The National Report of the First Nations Regional Health Survey Phase 3: Volume Two is intended to provide an overview of the national-level results from the survey, across children, youth and adult First Nations populations.

Health Care Access

• Inequality of access to health care for First Nations communities compared to the rest of Canada, and especially for remote and special access and rural communities compared to urban First Nations communities, is a significant barrier to First Nations adults receiving the health care that meets their needs. Unavailability of health-care professionals and long wait times are characteristic of the lack of health-care resources available to First Nations communities in Canada.
• The most commonly reported barrier to accessing traditional medicine was a lack of knowledge, which suggests that some form of educational program aimed at promoting the use of traditional medicine in First Nations communities could be successful in increasing the number of individuals accessing these types of services. This education, in combination with respect and acceptance among those in the health-care profession in Canada, as outlined in the TRC Calls to Action (TRC, 2015), would be a big step towards a health-care system that is culturally appropriate and respectful of First Nations Traditions and Knowledge.
• Work remains to be done to increase the rate of preventative health screening among First Nations males, especially regarding prostate cancer screening. The TRC Calls to Action could have an impact in this regard, especially if these managed to accomplish the goals of increasing the number of Indigenous health practitioners in First Nations communities as well as trust between health professionals and their First Nations constituents.
• As identified in the final report of the TRC, there is a need for greater health-care resources in First Nations communities. Perhaps more importantly, though, there is a need for health care which meets the cultural, medical and human needs of First Nations adults, youth and children.

Language and Culture

• Results from the RHS Phase 3 show that First Nations children, youth, and adults are connected to their languages and cultures. As noted by the Royal Commission for Aboriginal Peoples (1996),
  by participating in traditional culture through community cultural events, visiting Traditional Healers, using traditional medicines and foods, speaking a First Nations language, and valuing the importance of traditional spirituality, First Nations people are connecting to their language and culture through activities that are part of being with and on the land.
• The TRC’s Calls to Action (2015a) specifically address the need to reclaim, revitalize and embed First Nations languages in communities and provide opportunities for cultural activities. Ensuring the continued reclamation and strengthening of language and culture in communities means focusing on children and youth. The earlier that First Nations children are provided with language and culture the more likely that they will build a positive sense of their First Nations identity, thereby contributing to the cultural continuity of the community

• When younger First Nations people learn First Nations languages and cultures, these can act as protective factors and help to instill a positive sense of belonging and identity that can then influence general and mental health and well-being
• As parents, caregivers, siblings, and extended family are children’s first teachers, it is important to support those people who will be raising the child (Best Start Resource Centre, 2010; 2011). It is also important to provide opportunities for First Nations children and youth to participate in traditional or cultural activities, and this includes support for early childhood programs like Aboriginal Head Start on Reserve, of which language and culture are foundational components.

Nutrition and Food

• Income-related food insecurity is high within the First Nations population compared to the general population). Traditional foods and the sharing of traditional foods provide a foundation for better nutrition and well-being as well as impacting food security. Although remote geographical locations can increase the cost and availability of healthy traditional and store-bought foods, living in these communities allows First Nations people to remain connected to their land and traditional food systems.
• The RHS Phase 3 data have confirmed that the rates of food insecurity are high, with half of First Nations adults and more than half of households with children experiencing food insecurity. This is one effect of the ongoing nutrition transition (shift in dietary consumption) that exists today for First Nations people, coupled with high rates of diabetes and other nutrition-related diseases.
• Food security in the First Nations population is often explored within a deficit-based construct focusing on the needs or problems rather than on solutions. Positioning health and Indigenous food systems within an Indigenous food sovereignty framework provides an opportunity to ground solutions within Indigenous ways of knowing.
• It is important to draw upon the opportunities for reconnecting with traditional food systems as self- determining and health- and wellness-promoting strategies. When Indigenous people have the skills to practice Indigenous food sovereignty a whole range of positive benefits to their social and economic well- being can unfold
• Learning from and about the land is an essential aspect of First Nations learning and often entails experiential learning, a mode of learning that is frequently associated with traditional activities that occur outside the classroom (Canadian Council on Learning, 2009) Not only are traditional foods valued from cultural, spiritual and health perspectives, but the activities involved allow for the practice of cultural values such as sharing, reciprocity and cooperation
• The role of self- determination in health and food sovereignty is an important consideration that should be included in future survey questions to better understand nutrition and food for First Nations people. It is time for action to address food insecurity in First Nations communities.

Physical Activity and Sedentary Behaviours

• In terms of monitoring and surveillance, several Canadian studies have examined physical activity and sport participation rates among the population; however, similar data for Indigenous populations (especially First Nations living on reserve and in Northern communities) is relatively limited
• This chapter took a multi-faceted approach by looking at a host of factors at the individual, social and community levels which can influence physical activity and sedentary behaviours. These behaviours were associated with very good health, body mass index, diet, presence of chronic conditions, a sense of belonging, perceptions of being in balance with the four aspects of life (physically, emotionally, mentally, and spiritually) and participation in cultural events
• Although physical activity and sedentary behaviours can be considered independently, an intervention approach that considers both of these behaviours while also targeting certain common population segments may be useful.
• The development of guidelines, interventions, programs, initiatives and strategies for increasing physical activity and reducing sedentary behaviours must be culturally valid for First Nations populations

Personal and Community Wellness

• In light of the methodological and analytical limitations, the current analysis provides a necessary foundation for building future research, rooted in
  a strengths-based approach, that can examine the protective and risk factors, in particular, as they relate to personal and community wellness of First Nations people living on reserve and in Northern communities.
• More research and work is needed to address modifiable risk factors of personal wellness, particularly at the community level in order to facilitate personal wellness for future generations of First Nations people. In terms of community wellness, improvements in socioeconomic status can foster opportunities for such indicators of personal wellness as mastery, such as through stable and safe housing, food security, and employment and education opportunities in communities. The results also show that sense of belonging in your community is a predictor factor for personal wellness.
• There are broad implications of these findings that not only provide a fruitful avenue for future research, but also provide opportunities for policy and program development that would foster wellness at the individual, family, community, and environmental level. One implication is that there are sources of resilience that are unique to iving in a First Nations community.

This is not to say that risk factors for decreases in community and personal wellness should not be examined, but that it should be done while also investigating why some communities fare better than others. Such analysis would be useful in informing effective strategies for intervening with risk factors and promoting those factors found in communities that fare better to facilitate wellness