Honouring all our relations: Advancing health and wellness of uncounted Indigenous peoples in BC through addressing gaps in population health and wellness reporting

This Health System Impact Fellowship is co-funded by CIHR, MSFHR, and BC Office of the Provincial Health Officer (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.

Reporting on the health and wellness of populations is vital to monitor trends, identify priorities, track progress towards targets, and address inequities. All Indigenous peoples — including those who do not have ‘Status’ under Canada’s Indian Act — have the right to be counted. Their perspectives and priorities must guide how data is collected, used, and reported. Yet, at present, First Nations, Metis, and Inuit peoples who do not have ‘Status’ or are not registered with Metis Nation BC are ‘invisible’ and ‘uncounted’ within population health and wellness reporting in British Columbia (BC).  Responsibility for reporting on health of BC residents lies with the Office of the Provincial Health Officer (OPHO). Through agreements with federal, provincial, and Indigenous governments, the OPHO’s responsibilities include collaboratively reporting on health and wellness of diverse Indigenous peoples living in the province. Currently, there is no process in place to report on health and wellness of “uncounted” Indigenous peoples. This work must be done in partnership with Indigenous collectives representing this population. Current gaps include:

  • No strengths-based, self-determined terminology to refer to diverse Indigenous peoples who are uncounted in population health data.
  • Lack of formal relationships with Indigenous collectives representing uncounted Indigenous peoples.
  • No way of identifying this population in existing BC population health data.
  • Absence of research frameworks that reflect uncounted Indigenous peoples’ perspectives of health and wellness.
  • No implementation plan for province-wide population health reporting led by uncounted Indigenous peoples, on their terms .

The goal of this project is to support the health and wellness of uncounted Indigenous peoples living in BC by addressing current gaps in population health reporting, through partnerships that uphold Indigenous self-determination, decision-making, and perspectives of health and wellness.

Source: CIHR Funding Decisions Database

Qualitative analysis and integration of stakeholder engagement into provincial policy roll out of free prescription contraception: Application of gender-based analysis plus (GBA+)

This Health System Impact Fellowship is co-funded by CIHR, MSFHR, and BC Ministry of Health – Population and Public Health (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.

In late 2020, the Government of British Columbia committed to a policy of free contraception for all. This first-in-Canada policy presents an opportunity to address the cost barrier that limits access to contraception, and to understand and address how other identity factors like race, ethnicity, religion, age, and ability intersect with gender to affect the experience of contraceptive access. The goal of this project is therefore to use a gender and diversity lens called Gender-Based Analysis Plus (GBA+) to support the planning, implementation and evaluation of free contraception policy and programs in BC. Specifically, a family planning researcher will work with the BC Ministry of Health to engage with stakeholders about the impact of free contraception on communities known to face various barriers to safe and appropriate contraception care. Stakeholder engagement will be complemented by reviews of the relevant scientific evidence as well as invited presentations from researchers doing work connected to gender, diversity, and contraception. In alignment with the Ministry mandate to provide free contraception for all and addressing systemic discrimination, the results will be shared with policy makers to inform decisions about free contraception policies and programs and will be used to inform templates and guidelines for future GBA+.

Source: CIHR Funding Decisions Database

Identifying leverage points for strengthening coordinated intersectoral action for health promotion in British Columbia

This Health System Impact Fellowship is co-funded by CIHR, MSFHR, and BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.

