Thank you to you and to your colleagues as well, Madam Chair, for the invitation today. It's a pleasure to be here.
As all of you probably know, the Assembly of First Nations is the representative body of all first nations communities across Canada, totalling close to a million citizens over some 633 communities.
We look after many files at the AFN Health and Social Secretariat, such as public health, mental health, information management, and primary care, but one of the big ones as well, of course, is e-health. As technologies advance and as Internet access expands to our communities, telehealth and e-health are seen as indispensable tools towards developing a comprehensive, effective, and efficient health system for first nations people.
For a little context, the state of first nations health, as you are probably mostly aware anyway, certainly is lagging behind in terms of health outcomes. I was looking at the big six from Dr. Cafazzo, and I was like, “Yup, bing, bing, bing, check, check, check”.
Unfortunately, for type 2 diabetes, for instance, the rates on reserve are three to five times higher. Infant mortality is 1.5 times the national average. I can go on and on. I don't want to spend a lot of time on that. The story is well known.
Why is this the case? There are many, many reasons, but certainly one is access to care. Access to care is an issue that contributes to poor health outcomes for first nations.
In the recently released first nations regional health survey, respondents identified a number of health care barriers, which include: the inability to cover child care costs; difficulty in arranging and paying for transportation—medical transportation is another issue that is important here this morning, obviously; excessive wait times; and inadequate and culturally inappropriate care.
As well, mental health was mentioned already. That is another huge issue. Mental health and substance abuse services on reserve are often limited to paraprofessional staff with limited mental health training. The recent closure of the Aboriginal Healing Foundation and the wind-down of the Indian Residential Schools Settlement Agreement will almost be certainly felt within communities unless investments in mental health services are made.
An added complication is the fact that the first nations population is a very mobile one, both in terms of residency, moving from rural communities to Winnipeg or Saskatoon or what have you, and also in the way they are required to move between the federal and the provincial and territorial health care systems to receive care. Just to give you an idea, the RHS also looked at residency. It showed that 59.2% of first nations adults reported living outside of their communities at some point in their lives. Of those, something like 23% had moved two or more times in the last 12 months.
It's very clear that these factors present a challenge in terms of continuity of care and magnify the need for the development of electronic health records within first nations communities.
How can e-health and telemedicine help?
I don't want to present e-health and telehealth as the silver bullet; I think a number of things need to be fixed. They do, however, hold the potential for a number of different things, such as evidence-based policy development. “Give me the damn data”—I've heard that already this morning. I would echo that, for many different reasons.
They also hold the potential for increasing efficiencies by reducing transportation costs. This is another huge issue for the budgets we're trying to live with within the non-insured health benefits plan as it pertains to medical transportation. Certainly, that's another issue for my colleagues from Manitoba here, and for those first nations communities.
They also certainly could provide educational opportunities for nurses and community members; more safely manage and store health information with the community; utilize electronic health records to improve coordination of care between jurisdictions, which is a constant challenge for first nations clients; and ensure a circle of care as patients move between those jurisdictions.
As was mentioned already this morning, while the federal government, Canada Health Infoway, and the provinces and territories have made advancements in the deployment of e-health technologies and the development of electronic health records for Canadians generally, first nations e-health projects have tended to take a bit of a back seat. Investments in infrastructure, applications, and capacity development have not been made at a level that would allow for the electronic data exchange required to support health care service delivery to its fullest potential.
I know it's still a struggle across the country, and certainly what we're trying to do is keep pace. As all of you surely know, the 2004 health accord did call for the development of an electronic health record for all Canadians, and we simply want to ensure that first nations are part of that effort.
Without significant and sustainable investment within first nations communities alongside the development of technologies that align with federal and provincial-territorial systems, the wellness gap for first nations will remain.
Despite all of the challenges I've mentioned, jurisdictional, financial, and capacity challenges, e-health and telehealth projects are under way in first nations communities across the country.
The Mustimuhw cEMR, developed by the Cowichan Tribes in British Columbia, is up and running, for instance, and that has expanded to other provinces as well as other communities within B.C. I believe Saskatchewan and Manitoba are utilizing it as well.
The development of comprehensive and integrated information management and information technology services as a key feature in the exciting B.C. tripartite process is going on right now and is moving quickly toward implementation.
I would also mention that an exciting client registry project is being undertaken in Ontario by the Kenora Chiefs Advisory. The project has already joined seven first nations communities into a single database and has recently been awarded funding through the Health Services Integration Fund to accomplish numerous tasks, including developing first nations-led governance structures that support integration and address legislative and policy issues around integration.
There is also one that I think my colleague here is involved in with the trilateral working relationship in Manitoba with the Manitoba first nations.
Where do we go from here? As a national-level advocacy organization, the AFN has neither the resources nor the mandate to engage in e-health projects on the ground. However, we continue to engage in projects that support first nations e-health activities. For example, the Assembly of First Nations has taken early steps to engage first nations and federal-provincial-territorial partners in discussions to accelerate the journey toward e-health alignment, convergence, and clinical data integration.
On June 20, 2012, the AFN teamed up with COACH, which is Canada's Health Informatics Association, with the support of my colleagues from FNIHB and Canada Health Infoway, to co-host the First Nations eHealth Convergence Forum. Attendees included chief information officers and information management e-health staff from the provinces, territories, the federal government, and first nations e-health leaders. We're working to ensure that the watershed discussions at this event are not lost, and certainly we're working toward moving that forward.
Other projects currently under way include the development of an e-health strategic framework to assist first nations in developing and implementing fully aligned e-health projects based on first nations principles and priorities. As well, one of the other issues that we need to deal with, of course, is data sharing, so we're working on a data-sharing agreement guide that will provide first nations communities with many of the tools required to develop their own data-sharing agreements as they venture into this field and look to align themselves with federal and provincial systems.
It is worth noting that the e-health infrastructure program at FNIHB is up for renewal in 2013, and support from this committee here today would be greatly appreciated, so that FNIHB and first nations can continue to bring the transformative potential of e-health technologies to the communities that need it most.
In closing, I would like to take this opportunity to encourage committee members and this government to engage with first nations, provinces, and territories in coming to the table to recommit partners to achieving priorities of national importance, including the development of health technologies, to all Canadians, including first nations. I would also say that the renewal of the 2014 health accord could provide that opportunity.
With that, thank you very much, Madam Chair. I would be happy to take any questions.