CHASI is proud to maintain a longstanding partnership with the National Indigenous Fire Safety Council (NIFSC). The NIFSC supports Indigenous communities in the development of their internal capacity to enhance community safety and resiliency. As part of this partnership, CHASI is pleased to amplify their articles on our blog.
CHASI’s collaboration with the NIFSC, and many of their other research work, can be found on our NIFSC Publications page. For questions about the NIFSC and their work, please visit their contact page.
A New Mandate for Safety: Integrating Public Health into Canadian Fire Services through Indigenous Leadership
By Len Garis and Mandy Desautels
In Canada, the discussion around Indigenous health and safety often focuses on crisis response. However, a deeper, more systemic problem exists: the persistent and tragic disparity in early mortality. Indigenous communities experience disproportionately high rates of serious health challenges, leading to shorter life expectancies and more frequent, severe illnesses. While the alarming statistics on fire fatalities—where First Nations people face a fire-related death rate up to ten times the national average—are one clear measure of this disparity, the underlying issue is a community health crisis rooted in historical and systemic inequities.
This challenge demands a paradigm shift in how public safety is conceived and delivered. Instead of viewing community wellness, fire safety, and health as separate issues, a unified, preventative approach is necessary. This is the guiding principle behind the Indigenous HOPE 4 Project1, a groundbreaking initiative led by the National Indigenous Fire Safety Council (NIFSC), partnered with McMaster University and Hamilton Health Sciences that seeks to leverage the existing trust and infrastructure of local fire services to directly address the epidemic of chronic disease and premature death. This model transforms the firefighter’s role from purely emergency responder to a vital public health advocate and educator.
The Health Disparity: A Call for Systemic Intervention
The issue of premature mortality in Indigenous communities is complex, fueled by generations of systemic disadvantage and colonial policies that have created profound gaps in social determinants of health. While fire is a devastating and immediate threat, it is often chronic, preventable diseases—such as hypertension (high blood pressure) and diabetes—that account for the majority of years of life lost. These conditions, which are often poorly controlled due to barriers in access to care, lack of awareness, or systemic mistrust, contribute significantly to early death.
The Indigenous HOPE 4 Project recognizes that traditional, clinic-based healthcare models often fail to reach those most in need, especially in remote or under-resourced communities. To succeed, any intervention must meet people where they live, work, and gather, and be delivered by trusted figures within the community. The fire service, as an established, respected, and often locally governed entity, presents a unique and strategic avenue for this intervention.
The HOPE-4 Precedent: A Global Proof of Concept
The foundation of this Indigenous-led strategy is the successful Heart Outcomes Prevention and Evaluation 4 (HOPE-4) study. The original clinical trial, conducted by the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences, demonstrated that community-based interventions led by non-physician personnel could dramatically improve chronic disease outcomes.
The landmark trial, which involved communities in Colombia and Malaysia, proved that trained health coaches—including individuals with backgrounds similar to fire service personnel—could effectively screen for high blood pressure, counsel individuals on lifestyle changes, and promote adherence to medication. Key findings showed that this intervention led to significantly improved blood pressure control and reduced overall cardiovascular risk across diverse populations, health systems, and continents.
The success of the HOPE-4 model in these middle-income countries demonstrated its power in overcoming common barriers to care:
- Accessibility: The intervention moved health screening out of centralized clinics and into the community.
- Simplicity and Consistency: It provided a standardized, evidence-based process that could be reliably delivered by trained lay personnel.
- Effectiveness: It achieved clinical results comparable to more intensive, expensive interventions.
This validated, repeatable model provides the scientific justification for adapting the program to address the chronic disease burden—and thus, the early mortality crisis—within Indigenous communities in Canada.
Indigenous HOPE 4: The Firefighter as Public Health Educator
The Indigenous HOPE 4 project is fundamentally an application of the “for us, by us” principle, ensuring that the model is culturally grounded and community-led. By partnering with PHRI, the NIFSC ensures the project is informed by Western science while adhering to the Indigenous concept of “Two-Eyed Seeing,” which integrates Indigenous ways of understanding health—inclusive of physical, emotional, mental, and spiritual well-being—with modern research and data.
Within this adapted model, the Indigenous firefighter’s responsibilities expand significantly:
- Proactive Risk Screening: Firefighters are trained to conduct simple, non-invasive screenings for major health risks, such as high blood pressure and pre-diabetes, during routine community engagement or home visits. This moves screening out of formal clinics and into a trusted, accessible setting.
- Chronic Disease Management Support: Beyond screening, firefighters provide easy-to-understand health tips, education, and tools that are culturally relevant. Their role includes encouraging adherence to treatment plans and empowering individuals to make informed, healthy choices. This proactive support helps people manage illness before it becomes serious or life-threatening.
- Health and Safety Education: Firefighters become community instructors, teaching health and safety techniques that build overall community preparedness and confidence for emergencies of all kinds.
- Culturally Safe Access: The NIFSC’s leadership ensures the entire program is implemented with cultural safety and respect, addressing historical barriers and promoting an environment where community members feel safe and respected when seeking care.
Ultimately, the goal is to improve chronic disease management and increase access to culturally safe care, leading to better health and longer, stronger lives for Indigenous Peoples.
Operationalizing Wellness: Fire Services and Administrative Capacity
For a program of this scope to be successful and sustainable, local fire services must evolve their administrative and technical capabilities. The integration of public health data and service delivery with traditional fire services requires robust administrative capacity—the practical experience of fire departments in IT administration.
This includes:
- Data Integration and Management: Fire services must be equipped to securely collect, manage, and analyze sensitive health screening data alongside fire incident data. This requires training in modern IT administration to ensure data integrity, privacy, and effective reporting.
- Program Standardization and Training: NIFSC is responsible for developing, standardizing, and delivering the training for this expanded role. This administrative oversight ensures the program is implemented consistently across different communities while remaining locally adaptable.
- Resource Allocation: Strong fire service administration is essential for justifying and managing the funding required for this integrated approach—including resources for new equipment, training, and personnel time dedicated to health promotion.
By professionalizing these administrative and technical elements, the NIFSC and local fire departments are ensuring that the Indigenous HOPE 4 model is not a short-term project, but a lasting and self-sustaining service integrated into the core mandate of community safety.
A Community-Driven Future
The Indigenous HOPE 4 project is currently seeking essential input to guide its pilot phase. The design of this intervention—from the health issues prioritized to the methods of delivery—must be informed by the lived experiences of community members.
This is a direct invitation to shape the future of Indigenous health and safety.
We encourage all Indigenous readers to take a few minutes to complete the Indigenous HOPE 4 survey.
Your participation is vital. By sharing your experiences, insights, and ideas, you will help the NIFSC and the project team understand what health issues are most important in your community, what barriers exist to accessing care, and what supports can help make the Indigenous HOPE 4 program implementation successful. Your input will ensure that this Indigenous-led effort achieves its goal: to meaningfully reduce health disparities and contribute to a healthier, more resilient future for all Indigenous Peoples in Canada.
Authors
Len Garis is director of research for the National Indigenous Fire Safety Council, Ret. Fire Chief for the city of Surrey, B.C., associate scientist emeritus with the B.C. Injury Research and Prevention Unit. Contact him at lwgaris@outlook.com.
Mandy Desautels is Chief Administrative Officer at the National Indigenous Fire Safety Council. Prior to joining NIFSC, she worked for BC Emergency Health Services and prominent NGOs. Contact her at mandy.desautels@indigenousfiresafety.ca.
1 Heart Outcomes Prevention and Evaluation 4