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Making a difference: Saskatchewan Health Research with Impact TOOl kIT FOR COMMUNITy HEAlTH Sylvia Abonyi, Canada Research Chair in Aboriginal Health Associate Professor, Department of Community Health and Epidemiology THE ISSUE: Because aboriginal communities and organizations have limited local data on what they feel is important to the health of their communities, it is difficult to allocate resources to areas of greatest need and to evaluate effectiveness of the health services provided. “What is a healthy community?” asks Sylvia Abonyi. “How do we measure that?” THE CHAllENGE: Information on what communities consider to be important, such as strong and vital cultures, food and water security, environment, appropriate services and infrastructure, is often poorly recorded - if at all - and may not reflect local knowledge and experiences. Culture, for instance, is loosely understood as the language and customs of a group of people that create a feeling of pride and belonging. This is something not easily captured by a number. THE TOOl kIT: Working with northern Saskatchewan aboriginal communities out of the population health research facility in Prince Albert, and funded by the Canada Foundation for Innovation, Abonyi and her communitybased team produced a tool kit that identifies over 200 indicators of community health and wellness. Some indicators relate to culture. “Communities recognize the importance of intergenerational relationships and their link to cultural vitality,” says Abonyi. “Severed 16 C O M M U N I Q U É College of Medicine • University of Saskatchewan College of Medicine Faculty connections contribute to low self-esteem, substance abuse and self-harm. Communities using local measures that point to issues in this area may decide to target resources differently than they may have otherwise.” Realizing the value of Abonyi’s work, the community of Fond du Lac Denesuline First Nation and the Black Late Denesuline First Nation and the Athabasca Health Authority have all lent their support. THE IMPACT: The tool kit is having an impact across the country. For example, it is helping 13 First Nations communities in Nova Scotia develop their planning activities; it is informing the decision-making and actions of a nurse practitioner in a rural community with no physician. The health director in another community says, “It has been very helpful for me… showing the chief and counsellors that we do have problems in [Elder housing].” He is using the tool kit to write proposals leveraging resources for housing and food issues. THE FUTURE: Abonyi’s team is implementing the toolkit with the Athabasca Health Authority in northern Saskatchewan, building a community database of information and creating new measures as they better under- stand how to monitor intangibles such as the role of culture in community health. For Abonyi, this is a long-term project grounded in collaborative research. Among her collaborators: the Prince Albert Grand Council, the Athabasca Health Authority, nine First Nation and provincial communities, colleagues from the Saskatchewan Population Health and Evaluation Research Unit, the Indigenous Peoples’ Health Research Centre, First Nations University of Canada, the University of Regina and, of course, her colleagues at the U of S. Together, they represent an incredible pool of expertise in aboriginal health in Saskatchewan. “We are providing home-grown answers to questions that are being asked in indigenous communities around the world,” she says. Article provided courtesy U of S Research Communications Office s
Members – Why Their Research Matters... DIABETES VS. DEMOGRAPHICS Roland Dyck Professor, Department of Medicine THE ISSUE: In a 1937 survey, there wasn’t a single case of diabetes among Saskatchewan’s aboriginal population. By 2006, one in five individuals had been diagnosed, and the prevalence continues to rise. Though diabetes rates are increasing among all Canadians, researchers have long speculated that Aboriginal Peoples are genetically programmed to use calories sparingly, exposing them to obesity, diabetes and all the health complications that go with it. THE STUDy: Funded by the Canadian Institutes of Health Research, Health Canada, the Saskatoon Health Region and the Royal University Hospital Foundation, a team led by Roland Dyck has been researching the rise of diabetes among indigenous peoples for 20 years. The results of a recent ground-breaking study were published by the Canadian Medical Association Journal in February 2010. “The study looked at more than 90,000 people with diabetes in Saskatchewan since 1980 and gives the clearest picture to date of the demographic differences between First Nations and non-First Nations people across Canada,” says Dyck. THE FINDINGS: The first thing the study does is debunk that long-held notion of genetics. RESEARCH “It’s clear that the rapid appearance of Type 2 diabetes, particularly among First Nations populations, is due to environmental rather than genetic factors,” he says. Indeed, the epidemic is linked to rising rates of obesity, which in turn is associated with the loss of traditional lifestyles. The study also paints a distressing picture of how hard the disease has hit aboriginal communities. First Nations women aged 20 to 50 experienced the heaviest burden of diabetes, and by age 60 nearly 50 per cent had been diagnosed. Overall and compared to their non-First Nations counterparts, diabetes rates were four times higher among First Nations women and 2.5 times higher among First Nations men. Because diabetes strikes aboriginal women hardest during their reproductive years, women and their children are caught in an accelerating spiral. Higher rates of obesity lead to more diabetic pregnancies, which can lead to Type 2 diabetes in mother and child, and so on in future generations. Indeed, Dyck and computer scientist Nathaniel Osgood recently showed that gestational diabetes could be at the heart of 40 per cent of the epidemic among First Nations people. THE IMPACT: “Diabetes is arguably the most important chronic health issue among First Nations people and we’ve identified a key mechanism behind it,” said Dyck. Prevention of gestational diabetes could reduce the risk for Type 2 diabetes in both affected women and their unborn children. This knowledge provides great potential for developing innovative initiatives in First Nations communities. Both Health Canada’s First Nations and Inuit Health Branch and its associated Aboriginal Diabetes Initiative, which reaches more than 600 communities across Canada, have approached Dyck to explore ways of using his findings to provide more effective programs and services for diabetes prevention. n Article provided courtesy U of S Research Communications Office University of Saskatchewan • College of Medicine C O M M U N I Q U É 17
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