Ministry of Health and Long-Term Care (MOHLTC) Aboriginal Health Strategy Overview

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1 Ministry of Health and Long-Term Care (MOHLTC) Aboriginal Health Strategy Overview Presented by Sue Vanstone Manager, Aboriginal Health Strategy Unit Health System Strategy Division Ministry of Health and Long-Term Care Chiefs of Ontario Office Forum: Our Time Our Health February 24, 2010

2 Overview of Ontario s Health Care System Mental Health Services 334 community programs 159 homes for special care 3,600 homeless support units 6,900 dedicated supportive housing units 160 agencies for drug and alcohol and problem gambling treatment services Plus 73 out of 152 Ontario hospitals provide services under Schedule 1 of the Mental Health Act Drugs over 3,000 pharmacies over 3,400 drugs on formulary 14 LHINS Hospitals 152 Corporations on 226 sites (Public Hospitals) Health Care Providers > 22,000 physicians > 136,000 nurses 23 regulated professions 21 regulated colleges Groups and Associations 400 groups and professional associations Community Services Over 800 community service agencies 75,802 beds in 621 long-term care (LTC) homes 36 local boards of public health 103 Community Health Centres (CHCs) and CHC satellites 14 Community Care Access Centres (CCACs) aligned with geographical LHIN boundaries 969 independent health facilities 80 HIV/AIDS education and support programs Over 63 ministry-funded midwifery practice groups Over 175 diabetes education programs 2

3 As a steward of the health system, MOHLTC establishes clear standards within a local context in ways that are as effective and efficient as possible. MOHLTC is responsible for: Overall strategic direction, leadership and provincial priorities Developing legislation Monitoring and reporting on the performance of the system Planning for and establishing funding models Public health, doctors, family health teams (FHTs), ambulance services, and labs MOHLTC is not responsible for: The delivery of health care services (devolved to LHINs) Health promotion (MHP) 3

4 MOHLTC Organizational Chart Deb Matthews Minister B. Balkisoon Parliamentary Assistant D. Hallett Associate Deputy Minister Saäd Rafi Deputy Minister Dawn Ogram ADM (Organizational Transition) G. Hein Director (Ministry Integration and Coordination) K. Finnerty Director (Communications and Information Executive Director) Dr A King Chief Medical Officer of Health A. Keung CIO (Health Services I&IT Cluster) J. Crawford Director (Legal Services) K. Deane ADM (Health System Accountability and Performance) S. Fitzpatrick ADM (Negotiations and Accountability Management) A. Brown ADM (Health System Strategy) A. Stuart ADM (Public Health) J. Tepper ADM (Health Human Resources Strategy) R. Hawkins ADM and CAO (Corporate) J. McKinley ADM (Health System Information Management and Investment) R. Hawkins (Acting) ADM (Direct Services) H. Stevenson ADM and Exec Officer (Ontario Public Drugs Programs) 4

5 What we know about First Nations health Determinants of Health Lower socioeconomic status and the persisting effects of colonialism are the key drivers of health disparities. On-reserve in Ontario: 46% do not have a high school diploma, 17% are unemployed, and 21% live in crowded conditions. Average income is substantially lower for First Nations people in Ontario than non-first Nations Ontarians (Census, 2006). Low socioeconomic status (SES) is associated with a wide range of chronic diseases, including Type 2 diabetes, coronary heart disease and poor mental health. Low SES is also associated with riskier behaviour, and higher use of health services overall (but lower use of specialists and preventive care). Need for innovative thinking and collaboration to make health system culturally appropriate and attentive to these upstream factors. 5

6 What we know - Improving health information Evidence-based decision-making is now regarded as an essential means for improving health outcomes and having cost effective health service delivery. MOHLTC does not have a fulsome picture of the health status of Aboriginal people, as most data is derived from federal reports or secondary sources. Information that is available is often scattered and comes from disparate sources, including: Statistics Canada Census Statistics Canada Canadian Community Health Survey (CCHS) Statistics Canada Aboriginal People s Survey (APS) Statistics Canada Aboriginal Children s Survey Indian and Northern Affairs Canada (INAC) Registry Regional Health Survey (RHS) Provincial Health databases 6

