Better Access to Healthcare for Indigenous Peoples

According to the United Nations, there are over 476 million Indigenous Peoples living in 90 countries around the world. Historically, they share a deep bond with the land and a unique and vibrant culture. Through years of colonization and up until today, Indigenous Peoples are often excluded or poorly represented in decision-making processes on matters that directly affect them, resulting in significant social and health consequences. This in combination with living in remote communities and a legacy of mistrust has created a gap in healthcare delivery. Boehringer Ingelheim has recently launched two initiatives from New Zealand and Canada that demonstrate an approach with promising impact.

Recognition of the needs of Indigenous communities 

British Columbia, on the west coast of Canada, is home to many Indigenous Peoples, some of whom live in rural and more remote areas of the province. Living in or near cities, access to health care facilities is only a short drive or walk away. But in rural and remote areas of British Columbia, access to health care is limited. And thus narrows the medical opportunities for the Indigenous Nuu-chah-nulth nations living there. Indigenous Peoples in Canada are significantly disadvantaged by a high incidence of chronic illnesses, like diabetes, chronic obstructive pulmonary disease (COPD) and mental health. For example, 80 percent of Indigenous Peoples in Canada will develop type 2 diabetes (T2D) in their lifetime. Accessing primary care in an urban center often requires traveling hundreds of kilometers.

A system not meeting the needs of an entire community was something Mehmood Alibhai, Director of National Policy and Patient Access at Boehringer Ingelheim Canada, and his team were no longer willing to accept. “We wanted to work with the national Indigenous steering committee and focus on a healing journey”, he shares. Together, Boehringer Ingelheim Canada and the Indigenous Advisory Council created programs with the local community of Nuu-chah-nulth on the northwest coast of British Columbia that reflect their views and culture.

“Partnership is where you listen to the indigenous community, as to what their needs are. You respect the community to know what is best for their community in optimizing care,” says Mehmood. Today, this partnership is known as PATHWAYS – Indigenous Health Collaborations. It is indigenous-led and indigenous-informed and has the vision to close the health gap with indigenous communities, while focusing on relationship building and a positive, sustainable future for all partners.

Virtual care for indigenous T2D patients of the Nuu-chah-nulth 

Rachel Dickens, , who works as registered dietitians and certified diabetes educators within the Nuu-chah-nulth community.
Rachel Dickens, who works as registered dietitians and certified diabetes educators within the Nuu-chah-nulth community.

One of the pilot projects with the Nuu-chah-nulth aims to empower health care staff to leverage technology better. In return, this improves virtual diabetes care and supports health care staff in providing culturally sensitive care that considers the historical impacts and the unique needs of Indigenous Peoples: “Our vision is to reach out to all Nuu-cha-nulth peoples living with diabetes and seeing what their needs are and what kind of support they would like to move forward in their health journey,” explains Rachel Dickens, who works as registered dietitians and certified diabetes educators within the Nuu-chah-nulth community.

Walking miles with small steps

Better Access to Healthcare for Indigenous Peoples
PATHWAYS pilot participant Paul San, a member of the Ahousaht First Nation, and Rachel Dickens.

Small things can already make a big health difference, Rachel tells us: “I find that empowering community members with the knowledge in how to adjust their own insulin has made such a big difference in their overall blood sugar management.” One of the PATHWAYS pilot participants is Paul San, a member of the Ahousaht First Nation which are the largest member group of the Nuu-chah-nulth Tribal Council. He shares his success with T2D treatment: “I really had a hard time walking. Now I can walk for miles.”

More to come

Currently, three additional pilot projects are underway in Alberta, Manitoba and Nova Scotia, each tailored to the individual needs of the community – Samson Cree Nation in Alberta, Manitoba Metis Federation and Wagmatcook First Nation in Nova Scotia. What's next has already been identified: “We are expanding into progressive fibrosing interstitial lung diseases (PF-ILD), as our Advisory Circle has identified a need in this therapeutic area,” says Mehmood. PATHWAYS is aimed to impact the lives of over 20,000 people.

From Canada to New Zealand

Located 13,064 kilometers from Canada, the Māori and Pacific Island populations of New Zealand also have significant disparities in access to primary and secondary health care services. And a significant proportion of deaths are due to diseases for which effective health care wasn’t available: “New Zealand patients with T2D have been poorly managed with older pharmaceutical products in the past. There was a lack of information about what is the impact for T2D, especially for our vulnerable communities. Overall, our regular healthcare system does not suit the needs of the Pacific population. This was also evident in analyses collected during the Corona pandemic”, says Tony Davison, Business Unit Manager from Boehringer Ingelheim New Zealand. Both access and cost create even higher barriers for Pacific Island people. 

