I would like to begin by thanking the members of the Standing Committee on Health for the opportunity to stand on Algonquin territory and speak to you today about H1N1 in first nations communities.
My name is Marcia Anderson, and I'm Cree-Saulteaux from Manitoba, with clinical training in internal medicine and public health. l've been the president of the Indigenous Physicians Association of Canada for the past three years. As an organization of physicians and medical students who hold the vision of healthy and vibrant indigenous nations, communities, families, and individuals, we have been watching with great concern as H1N1 has circulated the globe.
At this point, we are all aware of how H1N1 disproportionately affected first nations people in the first wave, which was particularly striking in Manitoba, where 37% of all cases and 60% of those admitted to the ICU with H1N1 were first nations people. According to PHAC data, first nations were also disproportionately represented among pregnant women who were infected with H1N1. This should not have surprised us, given that in past epidemics of influenza there have been mortality rates four to seven times higher in indigenous peoples, and that each year first nations people are hospitalized for seasonal influenza at four to five times the rate of the general population. Further, we now know from Australia's experience with H1N1 that aboriginal and Torres Strait Islander people were hospitalized and died at ten and seven times the rate of the general population, respectively.
I consider it a success that aboriginal ancestry has been defined as a characteristic that makes people eligible for priority group one vaccination in Manitoba. I find it concerning that the federal government has not clearly identified all first nations people as higher risk for severe illness, as evidence has shown that urban first nations people are also disproportionately affected. There has been a lack of targeted and focused communications on the risk of H1N1 illness for first nations people that explains, at a literacy appropriate level, why the risk is higher and what to do. This is particularly striking as it pertains to pregnant first nations women. I cannot help but wonder if, had this been clearly recognized as a risk factor, more resources would have been made available to mitigate that risk.
First nations organizations in Manitoba have been setting up command centres at the community and regional level to support first nations communities in their H1N1 planning and response. I commend them for this, and I am aware that a proposal has been submitted for the support required to establish these systems and to ensure that the individuals are appropriately trained. It is my belief they should receive an equitable level of financial resources to support this new role for these representative organizations. They have done an excellent job in representing and advocating for their communities, filling gaps in communication pathways, and identifying the logistic and operational realities that many who work in the provincial public health system were not familiar with.
I also believe we need to provide an equitable level of public health expertise to the first nations incident command system as exists to national, provincial, and regional incident command systems. In Manitoba there is a single federal regional medical officer of health to serve 64 widespread communities, and that is simply inadequate even at the best of times. Perhaps consideration should be given to providing resources for the Assembly of Manitoba Chiefs to contract one to two public health professionals who can assist with finalizing the plans in the communities that have not finished them, and implementing them across the province as we are entering this second wave.
I will finish with two suggestions for addressing the risk of H1N1 in first nations communities.
First of all, an independent evaluation of the health care system response to the first wave of H1N1 in first nations contexts that can identify the effectiveness of different elements of the response, including adequacy of resourcing, communications, working structures, and working relationships, and clinical care, should be done. This is absolutely necessary to understand how to improve the health care system response, particularly inasmuch as we don't know if we as a system contributed to increasing the risk of severe illness or mitigated that risk. I will note that on a CBC The National interview, with respect to the health system response to H1N1 in aboriginal and Torres Strait Islander peoples, a senior Australian health official stated that he didn't feel they should have done anything differently, that the gap was only 10 times. It could be considered a successful outcome, because if they had not done so well the gap would have been wider. I hope that none of us would consider such a significant inequity acceptable and evidence of a job well done.
Second, the elevated risk for respiratory infections, including H1N1, is chronic and well known, and evidence shows that reasons for this include poverty, overcrowded and inadequate housing, higher rates of non-traditional tobacco use, and underlying medical conditions, which themselves are also due to underlying socio-economic inequalities. We must see a commitment to addressing these underlying social and structural inequities if we want to see a different outcome. I have heard Sir Michael Marmot, chair of the WHO commission on the social determinants of health, remind us that there is plenty of money to address underlying inequalities in social conditions. We saw the clear evidence of this with responses to the economic crisis. We have chosen to bail out banks and car manufacturers and have chosen not to ensure that all have access to appropriate shelter and to a safe and potable water supply.
If we truly want to see the gaps in health close for first nations communities, whether we are talking about H1N1, seasonal influenza, tuberculosis, diabetes, or heart disease, we must choose differently. We must have an explicit goal of health equity for indigenous peoples in Canada, and we must ensure that every policy and program decision is evaluated for how it will impact the gap in health for first nations, Inuit, and Métis people.
Thank you.