7 What we ve heard community voices Strategic directions are taken in part from what we hear from the communities. This table outlines some of what MOHLTC has heard consistently from the Aboriginal communities, including First Nations, Métis, Inuit, women and health service providers. Health Determinants Research Needs Priority Health Needs Accessible Health Care Oversight & Governance Address social determinants of health, especially poverty Support initiatives for improved housing, violence prevention, and food security (especially healthy, affordable food) Adopt broader conceptualization of health as wellness Emphasize disease prevention and health promotion in health delivery model Improve local capacity for data collection and health research Chronic disease, especially diabetes, cancer, heart disease, and asthma Mental health treatment, especially for concurrent disorders Prescription drug abuse Addictions and suicide prevention Women s health Fetal Alcohol Syndrome Disorder Improve access to primary care Improve access to traditional healers More culturally appropriate services through multidisciplinary health teams Increase use of patient navigators Improve recruitment, retention and cultural training of health professionals Commit to capital investments in infrastructure Expansion of telehealth Improve transportation to health services Greater attention to Aboriginal priorities in mainstream health system Greater consultation and accountability to Aboriginal community Improved federal/provincial coordination Sustained program funding Aboriginal leadership in health policy and governance, and in program design and delivery 7

8 Ontario s Approach and Objectives MOHLTC Goals What MOHLTC is doing now 1994 Aboriginal Health Policy for Ontario Legislation (midwifery, healers, traditional foods, tobacco) Aboriginal-specific components of mainstream programs (e.g. HIV/AIDS, mental health and addictions, Diabetes, Community Support) Strategic initiatives AHWS (10 AHACs, 6 Healing Lodges, etc.) Improved Measurement and Research Enhanced measurement of health outcomes and progress; enabling Ontario-specific research activities Priority Setting Need to address conditions with high prevalence and incidence (diabetes, mental illness) Enhanced Access and Quality Ensure supply of services meets needs of rapidly growing population Relationships Effectiveness at local and provincial levels Improving Aboriginal Health in Ontario 8

9 Emerging and Current Initiatives Ontario Diabetes Strategy Approximately $4M in new annual funding for expansion of services for Aboriginal communities, including: 10 new Diabetes teams in Aboriginal Community Health Centres (ACHCs) and Aboriginal Health Access Centres (AHACs) Additional foot care services in AHACs and ACHCs Mobile diabetes team to serve remote communities in the North Enhancement of diabetes prevention and management programs in Aboriginal communities via the Southern Ontario Diabetes Initiatives and the Northern Diabetes Health Network Diabetes and foot care clinics to complement the new dialysis satellite program at Six Nations of the Grand River Health Services. Maternal Child and Youth Health Strategy (MCYHS) Children and youth represent a higher proportion of the Aboriginal population and often experience a greater burden of illness when compared to the general population MCYHS will focus on maternal-newborn care, care coordination and access to specialized services 9

10 Emerging and Current Initiatives continued Mental Health and Addictions Strategy Strategy recognizes the diversity of Aboriginal communities and has a responsibility to ensure its Aboriginal peoples have access to opportunities for health and to health services. Opportunities for input include through web comments, as well as roundtables to discuss issues and opportunities for children and youth, Aboriginal people, seniors, business, and justice. Chronic Disease Prevention and Management Strategy Implementation, starting with Diabetes, will integrate care in four areas: prevention and risk factor management, mobilizing communities, primary care reform, and community care settings. Role of Ontarians initiative MOHLTC is engaging a range of community representatives to discuss the active role Ontarians can play in the healthcare system to contribute to the health of their communities and individual well-being. 10

11 Emerging and Current Initiatives continued Aboriginal Health Transition Fund (AHTF) - Adaptation Plan Ontario received a total of $6.18M from Health Canada Ontario s 31 projects are located throughout Ontario, and support Aboriginal communities in areas including acute care, primary care, chronic disease screening, community health programs, front line services, and health education / promotion. Ongoing engagement and collaboration In June 2009, MOHLTC hosted an Aboriginal health meeting in Toronto attended by over 30 representatives from Aboriginal organizations across Ontario. A similar meeting will be held in the near future. 11

12 Emerging and Current Initiatives continued Aboriginal Healing and Wellness Strategy (AHWS) Primary health care at 10 Aboriginal Health Access Centres (AHACs) Maternal and Child Centre at Six Nations Healing Lodges Outpatient hostels Translator Programs Community Wellness Workers Crisis Intervention Workers The future of AHWS is now being examined given the expiry in 2009 of the latest 5-year agreement. Collaborative strengthening of AHWS programs requires effective partnerships. 12

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