According to a recent PricewaterhouseCoopers (PWC) report, the number of New Zealanders suffering from T2D is projected to increase by 70 to 90 percent within the next 20 years – with Pacific and Māori being disproportionally represented. A quarter of all New Zealand's Pacific peoples could be diagnosed with T2D in 20 years' time: ten years younger than other diagnosed New Zealanders and likely with more complications. This concerning trend is similar for Māori people.

Our colleagues from New Zealand aim to address these realities through various initiatives, in partnership with patient advocacy groups, HCP and the Labour Pasifika Caucus, leveraging our expertise in T2D as a disease with major implications for their lives. Tony also has a very personal motivation: “My mother comes from the Cook Islands, and we have a tendency towards large, multi-generational families, all living under one roof. We put the family first and since funds tend to be stretched, we don’t go to the doctor’s as often as we should. Everyone has a family member with T2D.”

More equitable access to new T2D medicines

The greatest milestone to date was through the collaboration with healthcare professionals, patient advocacy groups and the national Pharmaceutical Management Agency, to prioritize inclusion of ethnicity as a criteria for T2D medicine access. “As a result, approximately 25,000 Māori and Pasifika patients with T2D received this effective medication within the first 12 months”, states Tony. “So, for the first time, these vulnerable communities are prioritized in the healthcare queue.”

“Nothing sweet about it”

Tony with the Pacific Media Network team.
Tony with the Pacific Media Network team.Tony with the Pacific Media Network team.

Another important initiative was a T2D engagement and awareness campaign: “We realized through the first COVID-19 outbreak that multi-lingual, non-conventional channels of communication and testimonials are key to effectively reaching the Pacific community, such as radio, Tik Tok, and Facebook; and featuring presenters, healthcare professionals, and real patients with whom they can identify and who use understandable language”, explains Tony. In partnership with Pacific Media Network (PMN), in March 2021 we invested in a media campaign about the cause and effects of T2D with Pacific healthcare leaders and community leaders from various Pacific Island communities. The goal is to create more awareness, understanding and support for families, so that they in return encourage afflicted family members to seek health care services sooner. The claim: “Nothing sweet about it”.

Creating more impact through greater reach

Moving forward, our colleagues from New Zealand would like to use the lessons learned from these projects to speak to and involve additional key stakeholders, such as policy makers and leaders within the Māori and Pacific communities: “A ‘one size fits all approach’ doesn’t work for remote, vulnerable communities. You need to go to the communities, involve their leaders, listen to their perspectives, and acknowledge that supplying the right medicine is just one component of a more holistic, sustainable approach to healthcare, in order to meet their needs,” concludes Tony.

About ‘Sustainable Development – For Generations’

Boehringer Ingelheim operates to serve the needs of human and animal health. This makes the company’s position unique in addressing intersecting sustainable development challenges. The ‘Sustainable Development – For Generations’ framework has three pillars: ‘More Health’, ‘More Green’ and ‘More Potential’. Through these pillars, Boehringer Ingelheim implements 20 initiatives around the globe to drive the company’s contributions and impact. These are in alignment with the United Nations Sustainable Development Goals. To succeed in reaching these goals, the company has a committed approach to working in partnership, calling for the multi-stakeholder collaboration needed to tackle complex global challenges.

About ‘More Health’ 

Develop better therapies, enable better healthcare solutions and contribute to a better world for future generations. Specifically, Boehringer Ingelheim has committed to areas in which it has the expertise and capability to create value for patients and communities: expanding access to non-communicable diseases (NCDs) healthcare for 50 million people in vulnerable communities, investing EUR 250 million in partnerships and collaborations to combat infectious diseases in humans and animals, and increasing investment in health innovation to EUR 35 billion to combat NCDs by 2030.

To ensure that its’ access to healthcare strategy reaches the most vulnerable communities, Boehringer Ingelheim has created a Vulnerability Framework based on vulnerability definitions and criteria provided by organizations, such as the United Nations. Among the most vulnerable communities in many countries are indigenous communities who lack appropriate access to healthcare. Boehringer Ingelheim is addressing this issue, by taking a holistic approach, starting from disease prevention to treatment to patient support.