Forging new partnerships in indigenous health care

Through FORGE AHEAD, Schulich School of Medicine & Dentistry professor Dr. Stewart Harris and his team are collaborating with 12 First Nations communities in six provinces across Canada to identify local health challenges and facilitate better care coordination and improved outcomes for diabetes patients in a community-driven, culturally relevant context.

Special to Western NewsThrough FORGE AHEAD, Schulich School of Medicine & Dentistry professor Dr. Stewart Harris and his team are collaborating with 12 First Nations communities in six provinces across Canada to identify local health challenges and facilitate better care coordination and improved outcomes for diabetes patients in a community-driven, culturally relevant context.

Alex McComber watched his mother battle Type 2 diabetes for more than 30 years.

The chronic, debilitating and sometimes fatal disease runs in the family, because McComber, who looks fit as a fiddle to the naked eye, has been diagnosed with pre-diabetes, a condition that could lead to full-blown diabetes without intervention.

“We’ve been fighting diabetes in our communities for decades now, but the tide is getting ahead of us,” said McComber, a member of the Mohawk community of Kahnawake, near Montreal.

According to the Canadian Diabetes Association (CDA), the incidence of diabetes in First Nations communities in Canada is three to five times greater than the general population – and is growing exponentially. This is due to a number of factors, including genetics, lifestyle and quality of health care in the communities.

In an effort to turn the tide on diabetes in his own community, McComber is participating as a co-investigator of the FORGE AHEAD program, a five-year, collaborative, national diabetes research effort in First Nations communities led by Dr. Stewart Harris, a professor in the Schulich School of Medicine & Dentistry and the CDA Chair in Diabetes Management.

Struck by the powerful collaborative approach of the FORGE AHEAD program, and its potential to provide lasting change in First Nations communities, global biopharmaceutical company AstraZeneca Canada Inc. has donated $500,000 in support of the initiative.

As part of the program, which is also funded by a $2.5 million grant from the Canadian Institutes for Health Research (CIHR), Harris and his team are collaborating with 12 First Nations communities in six provinces across Canada to identify local health challenges and facilitate better care coordination and improved outcomes for diabetes patients in a community-driven, culturally relevant context.

Participating communities range from small, remote fly-in reserves of no more than 500 residents to urban communities with populations of up to 10,000.

Harris’ research on diabetes in First Nations communities began more than 25 years ago while coordinating medical care for 30 fly-in communities in northern Ontario. There he was shocked to discover the high incidence of the disease, as well as fear, misinformation and a lack of coordinated health-care systems.

Today, the situation isn’t much different.

Despite a renewed emphasis on chronic disease management in Canada over the last 10 to 15 years, the disease is still rampant on reserves, where outcomes are far worse than the general population.

“When I travel to reserves I’m shocked to see that the model of care delivery is the same as when I traveled to those same communities in 1990,” Harris said. “We don’t need to learn anything more about diabetes. We don’t need to discover new drugs. We know how to manage the disease and we have all the tools. Now, we need to apply them in these communities.”

As part of FORGE AHEAD, researchers will assess the current state of care in participating communities, develop a unique toolkit to implement improved care coordination between community and clinical programs, provide workshops for community and health-care practitioners and create a registry of diabetes patients and their care.

“This research by Dr. Harris and his team, generously supported by AstraZeneca Canada, is a critical pillar in the effort to reduce not only the risk, but ultimately the tremendous healthcare costs to patients, families and Canadians as the prevalence of diabetes continues to escalate,” said Dr. Michael Strong, Schulich dean.

Ultimately, Harris hopes this research will halt, and eventually reverse, the upward trend of Type 2 diabetes and its associated complications – and that it can be adapted and expanded to address a whole host of chronic diseases in First Nations communities across Canada.