Public health is an area of shared responsibility. Various levels of government and jurisdictions, non-governmental organizations, other stakeholders, communities and national Aboriginal organizations are all involved in healthcare.

The Public Health Agency of Canada (PHAC) delivers national public health leadership through the Chief Public Health Officer, currently Dr. David Butler-Jones, as well as through national management of the emergency supply stockpile. PHAC also oversees contracts for antiviral and vaccine production.

The First Nations and Inuit Health Branch (FNIHB) of Health Canada provides funding for a range of programs and services on reserves including health promotion and illness prevention. Health Canada also provides some health care services and administration; supports development, testing, and revision of pandemic plans; distributes antiviral and vaccines to on-reserve communities, and manages a Personal Protective Equipment stockpile for community health care workers.

For all residents living off-reserve, including First Nations, Métis and Inuit, the provinces and territories are directly responsible for providing health care and public health programs and services.

Q2. Who looks after the H1N1 outbreaks in remote or isolated communities?

The Remote and Isolated Communities Task Group is made up of 25 members from across the country, including the provinces and territories, and First Nations and Inuit organizations.

The Task Group is responsible for building on existing guidelines to address the needs of remote and isolated communities and identify relevant research needs for this audience.

The Public Health Agency of Canada and Health Canada have assisted the Assembly of First Nations (AFN) on the development of a school based Influenza Surveillance tool designed to give practical advice on how to respond to illnesses like H1N1.

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Protecting First Nations and Inuit Communities

Q1. Why are people saying that people living in remote areas - where there are fewer people to spread the H1N1 Flu Virus - are at higher risk from the flu?

Many remote and isolated communities, including First Nations, Inuit and Métis communities, have higher than the national average incidence of underlying chronic medical conditions, putting them at increased risk of severe illness from H1N1 infection. Some of these communities face other public health challenges, such as overcrowding, that may increase the opportunity for H1N1 Flu Virus to spread.

A further concern for people living in remote and isolated areas is that if someone in a remote or isolated area does get severe complications from the H1N1 Flu Virus, it may take some time to get them to a hospital should they need hospitalization. This is especially true for fly-in communities, which is why getting a vaccine is highly recommended for all people in remote and isolated communities.

Q2. Do the Canadian clinical trials for testing the safety of the H1N1 flu vaccine include Aboriginal Canadians?

The Public Health Agency of Canada-Canadian Institutes of Health Research, Influenza Research Network (PCIRN) is conducting clinical trials for the H1N1 flu vaccine in 10 locations across Canada. About one-quarter (1/4) of the clinical trial participants are Aboriginal adults and children. The trials also include non-Aboriginal adults and children, healthcare workers, people with egg allergies and people with HIV.

Q3. How is Health Canada managing H1N1 Flu Virus in on-reserve First Nation communities?

A comprehensive and coordinated response to H1N1 Flu Virus in on-reserve First Nation communities has resulted from Health Canada’s ongoing work with the provinces, First Nation leadership, the Public Health Agency of Canada, Indian and Northern Affairs Canada, and other federal departments.

Access to care
Health Canada is committed to providing high-quality health care to First Nations people and Inuit. Nurses and home care workers are examples of the health staff working with Aboriginal communities. Nursing services are available 24 hours a day at nursing stations staffed by qualified healthcare professionals and additional medical staff are sent to communities as needed. Staffing levels are being closely monitored to ensure that adequate care is available at all times. Nursing staff are following provincial clinical care guidelines for respiratory illness.

Provision of personal protective equipment

Health Canada has sent personal protective equipment for health care workers to First Nation communities and is in the process of obtaining additional supplies to meet the long term needs of health care workers on-reserve. Health professionals at nursing stations in First Nation communities are following provincial guidelines for the use of personal protective equipment.

Prepositioning of antivirals
Health Canada has pre-positioned supplies of antivirals in nursing stations and in remote and isolated First Nation communities to be used for treatment if they are needed.

Epidemiological research
Epidemiology is the study of distribution and pattern of diseases in a population to determine the circumstances or events causing them. We are doing epidemiology work in First Nation communities to better understand the impact of the H1N1 flu virus on this population. We are also working diligently to ensure First Nation people have access to quality health care.