Health promotion (HP) enables people to increase control over health and reduce health inequities through action on the determinants of health. HP actions include developing personal skills, creating supportive environments, strengthening community action, building healthy public policy, and reorienting health services to improve population health and wellness.The COVID-19 pandemic has emphasized the need for more coordinated, integrated and intersectoral HP action. The focus and value-add of the project is the development of co-created (with research, policy, and practice stakeholders) recommendations for enhanced HP and the innovative application of a complex systems approach to support this work. Using physical activity as a starting point, this project will to map (inventory) HP initiatives targeting physical activity at the provincial, regional, and local levels and identify areas to enhance coordination and integration to build healthier communities. The anticipated impacts and value of achieving this goal include:

  • Shared leadership, governance, and accountability for HP.
  • Increased collaborative capacity to align HP.
  • Enhanced focus among stakeholders on reducing health equities.
  • Shared resources (human, financial, infrastructure) to implement HP.
  • Improved information (knowledge exchange, research and evaluation, monitoring and surveillance).
  • Shared learning and understanding among stakeholders of new approaches to HP identified through the lens of a complex systems paradigm.

There are three objectives:

  1. Describe and map existing physical activity HP initiatives and systems in BC.
  2. Assess systems to identify facilitating and hindering factors and key feedback mechanisms that influence implementation, coordination and integration.
  3. Strengthen systems through identification of priority leverage points and recommendations for more synergistic implementation of coordinated intersectoral HP in BC.

Source: CIHR Funding Decisions Database

Healing Indicators: Research in Indigenous health impact assessment and self-determination

This Health System Impact Fellowship is co-funded by CIHR, MSFHR, and First Nations Health Authority (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.

Healing Indicators is a research project that aims to improve health assessment policy. It addresses the need to create tools that centre communities and Indigenous knowledge in the assessment of the health impacts of resource development. The project is grounded in community-based Indigenous methods, with the purpose of developing land-based wellness indicators. The work draws on self-determination, culture, kinship, community, and land to inform and define health and wellness in a First Nations context. As a research program, Healing Indicators is committed to engaging land-based healing and health justice and features a decolonial ‘two-eyed seeing’ approach, with one eye informed by Indigenous ways of knowing, and the other western science. Progressing land-based indicator research is important within the context of the First Nations Health Authority’s “Public Health and Wellness Agenda.” Land-based health indicator development requires emergent community-based methods and design that is inclusive of leadership from Indigenous peoples. The impact of this collaboration is the promotion of critical Indigenous health research, with opportunities to expand on policy gaps in relation to land-based wellness and Indigenous health assessment. Asset-based work, such as this, is relevant within the context of provincially acknowledged widespread racism within the health care system in British Columbia. This work is also significant to the provincial commitment to implement the Declaration of the Rights of Indigenous Peoples (DRIPA 2019). Healing Indicators is a collaborative research project designed to promote community-led health through land-based indicator development to inform self-determination and wellness in collaboration with the First Nations Health Authority.

Source: CIHR Funding Decisions Database

Better Serving People with Multiple, Complex Needs in BC through Health System Impact.

The aim of this research project is to better understand and address the health needs and service requirements of people with multiple, complex needs under the purview of Community Living British Columbia (CLBC). The proposed research project will build on existing research and fill important gaps in knowledge regarding the health of people with a multiple complex needs designation and effective service delivery mechanisms at points of intersection with the healthcare system. This research project will advance CLBC’s research efforts through two key objectives. The first is to better understand the health-related needs of this population, which includes an analysis of health-related contacts (type and frequency), outcomes, and costs associated with this population. In BC, much is not known about the health-related needs of this group.  The second objective is to identify and learn from promising practices in BC — specifically, what is being done that works for this population and why, with particular attention to issues of sustainability and scalability. Although findings from CLBC’s qualitative research highlight the need for significant systemic change in the delivery of services for people with multiple complex needs, it also identified “pockets of excellence” in BC where local or regional solutions have emerged as examples of practice excellence. Through this objective, I will focus on services that directly intersect with the healthcare system (e.g. acute care, residential detox/treatment, etc.) and address underlying social determinants of health, including, for example: homelessness, poverty, and issues of gender and race (Indigenous people). The research will include an evaluation of selected services. In addition, an inventory of services for the multiple, complex needs people in BC will be developed.

End of award update: December 2021

Following the end of her award term, Dr. Cook has provided the following brief update on this project’s progress.

