have very much a focus on the whole width and breadth of life, but particularly around health protection—making sure that people stay well as opposed to dealing with them when they’re really sick.”

According to Adams, First Nations people have historically been “high needs, low demand” when it comes to accessing the health-care system.

“So they need help, but they think the system’s not for them,” he said. “And our statistics show that we use the provincial health-care system at half the rate of other British Columbians.”

While health indicators among First Nations communities are improving, the aboriginal population still faces a gap in health outcomes compared to other British Columbians.

“Our goal is health outcomes and health services equal to or better than the province’s,” Adams said.

“And we’re not just asking: we really are demanding it. It’s not acceptable­—it’s actually immoral—for one racial group to do well and the other not to do well living in the same place. And so we are trying to mitigate the circumstances that First Nations people find themselves in and give them the best possible chance.”

Some of the health authority’s initiatives include primary-care projects aimed at improving health-care access in First Nations communities—such as new teams of doctors, nurses, and mental-health clinicians—in addition to efforts like maternal-, child-, and family-health teams and mobile-support and complex-care teams.

“We’re reaching the hard-to-reach, which hasn’t always been the goal of the health system,” Adams said.

“The health system, to put it simply, before used to say, ‘Oh, we’ve set up a hospital; we’ve set up a clinic. If you want to come and visit us, that’s great,’ instead of doing really active outreach to those in the most need.”

Adams noted that the health authority’s work is being followed by the rest of the country—the organization has been contacted by other provinces and territories to see how it’s doing.

“Everybody’s watching very closely,” he said.

There are also “sky-high expectations” for the authority’s work, according to Kelly.

“But that doesn’t deter us—it actually motivates us,” he stated.

“We’re excited about doing our best to make those improvements to programs and services, to transform those programs that are not working,” Kelly added.

“So we’re going to do it in a way that’s consistent with our culture, our traditional medicines, our spiritual beliefs. We’re going to do it our way, but we are going to achieve significant change over the next 20 years.”