Support for developing and implementing pandemic plans
Health Canada provides support to on-reserve First Nations in the development, testing and revision of community-level influenza pandemic plans, integrated wherever possible with provincial efforts.

Q4. How is Health Canada currently supporting First Nations and Inuit living in remote and isolated communities?

Health Canada provides primary care services in on-reserve First Nation communities in remote and isolated areas where provincial services are not readily available. Nursing services are available 24 hours a day at nursing stations staffed by qualified healthcare professionals.

Budget 2009 provided $305 million over two years to strengthen current health programs for First Nations and Inuit. This included $135 million for the construction and renovation of health services infrastructure in First Nation communities, including health clinics and nurses' residences. These investments, along with others outlined in Canada's Economic Action Plan, reflect the importance this government places on improving the health and well-being of Aboriginal peoples in Canada.

In this current situation, there has been a concerted effort with First Nation partners and provinces to help communities update and implement their pandemic plans.

Health Canada is working with provinces, territories, the Assembly of First Nations and other stakeholders to adapt existing clinical care and public health guidelines to better respond to the needs of remote and isolated communities.

Q5. What is being done to protect Inuit during the H1N1 outbreak?

The majority of Inuit who reside in Nunavut and the northern parts of the Northwest Territories, Quebec and Newfoundland and Labrador are part of this provincial/territorial planning.

The Public Health Agency of Canada (PHAC) is working closely with the relevant provinces and territories. This work includes monitoring outbreaks in Inuit communities and the distribution of vaccines, antivirals and other key supplies.

The Public Health Agency of Canada is also working with Health Canada, provinces and territories, and other federal departments and Inuit health representatives to address the unique circumstances of remote and isolated communities during the H1N1 Flu Virus outbreak.

At the request of the Government of Nunavut, the Public Health Agency of Canada provided epidemiology support to the territory early in the outbreak to assist with assessing the impact of H1N1 Flu Virus in Nunavut.

PHAC also has been providing financial and technical assistance to develop a template for pandemic planning in community health centres in Nunavut. PHAC's Ontario and Nunavut Region will send staff into communities, in collaboration with Government of Nunavut staff, to assist health centre staff in completion of their individual plans.
PHAC collaborated with First Nations and Inuit Health Branch and Inuit Tapiriit Kanatami to develop culturally-appropriate posters on influenza prevention for use in community health centres and other public venues. We have sent public notices and infection prevention posters to Hamlets, Co-ops, Northern stores, Friendship Centres and Inuit organizations.

Under the Canadian Pandemic Influenza Plan, the provinces and territories are responsible for surveillance (monitoring the progress of a disease in a community), response activities and pandemic preparedness.

Q6. How do you treat H1N1 Flu Virus in residents of fly-in First Nations communities?

In fly-in communities, if a person falls ill, that person would be assessed at the local nursing station. If treatment is required, it would be provided according to provincial treatment guidelines. Individuals exhibiting signs of serious illness are transported to nearby hospitals.

Q7. Are First Nation communities included in the Government of Canada's pandemic planning process?

The Canadian Pandemic Influenza Plan for the Health Sector provides a framework that guides planning in all jurisdictions, including on-reserve First Nation communities. The information pertaining to influenza pandemic planning considerations in on reserve First Nation communities can be found in Annex B of the Canadian Pandemic Influenza Plan.

Q8. How is Health Canada addressing the incidence of H1N1 in First Nation communities?

Health Canada is closely monitoring the H1N1 Flu Virus situation in on-reserve First Nation communities.

A Task Group has been established specifically to review national guidelines for the H1N1 response and adapt them, as required, to better reflect the circumstances in remote and isolated communities. Members of this task group represent the provinces, territories, Health Canada, the Public Health Agency of Canada, Indian and Northern Affairs Canada and First Nations and Inuit.

Health Canada, in collaboration with the Public Health Agency of Canada, is also doing epidemiological work to better understand the impact of H1N1 on First Nations. In the meantime, we are doing everything possible to ensure First Nations people have access to quality health care.