Key impacts arising from fellowship program of work

Impact goal:
To inform policies and practices so that people with intellectual and/or developmental disability (IDD) and multiple, complex needs (MCN) receive high-quality service and care from Community Living British Columbia (CLBC).

Impact summary:
Dr. Cook’s research led to key academic and knowledge mobilization deliverables, such as a plain-language summary report of key findings and recommendations related to the health and service delivery needs of people living with IDD and MCN. The report will help inform future policies and practices. Stemming from the research and recommendations, CLBC will establish a data innovations project to help the organization better understand integrated and coordinated care across health systems for people with IDD/MCN. Dr. Cook’s research has helped reinforce a cultural shift within CLBC toward broad and long-lasting changes that will better serve people with IDD and MCN.

Read more about the impact of Dr. Cook’s fellowship in the CIHR HSIF 2017-19 Embedded Research Impact Casebook.

Interpreting and addressing barriers impeding effective care transitions for women diagnosed with breast cancer in British Columbia

The number of Canadians diagnosed with cancer is rising with a growing and aging population and we need to ensure our healthcare system is equipped to meet this growing demand. As the most common female cancer worldwide, breast cancer is the second leading cause of cancer deaths in Canadian women. In recent decades, advancements in breast cancer screening and treatments have resulted in approximately 87% of Canadian women diagnosed with breast cancer surviving 5 years after diagnosis. Increased survival rates are due in part to adjuvant endocrine therapy (AET) (e.g., tamoxifen), which is used to treat early-stage, hormone receptor-positive breast cancer, representing the large majority of breast cancer diagnoses. Women prescribed AET are recommended to take this medication everyday for 5-10 years depending on their diagnosis, which results in the need for increased follow-up care over a long period of time. Previous research, however, has shown there are many issues associated with transitions in care, particularly as breast cancer survivors move from receiving care from their oncologist back to seeing their family physician or nurse practitioner in the community. The objective of this project is to improve transitions in care to better support women diagnosed with breast cancer and also the healthcare providers that deliver care to these women. The goal is to meet the supportive care needs of breast cancer survivors as they transition through the healthcare system to support them in living well beyond their breast cancer diagnosis.

Investing wisely: using economic modelling to optimize public health strategies to reduce harm from alcohol, tobacco and cannabis and optimize benefits in British Columbia

Substance use costs British Columbia $4.9 billion in 2014, of which 70% was due to alcohol and tobacco. These estimates include costs related to the use of health care resources, productivity losses, criminal justice, and other direct costs such as accidents, research and prevention. Broader societal costs not included in these estimates relate to inequities, marginalization and hindered social development.  This project aims to develop a model to evaluate the economic and social impact of legal substance use harm prevention in British Columbia. Evidence on economic consequences and how public health programs can minimize costs and harms from substance use is important for policy makers, who need to consider the health system priorities against efficiency, scalability and sustainability of interventions. The challenges to developing comprehensive economic evaluations in public health are well known. In the area of substance use, these pertain to the multitude of the socioeconomic determinants that influence use – such as employment, income, social exclusion, and hopelessness – and the difficulty of measuring broader benefits including family wellbeing, community development and equity gains.   This fellowship will facilitate collaboration between knowledge users and academics with the aim of optimizing investment in the area of alcohol, tobacco and cannabis harm prevention in BC. It will provide the Ministry of Health with tools to implement efficient priority setting that aligns with the institution's values and development goals. This will be achieved through important methodological advances to allow evaluations to account for the broader societal impact of preventing harm from legal substance use in BC. As a result, this fellowship will sustain future research in health economics with an increased ability to respond to policy makers' needs when it comes to priority setting.

Building Capacity for Surveillance and Policy Development: Health Impact Assessments of Air Quality in Northern British Columbia

In Northern British Columbia, a region rich in natural resources, there has been a rapid expansion of resource extraction projects across the region in recent years. While generating economic growth for local communities, this has also led to concerns among health practitioners and community members about the potential health risks associated with declining air quality due to increased industrial emissions. In the BC Northwest, in particular, projections indicate that sulphur dioxide emissions will likely increase in the Kitimat airshed due to multiple new industrial projects and expansion of existing projects.Timely information about air quality and associated health risks is important for developing public health policies, to prevent potential negative health impacts, and for planning at both local and regional levels. The objectives of this project are to 1) conduct a health impact assessment of impacts of SO2 emissions on human health in the Kitimat region; 2) make recommendations for development of effective surveillance tools to assess air quality health impacts in the region; and 3) review how local and regional policy makers use environmental health impact information for decision-making.This project will directly support Northern Health's organizational impact goal of healthy people in healthy communities, through promoting and protecting healthy environments, and through helping to build regional capacity for conducting health impact assessments and surveillance.

Evaluating the response to British Columbia’s overdose crisis within Vancouver Coastal Health: Moving research into practice

The opioid crisis has been hardest felt in British Columbia (BC), which declared a public health emergency in 2016. Last year, there were 1510 drug overdose deaths recorded in BC, which represented 4.5 times the deaths from motor vehicle accidents. The overdose crisis has been largely driven by increasing contamination of the illicit drug supply with powerful synthetic opioids (e.g., fentanyl). Despite efforts to expand harm reduction services and treatments for opioid use disorder, these have had limited success in curbing the current crisis. Innovative strategies to mitigate the crisis have become an urgent public health priority. This includes a critical need to evaluate the response to the overdose crisis to help develop and implement a comprehensive addiction treatment program across BC and ultimately prevent future drug-related fatalities. Vancouver Coastal Health (VCH) provides services to more than 1.25 million residents in BC (nearly 25% of the population), and has been a primary player at the heart of the overdose crisis response. As such, alongside the newly implemented VCH Regional Addiction Program, VCH has identified key policy-related challenges that the proposed work will seek to address: prevent fatal overdoses, reduce drug-related harms, increase access to low barrier services, and improve integration of harm reduction and treatment. The proposed work will consist of several overlapping components to achieve the overarching goal to establish comprehensive and integrated addiction care programs across the region. This will include evaluating the impacts of 'naturally occurring' interventions (e.g., supervised consumption sites) and efficacy of novel clinical therapies, conducting health system and program evaluation to identify gaps in care and healthcare provider capacity, and engaging in integrated knowledge translation to mobilize research into evidence-based policies and practices across the health system.

Evaluating and optimizing rural and urban lesbian, gay, bisexual, transgender, queer, intersex, and Two-Spirit (LGBTQI2S) engagement with hospice and palliative care in the Island Health Region

Existing research focused on the experiences of gay and lesbian older adults with the health care system report that there is a general distrust and reluctance to access healthcare based upon the cumulative effect of discrimination over the life course. At present, while 75% of Canadians have indicated they would like to die at home, 45% of Vancouver Island residents die of in acute care. Clearly there exists a service gap and it appears possible that such a gap may be larger in the LGBTQI2S community. It is therefore vital to explore the level of LGBTQI2S engagement with hospice and palliative care, in order to ensure this population is not further marginalized in end-of-life. Victoria Hospice and Island Health will facilitate access to healthcare service providers, and I will recruit rural and urban LGBTQI2S participants and their families throughout the Island Health region via the relationships I have built with community gatekeepers. A Participatory Action Research strategy will be used and a Community Steering Committee of older LGBTQI2S people representing various geographies as well as sexual orientations and gender identities will be established. The Community Steering Committee will become an integral part of the Project Working Group, comprised of healthcare service providers, Island Health, Victoria Hospice, and the University of Victoria supervisory team and will be integrated into every step of the research process including development of research questions, refining research objectives, participant recruitment, data collection and analysis, evaluation of our findings, and knowledge translation.