Q9. Do First Nation communities have the equipment they need to manage H1N1 Flu Virus cases?

Efforts have been made to minimize the risk of the H1N1 Flu Virus in on-reserve First Nations by providing educational materials and public messaging regarding risks and risk avoidance, universal hygiene behaviours (such as hand washing and respiratory hygiene) and information on self-care, self-monitoring and self-isolation.

In addition, Health Canada has sent personal protective equipment to on-reserve First Nation communities, including remote and isolated communities, and is in the process of obtaining additional supplies to meet the longer-term pandemic related needs of health care workers providing health care services in on-reserve First Nation communities.
In collaboration with the provinces, antiviral drugs have been pre-positioned in many locations to ensure rapid access and Health Canada continues to assess the needs of each community to determine whether additional resources are required.

Regional offices continue to work closely with their provincial public health counterparts to ensure that on-reserve First Nation communities are obtaining accurate and timely information on the emerging situation, just as other provincial citizens do.

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Informing and Communicating with First Nation and Inuit Communities

Q1. How do you ensure that First Nation communities have the information they need about H1N1?

In April 2009, the Government of Canada launched a public awareness campaign to inform Canadians about H1N1 Flu Virus. The campaign consisted of public health notices which were placed in daily and weekly newspapers including print media reaching First Nation and Inuit audiences.

Health Canada also sent the public health notices directly to First Nation and Inuit communities, including Band Council Offices, Chiefs, Hamlets, Co-ops and Northern stores, Inuit organizations, and to more than 1,400 Aboriginal health organizations including addiction programs, community health representatives, healing lodges, health access centres, health education programs, hospitals, and nursing stations.

Health Canada completed a second component of a national public awareness campaign to inform First Nations and Inuit about H1N1 Flu Virus, with important information on protection and prevention measures. Included were advertisements for Aboriginal print, internet and radio media outlets as well as a pamphlet for First Nation and Inuit communities.

Health Canada regional offices continue to provide their health care facilities with provincial guidelines for elevated surveillance and reporting activities, and clinical care guidelines. They continue to work closely with their provincial public health counterparts to ensure that on-reserve First Nation communities are obtaining accurate and timely information on the emerging situation, just as other provincial citizens do.

Q2. How are federal public health officials communicating with First Nations, Inuit and Métis about the H1N1 Flu Virus outbreak?

We keep the lines of communication open with First Nations, Inuit and other partners to manage the current outbreak and support the ongoing vaccination plan for communities.

The Public Health Agency of Canada regularly conducts meetings with eleven (11) national Aboriginal organizations to deliver updates on H1N1 and to listen to concerns. These organizations include the Assembly of First Nations, Inuit Tapiriit Kanatami, Metis National Council, Native Women's Association of Canada, and the Congress of Aboriginal Peoples.

Q3. How is the Government of Canada informing First Nations, Métis and Inuit in Canada?

The Public Health Agency of Canada collaborated with First Nations and Inuit Health Branch, the Assembly of First Nations and Inuit Tapiriit Kanatami to develop culturally-appropriate posters on influenza prevention for use in community health centres and other public venues.

We have sent public notices and posters to Band council offices, Chiefs, Hamlets, Co-ops, Northern stores, Friendship Centres and Inuit organizations. We have also sent information to 1,400 Aboriginal health-related organizations (addiction programs, community health representatives, healing lodges, health access centres, education programs, nursing stations).

For those with Internet access, the Fight Flu website (Fightflu.ca) has a special First Nations, Métis and Inuit section established to provide information. There is also a section, Remote and Isolated Communities, with similar information.

Q4. What is the Government of Canada doing to understand the needs and concerns of the First Nations population?

We have been working with the Assembly of First Nations and others to find ways of learning about on-reserve First Nations' attitudes and awareness of H1N1 Flu Virus. Through a confidential telephone survey, people were asked how much they knew about H1N1 Flu Virus and how they protected themselves and their families. Based on what we have learned, we have made adjustments to our language and how we deliver information. Our report on our findings will be made available to the public.

Get all the facts on the H1N1 Flu Virus